The Daily Briefing

News for Health Care Executives

Realize the potential of clinical decision support systems

January 05, 2012

About the Infographic

Clinical decision support (CDS) promises fewer medication errors, shorter length of stay, and greater patient safety. However, most organizations struggle with questionable data, alert fatigue, and unintended consequences. Leading CIOs apply five principles to realize the full potential of CDS.

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Investigation: Unclean surgical tools a 'hidden threat' in ORs

iWatch News examines the dangers of filthy instruments

February 27, 2012

Dirty medical instruments are used during surgeries at hospitals and outpatient surgery centers "with alarming regularity," the Center for Public Integrity's iWatch News reports.

According to an iWatch News investigation, improperly cleaned surgical tools have led to various high-profile disease outbreaks in recent years. For example, the Department of Veterans Affairs in 2009 found that improperly cleaned endoscopes were used to perform endoscopies or colonoscopies on 10,737 veterans in Florida, Tennessee, and Georgia between 2002 and 2009. Some of those veterans later were diagnosed with HIV, hepatitis C, or hepatitis B.

Meanwhile, a hepatitis C outbreak in Las Vegas in 2008 was attributed to unclean surgical equipment at one outpatient surgery center. A subsequent CMS investigation of 1,500 outpatient surgery centers found that 28% of facilities had infection control deficiencies associated with equipment cleaning and sterilization.

Challenges to proper surgical equipment cleaning
According to iWatch News, several factors may impede proper cleaning of surgical equipment, including tool design and certain hospital sterilization processes.

For example, although intricate modern surgical tools have transformed medicine, iWatch News notes that they often are difficult to clean. Some tools feature internal channels that easily trap materials. In addition, some tools cannot be cleaned using steam sterilization, while others are made of materials—such as rubber—that cannot be fully heated.

"Cleaning was once a basic factory job," said Joe Lewelling, vice president of standards development at the Association for the Advancement of Medical Instrumentation. "Now it's very complex. It takes a lot of steps. It's more like a laboratory process."

At the same time, many hospitals continue to sterilize instruments in "central sterile processing" units, where staff are under pressure to quickly turn over medical equipment, iWatch News reports. In the country's largest hospitals, these units can process as many as 40,000 instruments per day.

Despite recent efforts by the International Association of Healthcare Central Service Materiel Management and various state-level organizations, iWatch News notes that only New Jersey requires equipment sterilization workers to receive certification (Eaton, iWatch News, 2/22).


Diagnosis breakdown? The cancer patients MDs struggle to diagnose

Study finds referral delays for certain cancers, patient groups

February 27, 2012

Physicians are less likely to quickly refer certain cancer patients to the hospital based on cancer types and patient characteristics, highlighting a need for greater investment in diagnostic tools and methods, according to a study in The Lancet Oncology

For the study, British researchers analyzed 2010 National Cancer Patient Experience Survey data for 41,299 patients with one of 24 types of cancer who were treated at 158 U.K. hospitals. Overall, 77% of participants who visited their primary care physician (PCP) with suspicious symptoms were referred to a hospital following only one or two consultations. Meanwhile, 23% of patients reported visiting their PCP at least three times before being referred to a hospital.

Based on the data, the researchers identified referral delays for patients with certain cancers, including Hodgkin's lymphoma, multiple myeloma, and cancers of the stomach, lungs, ovaries, colon, and pancreas. For instance, nearly 51% of patients with blood cancer multiple myeloma required several PCP visits before being referred to a hospital. In comparison, less than 8% of breast cancer patients required several PCP visits.

The study attributed the gap to differences in the nature and characteristics of certain cancers' symptoms. For example, it noted that multiple myeloma mimics the symptoms of other conditions, while breast cancer symptoms more readily suggest cancer.

The researchers also found that female, young, and non-white patients with uncommon cancers were more likely to visit their PCP three or more times before receiving a hospital referral. According to the study, physicians may be less likely to initially consider cancer in young patients and may face communication obstacles when treating patients of different ethnic groups.

According to Cambridge University's Georgios Lyratzopoulos, who led the study, the findings "highlight limitations in current scientific knowledge." He says, "Medical research in recent decades has prioritized improving cancer treatments, but knowledge about the 'symptom signature' of common cancers and practical solutions on how best to diagnose them is still emerging" (Preidt, HealthDay, 2/24; Kearney, Medical News Today, 2/24; McCall, Medscape Medical News, 2/24).


Million-dollar Medicare fraud system flops, halts only one claim

Taxpayer savings amounted to only about $7,000

February 27, 2012

A $77 million computer system designed to stop Medicare fraud before it occurs blocked only one suspicious payment in its first six months of operation.

The single halted payment saved taxpayers $7,591.

The computer system—called the Fraud Prevention System—launched last summer. It was designed to analyze large numbers of Medicare claims, identify potential problems, and issue alerts for suspicious claims so CMS could investigate them before payment.

Lawmakers hoped the system would help prevent the $60 billion in annual Medicare fraud.

Some lawmakers say the low level of halted payments raises questions about the effectiveness of the fraud detection system. However, Medicare officials say that when other benefits of the system are accounted for, potential savings for its first six months of operation could exceed $20 million.

Ted Doolittle—deputy director of Medicare's anti-fraud program—says the system has generated about 2,500 leads and flagged 600 suspicious cases. He adds that some of those cases could become major investigations.

Medicare officials also note that the system only started suspending payments in December 2011 (AP/Washington Post, 2/23; Kennedy/Alonso-Zaldivar, AP/U-T San Diego, 2/23).


Flu season sees latest start in 29 years

Only Calif., Colo., have reported widespread influenza

February 27, 2012

CDC on Friday announced the beginning of the 2012 winter flu season, marking the latest flu season start in about 29 years.

According to the New York Times, a national flu season officially begins when more than 10% of all respiratory specimens reported to CDC contain influenza for three straight weeks. CDC says that 14.4% of specimens last week tested positive, up from 13.4% the week before.

Despite the late start, Joseph Bresee, chief of CDC's epidemiology and prevention branch, says the virus has been reported in all 50 U.S. states. Overall, Bresee notes that this year's strains are "well matched" to the strains covered in the 2011-2012 flu vaccine.

Meanwhile, only California and Colorado have reported widespread influenza so far this season. Far fewer patients have been hospitalized with the flu so far this year, and CDC has confirmed only three pediatric flu deaths. In comparison, 122 children died from the flu last year and 282 died during the 2009-2010 season.

Bresee says the unusually warm winter may have contributed to the mild, late season. The influenza virus survives longer in cold, dry weather, conditions that often prompt people to gather indoors, where they can more easily spread the disease (McNeil, New York Times, 2/24; Pullen, Medscape Medical News, 2/24; Brown, "Booster Shots," Los Angeles Times, 2/24).


Curbing patient harm: Will hospital engagement networks do enough?

KHN examines the HHS program and its targets

February 27, 2012

HHS last year dispatched 26 "hospital engagement networks" to battle patient safety missteps, but experts question whether their safety improvement innovations can effectively reduce deaths and infections.

Participants of the $218 million HEN program, which is part of the Partnership for Patients, are responsible for disseminating proven safety strategies through training programs and technical assistance. The organizations' goal: to prevent more than 60,000 deaths and 1.8 million injuries from hospital-acquired conditions across three years—equivalent to eliminating HIV/AIDS and homicide deaths over the same period.

According to federal estimates, making such improvements to patient care could save up to $35 billion, including up to $10 billion in savings for Medicare. "This is a full-court press unlike anything I've seen in my 10 years of government," says Paul McGann, co-director of the program.

Does the program do enough?
Despite its goals, some safety experts highlight the difficulty of eliminating patient harm. According to Kaiser Health News, a Medicare patient currently has a one-in-seven chance of being harmed in the hospital. In addition, the Office of Inspector General has said that nearly 90% of adverse events never are reported.

Meanwhile, KHN notes that Medicare already denies payment to facilities that fail to meet certain quality goals—offering a significant financial incentive to enhance patient safety—but only about 3,800 of the nation's roughly 5,000 hospitals have joined HENs.

Federal officials stand by program
However, federal officials note that the government is paying HENs—not individual hospitals—to increase collaboration and innovation to meet the Partnership for Patients' goals.

For example, a consortium of academic medical centers is mounting a data analytics infrastructure to share with another HEN, while state and local HENs say they will offer technical expertise through "learning communities" (Millenson, KHN, 2/22).


ACGME to judge doc-training programs based on outcomes

NEJM: New process aims to foster innovation

February 27, 2012

The Accreditation Council for Graduate Medical Education (ACGME) is introducing a new accreditation process for residency programs that focuses on educational outcomes, according to a new report in NEJM.

The new process, called the Next Accreditation System (NAS), will be launched in two phases. The first phase begins in July 2013 and will implement the new system in seven of ACGME's core specialties: diagnostic radiology, emergency medicine, internal medicine, neurologic surgery, orthopedic surgery, pediatrics, and urology. The remaining 19 specialties will adopt the process by July 2014.

According to the authors of the report, a "key element" of the NAS will be reporting residents' milestones. Specifically, residents must demonstrate competency in patient care, medical knowledge, professionalism, and communication, among other metrics.

"Over time, we envision that the NAS will allow the ACGME to create an accreditation system that focuses less on the identification of problems and more on the success of programs and institutions in addressing them," says Thomas Nasca, CEO of ACGME and co-author of the report

Other changes associated with the NAS include:

  • Ongoing data collection and trend analysis;
  • Intermittent site visits to examine residents' learning environment; and
  • Extending the period between accreditation visits from five years to 10 years.

In addition, programs with high-quality outcomes will be afforded more flexibility to explore innovative learning practices. "By encouraging high-performing programs to innovate, the system will open the quality ceiling and produce new learning," the researchers say. "Simultaneously, an ongoing process-based approach for programs with less-than-optimal performance will continue to raise the floor for all programs" (Bankhead, MedPage Today, 2/22; Robeznieks, Modern Healthcare, 2/22 [subscription required]).


Weekly review

Key articles from Feb. 21-Feb. 24

February 27, 2012

Missed a day of the Daily Briefing? Here's a quick round-up of top stories and research highlights from last week’s issues.

HealthGrades lists top hospitals for emergency care (Feb. 21)

HealthGrades on Tuesday released its annual list of the top U.S. hospitals for emergency medicine, noting wide variation in mortality rates for patients admitted through the ED.  

Which hospitals are most likely to meet Stage 1 meaningful use? (Feb. 22)

Hospitals nationwide are striving to achieve Stage 1 meaningful use for electronic health records—but which ones are the most likely to succeed? New data from HIMSS Analytics reveal which hospitals are ahead of the pack. 

How hospitals accommodate Catholic, secular care  (Feb. 22)

The New York Times this week examined the increasing trend of Catholic-secular hospital mergers, highlighting how organizations have changed strategies to accommodate both types of facilities. 

Cleveland Clinic, North Shore-LIJ partner to advance innovation (Feb. 23)

Cleveland Clinic Innovations is collaborating with North Shore-Long Island Jewish Health System for its second innovation partnership, a move that CCI officials say could foreshadow a "national innovation alliance." 

CMS releases meaningful use Stage 2 proposed rule (Feb. 23)

The notice of proposed rulemaking on Stage 2 of meaningful use was released on Feb. 23, opening up a window into the next chapter of CMS's EHR incentive program.

Study names top 25 hospital websites (Feb. 24)

A recent study in the Journal of Healthcare Management names the nation's top 25 hospital websites, but notes that many hospital pages still miss the mark and could be improved.


Daily roundup: Feb. 27, 2012

Bite-sized hospital and health industry news

February 27, 2012

  • Colorado: The state Senate Health and Human Services Committee on Thursday passed a bill (SB 134) that would require hospitals to offer low-income uninsured state residents discounted care and flexible payment plans, the Denver Business Journal reports (Sealover, Denver Business Journal, 2/23).
  • Delaware: The state's not-for-profit hospitals provided $357 million in community benefits in fiscal year 2010, according to a report released last week by the Delaware Healthcare Association. The figure—which represents a 27% increase from 2008—comprises $96 million in uncompensated care, $169.5 million in subsidies for unpaid government health care programs, and $92 million for community health programs (AHA News, 2/23).
  • Minnesota: Rochester-based Mayo Clinic on Thursday announced plans to boost capital project spending to $700 million annually for the next five years. More than 50% of the funds will be applied toward projects already underway, including a proton beam therapy program. However, hospital executives say additional dollars will go toward new projects, such as initiatives that aim to fast-track medical research and technology. For example, Mayo CEO John Noseworthy notes that future spending likely will be directed toward the system's Center for the Science of Health Care Delivery, Center for Individualized Medicine, and Center for Regenerative Medicine (Crosby, Minneapolis Star Tribune, 2/24).
  • Texas: Many university administrators statewide have begun to consider campus-wide smoking bans because of new grant-eligibility rules adopted recently by the state's Cancer Prevention and Research Institute. The rules require grant applicants to have policies that prohibit smoking in and around buildings where their research will be conducted and provide smoking cessation services to their communities (Hamilton, Texas Tribune/New York Times, 2/18).


Prepared to manage chronic patients in the ambulatory setting?

February 27, 2012

Join this complimentary webconference to review a comprehensive approach to patient management and care coordination, highlighting tactics to elevate the performance of multi-disciplinary care teams. More.


Study finds colonoscopy cuts cancer death risk by 53%

Colonoscopies can reduce the risk of dying from colon cancer by about 53%, according to a study published in NEJM.

Although physicians have long thought that the procedure to remove precancerous growths, known as adenomatous polyps, would improve survival rates, independent researchers say this study provides the best evidence that it does.

Researchers at Memorial Sloan-Kettering Cancer Center in New York tracked 2,602 patients who underwent a colonoscopy between 1980 and 1990 and had polyps removed and compared the death rate to that of the general population.

The was observational, but Robert Smith, director of screening at the American Cancer Society, says it is the first direct evidence that removing polyps reduces colon cancer mortality rates (Winslow, Wall Street Journal, 2/23; Change, AP/San Francisco Chronicle, 2/22; Grady, New York Times, 2/22).