How does hospital ambience effect patient health?

Does a fancy hospital interior and soothing music help promote faster healing? Sharp Hospital system certainly things so. NPR’s Marketplace even covers the story:

Dan Gross is executive vice president of Sharp Healthcare. I meet up with him in the lobby for my tour of the swanky Sharp Memorial. Its a $200-million hospital in San Diego. And it’s built with the principals of what’s known as “evidence-based design.”

GROSS: There’s a lot of research today and a lot of conversation around how the design of a hospital really promotes comfort, healing and produces better quality outcomes for patients.

Does a “nice” hospital actually improve health outcomes? That will be difficult to ascertain. Building a fancy hospital may improve outcomes, or it may be the case that nicer hospitals attractive relatively richer, relatively healthier patients.

Even if “evidenced-based design” does improve health outcomes, the change in ambience may not affect patient health directly. For instance, Sharp talks about using the Disney concept of on-stage and off-stage work where “…nurses have private areas ‘off stage’ where they can prepare medications uninterrupted.” Having nurses think they are “on stage” may incentivize them to work harder, smarter and more professionally. Further, a more luxurious hospital may attract higher quality staff.

From an individual hospital’s point of view, it doesn’t matter which mechanism is causing this improvement in health. From society’s point of view, however, if fancy new hospitals simply attract the best staff and healthier, more affluent patients, then improved hospital design may be a waste of resources.


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Building a Network

In my walk into work this morning, I listened to a podcast titled “Building a Network”.  I felt it was appropriate to share in light of HIMSS and ACHE this month.  The podcast focuses on three main points:

1. Grow Volume Indiscriminately
2. GIVE GIVE GIVE (don’t take, take, take)
3. Keep In Touch

The cast also emphasizes the difference between “networking” and “building a network”.  As you travel to Atlanta or Chicago, spend 30 minutes listening to this podcast and let us know if it helps in how you appropriate you ACHE/HIMSS experience.

Oh, yeah ... and there's a blooper in the show. Did you catch it?

Source: http://manager-tools.com/2006/05/building-a-network

Win free netbook with Windows 7 and Office Ultimate

Time is running out to get your Student Rally entries in. Go here and submit today - http://cot.ag/56mU9X ^AG

Even if you don't win, you can get a copy of Office Ultimate for 60 bones using your student email :)


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Obama's Healthcare Summit

How did Obama’s Healthcare Summit go? It was basically a pile of bad ideas. Senator Harkin gave the best explanation of what’s truly needed, but I’ll save that for last.

Examples of BAD IDEAS include

Starting over. John McCain asked to “Go back to the beginning” and Republican Senator Lamar Alexander said ”If we can start over, we can write a healthcare bill.” The whole start over rhetoric is dumb. If you don’t like the current proposals, say what you don’t like about them. If you have suggestions on how to do it better, say them. Suggesting a “do over” is not helpful. Even if you think health care in the U.S. is perfect and prefer the status quo, you should stand up and say that rather than asking for a clean slate.

Health Reform will lower the deficit. Expanding federal entitlement programs will NOT lower the deficit. In the short-run, additional tax revenue and cuts to other programs may decrease the deficit in the very short run, but adding or expanding big government programs never lowers the deficit.

Reforming medical malpractice. I have documented that the medical malpractice system does not work well (see here and here). However, malpractice costs are a small share of the overall health care dollars. If physicians prescribe too many tests and treatments because they wish to avoid being sued, than tort reform could decrease costs more drastically. However, this issue is more of a partisan one where Republicans can pander to their physician supporters and Democrats can pander to their attorney supporters.

End Waste and Abuse. This is a laudable goal, but determining what is waste and abuse is difficult. If you get an MRI for an injury, you may not need the MRI, but it will provide the doctor with some helpful information. This is certainly not fraud, but it may be waste. Having Medicare administrators who are far from the hospital floor determine what is wasteful is not as easy as political rhetoric makes it sound. Further, although there is much waste in the Medicare system, there is much waste when doctors are paid by private insurers as well. Every President promises to reduce Medicare fraud and waste, but few succeed.

“We actually create more diabetes through the food stamp program and the school lunch program.” - Senator Coburn. Do poor people buy more unhealthy food? Yes. Is it because of these programs? No. The poor have less money and fast food is cheap. Fresh fruits and vegetables are expensive. Increasing redistribution would allow the poor to eat healthier, but if Senator Coburn wants to mandate that poor people eat healthy, that is stupid. People on food stamps aren’t all of a sudden start shopping at Whole Foods. The food police are not the solution to health reform.

Here’s where the GOOD IDEAS were:

Incremental Reform doesn’t work. Senator Wyden said, “The evidence says incremental reform not only does less, it costs more.”

The most sensible comments came from Senator Harkin. In order to reduce health insurance premiums and Medicare expenses, we need cost control (i.e., rationing). We need to limit the medical care we make available to ourselves. Every person who wants and MRI or back surgery shouldn’t get one. These will be tough decisions, but they must be made, otherwise health insurance premiums will gobble up more and more of our wages.

Of course, no senator could support rationing care, but that is what Senator Harkin is essence supporting. Here is a quotation:

“Well, quite frankly, if we want insurance reforms you can only do that if everybody is in the pool. You can only get everybody in the pool if you make it affordable for middle class families and others. You can only make it affordable for middle class families and others if you have cost controls.”

The full transcript of the summit can be found in three parts (1, 2, 3). NPR also has some good analysis here.



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Health IT & Productivity

Since I'm not sure when the 'powers that be' will cut me off from this site again...If you'd like to continue to read my posts, follow Health IT and Productivity:

http://healthblog.hutsoncentral.net

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Microsoft Unveils New Government Cloud Offerings at Eighth Annual Public Sector CIO Summit

REDMOND, Wash. — Feb. 24, 2010 — Today, at the eighth annual Microsoft U.S. Public Sector CIO Summit, Microsoft Corp. unveiled a number of new enhancements and certifications for the Microsoft Business Productivity Online Suite (BPOS) that continue to raise the bar in cloud security and privacy. In a keynote speech addressing more than 300 public sector CIOs, Ron Markezich, corporate vice president of Microsoft Online, launched an industry first — a new dedicated government cloud offering based on the BPOS. For education, Microsoft also announced it is extending identity federation services to Microsoft Live@edu to help schools improve collaboration and security, as well as simplify identity management and support interoperability among disparate software applications.

At Microsoft’s Public Sector CIO Summit in Redmond, Ron Markezich and Curt Kolcun introduce a new version of a dedicated government cloud offering as part of the Microsoft Business Productivity Online Suite to help meet the highest security and privacy needs of U.S. government agencies and contractors.
The new Business Productivity Online Suite Federal is optimized to meet the security, privacy and compliance needs of U.S. federal government agencies. In addition, Markezich announced future capabilities and certifications that will continue to raise the bar in cloud security and privacy, including two-factor authentication, enhanced encryption and the expected attainment of Federal Information Security Management Act (FISMA) certification, an important requirement for government information technology, in the next six months.
“Microsoft is the first and only cloud provider to offer this level of protection and security for governments,” said Markezich. “We were able to achieve this industry first thanks to our experience providing dedicated cloud services for the past five years.”
Markezich also announced several new customers including the City of Newark and Florida State College at Jacksonville, one of the 10 largest U.S. universities.
“In the City of Newark, we are focused on ensuring that our IT modernization and cost-saving programs exceed the mayor’s overall objectives of renewing government,” said Michael Greene, CIO of the city of Newark, N.J. “That’s why we closely examined Microsoft’s approach, which blends cloud-based services and on-premises software. It just made sense. We ultimately went with Microsoft Business Productivity Online Suite — it’s the catalyst that will allow our team to focus on upgrading to Windows 7 and Office 2010. This model provides us best-of-breed collaborative technologies along with the ability to comply with federal and state regulations. We’ll save money, receive guaranteed uptime, and now have the benefit of working with a trusted party to manage it with us.”
Microsoft Online Services for Government

Microsoft Online Services are available for government customers of all sizes. These versions, and the security and privacy enhancements being announced today, include the following:
•
Business Productivity Online Suite meets a wide variety of industry standards and certifications, including International Organization for Standardization (ISO) 27001, Statement on Auditing Standards (SAS) 70 Type I and Type II, Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA), Title 21 CFR Part 11 of the Code of Federal Regulations, Federal Information Processing Standard (FIPS) 140-2, and Trusted Internet Connections (TIC) compliance. Today, more than 500 state and local governments use Microsoft Online Services in the United States, including 48 of 50 states. These range from the largest entities with tens of thousands of seats to the smallest of municipalities.
•
Business Productivity Online Suite Federal is launching today for U.S. federal government agencies, related government contractors and others that require the highest levels of security features and protocols. The new offering includes all the certifications and security features of the Business Productivity Online Suite and more. The service is housed on separate, dedicated infrastructure in secured facilities. Physical access to those systems is limited by biometric access controls to a small number of individuals who, in compliance with International Traffic in Arms Regulations (ITAR), must be citizens of the United States who have undergone rigorous background checks, including fingerprinting.
“Microsoft Business Productivity Online Suite will now offer unmatched capabilities for our government customers and their unique needs,” said Curt Kolcun, vice president of Microsoft U.S. Public Sector. “The enhancements we’re introducing today and over the next six months raise the bar on security and privacy. The reason that governments in 48 of the 50 U.S. states have chosen from our Microsoft Online Services for offerings is in large part because our offerings are built from the ground up with enterprise-grade security and privacy in mind.”
Microsoft Cloud Services for Government
Microsoft offers a spectrum of cloud computing solutions — from infrastructure to applications for organizations and individuals. Microsoft cloud services for government are interoperable and elastic solutions that enable rapid delivery of easy-to-use solutions in response to changing business needs while leveraging existing IT investments and familiar applications.
At this week’s CIO Summit, several government entities’ cloud solutions based on Windows Azure, Microsoft’s cloud services platform that provides a development, service hosting and service management environment, will be featured. To aid government transparency, the City of Miami created a public-facing 3-1-1 application using Azure to monitor and analyze non-emergency requests, such as pothole repair or missed trash pickup in their area. Another unique application of Azure, an example provided by the City of Chicago, will also be discussed. Last summer, organizers of the “Taste of Chicago,” one of the largest outdoor food and music festivals in the world, used Azure to provide interactive, online maps that its residents and visitors used to plan visits to the event. Visitors to the event could search by day, stage, event, and vendor and then print out a tailored map to use as a guide at the festival.
Developing Identity Federation Services for Live@edu With the University of Washington
Microsoft’s cloud services deliver a unique value for schools and universities by providing solutions that foster simple, “anywhere, anytime” collaboration. In the past six months more than 10,000 schools have signed up for Microsoft Live@edu, Microsoft’s hosted e-mail, communications and collaboration solution for students. Florida State College at Jacksonville and the University of South Carolina are recent wins and join the thousands of other institutions in more than 100 countries already providing Live@edu to tens of millions of students worldwide.
“The University of Washington believes federation and interoperability are key elements to effective, seamless collaboration in complex environments,” said Terry Gray, associate vice president of Technology Strategy at the University of Washington. “We have a long-standing relationship with Microsoft, and we are excited to work together on the development of a wide range of technologies that will have an impact on how institutions collaborate worldwide.”
As part of this relationship, the University of Washington will help provide service configuration feedback, implementation documentation, migration guidance and service testing on two identity federation options. First, customers with an existing investment in Active Directory will be able to extend that platform to the cloud with Active Directory Federated Services (ADFSv2) and enable access to Live@edu services. Second, customers with investments in alternative identity platforms, such as OpenLDAP, will be able to take advantage of full SAML/Shibboleth federation support. The University of Washington will also be one of the first institutions in the world to roll out a federated identity solution with Microsoft on Live@edu.

Source: http://www.microsoft.com/presspass/press/2010/feb10/02-24CIOSummitPR.mspx

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SmartDraw: One Stop Mapping Tool

Microsoft Visio and Mindjet’s Mindmap have been my programs of choice for some time.  However, sitting in my operations management class, I was compelled to find a better tool for creating Decision Trees.  A brief google search produced “SmartDraw”….and I am impressed.  Not only does this program make decision tree creation easy, but it assists in creating fishbones, gantt charts, schematics, floors plans, mind maps, org charts…

Larger View

Tablet PC + OneNote = Right Sized EMR??

While the media will be focused today on Apple’s Tablet announcement, I’d like to remind HealthBlog readers that there’s nothing new about Tablet devices. I have been evangelizing the use of Tablet PCs in health for nearly a decade. And over the last several years, particularly with the release of Windows Vista and now Windows 7, the Tablet PC value proposition for healthcare providers just gets better and better.

First of all, the devices themselves are better. And, healthcare providers have more choices than ever before (I have four Tablet PCs on my desk right now). There are excellent Tablets available from most major manufacturers including ones made expressly for clinicians such as the devices offered by Motion Computing, Panasonic, Tablet Kiosk and other vendors.

Of course, it’s not really so much about the device as it is what you can do with it. First and foremost, these are full-function computing and productivity solutions (unlike that shiny new Apple). Tablet PCs more closely mimic the familiar patient chart. They can be used, digital pen in hand, without feeling intrusive in the physician-patient encounter. They accommodate multi-modal data input including keyboard (when docked), digital inking, point and click, voice and even touch including multi-touch with Windows 7. The inherent speech engine in Windows Vista and Windows 7 is so good, it is even possible to do excellent speech recognition dictation if you are willing to put in a little effort up front. When connected wirelessly to a corporate network or the Internet, Tablet PCs provide instant access to the information you need, when and where you need it. They can also run all of the other applications you might want to use in your office or home.

All of this functionality hasn’t been lost on clinicians. Just yesterday I was contacted by
Dr. Alan Rosenbach
. Dr. Rosenbach runs a very successful solo dermatology practice in the Los Angeles area. He called me because he wanted to share his enthusiasm for his Tablet PC running
Microsoft Office OneNote
. He said for the last three years, he has been using OneNote as the official EMR for his office. He does all of his chart notes and tracks all of his patients with OneNote. He uses a Tablet PC from
Fujitsu. He makes extensive use of digital inking for both data entry and illustrations on clinical findings. He also embeds photos in his patients’ “charts” and attaches transcriptions and other documents to each patient’s record. Most remarkably, he says, OneNote has never gone “down” for even a second. And of course, he loves the low, low price.

What Dr. Rosenbach didn’t know until I told him, was that there is actually a company that has for many years been selling an EMR solution based on Microsoft Office OneNote for the Tablet PC. That company is the Ablet Factory. I received an update from company founder, Fritz Switzer, in this morning’s mail. I had asked him to tell me what medical specialties where particularly drawn to his company’s solution. He replied:

“With regard to the mix of specialties we see using our OneNote EMR products, a large number of psychiatrists and podiatrists lead the specialty roster. I have referred to this fact as “we provide a head to toe solution”. Chiropractors and pain management specialists are also recurring practice types. We have seen a common thread with this usage mix. The practices have a large number of “graphically oriented” forms/templates. The digital inking of a Tablet with drawing capabilities of OneNote provide a platform where a conventional EMR falls short”.


The Ablet Factory also offers a medical vocabulary plug-in for their EMR solution called
WordMgr 2010. It takes care of spell check, digital inking recognition and improved speech recognition for more than 100,000 medical terms and abbreviations.

If there is a downside here, it is that this EMR solution isn’t “certified” by ONCHIT. It also may not meet “meaningful use” criteria. So, if you are looking for a government handout to pay for your EMR, you are likely out of luck. On the other hand, thousands of docs in solo or small group practices have found an easy pathway to digitizing patient records that is simply “good enough”, at least for now. And this solution will only set you back about $700 for software. Add another $250 if you want the medical vocabulary plug-in. At those prices, who needs a bailout from the government anyway?


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SharePoint in Healthcare

For those who may be doubting that SharePoint has any place in healthcare (or even referring to it as “ScarePoint”), here is a list of healthcare organizations using SharePoint to power both their public website and intranet:

Both Public and Private Sites

• Cleveland Clinic
• SSM Health Care
• St. Louis Cardinal Glennon Children’s Medical Center
• NHS Confederation
• Pfizer
• Washington University in St. Louis
• Sacred Heart Hospital

Intranets

• Partners Healthcare
• Mayo Health System
• VA Desert Pacific
• VA Saint Louis
• University of Illinios – Chicago
• UMHS – Family and Community Medicine

Something tells me that if Cleveland Clinic, Partners, Mayo, SSM, and the VA are using SharePoint, then it must have some legs.  What is holding others back?  How can barriers be addressed?

Oh, one more things….SharePoint is HIPAA compliant.  What?  Yea!  You’re move, Healthcare.

Healthcare Spending

Why is public spending overtaking private? Maybe a 39% increase in premiums would explain it.  Here’s some more detail on that and other stories of interest this week.

• Will government spending on health care overtake private spending in the U.S.?
• Government Stimulus: China vs. U.S. (in pictures)
• Odds of Obamacare becoming law.
• How economic theory is undermining efforts to solve environmental problems?
• California health insurance premiums rise by 39%.

Source

Hands on social media workshop in Berkeley

By Matthew Holt

Speranza Avram from the UC Berkeley School of Public Health Center for Health Leadership writes to say that they’re hosting a two-day conference on April 15-16 called 21st Century Tools for Health Leaders: Using New Media and Health Communication Technologies. New media tools including social media, blogs, digital storytelling, video, virtual communities, Twitter, mobile phones and more, are being effectively used to facilitate the management of health organizations, support health education and disease management, inform health research and promote health advocacy. We invite health leaders, practitioners, educators and students to join us. Early bird registration ends March 12! Click here for more information about the conference and to register on-line. Or watch the video.

Source