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Using Clinical Decision Support Can Decrease Care Costs

Posted on September 28, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A study of clinical decision support system use has found that abiding by its recommendations can lower medical costs, adding weight to the notion that they might be worth deploying despite possible pushback from clinicians.

The study, which appeared in The American Journal of Managed Care, looked at the cost of care delivered by providers who adhered to CDS guidelines compared with care by nonadhering providers.

To conduct the study, researchers reviewed 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations, and in the control group, the provider did not do so. The encounters took place over three years.

The data they gathered regarding the encounters included alert status (adherence), provider type, patient demographics, clinical outcomes, Medicare status, and diagnosis information. The research team looked at the extent to which four outcome measures were associated with alert adherence, including encounter length of stay, odds of 30-day readmissions, odds of complications of care and total direct costs.

After conducting their analysis, the researchers found that the total encounter cost was 7.3% higher for nonadherent encounters than adherent ones, and that length of stay was 6.2% longer for nonadherent versus adherent encounters. They also found that the odds ratio for readmission within 30 days increased by 1.14, and the odds ratio for complications by 1.29, for nonadherent encounters versus adherent encounters.

Not surprisingly, given these results, the study’s authors suggest that provider organization should introduce real-time CDS support adherence to evidence-based guidelines.

It is worth noting, however, that the researchers inserted one caveat in their conclusion, warning that because they couldn’t tell what caused the association between CDS interventions and improved clinical and financial outcomes, it would be better to study the issue further.

Besides, getting clinicians on board can be painful, with many clicking through alerts without reading them and largely ignoring their content. In fact, another recent study found that almost 20% of CDS alert dismissals may be inappropriate.

Most of the inappropriate overrides were associated with an increased risk of adverse drug events. Overall, inappropriate overrides were six times as likely to be associated with potential and definite adverse drug events.

Report Champions API Use To Improve Interoperability

Posted on September 26, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new research report has taken the not-so-radical position that greater use of APIs to extract and share health data could dramatically improve interoperability. It doesn’t account for the massive business obstacles that still prevent this from happening, though.

The report, which was released by The Pew Charitable Trusts, notes that both the federal government and the private sector are both favoring the development of APIs for health data sharing.

It notes that while the federal government is working to expand the use of open APIs for health data exchange, the private sector has focused on refining existing standards in developing new applications that enhance EHR capabilities.

EHR vendors, for their part, have begun to allow third-party application developers to access to systems using APIs, with some also offering supports such as testing tools and documentation.

While these efforts are worthwhile, it will take more to wrest the most benefit from API-based data sharing, the report suggests. Its recommendations for doing so include:

  • Making all relevant data available via these APIs, not just CCDs
  • Seeing to it that information already coded in health data system stays in that form during data exchange (rather than being transformed into less digestible formats such as PDFs)
  • Standardizing data elements in the health record by using existing terminologies and developing new ones where codes don’t exist
  • Offering access to a patient’s full health record across their lifetime, and holding it in all relevant systems so patients with chronic illnesses and care providers have complete histories of their condition(s)

Of course, some of these steps would be easier to implement than others. For example, while providing a longitudinal patient record would be a great thing, there are major barriers to doing so, including but not limited to inter-provider politics and competition for market share.

Another issue is the need to pick appropriate standards and convince all parties involved to use them. Even a forerunner like FHIR is not yet universally accepted, nor is it completely mature.

The truth is that no matter how you slice it, interoperability efforts have hit the wall. While hospitals, payers, and clinicians pretty much know what needs to happen, their interests don’t converge enough to make interoperability practical as of yet.

While I’m all for organizations like the Pew folks taking a shot at figuring interoperability out, I don’t think we’re likely to get anywhere until we find a way to synchronize everyone’s interests. And good luck with that.

Three Hot Healthcare AI Categories

Posted on I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The way people talk about AI, one might be forgiven for thinking that it can achieve magical results overnight. Unfortunately, the reality is that it’s much easier to talk about AI application than execute them.

However, there are a few categories of AI development that seems to be emerging as possible game-changers for the healthcare business. Here’s five that have caught my eye.

Radiology: In theory, we’ve been able to analyze digital radiology images for quite some time. The emergence of AI tools has supercharged the discussion, though. The growing list of vendors competing for business in this nascent market is real.

Examples include Aidence, whose Veye Chest automates analysis and reporting of pulmonary modules, aidoc, which finds acute abnormalities in imaging and adds them to the radiologist’s worklist; CuraCloud, which helps with medical imaging analysis and NLP for medical data and more. (For a more comprehensive list, check out this Medium article.)

I’d be remiss if I didn’t also mention a partnership between Facebook and the NYU School of Medicine focused on speeding up MRI imaging dramatically.

Vendors and industry talking heads have been assuring radiologists that such tools will reduce their workload while leaving diagnostic in clinical decisions in their hands. So far, it seems like they’re telling the truth.

Physician documentation: The notion of using AI to speed up the physician documentation process is very hot right now, and for good reason. The advent of EHRs has added new documentation work to physicians’ already-full plate, and some are burning out. Luckily, new AI applications may be able to de-escalate this crisis.

For example, consider applications like NoteSwift’s Samantha, an EHR virtual assistant which structures transcription content and inputs it directly into the EHR. There’s also Robin, also which “listens” to discussions in the clinic rooms, drafts clinical documentation using Conversational Speech Recognition. After review, Robin also submits final documentation directly to an EMR.

Other emerging companies offering AI-driven documentation products apps including Sophris Health, Saykara, and Suki, all of which offer some isotype of virtual assistant or medical scribe functions. Big players like Nuance and MModal are working in this space as well. If you want to find more vendors – and there’s a ton emerging out there – just Google the terms “virtual physician assistant” or “AI medical scribe.” You’ll be swamped with possibilities.

My takeaway here is that we’re getting steadily closer to a day in which simply approve documentation, click a button and populate the EHR automatically. It’s an exciting possibility.

Medical chatbots: This category is perhaps a little less mature than the previous two, but a lot is going on here. While most deployments are experimental, it’s beginning to look like chatbots will be able to do everything from triage to care management, individual patient screenings and patient education. Microsoft recently highlighted how companies can easily create healthcare chatbots on Microsoft Azure. That should open up a variety of use cases.

The hottest category in medical chatbots seems to be preliminary diagnosis. Examples include Sensely, whose virtual medical assistant avatar uses AI to suggest diagnoses based on patient symptoms, along with competitors like Babylon Health, another chatbot which offing patient screenings and tentative diagnoses and Ada, whose smartphone app offers similar options.

Other medical chatbots are virtual clinicians, such as Florence, which reminds patients to take the medication and tracks key patient health metrics like body weight and mood, while still others focus on specific medical issues. This category includes Cancer Chatbot, a resource for cancer patients,  caregivers, friends and family, and Safedrugbot, which helps doctors who need data about use of drugs during breastfeeding.

While many of these apps are in beta or still sorting out their role, they’re becoming more capable by the day and should soon be able to provide patients with meaningful medical advice. They may also be capable of helping ACOs and health systems manage entire populations by digging into patient records, digesting patient histories and using this data to monitor conditions and send specialized care reminders.

This list is far from comprehensive. These are just a few categories of AI-driven healthcare applications poised to foster big changes in healthcare – especially the nature of the health IT infrastructure. There’s a great deal more to learn about what works. Still, we’re just steps away from seeing AI-based technologies hit the industry hard. In the meantime, it might be smart to consider taking some of these for a test run.

Dreamforce 2018 – More Healthcare Than Ever

Posted on September 25, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The annual Dreamforce event starts today in San Francisco. This year, more time on the agenda has been dedicated to healthcare and life sciences highlighting Salesforce’s continued investment in these industries.

I have never been to Dreamforce, but every year I find myself enviously reading the tweets that fly past. There are always great quotes from the high-calibre keynote speakers and a lot of interesting talk about new technologies from attendees.

What I found noticeable about Dreamforce 2018,  #DF18, is the number of HealthIT companies that will be speaking and exhibiting at the event. I have seen more tweets and received more notices about companies participating at #DF18 than in any other year. Some of the Healthcare presenters this year include:

For the full list see this handy Dreamforce TrailMap for Healthcare and Life Sciences:

I remember when Salesforce first appeared at the annual HIMSS event. I spent a lot of time in their booth learning about their healthcare initiative. Back then their solution was focused exclusively on care coordination. Patients were entered as “customers” and health information from different source systems would flow into Salesforce. This data would be associated with the patient record and accessible to different members of the care team to help coordinate care. It was pretty rudimentary.

Company executives that I spoke to did not have answers to my questions about the future direction of their healthcare initiatives. They simply did not know. Fast forward to today and it seems clear that Salesforce is pursuing a healthcare strategy that is like what they have used in other industries – build a few apps on their own to prove it can be done, then be open to others building apps using Salesforce as the backbone and connective tissue.

Judging by the number of HealthIT companies that have chosen to partner with Salesforce, I would say the strategy is working.

“Our patient experience platform is built on the Salesforce platform,” explains Sunny Tara, Co-founder and CEO of CareCognitics. “EHRs are the operational systems for hospitals. They were well suited to replace healthcare’s fee for service billing system. However, as we move to a value-based system focused on improved care, hospitals need the power and personalization that comes from a true CRM system. What we have done is built a platform that bridges existing EHRs with advanced patient loyalty capabilities built on top of Force.com. Doctors and patients love it.”

“Our partnership with Salesforce and integration with Health Cloud is further proof of PointClickCare’s commitment to creating intelligent care coordination between health systems and post-acute providers,” says BJ Boyle, VP Product Management at PointClickCare. “With two-thirds of the skilled nursing market using PointClickCare, we’re uniquely positioned to help LTPAC providers across the country be great partners with health systems. Leveraging Salesforce’s Health Cloud offers us new and exciting ways to do this even more effectively.”

Over the next few days I will be watching for healthcare announcements and tweets from #DF18. I am hoping to see further proof that Salesforce is building an ecosystem of partners to help bring better personalization, interoperability and cloud capabilities to healthcare.

Montefiore Health Makes Big AI Play

Posted on September 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’ve been doing a lot of research on healthcare AI applications lately. Not surprisingly, while people find the abstract issues involved to be intriguing, most would prefer to hear news of real-life projects, so I’ve been on the lookout for good examples.

One interesting case study, which appeared recently in Health IT Analytics, comes from Montefiore Health System, which has been building up its AI capabilities. Over the past three years, it has created an AI framework leveraging a data lake, infrastructure upgrades and predictive analytics algorithms. The AI is focused on addressing expensive, dangerous health issues, HIA reports.

“We have created a system that harvests every piece of data that we can possibly find, from our own EMRs and devices to patient-generated data to socio-economic data from the community,” said Parsa Mirhaji, MD, PhD, director of the Center for Health Data Innovations at Montefiore and the Albert Einstein College of Medicine, who spoke with the publication.

Back in 2015, Mirhaji kicked off a project bringing semantic data lake technology to his organization. The first pilot using the technology was designed to find patients at risk of death or intubation within 48 hours. Now, clinicians can also see red flags for admitted patients with increased risk of mortality 3 to 5 days in advance.

In 2017, the health system also rolled out advanced sepsis detection tools and a respiratory failure detection algorithm called APPROVE, which identifies patients at a raised risk of prolonged ventilation up to 48 hours before onset, HIA reported.

The net result of these efforts was dubbed PALM, the Patient-centered Analytical  Learning Machine. PALM “represents a very new way of interacting with data in healthcare,” Miraji told HIA.

What makes PALM special is that it speeds up the process of collecting, curating, cleaning and accessing metadata which must be conducted before the data can be used to train AI models. In most cases, the process of collecting data for AI use is largely manual, but PALM automates this process, Miraji told the publication.

This is because the data lake and its graph repositories can find relationships between individual data elements on an on-the-fly basis. This automation lets Montefiore cut way down on labor needed to get these results. Miraji noted that ordinarily, it would take a team of data analysts, database administrators and designers to achieve this result.

PALM also benefits from a souped-up hardware architecture, which Montefiore created with help from Intel and other technology partners. The improved architecture includes the capacity for more system memory and processing power.

The final step in optimizing the PALM system was to integrate it into the health system’s clinical workflow. This seems to have been the hardest step. “I will say right away that I don’t think we have completely solved the problem of integrating analytics seamlessly into the workflow,” Miraji admitted to HIA.

A Nursing Informatics Perspective on Healthcare Analytics – Interview with Charles Boicey

Posted on September 21, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare informatics has been around for a long time. However, from my perspective, it feels like there’s something different in the air when it comes to healthcare informatics. I get the feeling that we’re on the precipice of something really special happening. In fact, I think we already start to see value being created by healthcare informaticists.

As Healthcare Scene continues to explore this subject, we sat down with informatics expert, Charles Boicey, Chief Innovation Officer at Clearsense, to talk with him about what’s changed in healthcare informatics that makes it different today than in the past. We also talk about what’s needed to make healthcare analytics efforts successful at organizations and what analytics trend he’s watching most. Plus, we had to talk about his background as a nurse and how a nursing background really helps his informatics work.

If you want to hear of some practical uses of healthcare analytics and how your organization can benefit from it, you’ll enjoy our interview with Charles Boicey.

Be sure and subscribe to all of Healthcare Scene’s videos on YouTube. Also, take a minute to check out EXPO.health and join us in Boston to mix and mingle with amazing healthcare IT professionals like Charles Boicey.

Do We Need Another Interoperability Group?

Posted on September 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the last few years, industry groups dedicated to interoperability have been popping up like mushrooms after a hard rain. All seem to be dedicated to solving the same set of intractable data sharing problems.

The latest interoperability initiative on my radar, known as the Da Vinci Project, is focused on supporting value-based care.

The Da Vinci Project, which brings together more than 20 healthcare companies, is using HL7 FHIR to foster VBC (Value Based Care). Members include technology vendors, providers, and payers, including Allscripts, Anthem Blue Cross and Blue Shield, Cerner, Epic, Rush University Medical Center, Surescripts, UnitedHealthcare, Humana and Optum. The initiative is hosted by HL7 International.

Da Vinci project members plan to develop a common set of standards for data exchange that can be used nationally. The idea is to help partner organizations avoid spending money on one-off data sharing development projects.

The members are already at work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery. Next, members will begin work on test cases for document templates and coverage rules, along with eHealth record exchange in support of HEDIS/STARS and clinician exchange.

Of course, these goals sound good in theory. Making it simpler for health plans, vendors and providers to create data sharing standards in common is probably smart.

The question is, is this effort really different from others fronted by Epic, Cerner and the like? Or perhaps more importantly, does its approach suffer from limitations that seem to have crippled other attempts at fostering interoperability?

As my colleague John Lynn notes, it’s probably not wise to be too ambitious when it comes to solving interoperability problems. “One of the major failures of most interoperability efforts is that they’re too ambitious,” he wrote earlier this year. “They try to do everything and since that’s not achievable, they end up doing nothing.”

John’s belief – which I share — is that it makes more sense to address “slices of interoperability” rather than attempt to share everything with everyone.

It’s possible that the Da Vinci Project may actually be taking such a practical approach. Enabling partners to create point-to-point data sharing solutions easily sounds very worthwhile, and could conceivably save money and improve care quality. That’s what we’re all after, right?

Still, the fact that they’re packaging this as a VBC initiative gives me pause. Hey, I know that fee-for-service reimbursement is on its way out and that it will take new technology to support new payment models, but is this really what happening here? I have to wonder.

Bottom line, if the giants involved are still slapping buzzwords on the project, I’m not sure they know what they’re doing yet. I guess we’ll just have to wait and see where they go with it.

Looking Forward to #AHIMACon18 – HIM Scene

Posted on September 19, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This weekend is the start of the AHIMA Annual Convention happening in Miami, Florida. For those not familiar with the AHIMA organization, it brings together HIM professionals from across the country. Something that I think makes AHIMA unique is that around the HIM conference are multiple days of training and certifications for HIM professionals. I’m always amazed at how much work HIM professionals have to put in to keep up with their certifications and to stay up with things like the ever-changing world of medical coding. HIM definitely doesn’t get the credit they deserve in this regard.

As I think what topics will be hot at this year’s AHIMA Annual convention, I’m most interested to hear what the HIM crowd thinks about the changes to the Physician Fee Schedule and E&M Coding. This is going to be a big deal for healthcare and medical coders are going to be the ones charged with dealing with the changes. Sure, doctors will have to change how they are documenting as well, but verifying that it was documented correctly and making sure the medical coding matches that documentation is mostly done by HIM professionals.

I’m really interested to hear what HIM professionals think about these medical coding changes. What do you think of the new time based coding options? Does this make life easier or not? Let us know what you think and what you’re hearing in the comments. The obvious part to me is that in the short term it’s not going to make medical coders’ lives easier at all. It’s just one more code they’re going to have to deal with and it doesn’t have a history of practices to support what’s acceptable or not. It’s not like these new codes are doing away with the old codes. At least I don’t think that’s how most practices are going to handle these new codes, but we’ll see. Let us know your thoughts in the comments.

Another big change that could impact HIM professionals, particularly medical coders, are the new remote monitoring and digital care coordination codes. I’ve heard a lot of people saying that these codes show some promise. However, I’m starting to hear overtures that the codes aren’t going to live up to their billing (excuse the pun). What are you seeing when it comes to the new coding for telemedicine, remote monitoring, and digital care coordination?

Outside of these two big topics, I’ll be interested to hear how HIM professionals are looking at security and privacy. It’s become a huge topic in the CIO and healthcare IT world. I wonder how much it will impact the HIM world. There’s always an interesting dance when a breach happens. The HIM world is great at understanding disclosures and HIPAA violations, but breaches often bring out a lot of different people. The reality is that when a breach occurs it needs to be all hands on deck. However, my guess is that many HIM professionals aren’t part of the discussion when a breach occurs. How’s your experience been in this regard? If you haven’t had a breach (lucky you), you should still have some policies and some drills in place to make sure you’re ready. So, you should have an idea of what HIM’s role would be in a breach.

Another trend I’ve been watching for a number of years is the push for more and more HIM professionals to be involved in things like healthcare analytics. This was highlighted by a recently published article in the Journal of AHIMA that makes the argument that all healthcare professionals need to learn data analytics. I argued something similar in this article on how HIM professionals can use Information Governance to ensure they’re heard. These are important messages that I think many in HIM are largely ignoring. It will be interesting to see how this shakes out. Those that embrace the changes will be well positioned for the future.

What other things should we be watching for from an HIM perspective? What’s keeping you up at night? What’s getting you most excited about your job? Let us know in the comments or on Twitter @HealthcareScene.

Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

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Prioritizing Nursing Sepsis Awareness and Compliance

Posted on September 17, 2018 I Written By

The following is a guest blog post by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Health Learning, Research & Practice, Wolters Kluwer.

September is Sepsis Awareness Month—an opportune time to reflect on the state of industry as it relates to reducing the impact of this potentially deadly condition. In terms of reach, the numbers are sobering: 1.5 million people in the U.S. contract sepsis each year, and a quarter of a million die annually from the condition.

In recent years, the healthcare industry has taken important steps to improve the sepsis outlook by keeping awareness and best-practice developments front and center. The Surviving Sepsis Campaign’s (SSC’s) 2018 release of the updated hour-1 bundle reflects this commitment by keeping care delivery in sync with the latest evidence—in this case the International Guidelines for Management of Sepsis and Septic Shock 2016.

The new bundle combines the SSC’s previously-released 3-hour and 6-hour bundles and prioritizes the need for early identification and more immediate response. Nurses play a critical role in this equation as the clinicians working on the frontlines of care. While sepsis is more likely to present in emergency departments and critical care environments, it is imperative that all nurses have the knowledge to quickly identify symptoms and begin appropriate treatment protocols.

The sepsis challenge is both mammoth and complicated, requiring a multi-pronged, multi-disciplinary approach that draws on the latest evidence and institutional accountability. There is much at stake for hospitals in terms of reputation as sepsis performance scores are now published on the Centers for Medicare and Medicaid Services’ Hospital Compare website, where patients can quickly and easily see how their facility of choice stacks up in terms of sepsis mortality.

Consequently, it is more important than ever for hospital clinical leaders to prioritize nursing education on the early signs of sepsis, especially when caring for at-risk patients. In addition, nurses need quick access to hour-1 bundle protocols at the point of care to ensure they are properly following the guidelines to optimize sepsis outcomes and save lives.

Sepsis Bundle Primer

The latest revision of the SSC bundles seeks immediate resuscitation and management of sepsis. In the update, SCC authors note: “We believe this reflects the clinical reality at the bedside of these seriously ill patients with sepsis and septic shock—that clinicians begin treatment immediately, especially in patients with hypotension, rather than waiting or extending resuscitation measures over a longer period.”

The guidelines detail five steps that should take place within one hour of identifying sepsis including:

  • Measure lactate level. Remeasure if initial lactate level > 2 mmol/L.
  • Obtain blood cultures before administering antibiotics.
  • Administer broad-spectrum antibiotics.
  • Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.
  • Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

The premise of the bundled elements is that the whole is better than the one. When implemented as a group, these protocols have the greatest impact on outcomes.

The Sepsis Knowledge Gap Challenge

Hospitals face nursing knowledge gaps related to sepsis on two fronts: 1) early identification; 2) adhering to best practice protocols. While nurses working in the ED or critical care are likely to have experience with sepsis and the hour-1 bundle, those working on the medical-surgical floor or in other specialty areas often lack a deep understanding of the complexities and urgency surrounding early identification and response.

To promote early identification, nurses need to first understand the symptoms that occur in patients who are septic. Key observations include:

  • Delirium
  • Extreme high or low temperatures
  • Shortness of breath
  • Extreme pain or discomfort
  • Elevated heart rate and/or low blood pressure
  • Cool and clammy skin

While the answers to these questions can provide a baseline, the reality is that sepsis is a complicated diagnosis that requires critical thinking. For instance, fever alone is not always the best indicator of the condition, as hypothermia and low temperatures are often more predictive of severity and death. In addition, nurses need awareness that certain patients are at higher risk of mortality, such as the very young and the elderly or those with certain co-morbidities like COPD, heart failure and diabetes.

The Quick Sepsis Related Organ Failure Assessment (qSOFA) provides an effective point-of-care prompt for identification of a suspected infection. The tool uses three criteria to determine sepsis mortality risk. These include one point for each of the following: low blood pressure (SBP≤100 mmHg); high respiratory rate (≥ 22 breaths per minute); or altered mentation. Nurses need to be educated to use this system and be made aware of alerts that point to these variables. For example, a positive score of 2 or higher would point to the need for intervention by a provider or initiation of rapid response protocols.

Standardizing Sepsis Identification and Response

To eliminate variations in sepsis care and ensure best-practice protocols are followed, hospitals must implement comprehensive and ongoing education programs for nurses that address three areas: 1) identification of early signs of sepsis; 2) hour-1 treatment bundle protocol and 3) use of qSOFA scoring. Technology is an important part of any strategy and should be a priority consideration for both education and point of care guidance.

The best clinical decision support tools at point of care provide automated updating of new evidence as it is established. In the case of the hour-1 sepsis bundle, these solutions foster confidence that nurses have that right information when they are with the patient, and if they forget, a quick look-up can provide the needed guidance.

Access to the most up-to-date digital professional development education resources help nurses garner a deeper understanding of sepsis, the latest standards and practice application. Hospitals can draw on the latest advancements to quickly create customized programs and exams that allow students to progress and master skills at their own unique level.

Sepsis mortality rates sit at greater than 40 percent. In the era of value-based care which focuses on patient outcomes, that’s significant and problematic for hospitals on many levels. Improving sepsis outcomes necessitates that clinical leaders invoke strategies that promote adoption of the latest evidence to move the needle on performance.

About Anne Dabrow Woods
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN is the Chief Nurse of the Health Learning, Research and Practice business unit at Wolters Kluwer.  She is also a critical care nurse practitioner for Penn Medicine, Chester County Hospital, and she is adjunct faculty for Drexel University in the College of Nursing and Health Professions.