Are Discharge Systems the Next Patient Flow Application
Doing a good job of getting patients discharged is key to good patient flow. There are many reasons why patients may not get discharged as soon as they could. Attending physicians at many hospitals don’t seem to get around to writing discharge orders until late afternoon or early evening of the day of discharge. Patients sometimes have a hard time getting a ride home. For patients who can’t be discharged to home, finding a SNF (skilled nursing facility) or nursing home that can take the patient can delay discharge.
The need to automate discharge workflows is self evident, with vendors and academics focusing on this area. The key is to replace phone tag and a flurry of faxing with an application that spans multiple health care enterprises.
“Before we actually looked at a variety of systems, we were making our referrals to skilled-care facilities and nursing homes by phone,” said Dee Mann Aust, director of care coordination for Swedish Medical Center in Seattle, which operates three acute-care hospitals and a free-standing emergency-care facility.”It was not efficient,” Aust said. “The facility or agency couldn’t see a lot clinically about the patient and it was not standard in any way.
We get a lot of patients from Alaska who come here for specialty surgery. They may not have a lot of needs; they just want a local place for their care.”
Under the old paper-based system, “Let’s say a family picked a geographical area; we’d have to call three nursing homes in the area and give them the (patient) information and see if they could handle the patient,” Aust said. “You’d spend five or 10 minutes on the phone for each one. That was just the initial referral.”
To address the problem, Aust said Swedish implemented in March 2006 a discharge planning system from ECIN, a developer of a suite of Web-based applications to assist hospitals in discharge planning and care management. Formerly Extended Care Information Network, the company claims installations at more than 300 hospitals and, as subscribers to its Web-based communications service, about 4,200 nursing homes, home health agencies and other long-term-care facilities, according to Charlie Jolie, an ECIN spokesman. In addition, the company maintains an online database of more than 80,000 providers of extended-care services.
The ECIN communication service provides a two-way link between the hospitals and subscribing care facilities. Hospitals typically recruit their local nursing homes to join them on the ECIN network, Jolie said.
The system works well facilitating routine placements and shines when it comes to hard-to-place patients with multiple conditions.
“We know we have some patients who are tough to place, and certainly it’s very efficient to create one referral and to send it out to
multiple facilities,” Aust said. “We have one patient this week we sent out (referral requests) to 35 nursing homes, and three said they want to look into more information for that patient. So you can do searches within ECIN and their provider database to search if someone has an Alzheimer’s unit. That’s a big time-saver. You’re not depending on what was in last year’s entry in a guide. It’s more up to date.”
In addition to the solution from ECIN, this E-Health Insider story describes what they’re doing in the UK. And here’s a paper from last year about automating communications between inpatient and outpatient physicians.
Private Equity Will Hasten Health Care's Transformation
Tony Chen at the Hospital Impact blog has a great post on the tsunami of recent deals in health care. These deals are changing the health care industry. Outsiders in the form of private equity investors and insider hospital M&A are gobbling up failing organizations or those weakened by market changes for which they have ineffective responses. Newly recast ventures that are successful will reward effective change which will drive additional change.
The change required is not the simple head count reduction, and trying to figure out how to do the same old thing with fewer people. What is needed are fundamental changes to the way that care is delivered. These are the changes that will reduce length of stay and improve both patient safety and outcomes. Hospitals today are stuck between a rock and hard place – the rock is the inexorable reduction in reimbursement, and the hard place is the increased visibility and transparency surrounding patient safety and outcomes.
Here are a couple quick examples of the change I'm referring to. Almost every hospital boards patients in the emergency department (ED) to a greater or lesser degree. These patients, shuffled off to out of the way halls awaiting admission, are cared for by off-service nurses (ED nurses) at ever worsening – and sometimes hair raising – nurse to patient ratios. A few heretical hospitals have started boarding those patients awaiting beds up on the floors, on their service. Consequently, each nursing unit could have 1 or 2 extra patients – receiving appropriate care (because they're in the appropriate unit) and at a nurse to patient ratio that is only slightly impacted by a couple extra patients. To someone from another industry this makes admirable sense. From my peers, I've heard excuses ranging from “it's jut not done” to “we can't do it because of fire codes (or department of health regs, etc.)”.
The other example is variable acuity care delivery. Hospitals are organized into units that are specialized based on the level of care, nursing vigilance, therapies that can be delivered, and staff training. This regimented organization was used in manufacturing 20 years ago. Like manufacturing in general, manufacturing healthy patients is not a steady state process. Consequently, census in units varies wildly from unit to unit and day to day. Some units are habitually over capacity, and represent the most common patient flow bottleneck found in hospitals – those over capacity units are critical care units with patient monitoring. Variable acuity units are an analog to manufacturing clusters or pods where the physical environment is quickly modified to adjust to new requirements. Rather than transferring patients because of needed patient monitoring, or a more sophisticated therapy, those patients are kept in their unit and those resources are brought to them. Monitoring patients outside traditional monitored units is a growing trend – half of the telemetry transmitters in hospitals are used on non-cardiology patients. Implementing variable acuity care units is not easy; it requires some pretty fundamental changes.
So, how do you accommodate falling reimbursement and demands to improve patient safety and outcomes? The opportunities to improve operations are many, almost as many as the excuses used to avoid substantive change. As private equity and M&A roils the health care industry, smart people will ask the hard questions with increasing fequency, and change will come.
Pictured right, “resistance is futile.”
Improved UMPC Spec from Intel
A year after launching their spec for the Ultra Mobile PC (UMPC), Intel is announcing a new spec based on Linux.
have screen sizes from 4.5 to six inches with a target audience
described as “consumers and prosumers” rather than mobile professionals.
While [the UMPCs] CPU components — codenamed Stealey — will be
dual-core processors clocked at 600-800MHz and capable of running
Windows XP and Vista, Intel plans for the devices to run an embedded
Linux OS but with a mix of open-source and proprietary code in the
final products.
Typical MID uses will be “staying in touch”, entertainment,
information and location-based services. Intel’s presentation
specifically cites Google Maps and Web-based “office and enterprise
applications” in the last two categories. Connectivity will be provided
through Wi-Fi and support for wide-area coverage via 3G HSDPA.
MID tablets will run a simplified “finger-friendly” user interface
optimised for the small screens, based on the Gnome desktop but with an
Intel-developed “master user interface” layer to serve as an equivalent
to the desktop.
Screen size and built in wireless capabilities are in line with point of care requirements. The 3G HSPDA mentioned is supported in the US by AT&T Wireless and T-Mobile (and a waste for in-hospital use). This standard is also the most prevalent standard in Europe.
Now all we need is something that is water resistant, can be wiped with harsh disinfectants, and will last a 12 hour shift on one charge. Pictured right is an artist rendering of a device designed to the new specification.
[Hat tip: Engadget]
UPDATE: Here's more on the actual announcement today at Gizmodo.
ED Diversion Continues to Challenge
The California Healthcare Foundation has underwritten a study looking at ambulance diversions across the state. Findings in this phase 1 report showed that state wide emergency departments (EDs) were on divert an average of 10% in 2005. Emergency department closings to ambulances continue to confound hospital administrators. You can read about a recent survey showing patient flow as an increasing problem here.
ED diversions also frustrate policy wonks and consultants due to the almost total absence of public reporting. Certainly hospitals (and their state associations), emergency response districts, along with some local and state governments, know their emergency room diversion statistics – they just aren't publicly available. Even though access to data is improving, organizations like the CHF have to pay to collect much of their data.
ED diversion affects patient care resources and may result in
continuity of care issues, such as the patient's physician not having
hospital privileges at the alternate receiving hospital and the
hospital not having the patient’s medical records. Diversion also
results in longer hours for ambulance units and, when patients cannot
be transported to hospitals within their health plans, greater overall
health care costs.
This study is part of a project to measure and publicly report the
extent of ambulance diversion. It identifies practices that can help
those communities that have had difficulty resolving their diversion
problems.
As expected, the study finds that ED diversions occur mostly in urban areas. Increasingly districts and hospitals are implementing “no diversion” policies – in other words they simply take the patients that they used to refuse – even though in most cases little or nothing has been done to improve emergency department overcrowding or patient flow.
You can download your version of the first report here.
Philips Acquires Health Watch
Philips' Consumer Healthcare Division has made another acquisition (press release). This time the target was Health Watch Holdings, a provider of emergency response services – yes, another one of those “I've fallen and I can't get up” companies. Philips paid $750 million for Lifeline last year, but pays only $130 million for Health Watch's 100,000 subscribers. Health Watch also distributes QuiteCare. I would expect an acquisition of a company with a product like QuiteCare at some point, unless Philips comes out with their own product.
Like everyone else circling the nascent home health/remote monitoring market, Philips wants to be a major player in home based chronic disease management. Unlike most everyone else, Philips is going after a related market that, you know, actually exists – the self-pay market.
The acquisition of Health Watch represents a further step for
Philips in building up its presence in the consumer healthcare market –
a business-to-consumer market, where consumers generally purchase
healthcare products and services. Health Watch will add over 100,000
US-customers to Philips Lifeline’s existing base of more than a half a
million subscribers in North America, thereby further expanding
Philips’ presence in the region’s personal emergency response market.
The deal will also increase the number of healthcare organizations and
healthcare referral sources in the Philips Lifeline network, further
contributing to future growth.
Philips Lifeline’s and Health Watch’s twenty-four hour a day
services give independently minded seniors the confidence to maintain
an active life at home, knowing if they suddenly need help, they can
send an alert to a monitoring center indicating they need assistance.
Two-way communication allows a professionally trained operator to
establish the nature of the problem so that appropriate action can then
be taken.
The business delivery system and customer base built up through acquisitions like Health Watch and Lifeline should allow Philips to move quickly when the Healthcare Unbound market actually takes off.
In the past year, Philips has gotten 15% growth from Lifeline and demographics will result in inexorable growth. Pictured right is a snazzy photo that Philips was nice enough to include on their web page with the press release.
