Welcome to the May issue of the Indidge Advantage newsletter.
We want to thank all the folks that stopped by to visit with us in Las Vegas at the HCCA conference. We hope you enjoyed the roses and pop corn.
Our first article addresses the Avian flu which is the talk of the nation this month. Is this the big global pandemic or an anemic version of the regular flu. Whatever you believe, beware of the second wave!
The next article explores comprehensive EHR adoption and the notion that these systems should cover the notion of sharing information with other providers.
The following article on how technology can reduce the compliance burden on hospitals is a tailor made argument for implementing a policy and procedure management system like idTracks-Docs from Indidge Systems.
From using technology to improve efficiency to educating patients to improve both patient and physician satisfaction.
The May edition of the Indidge Advantage presents a cornucopia of timely ideas and issues.
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
By GREGG CARLSTROM
FEDERALTIMES.com
May 04, 2009
Thousands of federal employees were in crisis mode last week
Centers for Disease Control and Prevention officials looked for signs of swine flu in crowds at 19 international airports, dispensed millions of doses of antivirals to state and local authorities, and issued scores of announcements to the public. Customs and Border Protection officers kept watch for symptoms at land borders. Agriculture Department officials monitored pig farms. National Institutes of Health researchers - working in concert with pharmaceutical companies - scrambled to find a vaccine. And State Department officials coordinated international travel advisories.
Government officials say their response evolved from their experience with previous outbreaks of SARS and avian flu earlier this decade.
"We've been preparing for years, we've been exercising," Dr. Anne Schuchat, the interim deputy director of the science and public health program at CDC, said last week. "We've been able to invest in preparedness."
The question now is whether the government can mitigate the impact of the disease if it blossoms into a pandemic - a challenge, since it will take months to create a vaccine and produce it in large quantities. And public health officials say they also must prepare for another possibility - that the virus will go "underground" for a few months, only to come roaring back at the start of the next flu season this fall.
Years of planning
Public health experts say they're encouraged by the federal government's rapid response to the swine flu outbreak - even as they caution that the disease still poses a serious threat.
"Every year we do a pandemic flu exercise with [the Federal Emergency Management Agency], we do training on that," said Rebecca Froboese, executive director of the Federal Executive Board in San Antonio. "So we're pretty used to dealing with these kinds of things and working in collaboration with the city and county governments."
Froboese and other federal executives across the country say they've mostly been focused on communication: gathering information about the flu in their area and reporting that to federal agencies.
Homeland Security Department officials are working closely with the Health and Human Services Department, which has the scientific expertise to deal with a pandemic. CDC, a HHS agency, is responsible for testing for the disease after it receives reports of possible swine flu from state health agencies. And the National Institutes of Health, also part of HHS, developed a "seed virus" that pharmaceutical companies can use to research a vaccine, a process which could take up to eight weeks.
Experts say many of the preparedness policies were developed in the past few years.
"It was SARS and avian flu that helped really bring them on," said Allison Aiello, an assistant professor of public health at the University of Michigan. "All of these steps are in line with the plans they've had in place."
Much of HHS' response has happened without political leadership. The department's new secretary, Kathleen Sebelius, wasn't confirmed until last week; CDC is operating under an acting director, Dr. Richard Besser, a career employee.
Agencies have also been conducting a massive public outreach campaign. Sebelius and DHS Secretary Janet Napolitano held an online question-and-answer session last week to address public concerns; a transcript was posted on the agency Web sites.
CDC is using a variety of tools, including the microblogging site Twitter, where, at press time, the agency had posted more than 50 "tweets" about swine flu. CDC's YouTube channel hosts nearly a half-dozen videos about swine flu preparedness, one of which has been watched more than 130,000 times.
Even President Barack Obama is getting involved: In comments during his April 29 news conference, he reminded Americans to wash their hands frequently and to stay home from work if they're sick.
Don Kettl, the incoming public policy dean at the University of Maryland, said agencies have tried to strike a balance between educating the public and not causing undue alarm. There have been occasional slip-ups: Vice President Joe Biden caused a stir when he said people should avoid "confined spaces."
"There's a risk. ... They might have inadvertently signaled that it was too serious," Kettl said. "So they have constantly recalibrated. There's a keen sense of communication."
A second wave?
Experts say the government's coordinated response has benefited from the relatively mild strain of swine flu that's struck the U.S.; the disease had caused one known death as of early Monday. Kettl said agencies should develop continuity-of-government plans to help them cope with a larger outbreak. Experts say a full-scale pandemic could make it difficult for the federal government to deliver services.
"So far the response seems to be fairly good. There's obviously a playbook that's already been written," Kettl said. "What we don't know is what happens if we have a crisis that blows up."
The government has about 50 million doses of antiviral drugs - a sizable number, but enough to cover only about one-sixth of the U.S. population. Most of those doses will be sent to state governments in the coming weeks; Kettl said states should work with CDC to figure out how to best distribute the supply.
About 11 million doses have already been sent out, mostly to states like Texas and California where swine flu has been confirmed.
Public health officials are also worried that this is just the first wave of the pandemic. Most countries in the northern hemisphere are nearing the end of flu season, and that could drive the virus "underground" for a few months, according to CDC's Schuchat.
"We might see an improvement; we might see cases go down, just like we do with the seasonal flu," Schuchat said. "[But] we need to be prepared, because this strain is out there, and it might come back in the fall."
NIH officials hope a vaccine can be found by summer. But it will take time to produce in large quantities and to distribute. Officials say they've been studying the national vaccination program that followed the last swine flu outbreak, in 1976; that program was plagued by difficulties, and wound up inoculating less than one-third of the U.S. population.
Closing the borders
Congressional critics are also pushing agencies to step up their monitoring at airports and land borders. CDC is monitoring airports, but it does not have the resources to staff land borders with Mexico. Instead, DHS employees - trained by CDC - watch for symptoms of swine flu.
Some legislators say that's not enough, and they're asking CDC to install thermal cameras at airports to monitor incoming passengers for signs of fever. Several Asian countries have taken that step; Hong Kong has had them in place since the SARS scare in 2003 and 2004.
"I'm just not following this," said Sen. Kay Bailey Hutchison, R-Texas. "It just seems to me that we should be taking a little more precaution about someone coming in."
But officials and public health experts say there's little point in trying to stop the disease from crossing borders. Keiji Fukuda, the deputy chief of the World Health Organization, said it was too late to stop swine flu, and he encouraged countries to focus on mitigating the effects of the disease.
"This is the most prudent step they can take at this point," said Aiello, the University of Michigan professor.
Other legislators have suggested closing the Mexican border. But public health experts say that wouldn't do much to stop the spread of swine flu. The virus has already traveled to at least a dozen other countries; air travel makes it easy for the disease to move from those countries to the U.S.
"It's a balance between doing something that would not be very effective instead of doing the kinds of mitigations that we need to do inside the community," Dr. Anthony Fauci, director of NIH, said at a hearing last week.
Comprehensive EHR system used by only 1.5% of hospitals, says report
By Joseph Conn as reported in Modern Healthcare
Posted: March 25, 2009 - 5:00 pm EDT
Only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system, according to HHS-funded researchers in a report released by the New England Journal of Medicine and mirroring preliminary survey results released by the same researchers this past November.
Blumenthal
Lead author Ashish Jha, an associate professor at the Harvard School of Public Health and a staff physician at staff physician at Veterans Affairs and Brigham and Women's hospitals in Boston, said in a news conference that just 7.6% of hospitals had a "basic" EHR that included the capability to record and store physician and nursing notes. The survey found that 10.9% of hospitals had a basic system without those clinical note-keeping functions.
"Very few hospitals in America have a comprehensive electronic health record," Jha said. In addition, Jha said, "We didn't get into effective use of these technologies. And we don't have information right now with the notion of sharing data with other providers. Just because they have these systems doesn't mean they are sharing that information with other doctors or hospitals down the street."
That said, not all was gloom and doom. For one thing, if data from the VA hospitals, which were gathered but excluded from the final survey totals, were added back in, the comprehensive EHR adoption numbers would nearly double to 2.9% and the national numbers for the basic adoption rates would be driven up as well.
"All VA hospitals now have adoption of comprehensive medical records," said Jha, who is serving as VA advisor. "There are as many VA hospitals with comprehensive medical records as there are non-VA hospitals (with those systems) if you look at it numerically."
Also, he said, "There is no suggestion here that 90% of hospitals don't have a computer in the hospital," Jha said. In fact, some component parts of an EHR are in widespread use. For example, the survey found that 75% of hospitals surveyed reported having electronic lab and radiology systems.
What hospitals don't have is "a constellation of functionalities" that help doctors and nurses provide the best care possible, Jha said, but the relatively high levels of adoption of some components "suggests we have a good place to start."
Information about the study was under embargo until Wednesday, but its authors and other healthcare luminaries were available to reporters via a telephone conference Tuesday. One of those was David Blumenthal, the physician founder of the Institute for Health Policy, who spoke briefly about the research report and an article he had written for the New England Journal of Medicine on the federal role for health IT promotion.
Last week, Blumenthal was named as President Barack Obama's choice to be the national coordinator for health information technology. Blumenthal said he will take over the post in mid-May.
Speaking of the impact the American Recovery and Reinvestment Act of 2009 would have on healthcare information technology, Blumenthal said that for physicians, "This whole project was conceived by the Congress as a building block as a pillar of healthcare reform."
"One of the key elements is to support behavior change," he said. "IT is one important and ultimately critical way to do that. I think it would be wrong to see it as a technology that can be adopted on its own, but as a technology to support that."
By Christina Torode, Senior News Writer
02 Apr 2007 | SearchWinIT.com
Whether IT shops like it or not, regulatory compliance is a way of life. The only solace IT managers have is that technology is available to help ease at least part of the burden.
"Compliance is very visible in everything we do," said Mark Granzow, vice president of global technology, equity options group, at TD Options LLC in Chicago. "It affects how we deal with record retention, it's changing our policies," said Granzow, adding that TD Options has its own internal compliance people.
"We have to make sure that everyone knows what our policies are," he said. His company has already applied ITIL best practices for change management; and for record retention, the company is using Iron Mountain Inc.'s journaling and email archiving technology.
Requests are also being made to upgrade its backup systems to respond quicker to requests for archived e-documents in the case of an audit. "We need almost instantaneous access to our archive, more capacity [and] indexing capabilities," Granzow said.
Above all, Granzow wants a product that can manage the whole process of compliance, a management system that does not exist at this point, he said. "A lot of vendors are saying they can meet all your compliance needs, but I haven't seen it," Granzow said. "We need one that stays on top of everything."
Some of the more urgent needs include better centralized storage and an easier way to manage policies for all the networks, file servers and business documents, he said.
Compliance touches many aspects of an organization
Compliance experts will be the first to say that many point products exist because, by its very nature, compliance can touch so many aspects of an organization -- legal, security, and records retention, among others. At the IT level, compliance involves asset management, identity access, storage, server and database monitoring and especially change management and configuration management.
One technology that is showing potential for bringing the policy and change process pieces together is configuration management databases. CMDBs hold the promise of giving IT managers a unified way to view and manage any changes made to systems, in real time.
Microsoft for one is expected to have a CMDB built into its upcoming help desk product called Service Manager, part of the vendor's System Center line of management products. The company is also working with third parties such as Brabeion Software Corp. in McLean, Va., to use Microsoft's Desired Configuration Manager in Systems Management Server as a way to manage and collect system changes as they relate to IT compliance, said Steven Schlarman, chief compliance strategist for Brabeion.
"Vendors are building in basic server and client configuration best practices that meet compliance requirements. The good news is that many of the regulations look for the same thing," Schlarman said, adding that they require some sort of commitment to manage changes. "You have an environment of checks and balances in areas such as systems access, and many vendors are building templates into their products to address this."
Hot button for Microsoft System Center
Kirill Tatarinov, corporate vice president of Microsoft's enterprise management division, said at the Microsoft Management Summit in March that compliance will be a number-one priority for the System Center group in 2007.
"We will have a set of products to help you bring your infrastructure and environment into compliance," Tatarinov said. "We will help you understand [what assets] you have and make sure they map to internal and external compliance."
Microsoft will embed one such effort in Service Manager. It will have the ability to notify an IT manager when a configuration on a desktop or server drifts out of compliance and offer click through capabilities to bring that machine back into compliance," Tatarinov said.
As for a unified view of controls, major systems management players, such as BMC Software Inc., CA, Hewlett-Packard Co., IBM and Microsoft, are all working toward offering a single CMDB to store and manage relationships among assets, change management, performance and availability information.
"CMDBs exist in distributed environments to manage IT operations, and you can see how it can be applied to IT compliance on the execution side," said Vivian Tero, an analyst at IDC, based in Framingham, Mass.
The problem is the pieces that make up IT compliance exist in different applications. "A challenge is that in a lot of companies, policies reside on spreadsheets, just as most of the reporting still resides on spreadsheets," Tero said. "This is very time consuming, with some companies being audited two to three times a quarter and having to produce those reports every time."
Which is where automation enters the picture and CMDBs can play a role.
Auditors want proof of data protection
"Automation is key with compliance, but you need to keep in mind that most large organizations have different versions of systems, and the configuration policies for each system is different," Tero said. "The challenge for IT is figuring out how to first unify this so that it can then be automated. And before any of that, policies need to be defined."
For the most part, auditors for specific regulations do not and should not give technology recommendations, say industry experts and IT managers. But auditors do offer guidance as to what an organization is expected to protect and prove in the form of reports.
For example, auditors may ask IT shops to run database reports to prove they can track changes made to critical databases containing customer information, said Phil Neray, vice president of marketing for database security and monitoring vendor Guardium Inc. in Waltham, Mass.
"The company panics and tells IT to turn on the native database auditing utilities, which reduces systems performance, impacts the stability and produces so many reports that it is impossible for the IT staff to go through them all," Neray said.
After the audit, it is not uncommon for companies to throw technology at an issue. Several IT managers at a recent TechTarget email archiving seminar in Chicago said they had installed an email archiving product, or bought one after an audit or possible litigation, and it remained shelved. The projects stalled because all the different departments involved could not decide what the system should flag and save.
One large hospital in the Midwest, for example, has implemented Quest Software Inc.'s email archiving software only to have its use halted by the hospital's legal department, which often has a delete-versus-save mentality, said IT managers at the event.
"The company wants the system, but what's happening -- and I think you'll see this a lot at companies -- is that legal keeps coming back and saying 'We're still formulating our retention policy,'" said an IT manager at the hospital who asked not to be named. "Legal needs to catch up with technology."
Technology plays only one role in compliance
In the end, the lesson is that technology plays only one role in compliance. Before technology can be implemented, there should be a department-wide consensus on policies, said Khalid Kark, an analyst with Forrester Research Inc. in Cambridge, Mass.
A company's product choice should ultimately be guided by these policies, he said. "We know it's not true that right now one vendor can solve all your compliance problems," Kark said. "With compliance, technology can help with automation, but you need equal processes, that keep people in mind, to get to that point."
As for choosing compliance products now, Kark said many companies are implementing security information management and enterprise security management products.
"The thing to keep in mind is that many vendors map to specific regulations, which does not work," Kark said. "And if you're buying point solutions, they need to be able to integrate with other products because this is a corporate-wide effort."
One webinar is Friday, May 22, 2009 from 11:00 AM - 12:00 Noon EDT.
If that does not fit your schedule, register for Wednesday, May 27, 2009 2:00 PM - 3:00 PM EDT. Send Tom Reid an email at tom.reid@indidge.com to register or call him now at (480) 829-0479 Ext. 138 to schedule a convenient web demo that better fits your schedule.
or
Gienna Shaw, for HealthLeadersMedia, April 22, 2009
Trisha Torrey has every right to be angry with the medical profession. After doctors removed a golf-ball sized lump on her torso, she waited two weeks for test results before she was told she had a rare form of cancer and another two weeks before she could get an oncology appointment. Without chemotherapy, the doctors said, she would die in six months. Even with treatment, they said, her prognosis was poor.
Torrey says her oncologist was an "arrogant SOB ." who refused to consider that the test results might be wrong, dismissed her questions about symptoms that didn't fit with what she'd read about the disease online, told her that seeking out a second opinion would be fruitless because surely no one would know any more than he, and failed to follow up on an important test that ultimately proved she did not have cancer after all.
That was nine years ago. Since then she's made it her mission to educate patients on navigating the healthcare system, communicating with doctors and other caregivers, and making the most of those eight-minute doctor appointments. She blogs, twitters, writes columns, is an expert on About.com, and hosts a radio show on patient rights.
Torrey , who was a marketer for 20 years, also speaks to healthcare marketers about how they can improve service at their organizations.
It starts with educating patients and managing their expectations.
"Nobody ever teaches us to be patients," Torrey says. "Doctors go through years and years of training , but no one ever teaches patients to be patients."
For example, many patients don't think about the fact that physicians are running a business-that they have to keep the lights on and pay their staff. Many don't understand the pressures of declining reimbursements and increasing costs.
Twenty years ago, a doctor could spend 20 minutes with a patient. That's no longer realistic. But if you tell the patient that the doctor has only eight minutes, the patient knows to maximize that time, she says. If the patient is old-school and you don't manage his or her expectations, he or she will be upset.
On the other hand, Torrey notes, if you tell patients they're getting eight minutes and they actually get 10? Now you've exceeded their expectations.
"You don't even have to change the experience to make it positive," Torrey says.
Of course, your docs probably don't have the time (or, in some cases, the inclination) to educate their patients. That's where you can step in, offering classes or online information about being a good patient-in turn making physicians' lives a lot easier. That's good for both patient satisfaction and physician relations.
When she first started on her quest, healthcare professionals were standoffish and defensive, Torrey says. Now, she says, "They are realizing how much of a friend I can be."
"A mild form of bird flu has been detected in New Jersey. Health officials said the bird flu was hard to detect, because in New Jersey, every bird coughs." --Conan O'Brien
INTENSIVE INSULIN THERAPY DOES NOT IMPROVE SURVIVAL AND MAY INCREASE THE RISK OF HYPOGLYCEMIA IN CRITICALLY ILL PATIENTS
Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ.
2009;180:821-827; discussion 799-800. PubMed ID: 19318387.
A meta-analysis (26 trials; n=13,567) was performed to provide an updated assessment of the effects of intensive insulin therapy on the risk of death and hypoglycemia in critically ill patients. Data were obtained by searching Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, as well as by manually searching abstracts from selected conferences and the bibliographies of relevant trials. Only published randomized controlled trials investigating intensive insulin therapy versus conventional glucose management in adult ICU patients were included. Included trials also used a target blood glucose concentration of < 8.3 mmol/L. The primary outcome measure was 90-day mortality, and the secondary outcome measure was hypoglycemic events (ie, blood glucose level of < 2.2 mmol/L). Pooling of data from all 26 trials indicated that, as compared with conventional therapy, the relative risk (RR) for death associated with intensive insulin therapy was 0.93 (95% c onfidence interval [CI] , 0.83-1.04). There was significant heterogeneity across the studies, however, which was found to be driven largely by 2 of 5 trials with surgical patient populations. Meta-regression analysis showed a significant reduction in death among surgical ICU patients who received intensive therapy as compared with those who received conventional therapy ( RR 0.63 ; 95% CI, 0.44-0.91 ; P=0.02). This reduction was not found among medical ICU patients (RR 1.00 ; 95% CI, 0.78-1.28 ) or mixed ICU patients ( RR 0.99 ; 95% CI, 0.86-1.12 ) . Intensity of insulin therapy ( glucose target of < 6.1 mmol/L versus < 8.3 mmol/L) was found to have no impact on the risk of death in a meta-regression analysis (P=0.94). Pooling of data from 14 trials reporting on hypoglycemic events indicated that the RR of hypoglycemic events with intensive insulin therapy versus conventional therapy was 6.0 (95% CI, 4.5-8.0). Type of ICU had no impact on the risk of hypoglycemic events.
CONCLUSION: Although surgical ICU patients may benefit from intensive insulin therapy, widespread adoption of this strategy in critically ill patients is not supported by these findings, which show that it confers no benefit in terms of survival and significantly increases the risk of hypoglycemia.
Class of Evidence: M (ie, a Meta-analysis)