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NY Times: Health Care's Infectious Losses?

Posted Jul 28 2009 12:07am

Books In the July 5, 2009 op-ed story by Paul O'Neill, he says, "What policymakers tend to forget is that only the people who do the work can make this happen. Legislation can’t do it, regulation can’t do it, infection-control committees can’t do it, financial incentives and disincentives can’t do it. But excellence is possible, and it has been demonstrated."

In this NY Times story, he poses the following questions on Health Reform. These appear to be specific "care related" questions to address problems that are usually a function of the available patient information/diagnoses and the actions/interventions taken by health care professionals.

There doesn't seem to be a direct correlation between specific, detailed problems as mentioned below and policy/political reforms, but some of the health care objectives and goals within the "Meaningful Use Matrix" (MU) for EHRs may provide a starting point for discussion.

One of the key Health Outcomes Policy Priorities is to "Improve quality, safety, efficiency, and reduce health disparities." Within this "policy priority", specific objectives for 2011 include (in italics)

    • Which of the reform proposals will eliminate the millions of infections acquired at hospitals every year?

      2011 MU Objectives:Maintain an up-to-date problem list of current and active diagnoses.

        • Which of the proposals will eliminate the annual toll of 300 million medication errors?

          2011 MU Objectives:Maintain an active medication list, including allergies and contraindications, implementation of drug-drug, drug-allergy, drug-formulary checks.

          • Which of the proposals will eliminate pneumonia caused by ventilators?

          2011 MU Objectives:Record and maintain problem list (as described above) including vital signs. Incorporate lab-test results.

          • Which of the proposals will eliminate falls that injure hospital patients?

          2011 MU Objectives:Maintain and generate lists of patients by specific conditions.

          This could include diagnoses or conditions of patients who are at high risk for falls. That said, the Joint Commission has specific requirements for National Patient Safety Goals to address infection control and to prevent these as well as other types of patient safety issues.

          • Which of the proposals will capture even a fraction of the roughly $1 trillion of annual “waste” that is associated with the kinds of process failures that these questions imply?

          Some of the annual "waste" associated with health care delivery is described in the Institute of Medicine (IOM) publications. A video by Dr. Donald Berwick of the Institute for Healthcare Improvement describes wastefulness in healthcare as duplicate tests and/or treatments.

          These problems will require a multi-faceted response. It is not only a policy priority to improve patient safety and care, but it could also be an opportunity to use appropriate technology to capture the rightinformation, for the right patient, at the right time and distribute or make this information available to the right health care professionals that enables preventative actions.

          To summarize, policy is only a first step in taking improvement actions. Actions taken should leverage prior research and knowledge published by these significant and important healthcare organizations. Elimination of the inefficiencies of "paper based health records" and distribution and collaboration between healthcare providers may help to achieve these needed improvements.


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