Posts by Danielle Scheurer

Analyzing Best Practice Alerts to Understand Blood Transfusions Ordered outside Recommended Guidelines

I had the pleasure of interviewing Lisa Shieh, a Hospitalist at Stanford University, about her team’s recent publication in JHM Why providers transfuse blood products outside recommended guidelines in spite of integrated electronic best practice alerts. The study found that many best practice alerts (BPAs) “overrides” were due to protocolized behaviors, resident/nurse practitioner/physician assistant ordering, or subjective indications, such as “symptomatic anemia”. What is your background and how did you become interested in using BPAs to enhance quality? I am a hospitalist and Medical Director of Quality for the Department of Medicine at Stanford University Medical Center, and have a longstanding interest in how the appropriate use of BPAs can enhance quality efforts. Our medical center has been on Epic EMR for many years, and over time we continually strive to optimize our EMR clinical decision support to try to achieve the right amount of support, without invoking alert fatigue.…

Shunshine Act

The Physician Payment Sunshine Act (PPSA) is intended to expose any financial relationships that could compromise a physician’s research integrity or patient care. In response to the PPSA, CMS created the “Open Payments” database, into which device-drug-supply manufacturers publicly report any financial transfers to physicians or teaching hospitals. This includes 3 types of payments: “general” payments, research payments, and physician ownership information. The database was released last week and contains ~2/3 of the payments made by manufacturers in the last 5 months of 2013, including $3.5 billion made to 1,360 teaching hospitals and 560,000 physicians.1 While the intent of the Sunshine Act seems laudable, there are flaws that should be considered by those attempting to digest the information included in the database. As outlined by a recent Annals article, the inclusion of research funding (which includes donated drugs) can result in extraordinary dollars attributed to well-meaning and successfully funded researchers.2…

What the Heck Is an HAC Anyway?

Many are well aware that Medicare has been publicly reporting the “Hospital Acquired Condition” or “HAC” list since 2008. These are conditions that should (ideally) never happen, or at least happen at a very low frequency. The HAC list has been controversial for a number of reasons: There is no risk adjustment Some HACs occur even if the best of care is provided (e.g. VTE after hip or knee surgery) They are defined by coded data (which does not always correlate with abstracted data) Despite these limitations, Medicare has penalized hospitals for HACs (by not reimbursing for a higher DRG payment, if the HAC would have resulted in a higher payment) and has publicly reported HAC rates by hospital. However, Medicare had stopped publicly reporting HACs for a period of months, but says it will resume public reporting soon, at least for eight of the HACs. Now, these HACs should…

Apple Health for Patient Engagement

Be on the lookout for Apple Health, a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” This HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, and helps them all “communicate” with one another. Apple may also be collaborating with a number of academic medical centers and electronic health record (EMR) companies (including Epic which controls 40% of the current EMR business), to determine how to innervate this new technology into healthcare systems. The primary purpose of this is to capture and maintain a patient’s engagement in their own health and wellness, a longstanding issue yet to be solved by the medical industry. But this also may be the next major healthcare breakthrough innovation to ease the burden of care continuity, which is the…

Top 10 Patient Safety Concerns for Hospitalists

This list is a worthy read for hospitalists; it's entitled, “Top 10 patient safety concerns for health care organizations.” This list is created annually by the ECRI Institute, which analyzes approximately a half-million patient safety events from more than 1,200 US hospitals, to determine what represents the highest risk for patient safety. Those that “made” the Top 10 List this year are: 1. Data integrity failures with health information technology systems 2. Poor care coordination with patient’s next level of care 3. Test results reporting errors 4. Drug shortages 5. Failure to adequately manage behavioral health patients in acute care settings 6. Mislabeled specimens 7. Retained devices and un-retrieved fragments 8. Patient falls while toileting 9. Inadequate monitoring for respiratory depression in patients taking opioids 10. Inadequate reprocessing of endoscopes and surgical instruments This list outlines what should be serious concerns for most hospitals and hospitalists; and hospitals are likely…
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