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Amazing Nurse Story

Posted on December 5, 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.

Nurses are amazing and they are often the unsung heroes of healthcare. When I think about the times I’ve spent in hospitals I have almost zero memories of the doctors, but I have a lot of great memories of the nurses.

I was reminded of this fact when reading this pretty untraditional nurse story that @rn_critcare shared. I wonder how many times healthcare IT developers think about these kinds of unique situations that nurses face. Ok, they aren’t all this large, but they are just as nuanced.

As told by @rn_critcare:
Today in my role as nurse I wore many hats. Let me tell you a story about how the day went… #NurseLife
#medtwitter

Came in this am to discover my pt from yesterday had imaging overnight that revealed catastrophic injuries, along with her sepsis and multi-system organ failure

Within 1/2 hr her fiance approached me about calling in a chaplain, which I assume is to do final prayers. He informs me that he wants to marry her. Today.

I’m not sure b/c pt is sedated and fully ventilated, with no hope of waking up.

Spend next few hours calling chaplains/priests/ministers. Keep in mind it’s Sunday AM and church is happening soon.

I find out that if we can show “intent to marry” that a ceremony can be performed. Photos of pt trying on dress are used. A minister agrees to come after church.

Preparations are being made. Family is happy that we can do this for their loved ones.

Except Pt starts to deteriorate. Cushing triad. Call family in and discuss options. They have a family member willing to perform ceremony, if only for symbolic reasons now…

Hair is washed and braided. I give the sisters some sheets and scissors for a makeshift wedding dress (new) while I go collect flowers from other rooms around the unit. (borrowed)

Flowers are placed in braids along with headband & veil. A blue blanket is draped at end of bed.
Everyone lines up outside the unit and begin the parade into the room. So. Many. People. Can hardly make my way around but secure a post at the med pumps and monitor.

Music is being played, someone has a guitar and another has a drum.

The chaplains words are brief but loving. Asks him does he take her… I do. Asks does she take him, bridesmaids all reply “she does”

Everyone in tears

They are now all in song with only the drum being played, which I feel is shaking my entire soul
Everyone singing Stand by Me and I’m in tears.

Pt stabilizes somewhat. I realize it’s now afternoon and I haven’t had a break or worse, my coffee! I decide to step away for a few minutes. Go outside for air. Find myself at grocery store across the street…

Purchase cake and have 2 hearts drawn with their initials, some bubbly (sparkling juice), and plastic champagne flutes. There was a wedding after all… New groom takes bottle outside with fam, pops the cork & comes back for mini reception.

So much love

I decide to get some charting done. Post-op comes back across the hall and I’m called to help. CRRT machine beeping next door and tend to that. Realize I still haven’t eaten. Grab a cookie from the desk (weekend tradition from consultants)

Pt begins to fail again.

Family called back in, this time the air has changed. It’s heavier and somehow feels hotter than hours before.

The guitar is being played and everyone is singing Amazing Grace. Am I singing along? Maybe. Not sure with this lump in my throat.

Have to turn away and pretend like I’m tending to something very important, which turns out is the wall, but it’s holding me up now, and the singing and drumming is getting louder and I’m just trying to keep it together, keep her comfortable… Won’t be long now…

Her children are at her side now telling her they love her, how wonderful she is, how much they love their step-dad, don’t worry they will take care of him.

A tear falls down her cheek and now everyone is sobbing. My sobs are internalized and I keep my eye on the monitor…

New groom is by her side and I whisper in his ear that she has passed, as this sacred news is shared with a spouse first.

The new groom is now a widow.

One by one the people exit the room, each one reaching out for a hug. Each hug brings me a little closer to the inevitable spill over of tears. My heart aches for them. There are no words, my eyes pleading with them to accept my sincerest condolences…

They need help with funeral home. Explain of course I can help guide them, this is unchartered territory and I do this all the time. My insides are screaming ALL THE TIME!

Call funeral home, with request to leave braids untouched… Veil and flowers too.

I finish my charting. Realize there’s no supper break happening either. Wash my pt up. Gently remove the countless tubes and IVs. Use hushed tones as I explain to her what I am doing, because even in death we deliver honour and dignity.

Take a new nurse down to morgue with me, because it’s a teaching hospital after all. Carry on chatting as though my spirit isn’t weeping inside.
Get back to unit.

Take a long overdue drink of water.

No time for tears.

There’s an admission on the way.

#nurselife

Health Systems, Hospitals Getting Serious About Telemedicine

Posted on December 8, 2017 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.

In the spring of last year, I wrote up a story about hospitals and health systems and their growing interest in telemedicine. The story included data from a survey on hospitals and telemedicine, which found that health systems averaged 5.51 telemedicine service lines at the time, up almost 20% from 2015.

Given these stats, I was not surprised to see a new press release from Teladoc reporting that the company now supports more than 200 hospitals, a number which represents a 100% growth in such relationships during this year.

If you’re wondering why this has happened, you’ll get more or less the same answer from last year’s study and Teladoc’s news release. In short, it’s all about the outcomes, baby.

When I wrote the story last year, one of the things that stood out for me was that 96% of respondents had said they were planning to roll up telemedicine services because they felt it would improve patient outcomes. While that made sense to me at the time, it seemed more like an aspiration rather than a practical plan.

What made the survey data even more provocative is that “improving financial returns” turned out to be a very low priority for hospitals working on telemedicine programs. At the time, this focus on outcomes rather than direct financial returns surprised me.

Now, about 18 months later, I’m doing the facepalm thing and saying “of course, hospitals want affordable, flexible care delivery options — they’re a great tool for managing population health!” It’s a no-brainer, actually, but I guess my brain wasn’t working at the time.

Now, as far as I know, the assumption that telemedicine can help with PHM and value-based delivery generally has not been rigorously tested. Also, even if the assumption is correct, hospitals are likely to struggle with deploying telemedicine for a while until they develop the most efficient workflows for using it.

Also, while it’s all well and good to say that focusing on outcomes will create ROI as a secondary effect, for some hospitals it will be pretty rough to carry telemedicine infrastructure and staffing costs upfront for a while. After all, if they want to make an impact with telemedicine, they have to make a serious commitment; I’m guessing that most of us would agree that a scattershot approach would get most hospitals nowhere.

Ultimately, though, I think hospitals have it right. Telemedicine is likely to offer health systems and hospitals some amazing options for extending service lines, managing populations more effectively, and yes, improving outcomes.

Reasons Hospitals Acquire Medical Practices

Posted on January 28, 2013 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.

The Charlotte Observer did a great report on the shift to hospital owned medical practices. For those not familiar with the shift, here’s the numbers the article offers:

Last year, 47 percent of U.S. physicians were employed by hospitals – roughly twice the percentage in 2002, according to surveys by the Medical Group Management Association.

One health care recruiting company predicts that hospitals could employ as many as 75 percent of U.S. doctors within two years.

I still think that some of this shift is cyclical, and independent thinking doctors will eventually leave their hospital overlords and be back on their own again. However, considering the financial side of the equation, many doctors might not be able to go back to their own practice even if they want to do so.

Here’s an example from the article that explains one of the reasons that hospitals are acquiring medical practices.

Gary Ziomek can vouch for that. The Waxhaw resident began getting physical therapy in 2011, after undergoing an unsuccessful spinal fusion surgery. He went to a therapist at Carolinas Rehabilitation on the campus of Carolinas Medical Center-Pineville hospital.

Early this year, his bill was $148 for 30 minutes of massage. But starting in May, the charge for a 30-minute massage rose sharply, to $249.30 – even though he got the same therapy from the same therapist in the same building.

Ziomek said an employee told him the higher charge came about because the office, which is owned by Carolinas HealthCare, began billing as a hospital-based setting. He said he was told that patients could go to the Ballantyne office and pay the lower amount.

Ziomek’s Aetna insurance reimburses differently based on where a service is rendered. For an office visit, Ziomek was responsible for a $20 co-pay, no matter if he had met his $250 deductible. For a hospital visit, he pays 10 percent of the bill after paying the $250 deductible.

In this case, Ziomek’s out-of-pocket expense dropped, because he had already met his deductible for the year. But he’s concerned that the overall cost went up, with no change in service or quality.

“Somewhere along the line, they realized, ‘We can charge more to the insurance company even though the patient is getting exactly the same service,’ ” said Ziomek, 70, a retired investment banker. “They could have kept the lower rate, but they chose not to. Why? Because of greed.”

I think the last line about greed is a little bit of sensationalism. In our market, healthcare is driven by revenue and profits. Many hospitals say they’re non-profit, but they certainly act like for profit entities.

What’s surprising to me is that insurance companies are putting up with this shift. I expect the loophole will be reversed again, but that often takes time. Some policy will be put in place to stop hospital owned medical practices from charging at the hospital rate. However, until that happens you can be sure that hospitals will continue their acquisition of medical practices.

AHA Says Meaningful Use Schedule Is Too Ambitious

Posted on May 4, 2012 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.

Wow. The American Hospital Association is stepping into the picture this late in the game to complain that Meaningful Use rules are imposing massive pressure on its members?  The AHA isn’t known for its reticence, after all. But anyway, it appears that this week the trade group has jumped in and started swinging.

AHA’s executive vice president and complainer-in-chief Rick Pollack sent a 68-page letter to the Obama administration this week complaining about the burden of the Meaningful Use program.

Why can’t hospitals force their way through the process to get their bucks (which, after all, can be as much as $11.5m)? Pollack apparently cited  “the high bar set and market factors, such as accelerating costs and limited vendor capacity” in his list of concerns.

He could just have easily cited a bunch of other obstacles we’ve covered here, including a lack of staff available to implement EMR projects, demands placed by the ICD-9 to ICD-10 or maybe even the fact that $11.5 million doesn’t do nearly enough to defray the sticker price on, say, an Epic installation for a mid-sized hospital (Assuming the mid-sized hospital can convince Epic to let them use their EHR software).

Given these factors, I have to agree with the AHA: it doesn’t make a lot of sense to start penalizing hospitals with non-qualifying EMRs by 2015, an eye-blink in time when it comes to planning enterprise software installations and upgrades.

So, what should the administration do?  Certainly, moving deadlines up further would be a sweet gesture, but unless hospitals had five to seven years to carry this thing through, it will still feel like eating glass for many hospitals. And of course, if the Obama administration were to do such a thing, should it offer extra bonuses to the 20 percent of hospitals which have somehow managed to meet MU criteria?  There’s far, far more questions than answers to consider here.

Honestly, I would have expected to hear this schpiel, which I sympathize with greatly, a long time ago.  Maybe it just took this long for a major news organ like Bloomberg Businessweek to understand the issues and pipe up.

An Important Shift, Most Hospitals Now Favor HIEs, Whatever Those Are

Posted on November 14, 2011 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.

For quite some time — I’d estimate five years at least — health information exchanges were the dark horse of the health IT world.  A few successful ones emerged, but far more foundered, in many cases because hospitals involved couldn’t or didn’t want to share information. Today, on the other hand, everyone seems pro-HIE. The question is, is everyone even talking about the same thing?

These days, with the big bad government breathing down their neck, hospitals are scurrying to connect with HIEs. According to new data released by healthcare technology research firm CapSite, which surveyed about 340 hospitals on HIE adoption:

  • 74 percent either plan to buy new HIE solutions or already have them in place
  • 32 percent are already
  • 16 percent plan to engage a consulting firm to help move their HIE planning and vendor selection process ahead
Hospitals planning HIE tech investments were most interested in buying MPI/patient and provider indexes, immunization reporting and results reporting/delivery solutions, CapSite’s survey found.Now, these results aren’t incredibly definitive.

As an InformationWeek story on the study wisely points out, CapSite didn’t do much to narrow down its definition of an  HIE before people there did the research.

The thing is, just about any networking technology could be called an HIE if you try hard enough.  For example, here’s Chilmark Research’s definition:

A Health Information Exchange (HIE) is a technology network infrastructure whose primary purpose is to insure the secure, digital exchange of clinical information among all stakeholders that are engaged in the care of a patient to promote collaborative care models that improve the quality and value of care provided.

If that wasn’t vague enough for you, here’s what HIMSS has to say on the subject:

A health information exchange is the electronic movement of health-related information among organizations according to nationally recognized standards.

The real clincher, though, is the breadth of vendors CapSite included in its research. Check out this list:

Accenture, ACS, Allscripts, athenahealth, Bass & Assoc., Carefx, Cerner, Covisint, CPSI, CSC, CTG, dbMotion, Deloitte, Dell, Dr. First, eClinicalWorks, Epic, GE Healthcare, Healthland, HIMformatics, HP, ICA, InterSystems,  KPMG, McKesson, Medicity, Meditech, MedPlus, MEDSEEK, Microsoft, MobileMD, NextGen, Northrop Grumman, OptumInsight (formerly Axolotl), Orion Health, Prognosis, QuadraMed, RelayHealth, SAIC, Siemens 
All that being said, I’m happy to see additional data suggesting that hospitals are making HIE progress. Got a feeling 2012 is going to be a good year — for vendors at least.

HIT Bigshots Tackle Post-Hospital Care Coordination, Miss The Point

Posted on October 13, 2011 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’d be a pretty shallow gal, I would, if I didn’t take the problems patients face when transitioning from hospital to another setting seriously.  But I swear I’m not being flip when I say that holding another conference on how HIT can solve the problem is, uh, a bit lame.

The conference in question, which will bring together some bigshots in healthcare policy, politics and health IT, includes speaker spots by Farzad Mostashari, MD, National Coordinator for Health IT, Health Affairs Editor-in-Chief Susan Dentzer and Todd Park, CTO  of HHS. Wow. And that’s just some of the headliners.

The participants will cover some of the critical ways HIT can support seamless transitions from hospitals to a patient’s next location, including standards, interoperability, exchange and Meaningful Use, the event’s press release notes.

OK. Fine. I get it — to coordinate care, EMRs and other HIT systems have to be individually robust and share data fluidly. Providers have to get on board. And it’ll all work if everybody adopts the right technology and plays nicely with their pals.

It’s telling, though, that event leaders aren’t promising much talk on how patients and their families can leverage IT to help make this happen. It isn’t about empowering patients to access their health information, communicate with doctors as supportive team members or even about patient education. It’s all about making sure the machines and software do their job. A brilliantly orchestrated, thoughtfully developed, boundlessly powerful set of machines and software solutions, but technology nonetheless.

So count me as impatient. Until policy types and health IT gurus get their heads out of the enterprise IT, networking and software business, they’re going to talk around the real care coordination issue. And that’s not only a bore, it’s a dangerous waste of time. We’re fighting for people’s lives here.

Hospitals have and arguably have had for some time more than enough firepower to solve their end of the problem. But historically, they’ve done little to involve patients and families in managing their conditions once they’re gone. Discharge summaries are perfunctory at best, particularly given how much info hospitals have at their fingertips, and virtually no education takes place throughout a patient’s visit. Once they leave, it gets far worse. “Out of sight, out of mind” may be a bit too strong but I’m sure you see what I mean.

If they want to be part of the solution, hospitals will need to think about how they can support the patients directly through smart IT use, especially super-smart new mobile options and remote monitoring of chronic or emergent conditions in the home.  Otherwise, patients are likely to remain sick, puzzled and likely to fall between the cracks.