Healthcare, Quality and Deming

I reread Deming's book over the summer and scanned the fourteen points as adopted for healthcare as part of a discussion on leadership in my masters program this fall. As someone who came from manufacturing to healthcare, one thing that strikes me is that the "quality revolution" seems to have missed healthcare. I think that this will change, with the quality reporting requirements that are a part of ARRA's meaningful use definition. As Yogi Bera said, "It's like deja vu all over again." I'm hearing some of the same arguments that I heard twenty years ago.

So, here they are: Deming's fourteen points as adopted for health care.

From Out of the Crisis by W. Edwards Deming --

Adaptation of the 14 points to medical service. The 14 points of Chapter 2 apply to a service organization with little modification. For example, my friends Dr. Paul B. Batalden and Dr. Loren Vorlicky of the Health Services Research Center, Minneapolis, have written the 14 points for medical service:

1. Establish constancy of purpose toward service.

a. Define in operational terms what you mean by service to patients.

b. Specify standards of service for a year hence and for five years hence.

c. Define the patients whom you are seeking to serve - those here, those that you seek, those that have been here only once.

d. Constancy of purpose brings innovation.

e. Innovate for better service for a given cost; planning for the future will require the addition of new skills, training, and retraining of personnel, satisfaction of patients, new treatments, new methods.

f. Put resources into maintenance of equipment, furniture, and fixtures; new aids to production in the office.

g. Decide whom the administrator and the chairman of the board are responsible to and the means by which they will he held responsible for working for constancy of purpose.

h. Translate this constancy of purpose to service into patients and to the community.

i. The board of directors must hold on to the purpose.

2. Adopt the new philosophy. We are in a new economic age We can no longer live with commonly accepted levels of mistakes, materials not suited to the job, people on the job that do not know what the job is and are afraid to ask, failure of management to understand their job, antiquated methods of training on the job, inadequate and ineffective supervision. The board must put resources into this new philosophy, with commitment to in-service training.

3a. Require statistical evidence of quality of incoming materials, such as pharmaceuticals, serums, and equipment. Inspection is not the answer. Inspection is too late and is unreliable Inspection does not produce quality. The quality is already built in and paid for.

b. Require corrective action, where needed, for all tasks that are performed in the hospital or other facility, ranging all the way from bills that are produced to processes of registration. Institute a rigid program of feedback from patients in in regard to their satisfaction with services.

c. Look for evidence of rework or defects and the cost that may accrue as a result - an incorrect bill, an incorrect or incomplete registration.

4. Deal with vendors that can furnish statistical evidence of control. This will require us to examine generic lowest-price buying; it will cause us to ask more penetrating questions about prospective colleagues regarding their interactions and the track record of their interactions with patients and with colleagues.

We must take a clear stand that price of services has no meaning without adequate measure of quality. Without such a stand for rigorous measures of quality, business drifts to the lowest bidder, low quality and high cost being the inevitable result. We see this throughout the United States industry and government by rules that award business to the lowest bidder.

Requirement of suitable measures of quality will, in all likelihood, require us to reduce the number of vendors. The problem is to find one vendor that can furnish statistical evidence of quality. We must work with vendors so that we understand the procedures that they use to achieve reduced numbers of defects.

5. Improve constantly and forever the system of production and service.

6. Restructure training.

a, Develop the concept of tutors.

b. Develop increased in-service education.

c. Teach employees methods of statistical control on the job.

d. Provide operational definitions of all jobs.

e. Provide training until the learner's work reaches the state of statistical control, and focus the training to assist the learner to achieve the state of statistical control.

7. Improve supervision. Supervision belongs to the system and is the responsibility of the management.

a. Supervisors need time to help people on the job.

b. Supervisors need to find ways to translate the constancy of purpose to the individual employee.

c. Supervisors must he trained in simple statistical methods for aid to employees, with the aim to detect and eliminate special causes of mistakes and rework. Supervisors should find causes of trouble and not just chase anecdotes. They need information that shows when to take action, not just figures that describe the level of production and the level of mistakes in the past.

d. Focus supervisory time on people that are out of statistical control and not those that are low performers. If the members of a group are in fact in statistical control, there will be some that are low performers and some that are high performers.

e. Teach supervisors how to use the results of surveys of patients.

8. Drive out fear. We must break down the class distinctions between types of workers within the organization-physicians, nonphysicians, clinical providers versus nonclinical providers, physician to physician. Discontinue gossip. Cease to blame employees for problems of the system. Management should be held responsible for faults of the system. People need to feel secure to make suggestions. Management must follow through on suggestions. People on the job can not work effectively if they dare not inquire into the purpose of the work that they do, and dare not offer suggestions for simplification and improvement of the system.

9. Break down barriers between departments. Learn about the problems in the various departments. One way would be to encourage switches of personnel in related departments.

10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead, display accomplishments of the management in respect to assistance to employees to improve their performance. People need information about what the management is doing on these 14 points.

11. Eliminate work standards that set quotas, commonly called also measured day work. Work standards must produce quality, not mere quantity. It is better to take aim at rework, error, and defects, and to focus on help to people to do a better job. It is necessary for people to understand the purpose of the organization and how their jobs relate to the purpose of the organization.

12. Institute a massive training program in statistical techniques. Bring statistical techniques down to the level of the individual employee's job, and help him to gather information in a systematic way about the nature of his job. This kind of training must be married to the management function rather than to the personnel function within the organization.

13. Institute a vigorous program for retraining people in new skills. People must be secure about their jobs in the future, and must know that acquisition of new skills will facilitate security.

14. Create a structure in top management that will push every day on the above 13 points. Top management may organize a task force with the authority and obligation to act. This task force will require guidance from an experienced consultant, but the consultant can not take on obligations that only the management can carry out.

Formula One Abu Dhabi

This is a beautiful track. They will start the race as the sun sets and finish under the lights. The track looks to be wide enough to allow for passing, so it should be interesting.

This is the last race of the year. Jenson Button won the driver's championship last week, so that's already been decided.

Alguersuari missed his pit and ran out of fuel on the following lap...that's how tight they run things. The video replay of him trying to pull into another team's pit was funny.

The race settled down. Vettel wins. His fourth win of the season. Mark Webber holds off Jenson Button for third. Button had a few looks during the last few laps, but couldn't pull off the pass. Reubens finished fourth.

It was an entertaining season! I'm already looking forward to next season with all of the new teams and driver changes!

Formula One Race in Brasil

Reubens starts from the pole! The Brasilian fans are going wild! The first corner should be exciting.

There were a couple of nasty crashes on the first lap and the safety car was deployed. Sutil, Liuzzi and Alonso are out on the first lap.

The race settled down after that.

Brawn won the constructor's championship. That team wasn't very good until Ross took over the team this year. You kind of wonder how Ferrari feels now, since they booted Ross after Michael Schumacher retired. You also wonder how Honda feels - this team was Honda last year, and they couldn't play dead. This year, they win the constructor's championship.

Mark Webber wins the race. No drama. Unlike last year's race.

Jenson Button wins the drivers championship with a fifth place finish today.

This was a fairly entertaining F1 season. There is one more race in two weeks in Abu Dhabi.

Red Wings Early Season

I've watched most of the Wings games so far this season. They have not looked very good. They are clearly not as good as they were last year, and that wasn't good enough.

They have some potential, if some of the kids play well, however, they lost a lot of talent over the off season, and that is a large gap to fill. Also, the injury to Franzen will not help.

Many of the teams in the Western Conference are improved this year. Edmonton will be fun to watch. The Kings are much better than they have been for a while. Colorado is also better. The Blues should be tough to play.

It is especially sad to see empty seats in the Joe and to hear the commercials during the telecast for tickets. This team used to have a waiting list for season tickets. It is in large part due to the poor economy in Michigan that the Wings are having such a hard time selling tickets.

They lost on Saturday to the Avs in a shootout. The Wings blew a two goal lead in the third period.

I think it will be a tough year for the Wings. I wouldn't be surprised if they do not make the playoffs.

Formula One Qualifying in Brasil

I've liked Formula One since they held a few races on the streets of Detroit back in the 80s. I was working in the Renaissance center at the time and it was in the middle of the track. I didn't watch the race, but I did walk around during Friday practice one year.

I am watching qualifying on Saturday as I type this. It is raining hard on the course. These are the best drivers in the world, so we expect them to be able to race in the rain. The on-board camera shots give some indication of just how poor the visibility is.

I always contrast that with the NASCAR attitude that says "We can't race in the rain."

I am an early riser, so I don't have an issue with getting up early on Sunday morning to watch an F1 race from Europe. I'm not dedicated enough to stay up and watch the races from Asia that start at 1am ET.

The completed the first qualifying session, but red flagged the second session following a nasty crash. It's raining very hard. The course has a number of elevation changes, which results in water running across the course.

They will finish qualifying this afternoon, but there is college football on, as well. I am going to watch that.

Reubens Baricello won the pole. I didn't see it.

Michael Vick

I am not a big Michael Vick fan. I didn't like him before his conviction. I still don't like him.

If I were a defensive coordinator facing the Eagles, I would do the following:

When Vick is lined up as a wide-out, especially near the formation, I would put a line-backer or defensive lineman on him and tell them to "tee off." When he is not lined up as a QB, he does not get the protection that a QB does. He's just another player at that point. I'd also find a linebacker who owns and loves dogs to line up against Vick. That would be just.

I don't buy the argument that says that Vick has "suffered enough." That's CRAP! He hasn't suffered anything like the suffering that he subjected his dogs to. At the least, he should be made to clean up kennels at dog shelters instead of spending his time in his mansion and in five star hotels.

I've never really liked the Eagles. I like them even less now. When you employ scumbags, you shouldn't expect everyone to love you.

I've added the Eagles to my list of teams that I root against.

Another NFL Season

I'm not really much of a football fan.

I've lived in Michigan all of my life. During my lifetime, the Detroit Lions have won a single playoff game. They have been dreadful. Last year, they went 0-16. It's tough to be a football fan in Michigan.

I once worked with a fellow from Pennsylvania. We had to explain the NFL's "blackout rules" to him, as he had never experienced a home game blackout while he lived near Pittsburgh. It is merciful to keep us from having to see the Lions stink every game. The downside is that the NFL punishes us by not showing any game when the Lions are blacked out. Back in the analog teevee days, I could pick up games from Toledo on my rabbit ears, and could watch the Browns when the Lions were blacked out.

I used to think that the Lion's longtime General Manager, Russ Thomas was the primary reason that the Lions stunk. Russ retired years ago. The Lions still stink. The only constant during this long period of stinkiness has been ownership: the Ford Family. They just don't care. NFL teams are guaranteed to make a profit. The revenue sharing from the TV contracts is more than the salary cap. They make money before they put a single behind into a seat, before they sell a single cardboard pizza, and before they sell a single watered down beer. As long as the team makes money, whether they win or lose, why should ownership care? They obviously do not.

I will watch a few football games this year. As I type this, I am watching the Raiders get their lunch money taken from them by the Saints. They look awful. Jeff Garcia just played for the Raiders. He was better than their starter (who's name escapes me). The Raiders may give the Lions a run for their money for the worst team in the league this year.

The Saints are playing Joey Harrington at QB on this drive. Another refugee from the Lions. He just threw a touchdown pass.

I think the Lions won their exhibition game with the Colts this afternoon. The game was not on teevee here.

It's tough to be a football fan in Michigan.

Health Care Quality

Back when I worked in manufacturing, there was a saying that went:

What gets measured gets done. What gets rewarded gets done well.

Healthcare escaped the "quality revolution" that swept through many other industries in the 80s and 90s. That is about to change. When manufacturing changed from a culture and reward structure that focused on quantity (build to the numbers) and incorporated quality metrics into the evaluation and compensation packages of leadership, we saw a dramatic improvement in quality. As I heard it stated once, "It's amazing what you can accomplish when management is paying attention." Management pays attention when their performance reviews, bonuses and promotional opportunities are influenced by achieving quality metrics.

ARRA requires HCOs to report 27 Quality Measures to CMS to qualify for "meaningful use" financial incentives.

Some of the ARRA Quality Measures seem to be pretty straightforward. For example, there is a requirement to report "The percent of orders entered directly by physicians through CPOE." We all know that the error rate is greater when physicians write out orders and someone else enters the data for them than it is with CPOE. CPOE has significant advantages over the manual order writing system. As a local radio commercial says "even McDonalds doesn't use paper orders in 2009." So, one measure of how effectively an organization is using its EHR will be the CPOE Percentage.

Another measure is to report the percent of smokers offered smoking cessation counseling. This is the sort of measure that I have an issue with. So, you offer them counseling. Big Deal. Since we are concerned with outcomes, a better measure would be "the percent of smokers that quit smoking." Just measuring whether you offered smokers counseling reminds me of those kids camps where every kid gets a ribbon for showing up, so that we don't hurt their feelings.

We know that once CMS has this data, it will be made public. And then organizations will be able to compare their scores against their competitors (yes, virginia, hospitals do compete with each other). Also, consumers will be able to look at the scores for hospitals and doctors and use this as a determining factor in deciding where to take their health care business.

An important component of any Quality Management System is specifying what is to be measured. If there is any ambiguity in the description of what is to be measured, we will end up with inconsistent results and will be "comparing apples to oranges."

HL7 is balloting a Healthcare Quality Measures Format (HQMF). I did some work helping to put the document together.

http://www.hl7.org/V3ballot/html/domains/uvqm/uvqm.htm#

Up North

I went to Michigan's Upper Peninsula for a week of camping last month. In Michigan, we say that we go "up north." The $3.00 fee that I pay to cross the Mackinac Bridge (http://www.mackinacbridge.org/), which connects the upper and lower peninsulas, is the best money that I spend each year.

I don't take a computer with me. I turn the cellphone off during the drive up Interstate 75. I stay disconnected from technology for a week. It does my soul good.

This trip, I read Deming's "Out of the Crisis." We can still learn a lot from Deming's teaching, especially in healthcare. I am continually amazed at how healthcare just missed the quality revolution.

I took my Chapman Stick with me and did a bit of practicing. I take a small, cigarette pack sized amp with me and practiced on three or four days.

I took my dog, Sonny with me and we did a bit of hiking. Sonny is getting older, and we don't hike as much as we did seven or eight years ago, but I still have to remind him to slow down when we are ascending or descending a hill.

The weather was cool and rainy and windy the first couple of days. The good thing about the wind picking up is that it knocks the mosquitoes out of the air. After the front rolled through, the weather was sunny and beautiful for the rest of the trip.

We stayed in campgrounds on Lake Michigan and Lake Superior.

A bad day in the woods is better than a good day in the office.

Wings vs Pens - History of Final Game Sevens

Game Sevens always make me nervous.

The last home team to lose a game seven in the finals was the Chicago Black Hawks in 1971. They lost to the Montreal Canadians. That Hab team had Ken Dryden in goal. He won the Conn Smythe (Playoff MVP) trophy that year. The Habs brought him up to the big club late in the year. He won the Rookie of the year trophy the following season because he had not played enough regular season games to qualify as a rookie the previous year. I expect that feat (winning the Conn Smythe one year, and the rookie of the year the next season) will never be duplicated. The series winning goal was scored by Henri Richard (the Pocket Rocket) at 2:34 of the third period.

Since 2000, four Cup finals have gone to a seventh game. The Hurricanes beat the Oilers in 2006, the Lightning beat the Flames in 2004, the Devils beat the Ducks (coached by Mike Babcock) in 2003 and the Avalanche beat the Devils in 2001.

In the nineties only one Stanley Cup Final went the distance. In 1994, the Rangers beat the Canucks to end a long drought.

In the eighties, only one Stanley Cup Final went the distance. The Oilers beat the Flyers in 1987.

In the seventies, the only final that went seven games was the aforementioned 1971 final between the Hawks and the Habs. The Hawks won the first two games at the old Chicago Stadium. The Habs won game seven in Chicago by a final score of three to two.

In the sixties, two final series went the distance. The Habs beat the Hawks in 1965 and the Leafs beat the Red Wings in 1964.

I'm looking forward to a great game at the Joe on Friday night. History is on the side of the Wings, but there is a reason that we play the games!

Wings vs Penguins - Game 6 Preview

I'm looking forward to this. The Penguins will play desperate hockey. The Wings know that they can win the cup tonight. I expect the Wings to play a solid, professional game and win the series tonight.

Datsyuk makes a big difference, even though he is not playing at 100%. He is one of the best back checking forwards in the game. His vision on the ice allows him to make passes that most other players dream of making. His return was a big part of the Wings victory in Game 5.

I hope NBC keeps their isolation cameras on Crosby and Malkin when the Wings celebrate with the Cup!

I smile every time the announcer says that the goalie "waffle boarded that one away." The goalie's blocker has not looked like a waffle board for twenty years or more.

I heard on the radio this morning that NBC will not allow the Wings to have a "Joe Vision" party and show the game on the big screen at Joe Louis Arena. If NBC are being pinheads, why don't the folks at the Joe just broadcast the CBC telecast instead? The Wings games in the finals have delivered huge ratings numbers in Detroit for NBC. Why do the suits at NBC have to be butheads about this? I hope that someone from the media asks Gary Bettman about this.

I watch the NBC (or Versus) broadcasts because I get them in High Def. I do switch to CBC for their intermissions. What hockey fan would miss Coach's Corner? I also watch the pre-game on CBC, because they show the national anthem, unlike NBC, which shows beer commercials instead.

Go Wings!

Wings vs Penguins - Game 5

It looked like the Penguins were believing all of that press about "old guys out of gas" that we've been hearing for the last couple of days. They seemed frustrated that the old guys did not just get out of their way and wave them on to their victory parade.

I did not join the panic attack that swept hockey town after the two losses in Pittsburgh. I expected that the Wings would play better back at the Joe.

I asked this when the series started, but will NBC finally get a clue and stop putting isolation cameras on Crosby and Malkin now? The only good thing about the isolations on the Penguins is that we get a nice replay of each whack they take at a Red Wing. At least NBC did not pretend that the slashes did not happen. I'm suprised, however, that they didn't edit out the crowd at the Joe chanting "Crosby Sucks!"

They showed Gary Bettman in the third period. He did not look very happy.

The Wings showed poise and the Penguins lost their cool. This game reminded me of Game four against the Black Hawks.

How can Crosby be considered a great player when he does not kill penalties? I take that back...he did kill a penalty last night....he took the first penalty on what ended up being a Wing five on three, so he did step out on the ice when his penalty was done, and technically, he did kill a penalty for all of twenty seconds. By the way, that was twenty more seconds of penalty kill time than Malkin had.

Ozzie played another solid game, stopping twenty two shots to earn the shutout. That's his fifteenth Stanley Cup Shutout. Ozzie is now fourth all time in Stanley Cup shutouts. He also got an assist on Detroit's second goal by Valtteri Filppula.

So, now we get game six in the Igloo. I expect the Penguins to play better (could they play worse?). I hope that the Penguins and their fans get to watch the Wings accept the Cup for the second year in a row!

Wings vs Penguins Game 1

Ozzie outplayed Fleury. That's my summary of game 1.

I hope NBC and CBC keep focusing on Cindy Crosby. I liked that NBC had isolation cameras on Crosby and Malkin (and probably Malkin's parents, too). At some point, they might realize that there are two teams in the series and that there are more than two players on the ice.

The Wings played another solid, professional game. The Wings showed once again that they can win without goals from their stars. I don't think that the Penguins can win that way.

I loved Justin Abdelkader's goal!

The Penguins outshot the Wings 32-30. Ozzie played another solid game. Fleury let in two bad goals.

Game two is in a few hours. Let's see if the Penguins can play a better game. If they do not, the series will be short.

Red Wings in the Stanley Cup Finals 2009

I've been a hockey fan for as long as I can remember. I can remember Gordie Howe and Alex Delvecchio and Terry Sawchuck.

I haven't always been a Red Wings fan. I can remember the "Darkness of Harkness" and the "Dead Wings" in the seventies and eighties. I was a fan of the Flyers and the Canadiens and the Islanders during those years. In my lifetime, the Wings have been pitiful. I can remember when they had great regular seasons and failed in the playoffs. I can remember facing the Oilers in the conference finals and failng. I can remember Brad Park being the only Wing back on an Oiler two on one and looking like a fish out of water. I can remember losing a game seven at home to the Maple Leafs in overtime.

I can remember the Wings being the dominating team in the regular season and losing in early rounds of the playoffs.

I can remember being shocked when the Wings lost in the finals to New Jersey.

I can remember crying when the Wings won the first Stanley cup in my lifetime.

Now, the Wings have won multiple Stanley Cups. They are now in the Finals against the Penguins, again.

I love the Stanley Cup Playoffs. They always seem to be decided by someone that most hockey fans have not been heard of before the Finals.

This year, it could be Helm or Filppula (folks from the UP know how to pronounce his name properly), or anyone from the fourth line. The Wings have rolled four line pretty consistently through this year and the playoffs. The hero of the playoffs will probably be someone that most hockey fans have not heard of much this year.

I feel pretty good about the Wings in these playoffs. They are skilled and deep and have good goaltending. I doubted Chris Osgood during the regular season, but he has played out of his mind during the playoffs.

I watched most of the Penguins games during their playoff run, and while they are a good team, they have not played well enough to beat the Wings.

Wings in five.

More on Meaningful Use

I wrote earlier about what Meaningful Use is and why it is important. Recall that providers will be reimbursed for purchases of certified HIT products and that they will then recieve financial incentive for the "meaningful use" of that technololgy, but all that the legislation says is that meaningful use is:

1. ePrescribing
2. participation in an HIE
3. submission of quality measures

The importance of the definition is that it is the first step in a process that involves many others.

1. The HIT Standards committee will need to select the standards and implementation guides that support meaningful use
2. The certification body (which may be CCHIT, but HHS has not confirmed this) will need to align its certification criteria with these
3. Vendors may need to adjust their EHR Systems to ensure that it meets the criteria. This may require recertification.
4. HealthCare Organizations (HCOs) that already have technology in place may need to upgrade or adjust their systems so that they can meet the meaningful use criteria. Those organizations that do not have EHRs in place will likely wait until the vendors have caught up with the certification criteria before they begin implementing.

Until the definition is published, we can guess at what they mean, and try to be ready for it.

Money becomes available for the purchase of "certified" EHR systems in October, 2010. So, the timing is extremely tight.

These dates are from the recovery.gov website:

http://www.recovery.gov/?q=content/program-plan&program_id=5299

Standards Rulemaking: Recovery Act §3004 (B) (1) - No later than December 31, 2009, HHS shall adopt and publish an initial set of standards, implementation specifications, and certification criteria. The rulemaking for this initial set of standards, implementation specifications, and certification criteria may be issued on an interim, final basis. Fully competitive contract awards will be utilized to support the impact analysis.

Milestones:

Complete Draft Rule/ Regulatory Impact Analysis. Start: 05/01/2009 End: 08/26/2009

Submit for HHS Clearance. Start: 08/26/2009 end: 09/25/2009

Clear OMB (up to 90 day process) Start: 09/25/2009 End: 12/24/2009

Publish in Federal Register. Start: 12/24/2009 End: 12/31/2009


So, if the HIT Standards Committee is to meet the deadline of submitting the list of standards that are required to support “meaningful use” (August 26), the definition has to be published very, very soon.

Red Wings vs Hawks, Game 4

First, a word about the Kronwall hit. I thought that this was a clean hit and did not warrant a penalty, let alone an ejection. If you cannot hit someone who is standing over the puck, we might as well put skirts on them.

Now, for Game 4. The Wings played a very poised, professional game. I did not hear about the injury scratches of Lidstrom, Draper and Datsyuk until just before the game. I expected that veteran Wings and the kids would pick up their games and that is what happened. Hossa and Zetterberg scored two goals each.

The Hawks lost their composure and very well lost the series. They took too many penalties for cheap shots after the whistle. The Wings made them pay on the ensuing power plays. Coach Q can be upset, but it is hard not to call a cross check when your player snaps his stick across the back of a Wing.

The Wings are now up 3-1, going back to the Joe for game 5 on Wednesday. I expect the Wings to finish the series then.

Red Wings vs Black Hawks, Game 1

Red Wings vs Hawks 5/17/2009

Final Score: Wings 5, Hawks 2

Both teams looked very good at times today. The Wings outshot the Hawks 43-32.

The Wings scored on a couple of nice high shots, which is what you have to do to beat a good butterfly goalie, and Khabibulin is a good butterfly goalie.

The first Wing goal by Dan Cleary was a great high shot, just under the bar on the glove side. The second Wing goal by Johan Franzen was a wrap around along the ice just inside the far post. The third Wing goal, by Mikael Samuelsson was another great wrist shot up that beat Khabibulin high on the short side. Samuelsson showed great patience and when the Hawk goalie went down to his knees, he was beaten by a high wrister. The fourth Wing goal was a tip by Cleary of a shot by Johan Franzen that went up and over the Hawk netminder. The fifth Wing goal was an empty netter by Henrik Zetterberg.

Chris Osgood, the Red Wing netminder, played a solid game. He faced 32 shots and stopped 30 of them.

Both sides looked out of sorts at times, but both teams played well for stretches of time. The game was physical at times with both teams laying on some good hits.

I expect both teams to play better in game 2 on Tuesday night.

Meaningful Use

I work in Health Information Technology (HIT) and am working on a Masters in Medical Informatics (MMI) degree at Northwestern University. One of the hot topics in HIT is the American Recovery and Reinvestment Act (ARRA) http://www.recovery.gov/. The act will reimburse hospitals and other providers for the “meaningful use” of HIT. But the act doesn’t fully define the term.

ARRA defines “meaningful use” as:

1. ePrescribing
2. participation in an HIE
3. submission of quality measures

This is ok, but what does it really mean.

ePrescribing is well understood. When ePrescribing is implemented, your doctor no longer hand writes a paper prescription that you carry to your pharmacist. The prescription is entered into a computer system and it is electronically transmitted to a pharmacy that you select. Hopefully, the bottle of pills will be waiting for you to pick up when you get there. The advantages of this are that no one has to try to read the Doctor’s handwriting, unless, the doctor still writes out the order and has a nurse or a clerk enter the data for them. If the doctor is using Computerized Physician Order Entry (CPOE), they enter the order directly into the computer. Another advantage is that we can compare this prescription with your current medical conditions and other prescriptions that you are taking and a Decision Support System will flag any potential adverse drug event (ADE) that might occur. With CPOE, the physician is alerted when the order is entered. In the old paper based system, your pharmacist might catch the error and would have to phone the physician to get the prescription changed.

The second component of meaningful use is participation in a Health Information Exchange (HIE). What is a Health Information Exchange? An HIE is a network of Hospitals and other providers that will electronically exchange clinical information about patients. The idea is that if you go to see Dr. Smith, his office will be able to electronically retrieve information about your past treatments other doctors and hospitals in the region. The problem is that HIEs do not exist. Well, ok. There are some things out there that are called HIEs, but they are few and far between. CCHIT just published their certification criteria for HIEs last fall but many of the HIEs that are operational may not meet these criteria. The hope is that states and regions will build HIEs so that providers can participate in them.

The third component is the submission of quality measures. We still do not know what quality measures will be reported and to whom. When providers have EMRs in place, it should be fairly straightforward to collect these quality measures and to electronically transmit them to the appropriate agency. This is just the reporting of quality measures; there are no targets….yet. Expect to see quality defined as a measure of outcome, and not as a measure of effort. In other words, just giving the patient an aspirin should not be considered a measure of quality. Similarly, you shouldn’t get quality points for giving the patient the same “quit smoking” pamphlet that they have been getting for years. A better measure of quality might be “has the patient stopped smoking?” Many other industries have adopted quality measures that relate directly to the quality of the product and to customer satisfaction with a product or service.

So, when will we know what meaningful use means? National Coordinator for Health IT David Blumenthal said: “We hope to provide a direction and some specifications in the late spring, early summer.” He did not specify which year :-)

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=58402

What’s the rush? Well we need to begin deploying these systems soon, because meaningful use must be achieved by 2012 in order for providers to get the full incentive money. Note that this refers to the federal fiscal year, so this really means October 1, 2011. These systems are complex and the timing is fairly tight.

Last month, the National Committee on Vital Health Statistics (NCVHS) met to discuss meaningful use. The meeting agenda and presentations can be found at the following link.

http://ncvhs.hhs.gov/090428ag.htm

One thing we can expect is that meaningful use will be a target that will change every year. Expect the bar to be raised each year. For example, once everyone has ePrescribing implemented I would expect to see the addition of Decision Support to check for drug interactions and to look for cheaper alternatives.

The HIT Standards Committee met on Friday, 5/15. There is a nice summary of the meeting on John Halamka's blog:

http://geekdoctor.blogspot.com/2009/05/first-meeting-of-hit-standards.html

That's enough of that. The Red Wings begin the conference finals this afternoon. Go Wings!

First Post

First Post!

I don't know how often I'll post here, but this is a start.

I'm an HIT Interoperability Standards geek. I play hockey goalie in local "beer leagues" during the fall and winter in Ann Arbor. I'm working on a Masters in Medical Informatics at Northwestern University. I play the Chapman Stick....well actually, I don't play so much lately, as work, school and hockey don't give me as much time as I would like.

The Stanley Cup Playoffs are going on as I type this, which makes this my favorite time of the year!