Understanding Meaningful Use.
If you are looking for a simple, well laid out depiction of meaningful use requirements by stage in a timeline format, I’d like to recommend the pictorial on the CareCloud blog at www.carecloud.com. The following screenshots are from the carecloud.com blog, and as you can see the timeline provides a high level view of initial, stage 1, stage 2 and stage 3 requirements from a physician practice perspective.
Securing Tablet devices in the clinical workspace.
“If we go with a Tablet device, how do we stop it from growing legs?”… Several CIO’s, IT Directors and CMIO’s have posed this very question to me over the past year and I must say the answer is somewhat more complex that it should be, considering the iPad has been widely adopted since 2010. I think it would be instructive to read a recent NewYorker essay by Chris Crowley titled “Follow that Cab!.. The age of the i-chase”. Mr. Crowley describes how he and his wife tracked a cab containing his i-pad laden suitcase in it’s trunk around Manhattan using Apple’s Mobile Me™ (now replaced by the iCloud service).
Stanford School of Medicine’s Information Technology and Resources (IRT) department advises users of Apple devices to install and configure “Find my iPhone” in order to protect Apple hardware. Unfortunately, their advice for securing non-Apple mobile devices consists of “you need to keep an eye on them”.
Another option to consider is a proximity alarm. Again, Apple’s App store sells a proximity alarm app called Proximity Alarm and the unimaginatively named but apparently effective Anti Theft Alarm System. Other device tracking systems include Gadgettrack and some hospital IT departments have even toyed with the idea of piggbacking tablet asset management onto their newborn location protection systems.
RFID – best practice? WiseTrack is Asset Tracking Software that can be used to determine the location of mobile devices and the identity of the individual using the device. I expect several vendors to develop RFID based tablet and device security systems in the coming months and will update this post with the latest information as it becomes available.
Other resources:
1) Securing Mobile Devices in Healthcare. Kevinmd.com 2011
2) Staypad.com
3) STOP
4) BitDefender
Tweeted! Why U.S. Hospitals aren’t nearly as Safe as you Think…
Scanning rapidly through my Twitter feed a short while ago, I ran across a tweet from Fareed Zakaria (CNN) that said “The U.S. ranks last out of 19 developed countries in preventable deaths in hospitals.” Clicking the link, I wound up at CNN World’s public blog site, Global Public Square, where some rather damning findings were presented in an e-pamphlet.
On the off-chance that a journalistic investigation of patient safety and medical errors is an outcome, patients, families, local press and others will likely have many questions for front line health care professionals and administrators. Leveraging this onslaught of publicity and using it as an opportunity to empower patients to take an interest in their safety would be a positive outcome. Educating patients, family members and local communities of steps taken to improve patient safety over the years would be another.
PatientSafetyHub.com is back online!
PatientSafetyHub.com - aiming for the sky once again!
Folks, I am pleased to announce that the contingency plans in place to counter hacking / technical outages were executed flawlessly during this site’s first such experience. Well, not exactly, but less than a day after detecting the incident that redirected this and many other Apache server websites to alternative url’s, and which caused test content containing erroneous medication information to be comingled with established, published content, the site was repaired and fully restored.
Many thanks to DreamHost Tech Support for sorting out the issue. One learns through experience and the occasional fire drill should be viewed as an opportunity to learn new skills – and that’s certainly what happened this weekend. I’d like to thank followers of this blog for your patience and a special thanks to the individuals who reported the website issues to me via email. JH, RPh
The correlation between temporary staff and medication errors
A study in the Journal for Healthcare Quality originally published in November 2010 and titled, :Are Temporary Staff Associated with More Severe Emergency Department Medication Errors?” was designed to evaluate whether medication errors in an Emergency Department linked to temporary staff were associated with more severe harm than those linked to permanent staff. The results of the study did indeed show a correlation between errors involving temporary staff and increased patient harm. Errors involving temporary staff were more likely to reach the patient, require additional monitoring, cause temporary harm and classified as life threatening than those involving permanent staff. The researchers concluded that emergency department medication errors associated with temporary staff were more harmful than those associated with permanent staff.
FDA limits Celexa (Citalopram) usage to doses under 40mg per day
I’d like to discuss strategies to ensure patient safety in the inpatient environment following the Food and Drug Administrations’ recently announced dosage limitations for Celexa.
As you may know, earlier this week the FDA, through a Drug Safety Communication, issued a stark warning that the popular anti-depressant should not be used at doses above 40mg per day. The concern is that changes in the electrical activity of the heart, seen as prolongation of the QT interval of the electrocardiogram, or ECG can lead to an abnormal heart rhythm, including Torsade de Pointes, which can be fatal. Patients at particular risk for developing prolongation of the QT interval include those with underlying heart conditions and those who are predisposed to low levels of potassium and magnesium in the blood.
Pets aboard aircraft present a patient safety issue – Canadian Medical Association
Crack Canadian journalist Andre Picard reports in The Globe and Mail from St. John’s that the Canadian Medical Association, during it’s annual meeting has called on airlines to “ban animals from cabins because their presence poses too great a risk to people with asthma and allergies”. The only exception, the CMA said, should be service dogs that assist people who are visually impaired or have autism.
Medical error catharsis… developing a workable and effective disclosure process
A story on the American Medical Association’s website, Amednews.com, discusses the story of three physicians who decided to share their perspectives on medical errors in which they were involved. Each physician’s story demonstrates how painfully easy it is to be distracted, make incorrect assumptions and to bypass safety processes designed to avoid errors. One case, that of a surgeon who inadvertently performed the wrong surgery on the wrong patient highlights how a language barrier, last minute change of venue and a lack of attention to detail were each contributing factors to the error. The story cites an Archives of Surgery study which found that about 250 physicians per year commit suicide and that this represents a rate that is double that of the general population.
Adoption of advanced clinical health IT – a national strategy
The Rand Corporation, a conservative think tank known for its research on national security issues published a dissertation by one of its graduates in 2007 (pre-ARRA, pre-meaningful use era) that analysed the process of adopting HIT and provided recommendations for government involvement and medicare reimbursement models that could drive adoption and thereby modernize this critical aspect of care delivery. The publication, titled “Accelerating the Adoption of Clinical IT Among the Healthcare Providers in the US – Strategies and Policies”, by Katya Fonkych, will inconvenience approx. 0.5 mb worth of electrons if you choose to download it here.
Providing safe care to obese patients requires obese specific infrastructure and sensitivity
Obese patients face additional safety issues
A recent study in the U.K. reviewed the types of patient safety issues faced by obese patients. It specifically focused on patient safety incidents where obesity was deemed to be a factor, reported to that country’s National Patient Safety Agency. The results of the study shed light into the causes of errors and safety issues related to care of obese patients. They also provide administrators and clinicians with data that could drive the development of a safer environment of care for this specialized but growing segment of the population.
The group carrying out the study, led by Dr. J.A. Moore of Manchester University Hospitals NHS Foundation Trust, searched the National Reporting and Learning System database for all reported incidents involving obese patients over some 3 1/2 years. It should be noted that all incidents listed in the database were voluntarily reported and may or may not be representative of the actual error rates prevalent in the health system. Of 555 patient safety incidents identified by the group, 388 met the study’s criteria for further analysis. 148 (38%) of these were related to assessment, diagnosis or treatment of the obese patient while 213 (55%) were infrastructure related, 84 (22%) were surgery related, and 28 (7%) represented staffing implications. While the majority of incidents – 86%, were classified as causing no or low harm, 12% represented moderate harm and three deaths, all related to anesthesia issues fell into the category of fatal errors.
