The Health Care Blog

Implementing a Modern Hospital Website

By JOHN HALAMKA Over the past two years, I've witnessed a transition in modern website design from plain text and static information to multimedia centric and interactive. I've written about the new BIDMC website we implemented to meet patient expectations...
June 30, 2009 in Hospitals, Technology | Permalink | Comments (7)

Is Hospital Peer Review a Sham? Well, Mostly Yes

By BOB WACHTER, MD Dr. Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term "hospitalist" in an influential 1996 essay in The New England Journal...
June 3, 2009 in Hospitals | Permalink | Comments (12)

The Red Flags Rule

By JOHN HALAMKA You may have seen the recent headlines "FTC delays Red Flags Rule implementation until August 2009". What is the Red Flags Rule and how does it relate to healthcare? The FTC has a great website that it...
May 19, 2009 in Hospitals, Privacy | Permalink | Comments (5)

Disgusting, and another reason why marriage needs to be re-defined

By Matthew Holt Tara Parker-Pope reveals two cases where discrimination kept a partner, and in one case the dying woman’s children, away from their loved one while they were dying in hospital. One hospital involved is Jackson Memorial in Miami,...
May 18, 2009 in Hospitals, Policy, Policy/Politics | Permalink | Comments (9)

Octomum gives Kaiser a bellyache

By Matthew Holt First KP somehow gets landed with the Octomum, whom they most surely didn't provided with the IVF in the first place. My assumption is that the multiple birth cost them into the middling 6 figures. Now because...
May 16, 2009 in Health Plans, Hospitals | Permalink | Comments (3)

“Mr. Obama, Tear Down These (Hospital) Walls”

By ROBERT WACHTER I like readmissions. Well, that didn’t come out quite right, did it? What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions,...
April 4, 2009 in Hospitals | Permalink | Comments (6)

And in today's scuttlebutt--Sutter pay grades

By Matthew Holt A little birdie contacted me leading me to wonder, what did the former CEO of Sutter Health Van Johnson do to get paid $5.6 million for working for a “part year” in 2006? (See page 100 of...
January 30, 2009 in California, Hospitals | Permalink | Comments (4)

OP-ED: The MRI Safety Gap

By Tobias Gilk In health care, particularly in patient safety, there is a cultural predisposition towards excellence. There’s a fundamental desire to create better, safer environments in support of care. That applies to staff qualifications, policies & procedures, medical technology,...
January 19, 2009 in Hospitals, Policy, Quality, Technology | Permalink | Comments (6)

Shocker--Karen Ignagni almost tells the truth

The NY Times' Robert Pear has an article on the politics of the Obama Administration introducing a public plan as part of FEHBP. As you might expect a boat load of Republicans who were told in grade school that private...
January 8, 2009 in Economics, Health Plans, Hospitals, Medicare Advantage, Obama administration, Policy, Policy/Politics | Permalink | Comments (20)

A new year's resolution for greater hospital transparency

By Paul Levy Just thinking, along the lines of a New Year's resolution. What if all of the hospitals in the Boston metropolitan area -- academic medical centers and community hospitals -- decided as a group to eliminate certain kinds...
January 3, 2009 in Hospitals, Patient Safety, Paul Levy, Quality, Transparency | Permalink | Comments (4)

The Hospitalist as Bed Czar: Indispensability, But At What Cost?

By Bob Wachter In last week’s Annals of Internal Medicine, Eric Howell and colleagues describe an innovative experiment in which the hospitalists at Johns Hopkins Bayview became the institution’s bed czars. It worked. So should my program and yours take...
December 18, 2008 in Hospitals, Nursing, Physicians | Permalink | Comments (0)

Dispatches from IHI's quality forum

By Amanda Goltz Don Berwick is one of the leading lights of the health care quality world; an oft-quoted and published visionary who founded the Institute for Healthcare Improvement to spread the gospel of transformation and improvement around the world....
December 14, 2008 in evidenced-based medicine, Hospitals, Patient Safety, Quality | Permalink | Comments (2)

Transforming medicine and saving lives

By Sarah Arnquist This week, Don Berwick will announce the results of the 5 Million Lives Campaign before thousands of people in Nashville attending the National Forum on Quality Improvement in Health Care. Twenty years ago, it was almost heretical...
December 9, 2008 in Electronic Medical Records, Hospitals, Patient Safety, Physicians, public health, Quality | Permalink | Comments (5)

Resident Duty Hours and Patient Safety: Did The IOM Get It Right?

By Bob Wachter The Institute of Medicine just released its long-awaited report on trainee duty hours. It is well researched and balanced, and its recommendations appropriately reflect what we know vs. what we believe. Now the fun begins. Let’s start...
December 9, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians, Quality | Permalink | Comments (1)

The Benefit of the Doubt

By Val Jones M.D. Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from...
December 4, 2008 in Hospitals, Pain Management, Val Jones, MD | Permalink | Comments (13)

Embracing palliative care as mainstream medicine

By Bob Wachter I’m on clinical service now and my patients are dying left and right. And I’ve never been prouder of my own care, and that delivered by my colleagues and hospital. When I was in training, a patient’s...
November 30, 2008 in Hospitals, Physicians, Quality | Permalink | Comments (11)

Running a hospital: The demands for robotic surgery

By Paul Levy Many months ago, I wrote about the da Vinci Robot Surgical System and expressed doubts about whether there was evidence to support the clinical efficacy of this equipment, as opposed to the marketing efficacy of the company...
November 24, 2008 in Hospitals, Medical Devices, Paul Levy | Permalink | Comments (13)

Hospitals hit by economic downturn

By Jane Sarasohn-Kahn Forty percent of American hospitals have seen drops in inpatient admissions, according to the American Hospital Association. In the AHA's survey, Report on the Economic Crisis: Initial Impact on Hospitals, it's clear that hospitals are already experiencing...
November 24, 2008 in Economics, Hospitals, Jane Sarasohn-Kahn | Permalink | Comments (2)

Are Hospitalists Recession Proof?

By BOB WACHTER Hospitals aren’t the first businesses hurt when the economy sours, but they get hurt nonetheless, as an article in last week’s NY Times points out. But hospitalists have never lived through a massive downturn. What happens to...
November 17, 2008 in Bob Wachter, Hospitals | Permalink | Comments (1)

Battling MRSA with transparency

By Sarah Arnquist Two weeks ago, I made an emergency trip home to Minnesota because my grandmother fell ill. She went to the emergency room on a Sunday night, complaining of fatigue and shortness of breath. The emergency physician diagnosed...
November 17, 2008 in Hospitals, Patient Safety, public health, Sarah Arnquist | Permalink | Comments (2)

Transparency Works!!! (And better than you can imagine)

By PAUL LEVY I just saw clear evidence of the importance of transparency with regard to the reporting of important adverse events and medical errors. Bear with me through the details, but I will not keep you in suspense regarding...
November 14, 2008 in Hospitals, Paul Levy | Permalink | Comments (1)

Using clinical decision support to get the right diagnosis the first time

By Joseph Britto, MD Joseph Britto is co-CEO of Isabel Healthcare, a clinical software vendor that helps clinicians with diagnosis. He practiced medicine in the UK before joining with co-CEO Joseph Maude to start Isabel, named after Joseph's daughter who...
October 10, 2008 in Electronic Medical Records, Hospitals, Patient Safety, Quality | Permalink | Comments (6)

Hospitals going green

By Sarah Arnquist Hospitals generate 6,600 tons of waste per day, and about 80 percent of that is nonhazardous waste. There are lots of opportunities to get greener, and some hospitals really are making concerted efforts to do so. While...
October 3, 2008 in Hospitals | Permalink | Comments (2)

Mixed reception for hospital ID bracelets

By Sarah Arnquist Color-coded hospital bracelets intending to identify categories of patients and prevent errors by ensuring they receive proper care have received a mixed reception, the New York Times reports. Red bracelets indicate allergies, amber says the patient has...
September 26, 2008 in Hospitals, Patient Safety, Quality | Permalink | Comments (2)

Wonder if your doctor is laughing at you?

By Sarah Arnquist That CNN headline grabbed my attention and got me to read a column that basically chastises the 17 percent of internal medicine residents who reported they had laughed at patient in a survey published in JAMA. The...
September 12, 2008 in Hospitals, Physicians, Quality, Sarah Arnquist | Permalink | Comments (3)

Creating a Facebook-like medical record

By Bob Wachter The explosive growth of Facebook and MySpace illustrates the market for electronic tools to enhance communication and collaboration. Could there possibly be another workplace more in need of social networking tools than the modern hospital? If you...
September 11, 2008 in Bob Wachter, Electronic Medical Records, Health 2.0, Hospitals | Permalink | Comments (11)

Medicare hospital quality reporting steps up in sophistication

By Bob Wachter Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR's "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it -- on...
September 2, 2008 in Bob Wachter, Hospitals, medicare, Quality | Permalink | Comments (2)

The mirage of a "nonprofit" health system

By Don Johnson Not-for-profit hospital monopolies are helping make health insurance unaffordable for millions of Americans. In its Thursday edition, The Wall Street Journal profiles the near monopoly that Carilion Health System has in Roanoke, Virg., and how it uses...
August 29, 2008 in Economics, Health Plans, Hospitals, The Industry | Permalink | Comments (3)

Hospital offers a window to the world

By Sarah Arnquist A hospital brings together the best and worst of people often in chaotic, traumatic scenarios that for some are everyday events, and for others are life changing moments. In her latest book, Hospital, journalist Julie Salamon uses...
August 4, 2008 in Hospitals, Sarah Arnquist | Permalink | Comments (1)

MedSphere CEO talks about big goals

By John Halamka I had lunch recently with the CEO of MedSphere, Mike Doyle, to learn about the company's plans for OpenVista. The idea is simple -- take the the publicly available code from the Veterans Administration clinical information system,...
July 28, 2008 in Electronic Medical Records, Hospitals, Technology | Permalink | Comments (0)

Communication 101: Shedding power imbalances to protect patients

By Katie Fiebelkorn Westman Katie Fiebelkorn Westman is a registered nurse at an acute care hospital in the Minnesota Twin Cities. She is working toward a clinical nurse specialist degree, focusing on improving patient care quality. The Joint Commission’s recent...
July 24, 2008 in Hospitals, Nursing, Patient Safety, Quality | Permalink | Comments (1)

Health Systems' Ferocious Challenges

By Brian Klepper Lately, I've had interesting discussions with a thoughtful exec. at a major Western health system about the ferocious challenges facing hospitals and health systems. Her organization's internal conversations at the moment are centered, in part, on what...
July 22, 2008 in Brian Klepper, Economics, Hospitals, medicare, The Industry, Transparency | Permalink | Comments (3)

Determination of need rule only goes partway

By Charlie Baker Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let's Talk Health Care. I usually spend some...
July 21, 2008 in Charlie Baker, Economics, Hospitals, Policy | Permalink | Comments (1)

Should a surgeon be punished for wrong-site surgery?

By Paul Levy During these couple of weeks following our wrong-side surgery, a number of people have asked me if we intend to punish the surgeon in charge of the case, as well as other people in the operating room,...
July 20, 2008 in Hospitals, Patient Safety, Paul Levy, Quality | Permalink | Comments (4)

Hospital rankings for positive press or for real?

By Sarah Arnquist Hospital & Health Networks magazine announced America's "100 Most Wired" hospitals for 2008 this week. You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report. Hospital &...
July 17, 2008 in Electronic Medical Records, Hospitals, Marketplace, Sarah Arnquist, Technology, The Industry | Permalink | Comments (2)

It's all about the billing

By Sean Neill Sean Neill is a South African-born, British-trained anesthesiologist, who recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care. Having arrived to see the last...
July 15, 2008 in Economics, Hospitals, Obesity, Physicians, The Industry | Permalink | Comments (5)

My Health Direct

Nearly two years ago Jay Mason called me telling me about his plan to create an appointment system whereby hospitals in Wisconsin could re-route their Medicaid patients to community and safety-net clinics. He told me that not only would it...
July 14, 2008 in Economics, Hospitals, Technology, The Industry | Permalink | Comments (2)

Another case of wrong-site surgery: are we averting our eyes from the root causes?

By Bob Wachter Yet another case of wrong-side surgery, this one at Boston’s Beth-Israel Deaconess Hospital. Though CEO Paul Levy does a nice job discussing the case on his blog, I’ll focus on two aspects Paul neglects: the role of...
July 10, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians, Quality | Permalink | Comments (8)

A message you hope to never send

By Paul Levy First, an email sent out on Thursday morning. My commentary follows. Dear BIDMC Community, This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body...
July 7, 2008 in Hospitals, Patient Safety, Paul Levy, Quality, Transparency | Permalink | Comments (6)

Mitigating interference between electronic medical devices

By John Halamka Last week, JAMA published an article about the risks of active and passive radio frequency identification to other hospital equipment. The Associated Press and ABC News issued major stories about it. Although the study focused on RFID...
July 3, 2008 in Hospitals, Technology | Permalink | Comments (1)

A classic from a cardiologist

By Matthew Holt The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee's fabulous book Overtreated which has...
June 30, 2008 in Hospitals, Physicians, Policy/Politics, Technology | Permalink | Comments (5)

How preventing infections rose to the forefront of the patient safety movement

By Bob Wachter The Joint Commission just released its 2009 National Patient Safety Goals, and –- no surprise –- they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control...
June 24, 2008 in Bob Wachter, Hospitals, Patient Safety, Quality, The Industry | Permalink | Comments (0)

Interest groups clash over doctor-owned specialty hospitals

By Donald Johnson Doctor-owned specialty hospitals deliver better quality of care, are more convenient for physicians and patients and take business away from not-for-profit and investor-owned general acute care hospitals, which have been trying to put them out of business...
June 17, 2008 in Hospitals, Policy, The Industry | Permalink | Comments (2)

In Indian hospital care, the past and future co-exist

By Sarah Arnquist Walking through the government-run Gandhi Hospital in Hyderabad, India feels like stepping back 50 years in time. The nurses wear white dresses with those funny paper napkin hats. Exhausted people overflow the stuffy waiting rooms. Family members...
June 3, 2008 in Announcements, Hospitals, Sarah Arnquist | Permalink | Comments (6)

Why diagnostic errors don't get any respect and what can be done about it

By Bob Wachter I gave a keynote yesterday to the first-ever meeting on "Diagnostic Error in Medicine." I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo said, the experts and advocates in the...
June 2, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians | Permalink | Comments (3)

Vision for hospital's future HIT

By John Halamka The role of the chief information officer is very operational -- keeping the trains running on time, ensuring budgets are sufficient and aligning IT resources with the needs of stakeholders. One other important task of the CIO,...
May 29, 2008 in Health 2.0, Hospitals, Technology | Permalink | Comments (2)

Let's talk about tax exemptions

By Paul Levy An excellent article by Stephanie Strom in Monday's New York Times covers what appears to be a growing controversy about the degree to which nonprofit organizations should or should not be permitted to be tax exempt under...
May 28, 2008 in Hospitals, Paul Levy, The Industry | Permalink | Comments (2)

Health 2.0 Consciousness Dawns - Even In Jacksonville, FL!

by BRIAN KLEPPER Today, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in Atlantic...
May 15, 2008 in Brian Klepper, Economics, Health 2.0, Health Plans, Hospitals, Policy, The Industry, Transparency | Permalink | Comments (2)

Mind your manners

By Paul Levy Dr. Michael Kahn, from Beth Israel Deaconess' Department of Pyschiatry, has published an article in the New England Journal of Medicine that suggests that doctors enhance their relationship with patients when they deal with patients in a...
May 14, 2008 in Hospitals, Personalized Medicine | Permalink | Comments (0)

The virtues of virtual visits

By Jane Sarasohn-Kahn Rush-Presbyterian Medical Center's Virtual Integrated Practice (VIP) is more evidence that remote health care can improve health outcomes. At Rush, a team has been refining the VIP model for the past four years. The VIP's objective is...
May 7, 2008 in Health 2.0, Hospitals, Jane Sarasohn-Kahn | Permalink | Comments (2)