How Systems Engineering Can Help Fix Health Care

Critics have long faulted U.S. medical education for being hidebound, imperious and out of touch with modern health-care needs. The core structure of medical school—two years of basic science followed by two years of clinical work—has been in place since 1910.

Now a wave of innovation is sweeping through medical schools, much of it aimed at producing young doctors who are better prepared to meet the demands of the nation’s changing health-care system.

When an aircraft manufacturer decides to create a new model, it doesn’t ask pilots and crew to identify the best cabin, wings, jet engines, and other parts, and then put all the pieces together. A plane developed that way wouldn’t fly. The company begins with a goal, such as safely carrying 250 passengers nonstop from New York to London in under six hours, and follows a disciplined approach to identify the components and subsystems that meet those requirements.

By contrast, the way we build hospitals and clinics typically happens in a piecemeal, patchwork approach. Institutions purchase hundreds of individual, siloed technologies — each with its own work processes, training, and user interfaces — based on what the market offers. We then plop them into an ICU or operating room and hope that they somehow work together.

The result is a constellation of technologies that rarely connect, to the detriment of patient safety, quality, and value. For example:

• Different monitors emit alarms that compete with one another for the attention of clinicians, who must sort out which signify serious conditions and which don’t. Sometimes they miss critical alarms amid the noise.
• Devices, electronic medical records, and even patient beds have electronic information that can help diagnose conditions and assess risks. However, clinicians must consult each one individually, rather than seeing a unified display of information from them.
• Time that could be spent with patients and their loved ones is instead squandered in front of computer monitors, as clinicians click through dozens of screens in search of relevant information.

All of this leads to needless patient harm, low productivity, excessive costs, and clinician burnout. Doctors and nurses feel as though they’re serving technology, not the other way around. Preventing complications, errors, and other harm too often depends on the heroism of clinicians rather than the design of safe systems.

We need a new approach, one that puts the needs of patients and clinicians first. We need to integrate technology, people, and processes so that they are seamlessly joined in pursuit of a shared goal.

While this is new for health care, it has become routine in other complex, high-risk fields. It is the realm of systems engineering, a field that has contributed to jaw-dropping achievements, such as sending a spacecraft on a nine-year voyage to Pluto and designing a nuclear submarine.

These projects would not have succeeded without clearly defined, measurable goals and a rigorous approach for achieving them.

At Johns Hopkins, we experienced how powerful systems engineering can be when we set out to improve patient safety and quality of care in intensive care units. Patient safety researchers and clinicians from Johns Hopkins Medicine partnered with the systems engineers and systems integrators of the Johns Hopkins University Applied Physics Laboratory (APL). For 75 years APL has supported the Department of Defense and other government agencies as a “trusted agent” to solve critical challenges, such as building satellites and weapons systems on ships.

The APL team guided patients, family members, clinicians, and researchers from nearly 20 medical disciplines through an exhaustive process of defining our goals, understanding our priorities, listing the functions that the system must perform, and determining measures of success. These discussions led us to set the goal of reducing seven of the most common and serious preventable harms facing ICU patients. They included five clinical harms, such as hospital-acquired infections and complications, as well as two “social harms,” lack of respect and misalignment of care with the patient’s goals. No doubt, patients are at risk for more than seven harms. But we had to focus because the Gordon and Betty Moore Foundation, which funded the project, wanted to ensure that we demonstrated results.

In interviews and meetings with stakeholders and through observing clinicians and patients interact, we identified layers and layers of requirements for a system that would achieve our goal. Our solution was Project Emerge, a system that integrates data from several sources into one easy-to-read computer display. It combined data from existing technologies, such as the electronic patient record, with new ones, such as sensors that track patient activity or the angle of a bed. In the same way that pilots get all essential information in cockpit displays, Emerge lets clinicians quickly see if patients are getting all the care necessary to prevent the seven harms. A second computer display helps patients and families engage with their care team and take a more active role in their care.

One module of Emerge, focusing on the prevention of ICU-acquired weakness, demonstrates the elegance of a systems engineering approach. Research tells us that patients regain their strength earlier and have fewer related complications when they start moving as soon as safely possible during their stay in the hospital. Yet in most ICUs there isn’t a culture to support early mobility; clinicians are not conditioned to ask every day whether their bedbound patients are able to get moving, or whether they are meeting their mobility goals. There are no devices or displays that inform patients of their progress or warn them if they are falling short.

The Emerge system compels clinicians to set a patient’s mobility goals and pulls data from different sources into the dashboard, where the ICU-Acquired Weakness display turns red if the patient is not on track. Clinicians can tap the touch screen, drill down for details, and address next steps. Meanwhile, patients and family members can pick up a tablet computer and learn about the importance of mobility; family members take part in getting their loved ones out of bed or walking in the ICU.

The whole team is part of this technology-enabled culture change, making early mobility something that’s routine rather than an afterthought. With this app, the percentage of patients who were given mobility goals went from 40% to 100%, and those receiving mobility therapy increased from 48% to 80%. Those who had significant functional declines in their mobility decreased from 19% to 10%.

Of course, ICU-acquired mobility is just one harm, and this module is just one of many that share data and knowledge, make processes more efficient, prevent harm, and keep families top-of-mind. These modules must be integrated so that clinicians are not overwhelmed with more information and tasks than they can manage.

Emerge demonstrated that the systems engineering approach can help reduce specific harms, but there are many other goals that it could help achieve — for example, improving productivity, enhancing patient experience, improving bed management, and enhancing transitions of patient care between providers.

Such efforts could accelerate if more manufacturers of health care technologies were willing to let their products “talk” to one another. Generally speaking, they don’t. While we were able to integrate data from several sources into Emerge, the work was highly technical and labor intensive. More innovation could occur across health care, and health care would become less fragmented, if technologies shared information more readily.

We hope our experience will give them one more reason to do so.

 Peter Pronovost is an intensive care physician and the C. Michael and S. Ann Armstrong Professor of Patient Safety at Johns Hopkins University. He serves as the Johns Hopkins Medicine Senior Vice President for Patient Safety and Quality and the Director of the Armstrong Institute, and helps to lead patient safety efforts globally.

How Systems Engineering Can Help Fix Health Care

Critics have long faulted U.S. medical education for being hidebound, imperious and out of touch with modern health-care needs. The core structure of medical school—two years of basic science followed by two years of clinical work—has been in place since 1910.

Now a wave of innovation is sweeping through medical schools, much of it aimed at producing young doctors who are better prepared to meet the demands of the nation’s changing health-care system.

Preparing Doctors to Meet the Demands of the Nation’s Changing Healthcare System

Critics have long faulted U.S. medical education for being hidebound, imperious and out of touch with modern health-care needs. The core structure of medical school—two years of basic science followed by two years of clinical work—has been in place since 1910.

Now a wave of innovation is sweeping through medical schools, much of it aimed at producing young doctors who are better prepared to meet the demands of the nation’s changing health-care system.

At the new Hofstra North Shore-LIJ School of Medicine in Hempstead, N.Y, students spend their first eight weeks not in lecture classes but becoming certified emergency medical technicians, learning split-second lifesaving skills on 911 calls.

At Penn State College of Medicine in Hershey, Pa., first-year students work as “patient navigators,” helping the ill, injured and their families traverse the often-confusing medical system and experiencing it from their perspective.

At New York University School of Medicine, one required course delves into a database that tracks every hospital admission and charge in the state. Discussions center on why, say, the average tab for delivering a baby is $3,000 in a rural area and $22,000 in New York City.

“This isn’t a textbook exercise. This is real life and students love it,” says Marc Triola, NYU’s associate dean for educational informatics.

Century-Old Model
Medical educators say such innovations are long overdue. The U.S. health-care system is rapidly becoming ever more data-driven, evidence-based, patient-centered and value-oriented. But for reasons having to do with tradition, accreditation concerns and preparing students for national board exams, the designers of medical-school curricula have been slow to shift their focus.

“The reality is that most medical schools are teaching the same way they did one hundred years ago,” says Wyatt Decker, chief executive of the Mayo Clinic’s operations in Arizona, which include a medical school in Scottsdale, Ariz., that is scheduled to enroll its first class in 2017. “It’s time to blow up that model and ask, ‘How do we want to train tomorrow’s doctors?’ ”

Doctors today are well schooled in the science of medicine, says Susan Skochelak, the American Medical Association’s vice president for medical education. “What’s been missing is the science of health-care delivery. How do you manage chronic disease? How do you focus on prevention and wellness? How do you work in a team?”

To encourage med schools to move their curricula in that direction, an AMA initiative called Accelerating Change in Medical Education is giving $1 million to each of 11 schools to help fund novel programs. Of the nation’s 141 medical schools, 118 competed for the 11 grants.

The push for change comes at a time when medical educators are also trying to address a critical shortage of physicians. No new med schools opened in the U.S. from 1985 to 2000, amid fears of a doctor glut. More recently, however, predictions of a shortfall of 90,000 physicians by 2020 have sparked a building boom: Some 17 new schools have been accredited since 2002 and nine more have applied for accreditation.

A few of the new schools have made it their mission to address acute shortages of primary-care physicians in certain areas. Texas Tech University’s Paul L. Foster School of Medicine, which opened in El Paso in 2009, emphasizes community medicine and Spanish-language skills. The University of Kansas School of Medicine’s new branch in Salina takes just eight students a year—all with a strong desire to practice medicine in rural areas.

Med schools old and new are looking for a broader range of qualities in applicants—particularly students who are empathetic and have experience relating to diverse kinds of people.

New MCAT
To that end, in April, a new MCAT—the Medical College Admission Test—will be administered, the test’s first major revision since 1991. The new version is 2 hours longer (6 hours and 30 minutes) and tests knowledge of behavioral and social sciences as well as biology, physics and chemistry. One sample question has applicants read a passage, then asks which of four statements “is most consistent with the sociological paradigm of symbolic interactionism?”

Some schools have replaced the traditional one-on-one interview with a series of simulations in which applicants are asked to show how they would make a tough judgment call or deliver bad news. At the University of California, Davis, School of Medicine, community residents join faculty members in rating the applicants, providing a broader range of views.

Styles of teaching and learning are also changing.

“We’ve replaced ‘the sage on the stage’ with ‘the guide on the side,’ ” says Richard Zimmerman, a neurosurgeon and medical director for education for the new Mayo med school in Scottsdale.

At both the new school and Mayo’s existing medical school in Rochester, Minn., much of the material traditionally taught in lecture classes will be converted to electronic formats that students can absorb on their own, leaving class time for discussions and case studies.

Mayo also is creating a new course of study, called the Science of Health Care Delivery, which will run through all four years and include health-care economics, biomedical informatics and systems engineering. With a few additional credits, students can graduate with both an M.D. and a master’s in health-care delivery from Arizona State University.

In a course called Checkbook, Mayo students will track all of the services provided to their assigned patients during clinical rotations and look for redundancies or routine tests that add little value.

Focus on Teams
Learning to work in teams is a main focus at Mayo—and a sharp departure from traditional training for doctors.

“The old model was, you’d go on rounds; the attending would ask a question, and the young resident had to get the right answer,” says Dr. Decker in Scottsdale. “In the new model, you’re part of a team, and somebody else might have the right answer.”

To understand the roles of team members who aren’t doctors, first-year Mayo students spend half-days shadowing clinic schedulers, registered nurses, nurse practitioners and physician assistants. They also assist in managing a panel of patients, as care coordinators do. For example, they review records to see which diabetes patients aren’t managing their health well; they call the patients on the phone to discuss why they are struggling; then the students consult with the patients’ primary-care doctors to determine the next steps.

In another departure from med schools past, Mayo is making an organized effort to help students avoid burnout. Classes in the first two years are pass/fail, not graded, and students can evaluate their level of stress, fatigue and risk of suicide in a confidential Med Student Well Being Index, which also offers resources for help.

“When I went to med school 30 years ago, I don’t remember anybody asking how we were doing,” says Michele Halyard, vice dean of Mayo’s medical-school programs. “But you can’t heal the health-care system if you’re sick yourself.”

Less Memorization
What’s being left out of medical education to make room for the new material?

Some schools are placing far less emphasis on memorizing facts, such as which drugs do what and how they interact with other drugs. Such information is now readily available electronically.

“The fund of medical knowledge is now growing and changing too fast for humans to keep up with, and the facts you memorize today might not be relevant five years from now,” says NYU’s Dr. Triola. Instead, what’s important is teaching “information-seeking behavior,” he says, such as what sources to trust and how to avoid information overload.

Technology is also changing how med students learn. Simulators that look like patients and can be programmed to go into cardiac arrest, have strokes, spike fevers, cry, vomit and eliminate are particularly useful for teaching.

“Some schools don’t use cadavers anymore,” says the AMA’s Dr. Skochelak. “But others think it’s an important way to learn respect” for the real human body. “They tell students, ‘This is your first patient.’ ”

Some schools are condensing the typical four-year curriculum into three years, to let students start their residencies sooner and graduate with less debt. The Association of American Medical Colleges is also studying ways to let students master needed skills and competencies at their own pace—an innovation that has come to medical residency programs as well.

“We should have done this 10 years ago,” Dr. Decker says of the many med school changes. Then he quotes a Chinese proverb: “The best time to plant a tree is 20 years ago. The next best time is tomorrow.”

Ms. Beck is a health reporter and columnist for The Wall Street Journal in New York. She can be reached at melinda.beck@wsj.com.

Medical Transcription and EMR – Digitizing Patient Health Record to Provide Health-Care Solutions

The present day health-care industry faces enormous challenges to satisfactorily deliver quality health solutions to the masses in a cost effective manner. The challenge gets stiffer, when remote communities are involved.

To … maximize the reach of medical personnel, it is important to merge wireless technology with medical documentation technologies like EMR and medical transcription.

The objective is to deliver health-care solutions through Telemedicine to near or distant communities, by creating a seamless health-care web.

A proper medical documentation system makes it easy for the physician to maintain a complete record of the patient. Medical documentation system like EMR or electronic medical record allows the physician to quickly enter the patient health information into relevant pre-structured templates through point-and-click mechanism. As a result, during medical diagnosis of patient, the physician directly enters the medical observations into computer to create an electronic record. This saves time and money as no additional staff and storage area is needed for maintaining bulky file cabinets.

In medical transcription, the diagnostic report of patient is dictated into the voice recorder and the voice file is sent to the transcriptionist. The voice file is converted into electronic text and sent back to physician. This is a manual process and takes time. The speech recognition software overcomes this drawback by directly converting dictation or spoken words into electronic file, which is then edited by the transcriptionist. This setup increases the transcription speed and at same time ensures high degree of accuracy.

EMR, medical transcription and speech recognition software make it easy to digitize the patient health information, in a safe and secure way. The digital data is then converted into suitable microwave signals by WIMAX (World Wide Interoperability for Microwave Access) and transmitted over large distances. All the security features are incorporated in the network to ensure that the bi-directional flow of the patient health data is as per HIPAA norms.

The wireless technology like the WIMAX, provides the last mile connectivity and allows for easy integration of the remote communities with urban centers, where majority of hospitals are located. Through WIMAX, it is possible to simultaneously receive and send, audio and video signals, an essential requirement of Tele-monitoring. The ECG and EEG of the distant patient can be easily monitored by a doctor in the hospital, situated thousands of miles away. In case of emergencies like accidents in remote areas, where the patient requires prompt medical attention, the paramedics can easily interact with hospitals. They can send medical observations, reports, videos and other records, online to hospitals and simultaneously receive instructions from doctors, on how to treat patients. This all can be easily done as the patient is being rushed to the nearest hospital. Thus WIMAX provides mobility to health-care delivery.

This type of health-care setup reduces patient visits to the hospitals or clinics, unless in case of an emergency or when it becomes necessary for patient. The stored health information can be easily updated regularly by doctor after each online interaction with the patient, during the course of the treatment.

Thus Medical transcription and electronic medical record can be smoothly integrated with WIMAX technology in such a manner that it reduces the cost of treatment. The patient does not have to pay for the transportation and accommodation charges, as he or she can easily avail online treatment.

Medical Transcription, EMR and WIMAX technology can together provide online health solutions in a cost effective manner.

Jason Gaya, Read more on medical transcription and EMR at www.mediscribes.com

Article Source: http://EzineArticles.com/?expert=Jason_Gaya

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Mouse Calls: Connecting to Your Patients Using Mobile Marketing

It’s an election year, and that means arguments regarding the future of American healthcare are every bit as abundant as the candidates themselves. One thing experts seem to agree in is the need for increased patient engagement and the corresponding need for healthcare providers to educate and develop a rapport with patients to foster a better relationship as we charge on in our collective quest for public health.

Build a Better Website

The first step of any great mobile marketing campaign is to ensure your website is optimized for mobile, and while you’re at it optimize your emails and your homepage and everything else online you’ll eventually want patients to see. The fact that 57 percent of smartphone users are unwilling to recommend a business with a subpar mobile website should service as a warning: fail to optimize and your appointment books and bottom line will both suffer. Ditch unnecessary Flash components, keep graphics to a reasonable size, use a skilled web designer who can streamline your site’s backend, and incorporate responsive design so that everything reads exactly as it should no matter what size device your website or emails, for example, are read on.

Produce and/or Sponsor Consumer-Centric Content

Your primary mobile marketing goal should be giving your patients what they want. Your content should inspire, entertain, and solve people’s problems – in other words, a blog is not an opportunity for you to wax on about your professional accomplishments or how much you spent on that waiting room renovation unless your new certification means improved patient services and that waiting renovation comes with a cappuccino bar and better reading material. Try touching on consumer-friendly subjects that mirror your practice’s focus; for instance, a dentist might blog about the 5 risk factors for
periodontal disease while a dermatologist might post a video tutorial demonstrating proper skincare techniques. Then reach out to the influencers in your niche. They have the power to share and promote your powerful content.

Create Your Own App

Seventy-nine percent of smartphone users say they use at least one app almost every day, and it’s little wonder why. Mobile apps offer a sort of one-stop-shop to consumers eager for an easy-to-use platform that negates the need for surfing from site to site,
waiting for multiple web pages to load, and so on. That same convenience appeals to patients who don’t want to sit on hold for 20 minutes to get an appointment or wait days or even weeks to know the outcome of their MRI. An app is a two-way conversation of sorts, where the provider can share test results and scan images and send referrals and also offer an interactive platform for the patient to schedule appointments, request refills, and download their entire patient histories should the need arise.

Harness the Power of SMS

Fifty percent of consumers surveyed say they would be more satisfied with customer service that incorporated texting, and 60 percent even prefer text-based customer service over phone calls. Companies are discovering that they can build valuable relationships via SMS, otherwise known as text, and that extends to medical practices, too. Texts are opened far more often and far faster than emails and certainly faster than ordinary snail mail, making it easier to deliver time-sensitive materials such as:

● Appointment reminders

● Vaccine or booster reminders

● Closures due to weather or other circumstances

● Updates in insurance coverage or in-network services

● New services

Physicians and other healthcare professionals can use mobile marketing to bring in new patients and better satisfy the clientele they already have, but there are other benefits to connecting using the power of 21st-century technology. When the information flows
through mobile apps, text, and more, the result is a better-educated public and empowered patients who are more prepared than ever before to help their doctors provide the best care possible.

-Sophorn Chhay
Sophorn deals in marketing at Trumpia, the most complete SMS software with mass text messaging, smart targeting and automation. www.trumpia.com