Comments

LMAO! You mean they JUST figured out a variation of what some of us knew at least a decade or more ago? Some of the best materials on CQI, TQM, team training, etc. came in the form of freebies sponsored by our tax dollars. The U.S. military is actually a wonderful repository of such materials, along with other government agencies. You just have to do a little digging and editing sometimes. I was using "public domain" goodies over a decade ago. Why WOULDN'T software fall into that category? Another good example is statistical/survey software. The actual software (including in-depth manuals and documentation) used by the U.S. Census Bureau to analyze the census numbers in every way imaginable is freely downloadable on the web. So this makes perfect sense.

Public domain software. I have a feeling hospitals won't be the only ones looking to tap into such resource as source code now.

On the fun side, just imagine some of the flight and combat simulators that our military has popping up as video games.

But I think the government can keep any budget and financial software. I wouldn't want my checking account a trillion dollars overdrawn. ;-)

I'll bet the big software houses and consultants ARE totally incensed over this.

I TOTALLY love it!

Posted by Dan Gunter at May 13, 2009 11:41 AM

Tom,

Thanks for sharing this one. Wonderful information for us health care quality advocates.

I must admit the data cited in the article for Midland Memorial was impressive -- if not downright startling, especially an 88% decrease in infection rates. Not that it's unique to the ViSTA system. But hospital acquired infections, medication errors, and errors caused by illegible written orders do not have to be as prevalent as they are. To me, these are huge factors in support of mandating conversion to electronic medical records. And as someone formerly in charge of en E.R., I can say with confidence that the possibility of making records compatible and accessible BETWEEN hospitals HAS to be explored and worked out, because it would save a lot of lives.

One of the hospitals I worked with did a partial conversion to electronic records (nurse's and tech's notes, but not physician records or orders) back in the early 1990's. What the article says is very true in terms of nurses going through a learning curve at first. But everyone adjusted in time. One of the things watched was how long after a patient contact it was before the nurse actually entered the notes/data in the computer. Typically, nurses that entered data sooner also made more detailed (and usually more accurate) patient notes. A definite "plus" in terms of communication, which is essential to health care quality.

This may sound far fetched, but I foresee the day when everyone has an implanted chip under the skin (just as you can with dogs and other pets now) that not only provides identification in an emergency (doable now), but has the capability of storing vital medical records (doable in the foreseeable future). As semiconductor technology advances, it is quite feasible to aim for this. I know a lot of privacy advocates would cry foul over such a thought, but we're constantly trading off at least SOME privacy in the name of convenience and safety, are we not?

Posted by Dan Gunter at May 13, 2009 3:05 PM

As in many other industries, with the difference of the embedded instrumentality, they need supervision and regulation, among other things (to state it tactfully).

Posted by Andres Agostini (Andy) at May 23, 2009 10:50 PM

The first thing that most hospitals need is a very clear and powerful shift in thinking -- back to the purpose for which they exist, which is for the benefit of the patient. Hospitals are thoroughly political creatures. Actually, they are on average much MORE politically charged environments, where traditional medical hierarchical thinking collides with financial motives and these in turn collide with the wants and needs of patients, staff, and accrediting/governmental agencies. Now let's throw a handful of people into the mix who are actually interested in thinking outside the box (to use the cliche) and creating yet a whole new environment of quality and teamwork, and there are so many battles taking place at once that hardly anyone can figure out who's actually at war with whom.

It is tragic that a hospital -- one of the environments where mistakes and service failures have the highest potential cost (deaths) -- can be one of the most difficult environments in which to implement and sustain change. But it is a fact. Not impossible. But very, very difficult.

The best start for the process is to put into place leadership with a strong quality focus. Yes, they need to understand "quality" in terms of numbers and measurements, but it still has to start at a deeper, more fundamental, yet also simpler level -- the desire to do a damn good job of taking care of patients. With that kind of leadership, change can be discussed, modeled, and over time achieved.

Without that type of leadership, people working to achieve the types of change called for in a hospital will not have the type of support and resources needed to be successful. And such change will not be modeled. The hierarchy and short-term needs (typically money) will edge out quality of care every time. It will be seen as an either/or situation -- quality of care vs. money. But that is the most false of dichotomies, because the two are not mutually exclusive. Indeed, they are perfectly intertwined -- they just don't appear that way from a short-term perspective.

Get leadership that understands this relationship and starts removing the barriers to effective change and achieving genuine quality care, and you're moving in the right direction.

Posted by Dan Gunter at May 24, 2009 12:49 AM