Pinterest for the Medical Office

For some time now, I've been struggling to figure out how to use Pinterest social media as it applies to a medical practice.

Pinterest is a pinboard-style photo-sharing website that allows users to create and manage theme-based image collections such as events, interests, and hobbies. Users can browse other pinboards for images, 're-pin' images to their own pinboards, or 'like' photos.

Pinterest is also one of the newest and hottest social media platform, especially among women and 20-40 years old demographic. As such, it behooves physicians and hospitals interested in social media to figure out how to incorporate Pinterest to their social media campaign.

For more interesting Pinterest statistics, check this webpage out.

BUT... given its visual and pictoral nature, it has been problematic when incorporating into something as privacy-ridden as healthcare.

How to use Pinterest for a medical practice and be successful without getting into trouble with HIPAA?

Not sure I have the secret, but I've ultimately decided that relevant medical infographics is the best way to go.

We shall see...

Check out our Pinterest page here!

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The Problem with Universal Healthcare

I usually hit the delete key whenever I get a chain email... But this particular one caught my eye enough for me to read the whole thing. This story is probably impossible to prove or disprove (I tried to find the name of this professor), but the overall message was quite intriguing... enough so to share given its applicability to universal healthcare.

My healthcare commentary is provided after the end of the story below (to preface, I believe in a compromise of sorts... I guess I'm a centrist)...

An economics professor at a local college made a statement that he had never failed a single student before, but had recently failed an entire class. That class had insisted that Obama's socialism worked and that no one would be poor and no one would be rich, a great equalizer.

The professor then said, "OK, we will have an experiment in this class on Obama's plan".. All grades will be averaged and everyone will receive the same grade so no one will fail and no one will receive an A.... (substituting grades for dollars - something closer to home and more readily understood by all).

After the first test, the grades were averaged and everyone got a B. The students who studied hard were upset and the students who studied little were happy. As the second test rolled around, the students who studied little had studied even less and the ones who studied hard decided they wanted a free ride too so they studied little.

The second test average was a D! No one was happy.

When the 3rd test rolled around, the average was an F.

As the tests proceeded, the scores never increased as bickering, blame and name-calling all resulted in hard feelings and no one would study for the benefit of anyone else.

To their great surprise, ALL FAILED and the professor told them that socialism would also ultimately fail because when the reward is great, the effort to succeed is great, but when government takes all the reward away, no one will try or want to succeed. Could not be any simpler than that. (Please pass this on) These are possibly the 5 best sentences you'll ever read and all applicable to this experiment:

1. You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity.
2. What one person receives without working for, another person must work for without receiving.

3. The government cannot give to anybody anything that the government does not first take from somebody else.

4. You cannot multiply wealth by dividing it!

5. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that is the beginning of the end of any nation.

Healthcare is complex, but for simplicity's sake, universal healthcare is a type of socialism/communism... Medical care costs a LOT of money... It's not fundamentally free.  As such, if everybody universally can get free healthcare coverage, somebody has to pay... which typically means those who are wealthier ends up paying for those who can't afford it.

This also means that universal healthcare cannot provide "expensive" treatment for everybody... whether it be cancer treatment, the latest robotic throat surgery, or the newest type of test.

Rather, in order to pay for healthcare given to those who otherwise would not have any, healthcare coverage at the top end is decreased which includes the latest and greatest types of medical treatment.

As such, the "wealthy" will not only grow resentful for paying into this universal healthcare, but also because they would not be able to obtain the greatest medical care due to lack of coverage in such a system.

So, the wealthy will flee this system in some way... but with the exit of the wealthy, there will be less money in the system to pay for universal healthcare which would lead to an overall decrease in coverage for everybody else still in the system.

In some ways, we already do have a form of universal healthcare for those who can't afford it in the form of Medicaid and Medicare. Those who work (the "wealthy") pay taxes to fund these programs for those who do not work or are too poor to afford healthcare.

These programs DO provide good BASIC healthcare services. But these programs also do NOT pay for the latest and greatest in medical treatment either... Such treatment even extends to the doctors you are able to see. Some physicians no longer accept Medicare or Medicaid insurance as reimbursement for services are too low.

When looking into the origin of this story (which appears to have surfaced in 2009), I encountered another similar story:

A young woman was about to finish her first year of college. Like so many others her age, she considered herself to be a very liberal Democrat, and among other liberal ideals, was very much in favor of higher taxes to support more government programs, in other words, redistribution of wealth.

She was deeply ashamed that her father was a rather staunch Republican, a feeling she openly expressed. Based on the lectures that she had participated in, and the occasional chat with a professor, she felt that her father had for years harbored an evil, selfish desire to keep what he thought should be his.

One day she was challenging her father on his opposition to higher taxes on the rich and the need for more government programs. The self-professed objectivity proclaimed by her professors had to be the truth and she indicated so to her father. He responded by asking how she was doing in school.

Taken aback, she answered rather haughtily that she had a 4.0 GPA, and let him know that it was tough to maintain, insisting that she was taking a very difficult course load and was constantly studying, which left her no time to go out and party like other people she knew. She didn't even have time for a boyfriend, and didn't really have many college friends because she spent all her time studying.

Her father listened and then asked, 'How is your friend Audrey doing?' She replied, 'Audrey is barely getting by. All she takes are easy classes, she never studies, and she barely has a 2.0 GPA. She is so popular on campus; college for her is a blast. She's always invited to all the parties and lots of times she doesn't even show up for classes because she's too hung over.'

Her wise father asked his daughter, 'Why don't you go to the Dean's office and ask him to deduct 1.0 off your GPA and give it to your friend who only has a 2.0. That way you will both have a 3.0 GPA and certainly that would be a fair and equal distribution of GPA.'

The daughter, visibly shocked by her father's suggestion, angrily fired back, 'That's a crazy idea, how would that be fair! I've worked really hard for my grades! I've invested a lot of time, and a lot of hard work! Audrey has done next to nothing toward her degree. She played while I worked my tail off!'

The father slowly smiled, winked and said gently, 'Welcome to the conservative's philosophy.'

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HIPAA Compliant Text Messaging (for Free)

Let's face it...

Physicians love to text message given it is fast, easy, and convenient. However, regular instant messaging (SMS, MMS) that comes with your smartphone is not secure, saved unencrypted on a server somewhere (forever), and most importantly not HIPAA or HITECH compliant.

Enter the encrypted and HIPAA compliant messaging services.

Though most of these services cost a nominal fee per month, there are a few and growing number of services which offer free and secure instant messaging. Even better, pretty much all these services including the free ones allow sending messages with unlimited characters, pictures, video, and audio along with text.

Regardless of the service, there are two elements that allow for encrypted SMS and MMS.

1) Userid and Password
2) All your secure contacts must also be using the same service (ie, they all have to sign up before using)

The best free HIPAA-compliant messaging services that's out there that I'm aware of are qliqConnect which is geared towards health professionals and Wickr which is geared towards anybody.

There are pros and cons to both.

qliqConnect is available for use on the desktop, iPad, iPhone, and Android. Wickr is available only on the iPhone (Android coming soon).

Wickr offers complete self-destruct of messages after a certain period of time (all metadata with pictures, video and audio files, like your device info, your location, and any personal information captured during the creation of those files). qliqConnect does not.

No email is required with Wickr. qliqConnect does.

Wickr also states that messages are secured using military grade encryption that exceeds HIPAA standards and unencrypted messages are NEVER stored on any server. It is unclear whether qliqConnect offers similar level of security.

Depending on your needs, one of these free services may be more suitable than the other.

Of course, the weakest link for full adoption is that everybody you want to securely message with also needs to sign up for the same service.

In the end, if I'm a betting man... Wickr will probably win out in the end, especially once they have software available for platforms beyond the iPhone.

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Healthcare Mobile Web Presence

It is pretty much a given that healthcare organizations, medical offices, and physicians maintain a web presence given how frequently consumers turn to the internet and google especially for health information.

Given that... I would like to point out that more and more of this web traffic occurs on a smartphone rather than a computer and in an effort to retain consumers who seek healthcare, it behooves that any web presence be also mobile friendly.

According to my own personal web statistics using google analytics (free), in the month of Sept 2012, more than half (59.7%) of all web visits occurred using a smartphone.

Compare this to 53% in July 2012 and 39% in January 2012.

In January 2011, it was a laughably small 12.5%.

Overall, mobile web browsing accounts for 20% of all web traffic in North America. Cisco in February 2012 predicted that:

"global mobile data traffic will increase 18x between 2011 and 2016... By the end of 2012, the number of mobile-connected devices will exceed the number of people on earth, and by 2016 there will be 1.4 mobile devices per capita. There will be over 10 billion mobile-connected devices in 2016, including machine-to-machine (M2M) modules-exceeding the world's population at that time (7.3 billion)."

Also, google's own internal research revealed that half of consumers will use a website less often if it does not work well with a smartphone even if they like a business. In essence, you WILL lose customers at the moments that matter without a website specifically made for mobile devices.

It is based on just such statistics that persuaded me to take the time and money to convert my practice website such that it is now mobile friendly earlier this month.

So what does it mean to have a mobile friendly web presence?

It means that a consumer does not have to enlarge or scroll around horizontally to view a single webpage. Information appears formatted specifically for the smaller smartphone screens automatically.

In the past, there was a call for healthcare to have a web presence. In the future, that may not be good enough... modern IT demands a web presence that is mobile-friendly. Indeed, if one made decisions purely based on statistics, the focus should be on "mobile presence" rather than "web presence".

Food for thought...

Sources:
Mobile-friendly sites turn visitors into customers. Google 9/25/12.

Google Research: No Mobile Site = Lost Customers. Forbes 9/25/12

Mobile is Not a Sideshow. Information Week 9/21/12

Cisco Visual Networking Index: Global Mobile Data Traffic Forecast Update, 2011–2016. Cisco 2/14/12

Mobile Devices Now Make Up About 20 Percent of U.S. Web Traffic. All Things D 5/25/12.

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Healthcare Websites and Blogs Worth Anything?

I wrote in the past that healthcare blogging was in some ways a losing proposition when compared to entertainment news in terms of web traffic and search queries.

However, when it comes to ad revenue and how much a website is worth to potential buyers, healthcare topics (as well as sports) are king in monetary generation.

Flippa is a website that mediates the buying and selling of websites. They also produced a handy visual aid infographic based on their internal statistics.

As you can see, health websites are worth a premium. Furthermore, websites that generate revenue based on ads are also worth more.  Why? Because on average, health niches also get a pretty good cost-per-click (amount a website owner is paid every time someone clicks on an ad on their site).

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The Problem with Patient Based Portals and Mobile Healthcare Today

I was recently asked by a large New York City based consulting firm regarding my thoughts about mobile healthcare and where I see things headed.

I gave them my two cents, but thought to share with my readers.

As any patient who has been through the healthcare mill knows, there is a profound lack of communication among private offices, hospitals, and health systems.

Let's start with a true story...

I recently saw a patient in the hospital who was admitted through the emergency room with severe sinusitis who had been on multiple different antibiotics without relief and even had surgery 1 week ago after which she was hospitalized for a few days for unclear reasons. She also had multiple drug allergies. Problem is, she didn't know much of what was done to her, what her allergies were, and most importantly, received all her care in a different hospital system. It was also the weekend. 

I couldn't really start treatment on this patient until I knew what was done as I didn't want to waste healthcare dollars on treatments already tried and failed as well as repeat CT scans that were already done as well. In terms of life and death, I couldn't really start any medications until I knew exactly what her drug allergies were. 

I called the other health system's medical records... closed for the weekend. 

I called the ENT on-call at the other health system who did not know anything regarding the patient. 

Ultimately, I was able to get the information I required by a back-end route... The patient knew cultures were obtained during surgery. I also had a friend in my hospital microbiology department. I contacted my friend who fortunately knew the microbiologist at the other health system who than looked up the information we needed and faxed them over to me.

If I did not have any personal contacts, I would not have been able to do anything until Monday.

Would a patient portal have helped me out here? Perhaps...

Would mobile healthcare have helped me? Doubtful if a non-functional patient portal system was in place.

The Problem With Patient Portals

It's all fine and dandy if a patient sees ALL their physicians within the same health system like Kaiser Permanente or Duke Medical Center. Mobile health makes perfect sense. Patient portal can access all a patient's records.

Problem is when you get beyond a large health system and where the majority of healthcare occurs which is in community settings.

For example in my community, there is no single large health system.

There are private practices and the hospital. We all use different electronic medical records. The electronic medical records (EMR) do not communicate with each other.

As such, if a patient portal is used, we ALL would have to use different patient portals which can only access information from that one practice and none of the others.

So for a given family, they may see the pediatrician that uses EMR #1. Father see primary care doctor using EMR#2. Mother sees OB/GYN that uses EMR#3. Mother also sprained ankle so also sees an orthopedic surgeon who uses EMR#4. One of the kids also sees ENT for recurrent ear infections who uses EMR#5.

Each of these EMRs do not communicate with each other. As such, even if all of the practices uses a patient portal, they all would require the parents to remember each practices'  different portal web addresses which each require different userids and passwords. Though I'm sure there will be some people who will do exactly that, most will not or won't remember the web information.

As it is right now, I have a hard enough time remembering my current collection of userids and passwords for my bank, Amazon.com, gmail, insurance, etc.

Not sure I will use a patient web portal which I may even think of accessing no more than once or twice a year if I'm basically healthy.

The Problem with Mobile Healthcare

How in the world will mobile healthcare work anywhere except in big medical centers if electronic medical records are fragmented out in the community like it is now? After all, mobile healthcare is basically being able to access medical records quickly and easily from a smartphone rather than a desktop computer.

But if you can't even achieve that task with a desktop computer, how can a smartphone???

It's like trying to build a house with a weak foundation.

In order for patient portals as well as mobile healthcare to REALLY work, communication needs to exist between different electronic medical records regardless of the vendor.

The Solution

For patient portals and mobile healthcare to really work and be used, we first need to treat electronic medical records like the computers they reside on. There currently are many different types of EMR systems just like there are MANY different types of computer models, speeds, makes, cost, sizes, etc.

However, unlike current EMR systems, in spite of who makes a computer and what operating system software it runs, it has standardized components... USB, Firewire, HDMI, VGA, BlueTooth, etc. as well as a universal communication medium called the "internet" that works with phones, computers, laptops, etc regardless of who makes it and what software it is on.

You would think that an EMR system given its digital essence would be able to easily communicate with other systems... but no... they don't communicate at all... which is why paper reports still exist... which are than scanned into the EMR.

Rather than the government dictating what physicians must do and mandating EMR initiatives, I believe the money would be much better spent on mandating inter-operability and communication standards. The free market will create the best EMR systems and physicians will pick the one that best meets their need.

Once inter-operability and communication standards exist for EMR systems, only THAN will mobile healthcare and patient portals be the disruptive concept that is being prematurely attributed to these systems right now.

The golden goose being a patient (or physician) will only needing to access ONE patient portal that can access medical records wherever they may reside.

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How to Save Time Doing Healthcare Social Media: A Primer for Physicians

Followers, friends, and colleagues of mine often think that I spend HOURS doing social media everyday; reading, writing, and posting to all the various social media outlets I participate in including Blog (the one you are reading), Twitter, Facebook, YouTube, Google+, and LinkedIn.

Nothing can be further from the truth.

Beyond writing blog posts which does take time... I probably spend about 30 minutes daily reading and sharing. My reading lists typically is from customized Twitter lists I have created following users I find particularly interesting and helpful for my purposes to gain ideas to write about as well as share information that I feel may be of interest to my own followers, mainly on Facebook and Twitter.

Subscribing to RSS feeds can also be used, but I find customized twitter lists easier.

And I automate nearly everything when it comes to sharing to save time.

Here are my workhorse applications I use to save me time: Hootsuite, IFTTT, and bufferapp.

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Hootsuite

Rather than using Twitter whose interface I find clunky and inefficient, I use Hootsuite which combines all my customized Twitter lists as well as my other social media accounts all onto one concise, clean, and efficient web interface. They also have an iPhone and iPad app.

Any tweets or shared links I encounter, I can easily post to any other social media account all automatically from within Hootsuite so I don't waste time going to each individual websites for posting purposes.

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IFTTT

I also extensively use a service from  IFTTT (IF This, Than That) which allows for easy-to-create macros that automatically creates a customized action whenever I do some action. For example, I created a macro (known as recipe in IFTTT) whereby whenever I post something on twitter, IFTTT will automatically repost on LinkedIn... instantly and invisibly. You can create as many macros (recipes) as you want. Automatic responses can occur to over 47 social media accounts (Blog, LinkedIn, Facebook, YouTube, instapaper, email, tumblr, yammer, etc)

So theoretically, you can post once on twitter... and IFTTT will automatically repost the same information on all the other social media services instantly.

Of course, IFTTT can do more than just repost, but that's what I mainly use it for.

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bufferapp

Lastly, I use bufferapp. This nifty website will send out tweets at designated times that is user-specified. All the user has to do is "fill" the bufferapp bucket with the information you want tweeted.

So monthly, I will fill the bucket with up to 30 tweets I want sent out twice per day during business hours when tweets typically are noticed.

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The Rationing of High Cost Healthcare

I would like to start this blog article with an extreme hypothetical situation...

Imagine a pharmaceutical company comes out with a pill... a WONDERFUL pill "Xyz" that is GUARANTEED to extend life by 1 month with no side-effects that works on kids as well as adults. For every 1 of the these pills that are taken, 1 month is added to your life expectancy guaranteed. Doesn't matter if you have cancer, in a coma, suffering from a horrible infection, stroke, or you are completely healthy. One month added to your life expectancy for every 1 pill you take.

Catch is, this pill is very expensive. For ONE person, it is $5,000 per pill or $150,0000 per month or $1.8 million per year.

In this hypothetical situation, should patients pay out-of-pocket for this treatment? Than only the rich will be able to afford such expensive treatment.

Should insurance pay for this treatment? Well, given the high cost, the insurance companies will raise premiums in order to afford to pay for this treatment... otherwise go into bankruptcy. With increase in premiums, more and more people as well as companies will not be able to afford health insurance.

In response, in order to make health insurance more affordable, insurance companies have increased deductibles as well as included riders that exclude the Xyz pill coverage.

• Increase in premiums
• Inability to pay for health insurance premiums
• Increase in deductibles
• Exclusion riders

All as a response to an increased cost of providing healthcare (via this wonderful "Xyz" pill).

Should the government pay for this treatment? The population in the United States is 312 million currently. The cost to government will be $562 million per year to provide treatment for every individual for one year. Given everybody theoretically could live forever while taking Xyz pill... nobody will die which means the population will increase. With population increase, the United States will eventually go into bankruptcy it it continues to provide treatment for everybody.

As such to prevent government bankruptcy, Congress passes a variety of laws that include cutting medicare/medicaid benefits, raising the United States debt ceiling, cutting back on education/military spending, increasing taxes, etc.

This story sound familiar?

That's because it is... though not because of the existence of the Xyz pill. But "expensive" healthcare exists due to new pills, new tests, new surgeries that keep coming out which are more expensive than prior healthcare interventions.

The insurance and government's responses are the same in real life as to the fictional response to the hypothetical Xyz pill.

So what's the answer???

I don't have one that will make everybody happy... Read more about the healthcare dilemma.

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If Computer Security Experts are Getting Hacked, Why are Hospitals/Doctors Expected to be Better?

As anyone knows from reading the newspaper recently, major computer security firms like RSA and Verisign have been hacked. Even the pentagon!

If companies that specialize in computer security get hacked, why are hospitals and doctors who do NOT specialize in computer security held to an even higher standard?

Criminal penalties against healthcare professionals and organizations are steep for computer data breaches at $100 per record with criminal penalties that can include fines of $250,000 and 10 years in prison.

Given such steep penalties, the assumption is that hospitals and physicians must be experts in computer and network security... even better than companies that specialize in this subject area... or can purchase one.

So who should healthcare organizations hire to secure their computers to avoid getting hacked as I can certainly tell you, they are most certainly not security experts?

Google? Symantec? RSA? Verisign? The pentagon?

They've all been hacked successfully... As such, how can we trust their security products?

The answer is simple... There is no company that can be contracted to provide bulletproof security.

The only way is to NOT use a computer at all!

So here's the interesting quandary...

The government is mandating hospital and physicians to transition to electronic medical records or start facing penalties for not doing so.

BUT, the electronic medical records must have bulletproof security or else criminal penalties and even jail-time can be had for any breaches.

With these mandates, the only thing doctors and hospitals can hope for is to not get noticed by hackers. Either get punished for not using a computer or get punished for not having a security system even better than the pentagon.

Source:
Why the security industry never actually makes us secure. CNET 3/3/12
HIPAA Violations and Enforcement. AMA

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Greater Patient Satisfaction At Expense of Better Care?

Much has been made about improving patient satisfaction in the healthcare industry in the belief that greater patient satisfaction equates with better health. To this end, patients are routinely asked to complete a survey based on their impressions on the care they received.

BUT... does greater patient satisfaction actually result in or is the result of better care???

According to a recent study... higher patient satisfaction actually resulted in:

• Greater inpatient hospitalization
• Higher overall healthcare utilization
• Higher prescription usage
• INCREASED RISK OF DEATH!

The one and only measured benefit of higher patient satisfaction scores was decreased ER use.

Why would there be an increased risk of death with higher patient satisfaction scores?

Well, if a doctor always does what the patient wants, that would tend to lead towards higher patient satisfaction... EVEN if it's the wrong thing to do.

For example... when a patient sees a doctor for a perceived sinus infection, it is not uncommon for a patient to expect to leave with an antibiotic.

Unfortunately, many sinus infections are actually viral URI for which antibiotics is the WRONG course of action.

Inappropriate antibiotics lead to drug-resistant infections which lead to deaths. They can also cause side effects that may require additional healthcare intervention.

However, if a doctor resists a patient's desire for an antibiotic, that would lead to a decrease in patient satisfaction.

Also, the more testing and treatment that is performed, the higher the risk of downstream adverse effects. For example, a patient may desire a CT scan of the chest to rule out lung cancer even though the chest x-ray is normal. Unfortunately, the CT scan picks up a small liver nodule. Needle biopsies are performed which unfortunately resulted in excessive bleeding requiring surgical correction and several days in the hospital. In the end, it was just a benign cyst that never required any treatment.

These examples may oversimplify a very complex issue, but it does suggest that one interpretation of higher patient satisfaction scores are that doctors and hospital systems may choose to do the wrong thing in order to get a better score.

Reference:
The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Arch Intern Med. Published online February 13, 2012. doi:10.1001/archinternmed.2011.1662

Media:
Why Rating Your Doctor Is Bad For Your Health. Forbes 1/2/13.

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What Makes a Successful Hospital - Where Are the Tweakers???

First off, I don't have a business degree (in fact, I'm a MBA drop-out) nor a degree in hospital administration (does chairing a hospital committee count?), but I do have an opinion (don't we all) in light of having co-founded a bioinformatics company (iCORD, LLC) in the past based on a patent developed during my surgical residency... But I also admit that the company was ultimately unsuccessful if one measures success in terms of monetary profits, but I can say I succeeded in that my now defunct company's "product" still lives on at Duke University Medical Center.

It is perhaps my mixed bag background of a few victories and even more failures that I learned a thing or two about what it means to become better... it is what I call evolutionary tweaking or to put it more bluntly... whining and doing something about it. But let's stick with the "tweaker" euphemism.

Tweakers are annoying and may be a thorn in any administrator's side, but they produce results. They tinker and tinker in an attempt to improve and better a situation they consider a problem whether it be an engine, a computer program, or an entire production system.

Based on Isaacson's biography about Steve Jobs, he had it in abundance... even on medical care and devices during his last days.

Apparently, in his very last days of life, he went through 67 nurses before he found 3 he liked. He also refused to wear an oxygen mask due to a perceived poor design until he personally reviewed 5 different mask options and picked the one he liked best.

I'm certainly not promoting a culture where every patient, nurse, doctor, and administrator should start whining and complaining about everything. The hospital would shut-down.

BUT, there should be a culture where incremental tweaks are not only allowed, but encouraged with the expectation that many ideas will fail with monetary setbacks. However, just like survival of the fittest, the cumulative evolutionary cycles of keeping successful ideas and tossing ones that aren't will lead to a better organization over time... continuously and cheaply.

Home run ideas should not be the goal. Batting consistent singles (or tweaks) are...

There are systems to describe this process: PDSA (Plan Do Study Act), Toyota Production System, Just-In-Time Production, Deming Wheel, Shewhart Cycle, Control Circle, etc.

Now I certainly am not the first to suggest this concept to hospital settings. In fact, I've seen PDSA posters tacked on a wall in hospital physician lounges in the past.

However, I have observed great variances in how different hospital systems incorporate this "controlled whining" into their culture and administration.

Some embrace this process wholeheartedly and have succeeded in abundance. Others give lip service and designate the "tweakers" as whiners to be shut-up with bureaucratic red-tape, offensiveness requiring peer-review, or worse.

Employees and staff are a hospital's greatest assets both in terms of knowledge and production services. A hospital can either embrace trying to unlock the knowledge of what it already possesses or it can stifle them by punishing those who try to "tweak" thereby sending the message to everybody else to stay in the background... passivity being the rule... or voluntarily leave (or get fired).

The long-term success of a hospital system depends on how well it utilizes ALL its resources including not only encouraging an idea a hospitalist physician may have about telephone communication (allowing for faster patient care), but also trying to discover the knowledge trapped in a janitor's head who just might know how to thoroughly clean a hospital floor in half the time (saving time and money), but is too afraid to say anything.

Adapt or perish. History is replete with immensely successful companies that failed to adapt and are now either bankrupt or nearing death... Eastman Kodak, Tower Records, Borders Bookstores, etc.

And how does a hospital adapt to avoid non-existence? Continuously tweak... even when things are going well. USE all your assets with all guns blazing rather than smothering them.

Celebrate the tweakers!!!

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Doctor Distraction Happens... It's Mandatory!

I admittedly snorted out loud when I read a New York Times article  earlier last week regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.

There is no question that electronic devices distract physicians as the article pointed out... But that's like complaining about a leaky faucet when there's a flooded basement and a hole in the roof.

The bigger problem that should be mentioned is hospital bureaucracy which probably creates just as much if not more unintended distractions for physicians and nurses.

What many patients and lay public may not realize is that there is a TON of paperwork that goes into the care of a patient. Regulatory bodies like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that accredits hospitals have made it mandatory in many cases though I suspect hospital administration often carries it a step above and beyond what is truly necessary.

What all this "mandatory" paperwork means is that nurses are calling physicians all the time just so they can check a box on a form... and there are a LOT of boxes to check.

Take a simple ear tube placement. A procedure that takes about 1-2 minutes to perform under sedation in the pediatric population.

It takes about 15-20 minutes to fill out all the nursing and physician forms (whether paper or electronic medical records). When the surgery actually begins, the nurse is too busy filling out even more forms rather than paying attention to the surgery... and often the surgery is already over... and the nurse is still busy filling out forms.

Talk about distraction... a registered nurse has been relegated to being a mere secretary rather than helping (or paying attention) in the care of a patient.

I recently asked a nurse how much time they spent on actual patient care versus how much time filling out forms during a typical shift.

It saddened my heart when I was told 60-70% of a nurse's time is spent on filling out forms (whether notes, chart documentation, medication reconciliation, etc) and only 30-40% on actual patient care. This time disparity was not always true in years past.

OR... ask any physician how many times they get called during a typical day because some form or paperwork was not completed or needs completion or just remind to get it completed by nurses who themselves are the main individuals who suffer under the crush of mandatory documentation in a hospital setting.

It is irritating to say the least to get a phone call during the middle of an operation, say dissecting a tumor off the facial nerve during a parotid cancer resection, by someone who wanted to remind me to sign off on a medication list on a patient I've already provided prescriptions for.

Another classic experience of mine was when the anesthesiologist had trouble intubating a patient who started to suffer a severe lack of oxygen. I was immediately called to the bedside and performed an emergency tracheostomy.

Of course, the nurse (well indoctrinated in form completion) involved in the case immediately instructed me to STOP performing the trach and to get consent as per the regulations... which is true 99% of the time... but never mind that. Heaven forbid we now can't check that little box that states "consent obtained prior to surgery." But in the interest of patient care, I did suggest that it would be better if the patient lived with an unconsented trach rather than died due to time spent obtaining consent.

Though electronic devices may be considered a "distraction" analogous to a mosquito buzz that comes and goes, one must not forget the avalanche of paperwork which is a much more pervasive and insidious distraction that DELIBERATELY takes attention away from the care of the patient. I understand the need for documentation, but at some point when the documentation itself dominates the majority of heathcare rather than the actual administration of care, there's something fundamentally wrong going on.

It's probably why medical missions are so gratifying to participating nurses and physicians where 90%+ of the time is in actual patient care.

Reference:

As Doctors Use More Devices, Potential for Distraction Grows. NYT Dec 14, 2011.

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Healthcare Blogging a Losing Proposition?

An interesting blog article from the folks at Compete came to my attention recently. Compete for those who don't know is a fantastic analytics site to see how ANY website is doing in terms of popularity (number of visitors in a given time period). The basic data is free. For more in depth information, there's a charge.

For example, for our practice's website, here is the Compete data I pulled which is "relatively" accurate based on my own analytics information:

My nearest local competitor in terms of website popularity is the hospital, Fauquier Health System:

Though I may smile that my solo private practice website is getting nearly 30X the number of visitors as a community hospital, such numbers PALE in comparison to what truly is driving website searches by the lay-population... celebrity, entertainment, and political topics which collectively garner more than 80X the search volume compared to searches related to healthcare. Here is the graph by Compete.

Healthcare is the purple line WAY down at the bottom.

Assuming people ARE searching for healthcare topics, what might those topics be?

They are pregnancy and cancer related by a vast margin (chart taken from here).

What is the take-home message?

Healthcare blogging is truly a niche market... and a small one at that...

BUT, if one wants to become a successful healthcare blogger, it should be slanted towards pregnancy and cancer topics.

"Thyroid" made the top 20 list, but beyond that, ENT healthcare topics are left out in the dust... perhaps  even smaller than dust.

Take a look at the stats for perezhilton.com, a website dedicated to celebrity and entertainment news:

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