healthcarereimagined

The MyHealthEData Initiative, announced by CMS’ Seema Verma at HIMSS18, is too light on detail to make much of a difference, said the former VP – who offered his own way forward.

By Mike Miliard March 19, 2018 04:44 PM

By Darius Tahir | 03/08/2018 10:00 AM EDT

With help from Arthur Allen (@arthurallen202) and Mohana Ravindranath (@ravindranize)

DoD CERNER INSTALL IS BROKE SO FAR: The Department of Defense’s Cerner installation is broken badly so far, our colleague Arthur Allen reports. Physicians at the four northwestern military sites at which the Cerner EHR is being installed are complaining of kludgy systems and long log in times. And while it’s difficult to precisely attribute any one adverse event to a specific software problem, Patient Safety Reports – which are required whenever a life- or limb-threatening medical error is discovered – were “being filed almost every day” in the first few months, said one physician at Bremerton.

“The bottom line is … the Cerner user build is immature and needs to be brought up to a functional level,” another doctor said. “There were some expectations at higher levels that this … was an out-of-the-box solution that would work perfectly, but it didn’t.”

Cerner and Leidos say the problems are temporary speedbumps; meanwhile, Jared Kushner was selling the program in sparkling terms a couple days back at HIMSS. Pros can get the rest here.

STRUGGLES AT VA CONTINUE: Meanwhile, the other part of the Cerner installation train – the Department of Veterans Affairs – is mucking around in the slop. Wednesday, another report from the department’s Office of the Inspector General faulted the agency – this time for “critical deficiencies” in the Washington, D.C., VA Medical Center.

While the most worrying allegations didn’t concern IT matters – the report said that some ostensibly clean areas were not – the center was sloppy in handling private health care information. It said 1,307 boxes were left unsecured and improperly stored, leading OIG to take possession of the records; 1,058 of those boxes housed private health information, including “individual patient pulmonary function studies, veterans’ identification cards, patient health records and films, as well as personnel and other administrative documents.”

Meanwhile, whispers that VA Secretary David Shulkin is not long for the job continue to brew; a Daily Beast report argues that his days are numbered, in an unspecified way.

All these struggles – ranging from real-life failings to more evanescent chatter – are swirling while the agency tries to complete its $10 billion acquisition of a Cerner EHR. At a Wednesday House Veterans Affairs’ Oversight and Investigations Subcommittee hearing, the timeline on that got no clearer.

Rep. Ann McLane Kuster, the subcommittee’s ranking member of the subcommittee, said she believed Shulkin would sign the Cerner contract by the end of the month. But Fred Mingo, director of program control at the VA’s Electronic Health Record Modernization Program, said he was “as anxious as anyone in this room to hear an award date,” while demurring on when Shulkin would put pen to paper. Mingo also wasn’t able to explain why the contract had yet to be signed, saying there were two issues – before catching himself and saying he’d submit the answer later, for the record.

Shulkin himself enjoyed the support of one of the witnesses from veterans’ organizations. The American Legion’s Louis Celli Jr. declared that the “Secretary [is] under fire by ideologues” at a time when he needed the support to begin the mammoth task of converting the VA to a new electronic health record.

The hearing had an official subject: consideration of a few reform bills. Two of them directly concern health IT matters: the first (H.R. 3497 (115)), sponsored by Rep. Cathy McMorris Rodgers, would support a pilot project to give veterans a gadget that would store – and allow them access to – their medical records. That bill was opposed by the VA, and split the witnesses from the veterans organizations present.

The second bill, the Veterans EHR Modernization Oversight Act of 2017 (H.R. 4245 (115)), requires the VA to submit documents and update Congress about the progress of its EHR project.

by Paige Minemyer |  Feb 14, 2018 12:35am

A lack of interoperability hinders the growth of value-based care, according to an HFMA survey of financial executives. (Image: Pixabay)

Biostasis aims to prevent death following traumatic injury by slowing biochemical reactions inside cells

The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.

Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.

But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.

How a push to cut costs and boost profits at surgery centers led to a trail of death.
A team of journalists based in California, Indiana, New Jersey, Florida, Washington, D.C., and Virginia worked to tell this story in a partnership between Kaiser Health News and USA TODAY Network.

Christina Jewett is a senior correspondent for Kaiser Health News. Mark Alesia is an investigative reporter for the Indianapolis Star.

Reporters pored through thousands of pages of court records and crisscrossed the U.S. to talk to injured patients or families of the deceased.

For more than a year, using federal and state open-records laws, reporters gathered more than 12,000 inspection records and 1,500 complaint reports, as well as autopsies and EMS documents and medical records, together forming the foundation for this report.

In desperation, a nurse did something that would not happen in a hospital.
She dialed 911.

By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.

If Tam had been operated on at a hospital, a few simple steps could have saved her life.
But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.

Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.
Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.

Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.

The investigation revealed:
Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.

To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.

Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.

Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.

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