However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.

As the subtitle of the report recognizes, there is an age chasm at the age of 50: physicians under 50 years of age more likely believe in the benefits of health IT; fewer older doctors do, on a global basis. Accenture points out that younger doctors are comfortable using computers during patient interactions in the exam room, compared with older physicians who prefer face-to-face conversations without what they may perceive as a disruptive interruption of looking at a keyboard or computer screen.

Physicians that more frequently use health IT are also more likely to believe in the benefits of health IT: Accenture measured 12 functions of EMRs and HIEs and found that those who more fully interact with these features perceive the fruits of the systems. 87% of doctors who use at least 9 of the 12 applications see positive impacts in using health IT; only 64% of doctors who use 4 or fewer functions believe in the positive benefits of health IT.

Health Populi’s Hot Points: American doctors are more skeptical about the use of health information technology than their colleagues in Asia, Europe and North America. US doctors are also live subjects in the experiment that is the adoption of health care information technology as part of the HITECH Act, working hard to demonstrate meaningful use to earn financial incentives in Stage 1 this year.

Meaningful use, in fact, deals with those kinds of functions that Accenture measured, finding that the more functions a doctor uses, the more likely he/she will appreciate the fruits of health IT in terms of patient outcomes, productive workflows, reducing medical errors, and reducing the risk of litigation.

US doctors are playing catch-up with their global colleagues. This is yet another benefit of the HITECH Act that doesn’t get enough attention.

Originally posted on Health Populi on January 10th.

The following is a guest post by Ms. Nasreen Sulaiman a Senior Instructor at Aga Khan University School of Nursing. She  has worked with palliative patients.

By Nasreen Sulaiman. Palliative care is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases as it provide comfort and ease suffering. Nearly 80 % of the cancer patients in Pakistan present late in stages 3 & 4 with terminal disease.  In Pakistan, the concept of palliative care is in its infancy stage and need to be strengthened. In Karachi, one of the mega cities of Pakistan, only two hospices each of 20-25beds provides palliative care services where the health care professionals’ main focus is on providing the physical aspects of care. Pain management, a crucial aspect in the palliative care still remains partially addresses due to lack of narcotic supplies and other medications.  Furthermore, I strongly feel that other than providing pain and symptom relief measures, the social, emotional, and spiritual needs of the patient should also be given prime importance in order to provide holistic care to the patients. Nurses need to learn to utilize various non-pharmacologic measures such as therapeutic communication techniques, use of humor, guided imagery, therapeutic touch, relaxation exercises, religious songs and other diversional activities in order to ease the suffering, emotional distress and provide optimal comfort and support to the patients including their caregivers. Moreover, in palliative care settings, caregivers hold a great importance as they are the ones who are providing the total care and most of the time with the patients. Caregiver role strain is an essential area to be looked at. Caregiver support is another area to be looked upon. We need to establish caregiver self-help groups or other avenues to support the caregivers as they go through lot of emotional pain and need immense help and affection which may assist them to perform their roles effectively with the patient suffering from the disease.

I have a number of friends who are battling MS, one of whom, Amy Gurowitz, shared a link on Facebook the other day to Jim Sweeney’s online empire of improv humor and chronic disease. Jim’s MS journey started with vision problems in 1985, he was officially diagnosed in 1990, and has been dealing with the disease – finding the funny most of the time – ever since.

Jim’s body of work includes decades of live improv, his one-man show “My MS & Me,” which you can hear on the BBC Radio 1 site. His MS has progressed to the point that he’s now in a wheelchair, and his public presence is mostly limited to Twitter, where his profile describes him as a housebound hedonist (hey, it made ME laugh) and YouTube.

How much courage does it take to laugh out loud, in public, at an incurable disease? Jim certainly has courage at the level required.

Other examples of funny-or-die in managing chronic disease include Mark S. King’s fabulously funny My Fabulous Disease blog (Mark is HIV-positive). The aforementioned Amy Gurowitz laughs out loud about her MS in a number of places, including MS Soft Serve and MS-LOL (life of learning OR laugh out loud, you pick).

On the provider side, there are a number of docs who are breaking up the waiting rooms and wards.

Dr. Patricia Raymond is a gastroenterologist whose mission in life is to take the “ick” out of colonoscopies. She bills herself as The Fabulous Butt Meddler. Since she looks like Bette Midler, the joke works on every level.

Dr. Zubin Damania, a/k/a ZDoggMD (“Slightly Funnier Than Placebo”), is a hospital medicine specialist in Palo Alto as well as a veritable buffet of medical humor, some G-rated and some most definitely NSFW. His videos alone guarantee hours of laughter.

There’s an entire site dedicated to clinician humor called GiggleMed.com – both ZDoggMD and Dr. Butt Meddler are featured there, along with a host of other find-the-funny MDs and RNs.

I even found a scholarly article entitled The Use of Humor to Promote Patient Centered Care – be warned, though, that (1) it’s a “scholarly article,” meaning that it’s probably had all the laughs surgically removed and (2) they want $34.00 for it. You have been warned.

What’s my point here? I actually have two:

1. Laughter really is the best medicine. Humor keeps us in touch with our humanity, and – unless it’s insult comedy, which I do not recommend in the health care arena, unless it’s insulting bad health care – it helps to comfort others in the same situation.
2. Patients and providers need to work together to help each other find the funny. If you’re a doctor, don’t just say “you’ve got [insert dread diagnosis here], here’s the treatment plan, call if you have any questions, … NEXT!” Look your patients in the eye, and channel your inner comedian whenever it’s appropriate. If you’re a patient, connect with other people in your situation and see how they’re finding the funny. And help your doctors find their funny. If they can’t find it, you should find another doctor.

We all need to work together to break each other up. Laughter can comfort, can calm, it can even heal.

That’s real disruptive health care, no prescription required.

“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.

Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer.  He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers.  He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable.  He needed that information to plan how to use the time that remained.

Many of us would make a different choice about knowing how long we will live when we are similarly ill.  But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases.

It is not just when we are seriously ill that numbers dominate our experience with health care.  Advances in technology have made it possible to quantify – and thus monitor – a seemingly infinite number of physiological and psychological health-related states. For instance: weight, blood pressure and cholesterol level, hemoglobin A1c level; the range of shoulder mobility; the size of a hernia; the risks discovered when we undergo genetic testing during pregnancy; the probability of developing diseases based on our smoking, physical activity and bike helmet-wearing; the amount of pain or sadness we feel.

Most of these numbers represent a marker that is potentially modifiable by some action we can take, often with guidance from and in collaboration with our clinicians. But while a change in a number may affect the course of treatment or indicate a higher or lower risk, it doesn’t guarantee a certain effect or outcome, as much as we would like it to.

These few familiar examples represent only a tiny fraction of the health-related numbers that compete for our attention over the airwaves and online. We can purchase a whole raft of numbers about ourselves by getting a full body scan or having our genome read.  Apps on mobile devices and various bands and devices allow us to monitor every heartbeat, every breath, every fluctuation in sleep, attention and anxiety.  And practically every month will bring something new for us to measure.

What do we do with all these numbers?  Are all of them important?  Are some more important than others?  If so, which ones?

We vary widely in the amount and type of information we want about our health. If we are to benefit from the health care available to us, all of us need to be acquainted with the top few numbers that are relevant to our specific situation and history. We should understand the numbers that put us in particular danger of illness or injury, and for which there is an action we can do (or can be done to us) to improve them.  We need guidance from our clinicians to separate the wheat from the chaff over time: today as I decide about getting a mammogram, next year when I get a new diagnosis, and afterward, as I make my way through treatment. Which numbers are imperative that I attend to, which are optional and which are irrelevant?

It may be the allure of health-related numbers comes less from the specific information they convey than from the illusion they support: that the practice of medicine is governed by empirically based algorithms, with effective strategies that can be used to “manage” the numbers, thereby reducing or curing the disease or symptoms.  My friend who was annoyed by his doctor’s inability to tell him how long he had to live shares with all of us the desire for predictability and perceived control of our health and illness.  So just what’s wrong with maintaining this illusion that numbers represent medical certainty?

Because while those numbers may spark the curiosity of some, the certainty imputed to them extinguishes it in many of us. Why should I be an active participant in my medical care and question my clinician’s approach, explore different treatment options, or maintain vigilance about medical errors, for example, if health care is as clean, scientific and exact as these numbers seem to imply?  The reality is different and it can be frightening, especially when we are ill. Despite the growth in knowledge about health and disease, gaping holes remain; clinicians piece together bits of evidence and experience to formulate treatment plans.  Often, there is no single right answer or solution.

Our challenge is to not be seduced by the false certainty of health-related numbers, but rather to see numbers as potentially valuable tools – but just tools, not guarantees — each of which may help shape our actions and those of our clinicians in our shared effort to make the best possible use of the services and technologies available to us so that we can live as well as we can for as long as we can.

My friend who wanted an estimate of the time remaining to him wasn’t looking for a promise that he wouldn’t die.  He was interested in figuring out how to fit in all the life he could into those few days or, as it turned out, meaningful, bittersweet but pain-free weeks.

Why has this happened, and why should we care — whether or not we’re Catholic?

The New York Times covered this story on August 22, 2011, titled, Nuns, a ‘Dying Breed,’ Fade from Leadership Roles at Catholic Hospitals. NY Times editors smartly placed this story in the “U.S.” section and not under the “Religion” corner of the paper.

At the crux of this historical transition at religious hospitals is whether the values that drove the heart and soul of these institutions — caring for the needy, the safety net population, and the larger community — will translate when MBAs and MHAs take over leadership of these organizations. The Times wrote, “Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.”

This is not a marginal issue in American health care: in 2009, 1 in 6 hospital admissions was in a Catholic hospital.

Health Populi’s Hot Points: With the U.S. economy in decline or stasis in most of the nation, and health benefits for covered workers lucky enough to be covered by a health plan, moving more financial burden onto employees, more health citizens in the U.S. have been moving into safety-net, under-insured, or un-insured status. As such, more people seek care in emergency rooms and outpatient care in the community, and more have a difficult time paying for health care (my blog posts have featured this issue over the past 4 years; search on the topics of safety net, Medicaid, self-rationing, and medical home in Health Populi‘s search box).

The wild card in the disappearing-nuns-from-healthcare scenario is how non-clergy will make decisions at the helm of Catholic health care. Will the so-called “healing presence of God” yield to the bottom-line and shuttered services that skew to the poor and under-served?

I can tell you that my work with Catholic health providers, including two of the nation’s largest Catholic systems and several local individual hospitals in the U.S. over the past twenty years, have shown me the power of nuns at the helm of health care. Many of these women have had MBAs themselves and other advanced degrees, and have had a knack at meshing business discipline with innovation in managing the bottom line while keeping the mission at the center: caring for people, whether insured or not, across socioeconomic strata.

The decline in the supply of nuns and priests in the U.S. is impacting a portfolio of human services: education, too, has been negatively impacted, witnessed by the growing number of Catholic schools shutting down throughout the country.

There’s a new school of thought among some business leaders that MBA students should have a broad liberal arts — and some say fine arts — education before entering business school. This is one way to strengthen left-right brain — and hopefully, heart and soul — in business people who will take on leadership positions in health.

Originally posted on Health Populi on August 22nd.

This is not a new concept: ten years ago, the IOM’s seminal report, Crossing the Quality Chasm: A New Health System for the 21st Century, called for “patient-centeredness.”

What is patient-centered care? Bertakis and Azari call out four communication behaviors:

1. Eliciting understanding and validating the patients’ perspective
2. Understanding the patient within his or her psychosocial context
3. Reaching a shared understanding with the patient of the problem and its treatment
4. Creating a partnership in which “activated” patients share in decision making, power and responsibility.

These four precepts were codified in a 2007 publication from the National Cancer Institute, Patient-centered communication in cancer care: promoting healing and reducing suffering.

Health Populi’s Hot Points: Adopting a patient-centered approach isn’t solely about reducing health care costs: it’s about patient empowerment, effective communication between doctor and patient, and participatory medicine. The secret in this sauce is in the communication between the partners: greater sharing of information from each side of the conversation, building greater trust, and leading to a decreased use of unnecessary diagnostic testing, hospital care, and specialty referrals. While long-term outcomes haven’t yet been quantified in the patient-centric approach, this study adds to the growing evidence base that participatory medicine is a win for the patient, a win for the physician, and a win for the larger health system and health economics.

Originally posted on Health Populi on July 19th.

I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.

The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone.  I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms.

And then something interesting happened – based on the short description of an imaginary patient’s complaint, I began to go down an inappropriate (and expensive) diagnostic pathway. Since I couldn’t see the patient, and some of the symptoms could have been life-threatening, I suggested some pretty aggressive measures. I would not have ordered any of these tests had I been able to see the patient in-person, because I would have been able to see what was actually wrong quite quickly.

I realized that when two doctors plan for the care of a patient they’ve never met, all manner of inappropriate and expensive testing and treatment can occur. So I wondered to myself: what will happen to our healthcare system if we continue to divorce ourselves from patient contact? When diagnostic algorithms become even more rigid, and patients are pressed into diagnostic code categories with pre-determined courses of action prescribed for them long in advance? It’s going to become easier and easier for people to be locked in to an incorrect diagnosis, and subjected to a battery of expensive, and unnecessary tests and procedures… when all that was needed was a pair of human eyes and a thoughtful exam at the very beginning.

I’m pleased to report that I passed my specialty board exam, and I’m now certified in Physical Medicine and Rehabilitation. However, as I consider my clinical future – I know that to be a good diagnostician, I must spend time with my patients in-person… and I’m looking forward to it.

Anna Gawlinski

The following is a guest post by: Anna Gawlinski, RN, DNSc, FAAN, Director, Research and Evidence-Based Practice and Adjunct Professor at Ronald Reagan UCLA Medical Center and UCLA School of Nursing and Elizabeth Henneman, PhD, RN, Assistant Professor at The School of Nursing at the University of Massachusetts-Amherst.

It’s easy to criticize the current state of our health care system. All over the place, even outside of Washington DC, people are talking left and right (politically, that is) when they should be talking right and wrong (care, that is). But, one important talking point that’s almost always left out of the equation is our role, the role of the nurse. Or more specifically, the critical care nurse whose job it is to save you or your family members’ lives if hospitalized in the intensive care unit (ICU).

With its latest effort to reduce medical errors through the National Patient Safety Initiative, the government is putting dollars behind this effort. Hospital ICUs not only house a hospital’s sickest patients, but they also account for up to 30 percent of a hospital’s costs. As many as 1 in 5 patients die in the ICU and this is partially attributed to the severity of medical conditions and the high rate of health care-associated infections (HAIs). However, we all know that medical errors also play a huge role.

Medical errors occur in the ICU. In the past, many have been of the mindset that they are inevitable. However, our study recently published in the American Journal of Critical Care illustrates that nurses can play a significant role in reducing medical errors.

It is commonly known and discussed that medical errors can be caused by both human and system error. While it is important to address the system problems, nurses are uniquely positioned to serve as a key player in the human “error recovery” process. The results of our study indicate 17 strategies nurses can use to identify, interrupt and correct common medical errors:

• 8 strategies to identify errors: knowing the patient, knowing the “players”, knowing the plan of care, surveillance, knowing policy/procedure, double-checking, using systematic processes and questioning
• 3 strategies to interrupt errors: offering assistance, clarifying and verbally interrupting
• 6 strategies to correct errors: persevering, being physically present, reviewing or confirming the plan of care, offering options, referencing standard or experts and involving another nurse or physician

These strategies show the nurse’s pivotal role in reducing medical errors. But let’s also not forget the advancements that have been made with health care technology. The Affordable Care Act and the meaningful use requirements are guiding where the industry is headed with respect to patient care. In the ICU, clinical decision support – an expanding requirement in phase two of meaningful use can help nurses make a difference in spotting and responding to medical errors.

Take sepsis, for example. Sepsis is a life threatening illness that is caused by bacteria that overwhelms a patient’s bloodstream. However, sepsis is also the #1 most preventable cause of death in hospitals. If nurses have the ability to combine the strategies identified above with clinical decision support tools, we can detect the subtle signs of sepsis before it becomes a crisis. 

As for the left and right, that battle may never come to an end. But as for right and wrong, these strategies are putting us on the right path.

The video conveys that while not every student will become a geropsychiatric nurse, almost all nurses at some point in their careers will care for older adults with mental health issues. Therefore, nurses will need the requisite knowledge, skills and compassion to improve the quality of life for this most challenging, rewarding and neglected population.

View the video. Note that this video can be used as a standalone resource or segments can easily be excerpted for specific uses. It is available for free download on the Portal of Geriatric Online Education: POGOe, Product #20893   (You must have an account to access the video for download, but registration is free.)

Please share with your colleagues. GPNC would love to hear who is using it in what venues and any responses about its utility and value. Send comments to Pamela Dudzik at pdudzik@aannet.org.

By Sandra Phillips Sperry and Caryl Mahoney. An unavoidable fact of business life is that the workplace is fraught with the potential for conflict. High performing organizations and effective teams must attend to not just the work that gets done, but how it gets done.  Unfortunately, intimidating and bullying behaviors have always been an unwelcome part of the healthcare workplace.  Unresolved, these toxic behaviors can lead to debilitating consequences such as lowered morale and productivity and loss of quality staff.  These toxic behaviors effect performance and are evidenced among peers, patients towards staff, staff towards patients, and throughout the matrix of the organization.  Toxic behavior or personalities can be defined as exhibiting counterproductive work behaviors that demoralize and incapacitate individuals, teams, and organizations.  These behaviors reflect a disconnect between stated organizational values and performance.  The behaviors are often tolerated because an individual is viewed as talented, in a position of power, a significant contributor to the bottom line, a “driver” of other’s performance or simply affected by situational stress.  There is significant evidence that toxic behaviors are no longer just an irritant to can be put up with but are serious disruptions that contribute to decreased productivity, safety and increased cost.  The nature and form of bullying is often unclear in the workplace.  Overt bullying behavior is more easily recognized in a schoolyard, but can be masked or more subtle in the workplace.  Dealing with bullying in the workplace is a compelling reason for the broadening of organizational goals and culture.  Developing individual and group awareness can result in positive organizational outcomes and wise personal and professional relationships.

The Institute for Safe Medical Practices (ISMP, 2010) survey findings found that 49% of health care professionals felt that intimidating behaviors had altered their ability to manage medication orders.  The Joint Commission for the Accreditation of Hospitals (JCAH) found that 70% of sentinel events were directly correlated with poor communications that are the result of negative, toxic behavior and bullying in the environment.  Findings were of such significance that standards for the management of bullying and toxic behavior were established (JCAH, 2009).  Another example is the work of Kusy and Holloway (2009) who found that 64% of individuals surveyed from a range of industries responded that they were currently working within a toxic situation or with a toxic individual.   Unprecedented interest in workplace bullying in the U.S. and globally has arisen out of the recognition that bullying, intimidation and other toxic behaviors have severe consequences and are on the rise first in our families, then in the education system, and finally in the workplace.

We are a collaboration of professional coaches and consultants who work with individuals and teams to resolve these issues in the workplace.  We are in the process of developing solutions and new approaches to education and management of this problem.  We are seeking individuals who would be willing to share their stories and experiences with bullying and intimidating behaviors in the workplace.  The process will include a brief telephone interview and subsequent submission of a written description of the individual experience.  Case studies or “stories” will be confidential and will be used for teaching, case study applications in coaching, and writing purposes.  Stories will remain anonymous and will not identify any person, organization, or entity by name.  A letter of agreement to that intent will be provided upon request.   

If you are interested in participating please contact Sandra Phillips Sperry at sandrasperry@connect2careamerica.com  or by phone at 718-207-5641 or Caryl Mahoney at caryl.mahoney2@gmail.com, 301-580-9528.

The following is a guest post by Elizabeth Madigan, PhD, RN, FAAN who is a professor of nursing at the Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, Ohio. She has been an RN for more than 30 years and has spent the last 14 years as a researcher focused on quality and safety in health care, primarily home health care.

By Elizabeth Madigan. There really is no low hanging fruit in safe health care. The “hurray for checklists in health care” mantra that has been recently promoted in the popular media, misses a couple key points—it’s not the checklist that improves the outcomes—it’s the change in the organizational culture and where that cultural change happens. Anyone who has worked in quality improvement or performance improvement long enough knows the familiar story of a blip of improvement in patient outcomes following one simple intervention that is not maintained and often falls to worse when QI and PI attention moves to another problem. Persistent changes come about through changes in organizational beliefs and operations. The Institute for Healthcare Improvement has identified the importance of the engagement of key leadership in bringing about organizational change, but it also requires the frontline workers, regardless of the health care setting, who do the heavy lifting in making changes in day-to-day work practices. The implication of the popular media is that if the health care industry would adapt the same successful and (oh by the way) very simple approaches (the checklists) from aviation or nuclear power, we would see big and persistent improvements in patient safety. Here’s the rub: on the other end of that checklist is a person, not an airplane or a nuclear plant. And people, particularly people seeking health care, are complicated in ways that airplanes and nuclear plants are not and deserve a provider who recognizes their unique perspectives, needs, backgrounds and current status. The other part of the story from both the aviation and nuclear power industries is that the successes associated with the checklists resulted from changes in the organization as well. For example, in the aviation industry, co-pilots were encouraged to and actually empowered to question the pilots about safety issues. Can using checklists help improve health care quality and safety? Should checklists be integrated in some parts of health care? Absolutely on both counts. Are checklists low hanging fruit that the health care industry has chosen to ignore because health care providers are (pick one) greedy, not caring, resistant to change or not smart enough to recognize? Not a chance. All of health care is under increased scrutiny for quality and safety outcomes; implying that the industry and all the research to date has missed the simple “silver bullet” solutions is not helping and is actually counter-productive to addressing the complex issues here.

Altarum Institute has crunched the health job numbers from the Bureau of Labor Statistics (BLS) and published their analysis in Health Sector Economic Indicators, published February 9, 2011. Altarum’s top-line: health care employment has reached an “all-time high” in the U.S.

Outpatient care settings accounted for the fastest-growth in jobs with a 12-month rate of increase of 5.3%. The hospital segment grew the slowest, at a mere 0.7% — basically flat-lining (though still representing, by far, the largest segment in terms of jobs). Home health jobs grew by 4.3%.

Health Populi’s Hot Points:  It is impossible to separate the U.S. health microeconomy from the nation’s macroeconomy. With only 39,000 new jobs added to the U.S. economy in January 2011, we economists look for bright signs wherever we can find them. One-third of this increase in total new employment was in health care.

The number of jobs in the health sector will continue to grow. This will continue to be the case for the next decade, at least. Among many drivers for health job growth, two are at the top of the list in 2011: health information technology and the aging of the population. There will be intense demand for workers skilled in health information technology, based on the adoption of electronic health records by providers (both doctors and hospitals), along with growing digitization of all health information generated by digital imaging, point-of-care diagnostics, smart infusion pumps, and other medical devices. Dr. Blackford Middleton of Partners HealthCare projects a need for an additional 40,000 to 160,000 workers in health IT in the coming years.

As for aging, the chart shows already-growing demand for more home care workers. Boomers won’t age quietly into that good night, wishing to avoid institutional care in nursing homes. So home care work will be re-defined back in the person’s home — requiring even more digitally savvy workers to re-imagine and re-design what home care is. This will mean more jobs for new kinds of design and ideation, applying the disciplines of anthropology and sociology, and of course, more IT developers who can marry, say, miniature accelerometers to milk bottles and sensors to scales.

How we define health care jobs today will morph into a new definition for jobs in health tomorrow.

Originally posted on Health Populi on February 10th.

The American Medical Association‘s survey, Truth in Advertising, published in January 2011, follows up the AMA’s 2008 survey which had similar results.  Data based on consumers answering the question, “Is this person a medical doctor,” are organized in the chart.

90% of people say that a physician’s additional years of medical education and training are ‘vital’ to optimal patient care. At the same time, only 51% of people say it’s easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their title and other licensing credentials in ads and marketing materials.

In a related story, my colleague and friend Michael Millenson wrote in Kaiser Health News today about “Fixing the Failure at Physician Compare.” Physician Compare is the Centers for Medicare and Medicaid Service’s (CMS’s) portal meant to assist the health citizens (whether enrolled in Medicare or not) in finding doctors in their local communities. Millenson writes,

“In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a ‘patient-centered … extremist’ in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, ‘We couldn’t care less whether any consumer ever uses this.’”

The AMA survey was conducted in November 2010 among 850 adults.

Health Populi’s Hot Points: The AMA poll and Millenson’s analysis point to the desperate need for greater health literacy, transparency and useful, usable tools for health citizens for becoming more engaged and empowered in their health and health care choices. Most health citizens don’t aspire to be couch potatoes when it comes to tapping into health information: in fact a majority of U.S. adults who have a primary care doctor would like more comprehensive information about their doctors online, learned in a survey conducted in November 2010.

AHRQ is soliciting comments for the Agency’s project, Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT.  This project will focus on consumer health information search and storage, and health monitoring. Health Populi readers involved in consumer-facing health IT innovation and design should tap into this site and get involved. As the Physician Compare early experiences point out, AHRQ — which is a ‘sister’ organization to CMS under the umbrella of the Department of Health and Human Services — can benefit from your input.

Originally posted by Jane Sarasohn-Kahn on January 27th on Health Populi.

Health care delivery is strained under tremendous pressure from the demands of chronic health issues, downward trends in third party payments, and while insurance coverage will address some of these issues, many of these problems may persist even when near universal insurance coverage is achieved in the United States. So what else needs to happen to make health care reform a success? 

In recent years, a series of “disruptive innovations,” (as coined by Harvard Business Professor, Clayton Christensen, PhD), in the health care sector have capitalized on non-physician providers, such as nurse practitioners. Their ability to provide high-quality primary and preventive care in retail-based settings such as Convenient Care Clinics (also known as retail-based clinics) and in community-settings, such as Nurse-Managed Health Clinics has been well documented.

Research by RAND Corporation and publications in Health Affairs, the Institute of Medicine and Robert Wood Johnson Foundation’s Future of Nursing report and peer-reviewed journals have documented that retail-based clinics and Nurse-Managed Health Clinics provide safe, accessible, affordable care to millions of Americans without threatening continuity of care.   Nurse practitioners practicing in these independent settings already touch 20 + million or more people annually. Consumers gravitate to both models because they are accessible, affordable, provide quality care but most importantly, they are convenient in their locations, hours and ease of use.  For health care reform to be successful, we need to embrace these and many other disruptive innovations.

Disruptive innovation does not happen overnight or without a strategy – rather, innovation is built on a series of innovations that happen over time; time needed to grow and mature outside the limelight.  Neither the convenient care clinics nor Nurse-Managed Health Clinics would exist without the nurse practitioner in the primary care service seat. 

The nurse practitioner workforce, 150,000 strong today, with an annual growth rate of 5,500, was first established in the late 1960s as a response to a physician shortage and a belief that nursing could play a critical role in primary care.  It grew slowly over a 30 year period.  Like Thomas the Little Tank Engine, it stayed focused and gained steam as the number of providers grew. 

First, nurse practitioners proved their worth by silently filling the health care needs of underserved populations in rural and urban settings. Over time, and thanks to national and state legislative and regulatory reforms that have taken place over decades, including those recently led by governors in Pennsylvania and Massachusetts, nurse practitioners gained public support, were defined in law as primary care providers, and now are legally authorized to prescribe medications and provide care that is a comparable in scope to that of a primary care physician in all 50 states. Today, they are known by most Americans and have become a household name and provider of choice.

* This post is part of the Disruptive Women series on innovation.

Debra Lappin

The following is a guest post by the President of the Council for American Medical Innovation, Debra Lappin.

By Debra R. Lappin. A recent survey of 6,000 people across six countries found that a majority believe that the United States will lose its billing as the most innovative country in less than 10 years.  Aside from the competitive and reputational repercussions of such a drop, losing ground in innovation, especially medical innovation, means significantly less hope to discover cures, invent devices, and fundamentally bend the cost curve for health care, thus having a positive impact on the nation’s deficit.

America’s medical innovation enterprise will lead our nation out of the current economic recession. It provides excellent jobs in the public and private sectors, and improves health for all Americans. Medical innovation industries continue to be an important source of high-wage jobs, and while other sectors have been negatively impacted by the recession, medical innovation sectors have fared better and appear to be rebounding more quickly than other sectors from the economic downturn.  Health care and biomedical fields are expected to generate more new jobs than most other industries between 2008 and 2018.

From a health perspective, a single discovery in the world of chronic diseases resulting from investment in medical innovation today has the potential to save billions – if not trillions – of dollars tomorrow. This is what I call the new ROI, or return on innovation. And it is something I am advocating for through my role as president of the Council for American Medical Innovation (CAMI).

This past summer, CAMI commissioned a study by Battelle that offered a road map on what the U.S. needs to do to retain its leadership position in medical innovation. In particular, continued American leadership in medical innovation will require strong presidential vision, new public-private partnerships to promote medical innovation, a better investment climate, a smarter regulatory infrastructure and a stronger educational system.

Let me focus on two of those areas that where I believe we have the best opportunity to enact change in the near term.

Right now, public sector research helps fund many early-stage breakthroughs, but private sector investment is critical to bringing these innovations to market often lag behind. We must bridge this “valley of death” and bring new cures, devices, treatments and technologies to market more quickly. As a nation, we have combined public and private forces to meet similar challenges in the past, whether it is the launch of our system of national labs, placing a man on the moon or rising to the challenge of building new capacity as the era of the semiconductor emerges. Nothing less is required today.

At the same time, the private sector needs a climate that welcomes and supports entrepreneurial activity and venture capital investment. The nation’s research and development tax credit—which lets firms write off a portion of the costs of innovation—is significantly lower than that offered by our global competitors.   In fact the OECD ranks the U.S. 17th in terms of the “generosity” of our tax incentives for research and development.  A predictably more generous R&D tax credit will help the US maintain its medical innovation and global leadership in an increasingly competitive global marketplace, and will work to retain and grow our technology-driven, cutting-edge businesses and the high-wage, high-quality jobs they provide.    

The Battelle study presents a call for a unified national medical innovation policy agenda that adopts a range of strategies such as these. This call comes at a time when the medical innovation enterprise that distinguishes our nation faces serious threats that could result in its decline.  To ensure the health of our nation and economy, we must reverse this trend before it’s too late.

* This post is part of the Disruptive Women series on innovation.

You’re Invited

10 Years after Legislation was Enacted,

How Safe are Health Care Professionals from Sharps?

THURSDAY, November 4th, 2010

9:00 – 10:30 a.m. (Continental Breakfast Served)

The American Nurses Association (ANA) will host a critical discussion on the Needlestick Safety and Prevention Act, 10 years after it was enacted. The new ANA President Karen Daley, PhD, MPH, RN, FAAN who was instrumental in the Act’s passage will be a featured speaker. Panelists will discuss where we need to go from here in order to further improve needlestick safety.  According to the Centers for Disease Control and Prevention (CDC), more than 1,000 needlesticks and other sharp object injuries occur each day in health care settings and many others go unreported.

SPEAKERS:

• Karen Daley, PhD, MPH, RN, FAAN, President, American Nurses Association
• Jordan Barab, Deputy Assistant Secretary of Labor for Occupational Safety and Health
• Mary Ogg, MSN, RN, CNOR, PeriOperative Nursing Specialist, Association of PeriOperative Registered Nurses
• AnnMarie Papa, MSN, RN, CEN, NE-BC, FAEN, Board Member, Emergency Nurses Association
• Annie Lewis O’Connor, NP, MPH, PhD, Emergency Department Nurse 
• Susan A. Dolan, MS, RN, CIC, Chair, Public Policy Committee, Association for Professionals in Infection Control and Epidemiology, Inc.
• Angela Laramie, MPH, Project Coordinator, Massachusetts Sharps Injury Surveillance Program, Massachusetts Department of Public Health
• Marla J. Weston, PhD, RN, Chief Executive Officer, American Nurses Association (moderator)

WHEN:          Thursday, November 4, 2010 – 9:00 to 10:30 a.m. (Continental breakfast will be served)

WHERE:        National Press Club – Fourth Estate Room

 TO RSVP:      Contact Hope Ditto at 202-263-2900 or hditto@amplifypublicaffairs.net

This educational project was developed exclusively by the American Nurses Association for the purpose of providing objective information regarding needlestick safety and prevention. Financial support was provided in part by BD (Becton, Dickinson and Company).

Organized medicine continues to be stuck on protecting its view of its turf. In a statement issued after the IOM report was released, the American Medical Association (AMA) claimed that only physicians can lead health care teams because they are more educated than nurses. They claim it’s a matter of quality and safety, but they are ignoring the evidence to the contrary that is laid out in the IOM report. To better understand the origins of this turf battle, read Chapter 3 of the IOM report and look at the work of legal scholar Barbara Safriet.

What the AMA doesn’t seem to understand is that the future of health care requires skills that other health care providers have. Especially in primary care, clinicians need to emphasize health promotion, chronic care management, and care coordination. Physicians are highly trained diagnosticians of disease and surgeons, but this is a narrow skill set for primary care. The ideal is to have primary care physicians who can provide that expertise when needed but be on teams that may be headed by them, nurse practitioners, nurse midwives, social workers, or others. For example, for people with chronic mental illness who have developed important relationships with mental health practices, the social worker may be the best person to head the team.

Nurse-managed health centers have demonstrated that nurses can lead primary care centers that are health or medical homes using interprofessional teams that include physicians. We know that nurse practitioners can do 90% of what primary care physicians do with comparable outcomes, plus the health promotion and care coordination.

If we all can keep our eye on the real aim defined by Jack Rowe—focusing on what people need to promote health—the approaches to health care will become clear. Here’s hoping that the AMA achieves an understanding of this essential point soon.

I checked my health plan, researched the local paper, called the university medical centers and settled on a highly regarded, mid-50s, white-haired cardiologist in private practice with an affiliation at one of the medical centers in the area. 

Our relationship lasted six months.  Well, maybe one year, but that would be a stretch.

As a former physician assistant, I handled the paperwork and repetitive tests that come with seeing a new doctor without concern.  But the first few months of my move I was miserable and an emotional wreck.  My mother died four days after I moved; her mother the next month.  The job I was hired to do was canceled and I missed passing the bar exam by one point.  I was exhausted and trembling at night from the weight of all the changes and uncertainty in my life. 

When the palpitations started, I knew the stress was too much.

“I think I’m depressed,” I said with a lump in my throat to the Midwest cardiologist a bit shocked that I could utter the word.  It was our third visit.  I went on.  “I’m not sleeping well, all I do is cry, and I’m just a bundle of nerves.”    

Without looking up from the note he was scribbling in my chart he said, “Have you thought about looking for help on the internet?”

It was all I could do to sit upright on the examining table.  I was shocked and disappointed that this was his best suggestion.

 “The internet?” I thought to myself.  “Who is going to hold my hand or hug me on the Internet?”

At that moment I realized I needed a different doctor.  I walked out of his office and never returned.

What I had overlooked was the importance of finding a doctor I meshed with personally.  Not just one who had a prominent title, several clinical trials to his name, and a prestigious academic center standing behind him, but one that could simply look me in the eyes and tell that something wasn’t right.  Someone with empathy and a gentle touch.  Someone I could build a relationship with.

The doctor-patient relationship is delicate; for patients living with chronic conditions or illnesses it means balancing personal rapport with clinical knowledge.  Sometimes all you want are the facts from your doctor.  But sometimes, you want a hug and some encouragement and the personal connection is as healing as any pill.   Keep looking until you find the best of both.