“Spurred on by renewed investment in digital health and government health reform, hundreds of startups are now working to address friction points and broken systems within health care.
But only a select number of those startups will find their niche and become vital parts of the system for the long haul. These startups will be the ones that have the best products and the clearest vision of where their part of the industry is headed. They’re the ones that empower patients, improve outcomes, manage costs, and reduce waste.
It’s these kinds of companies that we sought out for the Innovation Showcase at HealthBeat 2014.”
Mike Doyle, CEO of QPID Health, was asked to provide his comments to Alison Diana of InformationWeek Healthcare (Oct. 3) on the news from Texas that a patient later diagnosed with Ebola had been released to his home after his first hospital visit. Apparently a nurse had documented that the patient had been in Liberia, but this may not have been noticed or considered by the physician.
Mike helped shed further light on the problem:
I don’t think anyone would argue if that [Texas] physician had known that person was from West Africa he would not have discharged that patient. Unfortunately, in today’s healthcare world, data is very, very siloed. Inpatient systems don’t talk to outpatient systems. Eighty percent of data in electronic health systems is unstructured so it’s very hard to report. As a result, critical and acute information goes unnoticed — and this is a very prime example of that.
Although Texas Presbyterian Hospital first blamed the issue on the design of its EHR, they later retracted that. While the facts of this case remain unclear, the reality is that today’s EHRs bury essential information. As noted in the article:
Many hospitals complain about interoperability problems within their EHRs — between disparate workgroups, such as doctors and nurses, or different departments, including emergency rooms and cardiology — that lead to errors. The technology is new and many providers are in the early stages of adoption, seeking software and procedures that fine-tune capabilities and eliminate mistakes like this, experts said. Having evolved from billing, newer systems now focus more on clinician and patient needs, they said, and these later editions provide more of the capabilities, tools, and features medical users need.
The author notes that to address these issues “healthcare providers can purchase third-party products, such as QPID Health’s clinical intelligence software, that discerns patient information from EHRs and other sources, and then delivers it to clinical and administrative workflows.” QPID Health is adding specific Ebola-screening functions to our software, Mike also explained.
QPID Health is committed to making healthcare better, and to a world in which the IT systems we use enhance the ability of nurses, doctors and patients to communicate and take the best course of action.
Two recent studies with findings summarized in JAMA caught our eye because they provide interesting proof points on the value and need for “operationalizing” best practice guidelines as a hedge against habit and, sometimes, fear.
Both studies suggest that physicians may have a hard time being judges of the reasoning behind their own decision-making. And that old habits die hard!
Per lead author Dr. Michael Rothberg, “Some people might say it’s defensive, and other people might think it’s the standard of care. “There’s really more of a culture about how people treat a particular problem, and many may not recognize it as being defensive. […] Clear communication about evidence-based guidelines and tort reform that would protect clinicians when they follow those guidelines would help reduce providers’ fear and improve patient care.”
“Various efforts to reduce the perceived overuse of cardiac telemetry at Christiana Care Health System, a 1100-bed tertiary care system, were unsuccessful. In August 2012 we convened a team to increase the appropriate use of non-ICU cardiac telemetry through the integration of AHA guidelines into our electronic ordering system.”
Results were dramatic.
“After the changes, the researchers found the hospital group’s mean daily number of non-ICU patients monitored with telemetry fell by 70%, from 357.5 to 109.1, while the mean daily cost for delivering non-ICU telemetry also fell by 70%, from $18,971 to $5,772. The changes had no negative effect on patient care; mortality rates at the hospitals remained stable, as did the number of “code blue” emergency calls to resuscitate patients.” (“Hospitals Cut Costs by Getting Doctors to Stick to Guidelines,” Wall Street Journal, Sept. 22, 2014)
Our takeaway: Operationalizing best practice guidelines by incorporating those guidelines in software is a valuable tool for changing entrenched behavior.
P.S. QPID Health helps providers address utilization issues with our Q-Guide solution. Q-Guide counterbalances the adverse effect of accidental, “defensively-motivated” procedures and habits, which are brought to light in the JAMA studies.