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Friday, August 1, 2014

Mistakes were made

From our friends at Healthcare IT News: "EHR rollouts gone wrong"
Athens Regional Health System, Athens, Ga.
Staff and clinicians of the health system had reportedly expressed several concerns over the "aggressive" rollout of its $31 million Cerner EHR, which started beginning of May 2014, according to a report in the Banner-Herald. The report cited a letter sent to CEO James Thaw, signed by more than a dozen clinicians, recounting cases of medication errors, misplaced orders, "emergency department patients leaving after long waits; and of an inpatient who wasn't seen by a physician for (five) days." There was so much criticism toward upper management's handling of the rollout, it reportedly led to the resignation of Thaw and CIO Gretchen Tegethoff. 

Maine Medical Center, Portland, Maine
Four months after the hospital's December 2012 go-live of its $160 million Epic EHR, Maine Medical Center CIO Barry Blumenfeld, MD, was out of a job, and hospital CEO Richard W. Petersen announced a delay in rolling out the EHR to other MaineHealth locations. In an April 2013 letter to employees, he pointed to a $13.4 million operating loss in a six-month period. Part of that loss, he said, came from the launch of the electronic medical record. "The launch of the shared electronic health record has had some unintended financial consequences," he wrote. Much of these consequences stemmed from serious charge capture issues. For starters, for a period of six weeks, caesarian sections were not charged, according to one Maine Medical nurse.

Mountainview Medical Center, White Sulphur Springs, Mt.
In December 2013, the rural Montana hospital filed suit against EHR vendor NextGen Healthcare, alleging the company violated its contract. In September 2012, the six-bed hospital entered into a software agreement with NextGen which stipulated the EHR provider would install a system no later than June 2013, a system which allowed the hospital to meet meaningful use requirements. However, NextGen failed to meet the go-live deadline and subsequently requested a four-month extension to October 2013, the complaint alleges. Moreover, the critical access hospital, after spending more than $441,000 to install the EHR, discovered the EHR system did not meet 2014 MU standards.

Wake Forest Baptist Medical Center, Winston-Salem, N.C.
The Epic EHR implementation at Wake Forest Baptist reportedly was plagued with problems and unforeseen expenses. According to an August 2013 audit report, the Epic EHR resulted in a $55.1 million operating loss for the 2012-2013 fiscal year. The hospital cited $8 million in "other Epic-related implementation expense(s)," according to a Winston-Salem Journal report. The implementation, according to hospital officials, led to "business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity. Sheila Sanders, the chief information officer of the hospital, who was hired in 2009 to implement the EHR stepped down from her post in May 2013 amid the troubled rollout.

Affinity Medical Center, Massillon, Ohio
Citing insufficient training, system shortfalls and the hospital's failure to involve direct-care nurses in the implementation process, RNs at the 266-bed Affinity Medical Center in northern Ohio asked hospital officials to delay rollout of its new Cerner EHR. The 250 direct care nurses, represented by the National Nurses United -- a national RN union, called into question the safety of such a system that prevents registered nurses from overriding the EHR in many cases. NNU Spokesperson Liz Jacobs told Healthcare IT News last June that nurses only received one day of training; she also cited unclear communication over implementation details.

Ventura County Health Care Agency, Thousand Oaks, Calif.
The county-run healthcare system made serious missteps with its EHR implementation -- this according to a grand jury investigation, which concluded the agency neglected to plan, hire and adequately train staff for the switchover. Moreover, the jury report highlighted the fact that the agency had no project manager for the implementation further hindering chance of successful rollout. Ventura had tapped Cerner for a $32 million EHR contract. "User license requirements were underestimated by VCHCA leading to inadequate system capacity -- Cerner later provided additional licenses; training of the staff was insufficient leading to inexperience with components of the EHR early in its implementation," according to the report. | Photo: Ventura County Medical Center, Google 2013

Girard Medical Center, Girard, Kan.
The 35-bed hospital in Girard, Kan. sued its EHR vendor Cerner for violating contract agreements, including quoting inaccurate prices, promised components being dropped and failing to deliver a certified system by the dates stipulated in the original agreement. One component of the system, for example, a microbiology module was quotes at $24,000 but ultimately cost $70,000, according to the lawsuit. The hospital blamed Cerner employees for lacking "basic maturity" and healthcare experience, but Girard had no IT team of its own to supervise the implementation. When sent an email from then hospital CEO Michael Payne that detailed a list of ongoing issues, Cerner officials announced they were going to discontinue their implementation at Girard in September 2011. The hospital had paid some $1.2 million for a system that was never fully implemented. 
Ugh. Big players, these vendors. Cerner appears to be the "winner" here in the "gone wrong" competition.


10 reasons America is morbidly obese
It's not just the fast food: Our country faces a perfect storm of obstacles to living a healthy lifestyle

A popular talking point on the far right is that the United States has such a high standard of living and is so blessed that even its poor are obese. But the exact opposite is true: rampant obesity reflects the country’s decline and underscores the fact that the quality of life is growing worse for much of the U.S. population...
  1. Widespread, Increasing Poverty. Between corporate downsizing, outsourcing of American jobs to developing countries and the economic crash of September 2008, poverty has become much more widespread in the U.S. (where the number of people poor enough to quality for food stamps went from 17 million in 2000 to 47 million in 2013). While it is certainly possible to eat healthy on a budget, it can be challenging—especially when unhealthy processed food is cheap, ubiquitous, convenient and easy to obtain. In a 2013 article for the Washington Post, Eli Saslow took a close look at the relationship between poverty and  obesity in the Rio Grande Valley in Texas: not surprisingly, many of the poor, obese people Saslow interviewed were living on a steady diet of processed foods.
  2. Food deserts. The term food desert refers to a poor area (urban, suburban or rural) with limited access to fresh fruits, whole grains and vegetables; a place where it is much easier to find unhealthy processed foods. In a food desert, a place that sells whole foods might be 10 or 15 miles away while a convenience store or dollar store selling an abundance of processed foods is much closer. Food deserts are plentiful in the U.S.: the United States Department of Agriculture even has an interactive online  map of food deserts, showing that they can be found all over the country. In that type of environment, eating healthy and staying thin requires a lot more time and effort. One of the Rio Grande Valley residents Saslow interviewed for his Washington Post article lived seven miles from the nearest place that sold fresh produce.
  3. Processed Foods Are Omnipresent. Even if Americans who are poor and obese don’t live in a food desert, they may live in an area where frozen corn dogs sold at the local dollar store are more affordable than fresh fruits and vegetables sold in a supermarket. In 2013, NPR ran a segment on  childhood obesity, comparing what healthy and unhealthy food can cost: Central California resident Araceli Flores, a mother of two, noted, “I can buy a box of macaroni and cheese for a dollar. A bunch of bananas—like a good maybe week-and-a-half’s worth of bananas—will cost me over a dollar. Strawberries are four dollars. Apples, a bag of apples, is going to cost me five dollars—way more pricier to buy vegetables and fruits than it is to buy boxed food.”

    Then there’s the time factor: microwaving unhealthy processed food is less time-consuming than cooking a healthy meal from scratch. Many poor Americans are working 50, 60 or more hours a week and are plagued by a lack of free time. Processed foods save them time and money, though they will prove more costly in the long run should they develop heart disease or diabetes.
  4. Not Enough Places to Walk or Exercise. One of the best pieces of advice to give someone who is watching his/her weight is to get out and walk an hour a day. But that is much easier to do in some places than in others. New York City, Philadelphia, Boston and Chicago have the pedestrian-friendly appeal of European cities: it is possible to function without a car. But many Americans live in small towns, suburbs or rural areas that are not pedestrian-friendly, and those places encourage driving rather than walking. That doesn’t mean people who live in the Sun Belt can’t find places to walk, but they have to drive to get to them.
  5. Nonstop Stress. From job insecurity and high unemployment to a dysfunctional health insurance system, life has becoming increasingly stressful in the U.S.—and research shows a strong link between stress and weight gain. People who are under a lot of stress might resort to overeating or binge eating, but that is something they have control over. Stress eating is a learned behavior. However, there is much scientific research indicating that stress can affect a person’s metabolism. So even if one exercises and refrains from overeating, stress can make it easier for a person to gain weight. In 2010, a study conducted at the University of Cincinnati College of Medicine indicated that stress not only had negative short-term results, but could also cause metabolic changes in the long term, making it easier to gain weight and harder to lose it.
  6. Poor Work/Life Balance. According to the 2013 OECD Better Life Index, the U.S. ranks 28th among advanced nations when it comes to work/life balance. Denise Dellarosa Cummins (author of Good Thinking: Seven Powerful Ideas That Influence the Way We Think) has pointed out that obesity is one of the results of Americans’ poor work/life balance. Americans are not only overworked and stressed out, they are consumed by the workplace in a way most Americans of the 1960s and ’70s were not. And the ever-increasing demands of work leave little time for people to take care of themselves and get adequate exercise or rest.
  7. Lack of Universal Healthcare. The Affordable Care Act of 2010 has given millions of previously uninsured Americans access to health insurance. But millions of other Americans remain uninsured, and cut off from things that discourage obesity, such as programs  promoting wealth loss or weight management. The ACA does encourage programs for obesity screening and counseling, although how much is offered can vary from plan to plan. Bottom line: the ACA is a small step in the right direction when it comes to offering overweight Americans access to medical care, but there are still millions of Americans who have weight problems and aren’t getting the attention they need.
  8. High Unemployment and Underemployment. According to the Bureau of Labor Statistics, the U.S. unemployment rate was 6.1% in June. But that figure is misleading because it ignores all of the Americans who have been out of work for so long they have simply vanished from the government’s radar. The Washington Post’s Michael S. Rosenwald and the Huffington Post’s Arthur Delaney have both asserted that there is a major link between  unemployment and obesity. Rosenwald points out that American counties with higher unemployment rates also have higher obesity rates, and Delaney said that unemployment promotes obesity because these days, the unemployed spend so much time online looking for work. Delaney recently told journalist Bill Press: “The only way to get a job is to sit at a computer and fling résumés off. If you pound the pavement and knock on doors, they’ll tell you to get lost and file your application online. So you become chained to a computer when you are laid off.”
  9. Not Enough Sleep. The U.S. was far from perfect in the 1950s, 1960s and ’70s, but overall, the working conditions for most Americans were much better then than they are now—and as more and more Americans find themselves working longer hours and making less money in the 21st century, they also end up sleeping less. In 1960, sleeping an average of 8.5 hours per night was the norm for most Americans; in 2002, less than seven hours per night was the norm. A 2004  University of Chicago study found a link between increased appetite and inadequate sleep. To make matters worse, the study said, lack of sleep encourages cravings for unhealthy snacks.
  10. Powerful Junk Food Lobby. For many years, lobbyists for the tobacco industry enjoyed enormous power on Capitol Hill. But these days, with fewer Americans smoking and big tobacco having shifted its marketing efforts to developing countries, the lobby that’s doing the most to promote poor health may very well be the junk food lobby, which spends millions of dollars trying to influence policy in Washington, DC. Junk food lobbyists went ballistic when First Lady Michelle Obama asserted that schoolchildren should be watching their weight and eating more fresh fruits and vegetables. The food industry has lobbied aggressively to prevent  food stamp benefits from excluding soda, potato chips and other obesity-promoting junk food.
Interesting. Props to I just had my annual "wellness screening" required by my wife's employer (for our insurance discount). At 176, I remain 9 lbs over my high school weight of 50 years ago (BMI 24), my BP and lipids are under control. I just don't eat junk food, period. No soda. Rarely ever have dessert with meals. Moderate meat consumption (little red meat), lotta fruits, vegetables, and grains. And, post-"retirement," my stress level is way down.

I do, however, spend too much time reading and writing. Gotta get back on the bike and in the gym.

More to come...

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