Population Health Poses Unique Challenges in Rural Areas

From HealthLeaders Media:

Population health management is being pursued by many healthcare leaders, but it’s a hard strategy to manage when the population is small and spread out. That’s the difficulty facing rural healthcare providers, who have long dealt with an older and sicker demographic, difficulty in finding physicians, and economic constraints, and are now pushed to the brink by healthcare reform.

Yet many rural healthcare leaders are embracing population health as their future—not because it offers economic salvation (it doesn’t), but because it makes perfect sense for their mission: to provide care for the community.

Should Malingering Be on the Differential?

From Emergency Medicine News:

Acute incarceritis is defined as the sudden onset of illness when a person is arrested. Its prevalence is difficult to quantify because the incidence depends on how many newly arrested patients an emergency department sees per year and how knowledgeable those individuals are regarding the mandate by the police to seek care for any medical complaints, even feigned ones. Common symptoms include seizures, asthma attacks, and chest pain, most of which rapidly disappear upon entering the emergency department.

The diagnosis of acute incarceritis carries with it several potential pitfalls. Unless the patient presents with obvious external signs of trauma, he is likely to be dismissed by the examining physician. After all, the problem-solving principle of Occam’s razor suggests that the most likely diagnosis for a newly arrested patient’s chief complaint is malingering. Feigning illness may be a common action taken among arrested patients, but a physician must also be cautious not to miss a true concerning diagnosis in light of this inherent bias.

We Mapped the Uninsured. You’ll Notice a Pattern.

From the NY Times:

Two years into Obamacare, clear regional patterns are emerging about who has health insurance in America and who still doesn’t.

The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.

Doctor who helped launch modern paramedic system dies at 98

From the Tribune:

As a cardiologist in Los Angeles during the 1960s, Dr. Walter S. Graf became alarmed by the number of heart attack sufferers who died while en route to hospitals.

Inspired by an Irish physician who sent hospital doctors and nurses out into Belfast to treat cardiac patients, Graf in 1969 converted a white Chevy van into a “mobile critical care unit.” He went on to outfit ambulances with defibrillators and technicians who knew how to use them, becoming one of a handful of doctors who created the modern paramedic emergency system.

Graf died Oct. 18 while under home hospice care in Los Angeles, according to Dr. Baxter Larmon, a professor at the David Geffen School of Medicine at University of California, Los Angeles. He was 98.

“He was a pioneer,” said Larmon, who knew Graf for 40 years and delivered a eulogy at a memorial last week. “Today ambulances do trauma care, they do respiratory care, they provide all kinds of care. And it’s all based on Graf’s original model.”

A procession of ambulances and fire trucks were driven to Graf’s memorial, which was attended by 100 firefighters, Larmon said Thursday.

Low-dose Ketamine Eases Pain, Reduces Opioid Use in ED

From Medscape:

The use of low-dose ketamine as an adjunct to opioids for pain control in the emergency department led to reductions in pain scores, total opioid dosing, and frequency of opioid dosing, results from a randomized, placebo-controlled trial indicate.

“The reduced frequency of opioid dosing, in particular, may be clinically significant,” said lead investigator Karen Bowers, MD, from the Emory University School of Medicine in Atlanta, Georgia.

She presented the study results here at the American College of Emergency Physicians (ACEP) 2015 Scientific Assembly.

Study: More rural Kansas hospitals at risk of closing

From the Eagle:

Mercy Hospital in Independence closed earlier this month, eliminating 190 jobs and leaving residents in this southeast Kansas town with a 20-minute drive to the nearest hospital emergency room.

Some warn that Independence is not an isolated case.

A national study shows that 17 other rural hospitals in Kansas are at risk of closing.

The study, published by iVantage Health Analytics, a for-profit research group based in Maine, does not identify the hospitals by name out of fear it would worsen the hospitals’ financial problems.

Emergency medicine physicians feel that the “business and regulation of health care” is changing medicine practice for the worse

From Central Penn Business Journal:

The “business and regulation of health care” is changing medicine practice for the worse, according to a majority of emergency medicine doctors.

And, according to them, advance directives, or legal documents informing the doctor of a patient’s health care wishes, would make things easier.

The information comes from a survey released this week by Harrisburg-based health care technology company, Geneia, which surveyed more than 300 emergency medicine physicians nationwide.

The majority – 92 percent – is slightly higher than the results from a survey conducted earlier this year, which found that 87 percent of physicians as a whole felt the same way.

It discovered that emergency medicine physicians scored 3.9 out of 5 on the “Physician Misery index,” whereas physicians as a whole previously surveyed scored 3.7.

EHR Replacement Trend Expands to Emergency Departments

From EHR Intelligence:

A lack of usability, interoperability, and mobility will lead to enterprise EHR technology giving way to best-of-breed health IT in the emergency department, according to Black Book.

A survey of hospitals between August and October found the great dissatisfaction with an enterprise EHR technology among Epic Systems clients, a sizeable majority of which deplored the Epic EHR model for the ED for being unable either to integrate with best-of-breed emergency department information systems (EDIS) (86%) or enable access to external records (83%).

Rival enterprise EHR technology companies (e.g., Cerner, Allscripts, MEDITECH), meanwhile, were credit with outcompeting best-of-breed EDIS products, largely the result of increased EHR usability over the past five years.

“Most best of breed EDIS solutions, not all, are fined tuned for the emergency department environment and workflows,” Doug Brown, Managing Partner of Black Book, said in a statement midweek. “In contrast, enterprise EHR solutions have typically been very generic with difficult customization processes and long implementations for emergency departments.”

39% of hospitals with enterprise EHR emergency modules identify themselves as moderately to highly dissatisfied with their current EDIS

Press Release:

Seven of every eight US hospitals are reporting 18%+ increases in ED visits over a year ago, mainly sourced to the shortage of primary care physicians, an aging population, a data driven industry and the increase of high-deductible Obamacare insured patients. The increase is reportedly congesting facilities, overtaxing physicians, causing nursing shortages, and triggering descents in overall hospital patient satisfaction.

Emergency department managers and physicians are also attributing ED complications to the lack of Emergency Department Information Systems (EDIS) usability and interoperability to external providers, affecting a swiftly growing replacement market.

35% of hospitals over 150 beds are currently, or plan to replace their EDIS in 2016. The majority of replacements (69%) will be those now using enterprise EHR emergency modules, opting for best-of-breed EDIS systems that can integrate with the hospital’s EHR.

Hospital administrators are also including the ED physician and nursing staff on the EDIS decision, something that was rarely done just a few years ago when original systems were chosen primarily for government incentive dollars.

In 2010, Black Book surveys recorded only 7% of ED physicians and 2% of ED nursing staff were involved on the EDIS selection teams where enterprise EHRs were given as the only technology option for their respective EDs. In 2015, and 2016 pending EDIS selection processes, 70% of ED physicians state their feel incorporated, as well as 16% of ED nurses.

39% of hospitals with enterprise EHR emergency modules identify themselves as moderately to highly dissatisfied with their current EDIS, yet 90% of those managers and physicians claim they are stuck with making hospital-wide generic EHR systems work, and/or they have been denied budget funds for 2016 EDIS replacements.

Many of those EDIS purchases were made as part of EHR systems, some hospitals dedicated six months to two years in implementations, just to remove those systems for significant issues with patient satisfaction, physician productivity, even safety issues, according to Doug Brown, Managing Partner of Black Book.

“Most best of breed EDIS solutions, not all, are fined tuned for the emergency department environment and workflows,” said Brown. “In contrast, enterprise EHR solutions have typically been very generic with difficult customization processes and long implementations for emergency departments.”­

The survey, conducted August through October, found hospitals polled utilizing Epic Systems’ enterprise EHR solutions were most dissatisfied with the inability to integrate with best of breed EDIS solutions (86%) or provide widespread connectivity to obtain external records (83%).

Cerner, Allscripts, Healthland, Evident CPSI and Meditech enterprise EHR solutions faired much higher, all surpassing several long standing best of breed EDIS products in 2015. 79% of collective users of those EHR systems credit substantial enhancements in usability since 2010.

Hospitals employing the EDIS solutions from best of breed vendors T System and Optum (Picis) rated their experiences the highest including usability by ED nurses and order entry by ED physicians.

Hospitals ranked their six (6) most desirable features in a 2016 replacement EDIS, either best of breed or enterprise EHR based:

Coding Improvements, 42%

Reporting Improvements, 66%

Customer Services Improvements, 24%

Cost Reductions, 19%

Ease of Use, 86%

Improved Resource Planning, 23%

Diagnosis Enhancements, 70%

Physician Productivity Improvements, 89%

Staff Productivity Improvements, 63%

Patient Satisfaction, 68%

Interfaces, 29%

Revenue Cycle Improvements and Charge Capture, 43%

Interoperability & Connectivity (Internal and External Sources) 93%

Tablets/Smart Phones 87%

“An obvious game changers in the EDIS replacement environment are developments in EDIS interoperability and mobility,” said Brown.

The US EDIS market estimated by Black Book to now exceed $235M is expected to grow to $420M in 2018.

Other significant findings:

78% of hospitals that implemented a replacement EDIS in Q2 2014- Q1 2015 claim they have seen improved reporting capabilities in less than three months post deployment.

76% of hospitals that implemented a replacement EDIS in Q2 2014- Q1 2015 report improved customer services outcomes attributable to some feature or benefit of the replacement EDIS.

44% of hospitals over 200 beds that implemented a replacement EDIS in Q2 2014- Q1 2015, report reduced visit costs of between 4% and 12% as compared to the same period the year prior.

Black Book™ well known internationally for accurate, impartial customer satisfaction surveys in the services and software industries, conducted its annual emergency department software/technology user polls to determine the highest ranked client experience vendors for 2015. As part of a special research focus on hospital, healthcare networks and corporate users, Black Book surveyed the clients of EDIS vendors with the highest scores in customer experience in the functional areas of documentation, interfaces, connectivity and interoperability, data sharing, tracking, charge capture, order management/CPOE, and coding support.

“As hospitals and emergency room physicians grapple with intense pressure to optimize processes with ED visits predicted to rise by double digits again in 2016, EDIS has emerged as a powerful solution to the challenges of a rapidly changing healthcare model,” said Brown.

The top ranked EDIS vendors for 2015 were identified as follows:

T Systems – Best of Breed EDIS

Cerner – Single Source Enterprise EHR/ED Solution

T System, Optum Picis and Cerner have jockeyed for the top spots for the past three consecutive years in the Black Book EDIS surveys.

Other top ranked vendors honored by clients in the customer satisfaction survey on 18 EDIS specific key performance indicators are: Optum (Picis), Wellsoft, Evident (CPSI), Healthland, and Allscripts.

About Black Book

Black Book™, its founders, management and staff do not own or hold any financial interest in any of the vendors covered and encompassed in the surveys it conducts. Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results and does not solicit vendor participation fees, review fees, inclusion or briefing charges, and/or vendor collaboration as Black Book polls vendors’ clients

Since 2000, Black Book™ has polled the vendor satisfaction across over thirty industries in the software and services sectors around the globe. In 2009, Black Book began polling the client experience of over 510,000 current healthcare software and managed services users. Black Book expanded its survey prowess and reputation of independent, unbiased crowd-sourced surveying to IT and health records professionals, physician practice administrators, nurses, financial leaders, executives and hospital information technology managers. Over 2000 users participated in the 2015 polls of EDIS client experience in a sweeping four month set of studies. Additionally, 900 respondents that have not yet fully implemented or optimally using emergency department technology provided insight on budgeting, adoption plans, factors driving EDIS decisions and vendor awareness.

Study Indicates That Loss Of Emergency Department Will Lead to Greater Death And Debility

From the Observer (opinion):

In the hospital debate, it is critical for Lakewoodites to understand the difference between a real hospital emergency department (ED), and any other kind of facility, whether it is described as “Urgent Care” or an “Emergency Room.”

There is no debate that Mayor Summers, the Lakewood Hospital Association (LHA) and the Cleveland Clinic (CCF) propose to close Lakewood Hospital’s Emergency Department and end hospital services in Lakewood.