Richard Quinn

New Society of Hospital Medicine board member Tracy Cardin, ACNP-BC, SFHM, isn’t on the board because she’s a nurse practitioner (NP). But that doesn’t make her election as the first NP or physician assistant (PA) as a voting member of SHM’s oversight panel any less momentous.

“I can’t describe to you how passionately I believe that [NPs and PAs] have a huge role moving forward,” Cardin says. “I think our representation, our visibility, has sort of been flabby and kind of under the wire for a long time. We can really impact the design of care models at the bedside in a way that’s innovative and more efficient and in a way that’s really huge. I think there’s a transformation that’s going to be coming, and we’re going to be a huge part of it.”

Cardin officially started her new position as a board member in March at HM16 in San Diego. She previously—and fittingly—was chair of SHM’s Nurse Practitioner/Physician Assistant Committee. Last year, she received the society’s Award in Excellence in Hospital Medicine for NPs and PAs. She has worked at the University of Chicago for about 10 years.

SHM Past President Robert Harrington Jr., MD, SFHM, who pushed for her inclusion on the board, says that the value of bringing different perspectives to the society’s board can’t be overstated.

“I’m a family medicine–trained hospitalist, and so from firsthand experience, it was important to me before I ever thought about running for the board that there was some representation of our constituency whether that was at the committee level or at the board level,” Dr. Harrington says. “I think that is part of what drew me to seek a higher voice within SHM. … I thought it was important that somebody represent those growing constituencies.”

Dr. Harrington, who among others refers to SHM as a “big tent organization,” says Cardin’s appointment is evidence of that. He believes that his background in family medicine and her background as an NP show healthcare professionals that SHM is not just a group for doctors.

“It does send a message to the rest of our membership that SHM values those other constituencies and that this is not a physician membership organization but rather a membership organization comprised of people who are interested in improving healthcare for our hospitalized patients,” he says.

In fact, Dr. Harrington says one of the first official actions he took as president was to name Cardin an ex officio member of the board. While that meant she could not vote on issues, her perspective alone helped shape conversations.

“Over the course of the last year, she has proven herself to be exactly what I would have hoped she would be: a voice of an important constituency within our membership,” he says. “And as a result of that, [she] ended up being voted into the board.”

Cardin says the time is perfect for her to bring an added viewpoint to the board. First, the number of NPs and PAs is growing.

“NPs and PAs are such a huge part of all acute-care practices,” says Cardin, a past member of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “The State of Hospital Medicine surveys showed that 83% of hospitalist groups are utilizing NPs and PAs. I think that is going to be reflected not only in hospitalist practices but in all acute-care practices—there is going to be more deployment and integration of NPs and PAs into practice.

“[SHM] is ahead of the curve recognizing that value.”

Second, healthcare is undergoing payment reform unseen since the introduction of Medicare and Medicaid. Technology is revamping bedside manner, care delivery, and everything in between. And quality of care is more important than ever as doctors will be increasingly paid for how well patients get, not for services provided to them.

“NP and PA providers can have a great impact on care design and throughput as well as other contributions in the hospital environment,” she adds.

Cardin says there can’t be too many educated viewpoints on complicated issues that will affect care delivery in the United States for decades to come. And the first NP/PA voice might be, gulp, just what the doctors ordered.

“We’re at a pivotal time for this organization and also for healthcare in general with the shifts in how we’re paid and what we’re paid for and the complexity of electronic medical records and fragmented healthcare and billing and quality metrics—there’s just so many challenges right now,” she says. “It’s just hugely humbling to be a part of that and try to anticipate what direction that we as a society should go into.” TH

Richard Quinn is a freelance writer based in New Jersey.

New Society of Hospital Medicine board member Tracy Cardin, ACNP-BC, SFHM, isn’t on the board because she’s a nurse practitioner (NP). But that doesn’t make her election as the first NP or physician assistant (PA) as a voting member of SHM’s oversight panel any less momentous.

“I can’t describe to you how passionately I believe that [NPs and PAs] have a huge role moving forward,” Cardin says. “I think our representation, our visibility, has sort of been flabby and kind of under the wire for a long time. We can really impact the design of care models at the bedside in a way that’s innovative and more efficient and in a way that’s really huge. I think there’s a transformation that’s going to be coming, and we’re going to be a huge part of it.”

Cardin officially started her new position as a board member in March at HM16 in San Diego. She previously—and fittingly—was chair of SHM’s Nurse Practitioner/Physician Assistant Committee. Last year, she received the society’s Award in Excellence in Hospital Medicine for NPs and PAs. She has worked at the University of Chicago for about 10 years.

SHM Past President Robert Harrington Jr., MD, SFHM, who pushed for her inclusion on the board, says that the value of bringing different perspectives to the society’s board can’t be overstated.

“I’m a family medicine–trained hospitalist, and so from firsthand experience, it was important to me before I ever thought about running for the board that there was some representation of our constituency whether that was at the committee level or at the board level,” Dr. Harrington says. “I think that is part of what drew me to seek a higher voice within SHM. … I thought it was important that somebody represent those growing constituencies.”

Dr. Harrington, who among others refers to SHM as a “big tent organization,” says Cardin’s appointment is evidence of that. He believes that his background in family medicine and her background as an NP show healthcare professionals that SHM is not just a group for doctors.

“It does send a message to the rest of our membership that SHM values those other constituencies and that this is not a physician membership organization but rather a membership organization comprised of people who are interested in improving healthcare for our hospitalized patients,” he says.

In fact, Dr. Harrington says one of the first official actions he took as president was to name Cardin an ex officio member of the board. While that meant she could not vote on issues, her perspective alone helped shape conversations.

“Over the course of the last year, she has proven herself to be exactly what I would have hoped she would be: a voice of an important constituency within our membership,” he says. “And as a result of that, [she] ended up being voted into the board.”

Cardin says the time is perfect for her to bring an added viewpoint to the board. First, the number of NPs and PAs is growing.

“NPs and PAs are such a huge part of all acute-care practices,” says Cardin, a past member of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “The State of Hospital Medicine surveys showed that 83% of hospitalist groups are utilizing NPs and PAs. I think that is going to be reflected not only in hospitalist practices but in all acute-care practices—there is going to be more deployment and integration of NPs and PAs into practice.

“[SHM] is ahead of the curve recognizing that value.”

Second, healthcare is undergoing payment reform unseen since the introduction of Medicare and Medicaid. Technology is revamping bedside manner, care delivery, and everything in between. And quality of care is more important than ever as doctors will be increasingly paid for how well patients get, not for services provided to them.

“NP and PA providers can have a great impact on care design and throughput as well as other contributions in the hospital environment,” she adds.

Cardin says there can’t be too many educated viewpoints on complicated issues that will affect care delivery in the United States for decades to come. And the first NP/PA voice might be, gulp, just what the doctors ordered.

“We’re at a pivotal time for this organization and also for healthcare in general with the shifts in how we’re paid and what we’re paid for and the complexity of electronic medical records and fragmented healthcare and billing and quality metrics—there’s just so many challenges right now,” she says. “It’s just hugely humbling to be a part of that and try to anticipate what direction that we as a society should go into.” TH

Richard Quinn is a freelance writer based in New Jersey.

New Society of Hospital Medicine board member Tracy Cardin, ACNP-BC, SFHM, isn’t on the board because she’s a nurse practitioner (NP). But that doesn’t make her election as the first NP or physician assistant (PA) as a voting member of SHM’s oversight panel any less momentous.

“I can’t describe to you how passionately I believe that [NPs and PAs] have a huge role moving forward,” Cardin says. “I think our representation, our visibility, has sort of been flabby and kind of under the wire for a long time. We can really impact the design of care models at the bedside in a way that’s innovative and more efficient and in a way that’s really huge. I think there’s a transformation that’s going to be coming, and we’re going to be a huge part of it.”

Cardin officially started her new position as a board member in March at HM16 in San Diego. She previously—and fittingly—was chair of SHM’s Nurse Practitioner/Physician Assistant Committee. Last year, she received the society’s Award in Excellence in Hospital Medicine for NPs and PAs. She has worked at the University of Chicago for about 10 years.

SHM Past President Robert Harrington Jr., MD, SFHM, who pushed for her inclusion on the board, says that the value of bringing different perspectives to the society’s board can’t be overstated.

“I’m a family medicine–trained hospitalist, and so from firsthand experience, it was important to me before I ever thought about running for the board that there was some representation of our constituency whether that was at the committee level or at the board level,” Dr. Harrington says. “I think that is part of what drew me to seek a higher voice within SHM. … I thought it was important that somebody represent those growing constituencies.”

Dr. Harrington, who among others refers to SHM as a “big tent organization,” says Cardin’s appointment is evidence of that. He believes that his background in family medicine and her background as an NP show healthcare professionals that SHM is not just a group for doctors.

“It does send a message to the rest of our membership that SHM values those other constituencies and that this is not a physician membership organization but rather a membership organization comprised of people who are interested in improving healthcare for our hospitalized patients,” he says.

In fact, Dr. Harrington says one of the first official actions he took as president was to name Cardin an ex officio member of the board. While that meant she could not vote on issues, her perspective alone helped shape conversations.

“Over the course of the last year, she has proven herself to be exactly what I would have hoped she would be: a voice of an important constituency within our membership,” he says. “And as a result of that, [she] ended up being voted into the board.”

Cardin says the time is perfect for her to bring an added viewpoint to the board. First, the number of NPs and PAs is growing.

“NPs and PAs are such a huge part of all acute-care practices,” says Cardin, a past member of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “The State of Hospital Medicine surveys showed that 83% of hospitalist groups are utilizing NPs and PAs. I think that is going to be reflected not only in hospitalist practices but in all acute-care practices—there is going to be more deployment and integration of NPs and PAs into practice.

“[SHM] is ahead of the curve recognizing that value.”

Second, healthcare is undergoing payment reform unseen since the introduction of Medicare and Medicaid. Technology is revamping bedside manner, care delivery, and everything in between. And quality of care is more important than ever as doctors will be increasingly paid for how well patients get, not for services provided to them.

“NP and PA providers can have a great impact on care design and throughput as well as other contributions in the hospital environment,” she adds.

Cardin says there can’t be too many educated viewpoints on complicated issues that will affect care delivery in the United States for decades to come. And the first NP/PA voice might be, gulp, just what the doctors ordered.

“We’re at a pivotal time for this organization and also for healthcare in general with the shifts in how we’re paid and what we’re paid for and the complexity of electronic medical records and fragmented healthcare and billing and quality metrics—there’s just so many challenges right now,” she says. “It’s just hugely humbling to be a part of that and try to anticipate what direction that we as a society should go into.” TH

Richard Quinn is a freelance writer based in New Jersey.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

SAN DIEGO—Add three more names to the short list of individuals who’ve reached the peak of the specialty. The Master in Hospital Medicine (MHM) designation, introduced in 2010, honors “highly accomplished individuals” who have made major contributions to HM. Twenty-one people have now attained the designation.

Because Eric Howell, MD, MHM, is an introvert by personality and an engineer by training, he knows full well perfection doesn’t exist. But he tries, as evidenced by a résumé that includes being a past SHM president, current SHM board member, perennial faculty member at the society’s annual meeting, and award-winning professor.

“You’re constantly trying to achieve mastery, but no one ever really reaches it,” says Dr. Howell, director of the collaborative inpatient medicine service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore and chief of its Division of Hospital Medicine. “It’s just good to know that at least I’m viewed by others as being worthy … at least I’m on the right track.

“It’s hard as you become more experienced to find ways to assess your performance, and so getting an award like a Masters is incredibly rewarding because it verifies that your colleagues feel like your work to improve is valid and [has] paid off.”

Tina Budnitz, MPH, MHM, doesn’t see her MHM honorarium as hers alone. Sure, the designation is a nod to accomplishments made over 14 years in multiple leadership roles, including as SHM’s chief strategy and development officer. She helped the nascent specialty craft the “Core Competencies in Hospital Medicine,” design the leadership academies, and launch the now well-established Project BOOST. She developed SHM’s mentored implementation program and the SHM strategic communications plan to help guide the society into 2020.

“As the first non-physician to get this award, I am humbled and honored,” she says. “But what’s most important is the statement being made by SHM that hospital medicine will be propelled forward through the contributions of many professionals including, but not only, physicians. That’s such an important message that I want people to hear.”

Budnitz says SHM is not just a group of individuals.

“The entire team is needed to improve healthcare,” she says.

Gregory Maynard, MD, MSc, MHM, has been a clinician, educator, and quality improvement (QI) pioneer. He helped build and lead mentored-implementation programs to improve transitions of care, upgrade glycemic controls, and prevent venous thromboembolism (VTE).

And now, as chief quality officer at the University of California Davis Medical Center in Sacramento, he is a master.

So why does he still feel like the student and not the teacher?

“What I probably feel best about in hospital medicine is the collaborative approach to mentored implementation, these coaching models to educate broad groups,” he says. “When I’ve had an opportunity to try to work with other hospitalists and mentor them in terms of how to survive as a hospital medicine program or how to attack a problem in quality, be it VTE or something else … they end up teaching me a lot and mentoring me in return.” TH

Richard Quinn is a freelance writer in New Jersey.

The incident that perhaps most fully impressed the potential dangers of electronic health records (EHRs) on hospitalist pioneer Robert Wachter, MD, MHM, came two years ago. It started, innocently and well-intentioned enough, years earlier with the installation of EHR systems at the University of California at San Francisco (UCSF). Flash-forward to 2013 and a 16-year-old boy’s admission to UCSF’s Benioff Children’s Hospital for a routine colonoscopy related to his NEMO deficiency syndrome, a rare genetic disease that affects the bowels. For his nightly medications that evening, the boy was supposed to take a single dose of Septra, a common antibiotic that hospitalists and internists across the nation routinely prescribe for urinary and skin infections.

But this boy took 38.5 doses, one pill at a time.

How could that possibly happen? Hospitalists might rightly ask.

Because the EHR told everyone involved that’s what the dose should be. So every physician, pharmacist, and nurse involved in the boy’s treatment carried out the order to a T, discovering the error only when the teenager later complained of anxiety, mild confusion, and tingling so acute he felt “numb all over.”

In an era when EHR is king, an adverse event such as a 39-fold overdose is just another example of the unintended consequences technology has foisted upon hospitalists and other providers in America’s massive healthcare system. It is the unfortunate underbelly of healthcare’s rapid-fire introduction to EHR, thanks to a flood of federal funding over the past 10 years, Dr. Wachter says.

“Most fields that go digital do so over the course of 10 or 20 years in a very organic way, with the early adopters, the rank and file, and then the laggards,” Dr. Wachter said at SHM’s 2015 annual meeting in Washington, D.C., where he recounted the UCSF overdose in a keynote address. “In that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them. What the federal intervention did was essentially turbocharge the digitization of healthcare.”

And with the relative speed of digitization comes unintended consequences, including:

• Unfriendly user interfaces that stymie and frustrate physicians accustomed to comparatively intuitive smartphones and tablets;
• Limited applicability of EHRs to quality improvement (QI) projects, as the systems are, in essence, first constructed as billing and coding constructs;
• Alert fatigue tied to EHRs and such medical devices as ventilators, blood pressure monitors, and electrocardiograms desensitize physicians to true concerns; and
• The “cut-and-paste” phenomenon of transferring daily notes or other orders that’s only growing as EHRs become more ubiquitous (see “CTRL-C + CTRL-V = DANGER”).

“Health IT [HIT] is not the panacea that many have touted it as, and it’s really a question of a reassessment of where exactly we are right now compared with where we thought we would be,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “I think our endpoint—that we’re going to get to—this is all going to result in better care. But we’re in that middle period of extreme danger right now where we could actually be doing harm to our patients but certainly are frustrating our providers.”

Funding Failure?

HIT’s rapid evolution starts with the creation of the Office of the National Coordinator for Health Information Technology (ONC) in 2004, which began receiving funding in 2009 to the tune of $30 billion to improve health information exchanges between physicians and institutions.

The money “spent in adoption should have been spent in innovation and development and research to show what works and what doesn’t well before you started pushing adoption,” Dr. Rogers says. “But at this stage, we can’t go backward … the plan is in flight, and we have to try to repair it in the air at this point.”

To that end, The Joint Commission in March 2015 issued a Sentinel Event Alert to highlight that the safest use of HIT still needs structural improvement. The Joint Commission analyzed 120 sentinel events (which it defines as unexpected occurrences involving death or serious physical or psychological injury or the risk thereof) that were HIT-related between Jan. 1, 2010, and June 30, 2013. Eighty percent were issues with human-computer interface, workflow and communication, or design or data issues tied to clinical content or decision support.

“As health IT adoption spreads and becomes a critical component of organizational infrastructure, the potential for health IT-related harm will likely increase unless risk-reducing measures are put into place,” the alert stated.

To that end, The Joint Commission recommends:

1. Focusing on creating and maintaining a safety culture;
2. Developing a proactive approach to process improvement that includes assessing patient safety risk; and
3. Enlisting physicians and administrators from multiple disciplines to oversee HIT planning, implementation, and evaluation.

Terry Edwards, chief executive officer of PerfectServe, a Knoxville, Tenn., firm that works on healthcare communications systems, says that a survey his firm conducted in 2015 found that, among clinicians needing to communicate with an in-house colleague about “complex or in-depth information,” an EHR is used 12% of the time. Just 8% of hospitalists surveyed used it. The rest used workarounds, face-to-face conversations, and myriad customized solutions to communicate.

“Workarounds happen all the time in healthcare because many of the tools and technologies impede rather than enhance a clinician’s efficiency,” Edwards says in an email to The Hospitalist. “It’s pretty clear that many physicians are frustrated by EHR technology.”

Backwards Revolution

The natural question around unintended consequences: Why didn’t physicians or others see them coming as EHRs and HIT were burgeoning the past decade? Dr. Rogers says that hospitalists and physicians weren’t involved enough on the front-end design of EHRs.

So instead of systems that have been built to be intuitive to the real-time workflow of hospitalists, nurse practitioners, and physician assistants, the systems are built more for back-office administrative functions, he adds.

“When we have programmers and non-clinical people trying to build products for us, they’re dictating our workflow,” Dr. Rogers says. “In many cases, they don’t understand our workflow, and in many more cases, our workflow differs from the last person or the last hospital they worked at.

“This is where we get into issues around usability.”

Take the overdose patient at UCSF. One wrong number typed into a single field led to the oversize dosage. Safety redundancies built in the system flagged the excessive dosage each time, but at each point, a human decided to keep the dosage at the incorrect size because, essentially, everyone trusted the EHR.

All of those red flags come with their own unintended consequence: alert fatigue.

“When people really get fatigued with all of these alerts, they start to ignore them,” says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. “So now here comes the question: How do we properly set the limit or threshold?”

In the airline industry, alerts are often tiered to give pilots an immediate sense of their importance. But Dr. Kao says the typical EHR interface is not that advanced, an often frustrating trait to younger physicians accustomed to user-friendly iPhones and web applications. The same frustration often is found with the litany of medical devices hospitalists interact with each day.

“Everything is a fundamental question: How do we set up an optimal environment for humans to interact with computers?” Dr. Kao adds. “We are talking about usability. We are talking about optimizing the IT system that blends into people’s daily workflow so they don’t feel disrupted and have to develop a workaround.”

Solutions Wanted

One EHR critic suggests that the proliferation of workarounds could be solved by a moratorium on further implementation and rollout of EHR systems.

“During that moratorium, there needs to be a complete rethinking of roles, i.e., who does what with these systems, and what needs to be severely rethought are the roles of who gets to do what, including data entry,” says Scot Silverstein, a health IT consultant in Philadelphia. “There’s just no way you can make entry of information into complex computer systems rapid with multiple computer screens that have to be navigated through ad infinitum. There’s just no way you can make that anywhere near as efficient, and you can’t make it less distracting and untiring compared to paper.

“I’m advocating not a return to paper but a consideration of where a paper intermediary—such as specialized forms—between clinicians and information system are appropriate.”

Silverstein says that the relatively rushed overlay of computer systems on medicine meant that corporate computing models were simply pushed into healthcare, a world that operates very differently than most other industries. He says that is why adverse events will continue to occur; why The Joint Commission felt the need to issue an alert; and why the ECRI Institute, a quasi-Consumer Reports organization for healthcare, listed “data integrity failures with health information technology systems” atop its Top 10 Patient Safety Concerns for 2014. Other EHR concerns have been on the list the past several years as well.

“The business computing model, which dates back to the days of card-punch tabulators that IBM developed in the 1920s and ’30s, really has a completely wrong model of medicine,” Silverstein adds. “Medicine is not a predictable, controlled, regular environment. It is an environment of emergencies, irregular events, unpredictability, poor boundaries. Every possible thing in the world can and does go wrong.”

Dr. Rogers agrees that HIT is not optimal, but he sees little point in a moratorium or trying to stop whatever positive progress has already occurred.

“The train has left,” he says. The best approach now is twofold.

First, Dr. Rogers urges hospitalists to formalize their HIT duties by seeing if they would qualify to take the exam for board certification in medical informatics, which was created in 2013 by the American Board of Medical Specialties (ABMS). The more hospitalists who are recognized for the work they already do with EHRs, the more they can then use their positions to help lobby their institutions for changes.

Second, Dr. Rogers wants hospitalists to work as much as possible with vendors, other clinical informaticians, and related stakeholders to help improve the existing system as much as possible. In particular, improvements could help EHRs integrate clinical decision support better, which could then serve as the foundation for research and quality improvement.

Dr. Rogers uses VTE prophylaxis as an example. Before digitalization, “we were able to build all those flow diagrams onto a sheet of paper that would have logical branching points.” Now, pull-down menus and long, one-dimensional order sets regiment what can be input, and medical logic is not the primary concern.

Often, EHR providers will say issues are tied to a lack of training.

“When a vendor repeatedly says this is a training issue, I guarantee that there is a design issue that can be improved,” Dr. Rogers says.

Instead, he and others urge third-party vendors be allowed to design programs and software that can help. He likens it to independent application developers building programs for iPhones and Androids, as opposed to firms like Apple saying that only their internally developed applications would be used.

“Apple would be nowhere right now” had they done that, Dr. Rogers says. “What made them successful was creating a marketplace that all of these individuals out there—thousands of people—could start designing innovations and applications that would fit what that population needed, no matter how small that population was.”

He says a single system, applicable across all healthcare settings, would make an “even playing field for third-party vendors.”

“I think we could get there much faster,” he says. “Within a five-year period of time, I think we could solve a lot of these issues that we’re having right now.” TH

Richard Quinn is a freelance writer in New Jersey.

CTRL-C + CTRL-V = DANGER

Cut-and-paste is as basic a technique as there is in word processing. But with electronic health records (EHRs), that simple maneuver is becoming a danger as repetitive orders, outdated diagnoses, and other inaccurate information is just moved forward unwittingly.

“It’s almost ubiquitous in many cases,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “Certainly, almost every note that I see in our EHR has some portion of cut-and-paste in it.”

The phenomenon is one borne of a simple workaround. Much of the daily note input on an admitted patient’s screen is repetitive and time-consuming, says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. So it might seem to make sense to reuse yesterday’s note today.

But if the note called for a test or a treatment, mistakes can happen.

“We are trying to create new note templates that allow extracting discrete data for billing and research purposes,” Dr. Kao says. “We don’t allow [users] to copy easily, but we do try to make it much easier for them to write a note. So they wouldn’t be copying exactly the same notes from yesterday, but in the meantime, they are able to put in some meaningful information each day.”

Put more simply: “When the right things are made easier to do, people tend to do the right thing. And that is our goal.”

Dr. Rogers suggests keeping the dangers of cut-and-paste errors front of mind and, similar to other EHR documentation issues, lobbying for improvements to the system itself.

“Copy-and-paste is our workaround for poorly designed documentation systems,” he adds. “That does not make it right to use it, but the way to eradicate it is to build better systems that allow documentation to become a part of providing care.”

—Richard Quinn

The incident that perhaps most fully impressed the potential dangers of electronic health records (EHRs) on hospitalist pioneer Robert Wachter, MD, MHM, came two years ago. It started, innocently and well-intentioned enough, years earlier with the installation of EHR systems at the University of California at San Francisco (UCSF). Flash-forward to 2013 and a 16-year-old boy’s admission to UCSF’s Benioff Children’s Hospital for a routine colonoscopy related to his NEMO deficiency syndrome, a rare genetic disease that affects the bowels. For his nightly medications that evening, the boy was supposed to take a single dose of Septra, a common antibiotic that hospitalists and internists across the nation routinely prescribe for urinary and skin infections.

But this boy took 38.5 doses, one pill at a time.

How could that possibly happen? Hospitalists might rightly ask.

Because the EHR told everyone involved that’s what the dose should be. So every physician, pharmacist, and nurse involved in the boy’s treatment carried out the order to a T, discovering the error only when the teenager later complained of anxiety, mild confusion, and tingling so acute he felt “numb all over.”

In an era when EHR is king, an adverse event such as a 39-fold overdose is just another example of the unintended consequences technology has foisted upon hospitalists and other providers in America’s massive healthcare system. It is the unfortunate underbelly of healthcare’s rapid-fire introduction to EHR, thanks to a flood of federal funding over the past 10 years, Dr. Wachter says.

“Most fields that go digital do so over the course of 10 or 20 years in a very organic way, with the early adopters, the rank and file, and then the laggards,” Dr. Wachter said at SHM’s 2015 annual meeting in Washington, D.C., where he recounted the UCSF overdose in a keynote address. “In that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them. What the federal intervention did was essentially turbocharge the digitization of healthcare.”

And with the relative speed of digitization comes unintended consequences, including:

• Unfriendly user interfaces that stymie and frustrate physicians accustomed to comparatively intuitive smartphones and tablets;
• Limited applicability of EHRs to quality improvement (QI) projects, as the systems are, in essence, first constructed as billing and coding constructs;
• Alert fatigue tied to EHRs and such medical devices as ventilators, blood pressure monitors, and electrocardiograms desensitize physicians to true concerns; and
• The “cut-and-paste” phenomenon of transferring daily notes or other orders that’s only growing as EHRs become more ubiquitous (see “CTRL-C + CTRL-V = DANGER”).

“Health IT [HIT] is not the panacea that many have touted it as, and it’s really a question of a reassessment of where exactly we are right now compared with where we thought we would be,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “I think our endpoint—that we’re going to get to—this is all going to result in better care. But we’re in that middle period of extreme danger right now where we could actually be doing harm to our patients but certainly are frustrating our providers.”

Funding Failure?

HIT’s rapid evolution starts with the creation of the Office of the National Coordinator for Health Information Technology (ONC) in 2004, which began receiving funding in 2009 to the tune of $30 billion to improve health information exchanges between physicians and institutions.

The money “spent in adoption should have been spent in innovation and development and research to show what works and what doesn’t well before you started pushing adoption,” Dr. Rogers says. “But at this stage, we can’t go backward … the plan is in flight, and we have to try to repair it in the air at this point.”

To that end, The Joint Commission in March 2015 issued a Sentinel Event Alert to highlight that the safest use of HIT still needs structural improvement. The Joint Commission analyzed 120 sentinel events (which it defines as unexpected occurrences involving death or serious physical or psychological injury or the risk thereof) that were HIT-related between Jan. 1, 2010, and June 30, 2013. Eighty percent were issues with human-computer interface, workflow and communication, or design or data issues tied to clinical content or decision support.

“As health IT adoption spreads and becomes a critical component of organizational infrastructure, the potential for health IT-related harm will likely increase unless risk-reducing measures are put into place,” the alert stated.

To that end, The Joint Commission recommends:

1. Focusing on creating and maintaining a safety culture;
2. Developing a proactive approach to process improvement that includes assessing patient safety risk; and
3. Enlisting physicians and administrators from multiple disciplines to oversee HIT planning, implementation, and evaluation.

Terry Edwards, chief executive officer of PerfectServe, a Knoxville, Tenn., firm that works on healthcare communications systems, says that a survey his firm conducted in 2015 found that, among clinicians needing to communicate with an in-house colleague about “complex or in-depth information,” an EHR is used 12% of the time. Just 8% of hospitalists surveyed used it. The rest used workarounds, face-to-face conversations, and myriad customized solutions to communicate.

“Workarounds happen all the time in healthcare because many of the tools and technologies impede rather than enhance a clinician’s efficiency,” Edwards says in an email to The Hospitalist. “It’s pretty clear that many physicians are frustrated by EHR technology.”

Backwards Revolution

The natural question around unintended consequences: Why didn’t physicians or others see them coming as EHRs and HIT were burgeoning the past decade? Dr. Rogers says that hospitalists and physicians weren’t involved enough on the front-end design of EHRs.

So instead of systems that have been built to be intuitive to the real-time workflow of hospitalists, nurse practitioners, and physician assistants, the systems are built more for back-office administrative functions, he adds.

“When we have programmers and non-clinical people trying to build products for us, they’re dictating our workflow,” Dr. Rogers says. “In many cases, they don’t understand our workflow, and in many more cases, our workflow differs from the last person or the last hospital they worked at.

“This is where we get into issues around usability.”

Take the overdose patient at UCSF. One wrong number typed into a single field led to the oversize dosage. Safety redundancies built in the system flagged the excessive dosage each time, but at each point, a human decided to keep the dosage at the incorrect size because, essentially, everyone trusted the EHR.

All of those red flags come with their own unintended consequence: alert fatigue.

“When people really get fatigued with all of these alerts, they start to ignore them,” says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. “So now here comes the question: How do we properly set the limit or threshold?”

In the airline industry, alerts are often tiered to give pilots an immediate sense of their importance. But Dr. Kao says the typical EHR interface is not that advanced, an often frustrating trait to younger physicians accustomed to user-friendly iPhones and web applications. The same frustration often is found with the litany of medical devices hospitalists interact with each day.

“Everything is a fundamental question: How do we set up an optimal environment for humans to interact with computers?” Dr. Kao adds. “We are talking about usability. We are talking about optimizing the IT system that blends into people’s daily workflow so they don’t feel disrupted and have to develop a workaround.”

Solutions Wanted

One EHR critic suggests that the proliferation of workarounds could be solved by a moratorium on further implementation and rollout of EHR systems.

“During that moratorium, there needs to be a complete rethinking of roles, i.e., who does what with these systems, and what needs to be severely rethought are the roles of who gets to do what, including data entry,” says Scot Silverstein, a health IT consultant in Philadelphia. “There’s just no way you can make entry of information into complex computer systems rapid with multiple computer screens that have to be navigated through ad infinitum. There’s just no way you can make that anywhere near as efficient, and you can’t make it less distracting and untiring compared to paper.

“I’m advocating not a return to paper but a consideration of where a paper intermediary—such as specialized forms—between clinicians and information system are appropriate.”

Silverstein says that the relatively rushed overlay of computer systems on medicine meant that corporate computing models were simply pushed into healthcare, a world that operates very differently than most other industries. He says that is why adverse events will continue to occur; why The Joint Commission felt the need to issue an alert; and why the ECRI Institute, a quasi-Consumer Reports organization for healthcare, listed “data integrity failures with health information technology systems” atop its Top 10 Patient Safety Concerns for 2014. Other EHR concerns have been on the list the past several years as well.

“The business computing model, which dates back to the days of card-punch tabulators that IBM developed in the 1920s and ’30s, really has a completely wrong model of medicine,” Silverstein adds. “Medicine is not a predictable, controlled, regular environment. It is an environment of emergencies, irregular events, unpredictability, poor boundaries. Every possible thing in the world can and does go wrong.”

Dr. Rogers agrees that HIT is not optimal, but he sees little point in a moratorium or trying to stop whatever positive progress has already occurred.

“The train has left,” he says. The best approach now is twofold.

First, Dr. Rogers urges hospitalists to formalize their HIT duties by seeing if they would qualify to take the exam for board certification in medical informatics, which was created in 2013 by the American Board of Medical Specialties (ABMS). The more hospitalists who are recognized for the work they already do with EHRs, the more they can then use their positions to help lobby their institutions for changes.

Second, Dr. Rogers wants hospitalists to work as much as possible with vendors, other clinical informaticians, and related stakeholders to help improve the existing system as much as possible. In particular, improvements could help EHRs integrate clinical decision support better, which could then serve as the foundation for research and quality improvement.

Dr. Rogers uses VTE prophylaxis as an example. Before digitalization, “we were able to build all those flow diagrams onto a sheet of paper that would have logical branching points.” Now, pull-down menus and long, one-dimensional order sets regiment what can be input, and medical logic is not the primary concern.

Often, EHR providers will say issues are tied to a lack of training.

“When a vendor repeatedly says this is a training issue, I guarantee that there is a design issue that can be improved,” Dr. Rogers says.

Instead, he and others urge third-party vendors be allowed to design programs and software that can help. He likens it to independent application developers building programs for iPhones and Androids, as opposed to firms like Apple saying that only their internally developed applications would be used.

“Apple would be nowhere right now” had they done that, Dr. Rogers says. “What made them successful was creating a marketplace that all of these individuals out there—thousands of people—could start designing innovations and applications that would fit what that population needed, no matter how small that population was.”

He says a single system, applicable across all healthcare settings, would make an “even playing field for third-party vendors.”

“I think we could get there much faster,” he says. “Within a five-year period of time, I think we could solve a lot of these issues that we’re having right now.” TH

Richard Quinn is a freelance writer in New Jersey.

CTRL-C + CTRL-V = DANGER

Cut-and-paste is as basic a technique as there is in word processing. But with electronic health records (EHRs), that simple maneuver is becoming a danger as repetitive orders, outdated diagnoses, and other inaccurate information is just moved forward unwittingly.

“It’s almost ubiquitous in many cases,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “Certainly, almost every note that I see in our EHR has some portion of cut-and-paste in it.”

The phenomenon is one borne of a simple workaround. Much of the daily note input on an admitted patient’s screen is repetitive and time-consuming, says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. So it might seem to make sense to reuse yesterday’s note today.

But if the note called for a test or a treatment, mistakes can happen.

“We are trying to create new note templates that allow extracting discrete data for billing and research purposes,” Dr. Kao says. “We don’t allow [users] to copy easily, but we do try to make it much easier for them to write a note. So they wouldn’t be copying exactly the same notes from yesterday, but in the meantime, they are able to put in some meaningful information each day.”

Put more simply: “When the right things are made easier to do, people tend to do the right thing. And that is our goal.”

Dr. Rogers suggests keeping the dangers of cut-and-paste errors front of mind and, similar to other EHR documentation issues, lobbying for improvements to the system itself.

“Copy-and-paste is our workaround for poorly designed documentation systems,” he adds. “That does not make it right to use it, but the way to eradicate it is to build better systems that allow documentation to become a part of providing care.”

—Richard Quinn

The incident that perhaps most fully impressed the potential dangers of electronic health records (EHRs) on hospitalist pioneer Robert Wachter, MD, MHM, came two years ago. It started, innocently and well-intentioned enough, years earlier with the installation of EHR systems at the University of California at San Francisco (UCSF). Flash-forward to 2013 and a 16-year-old boy’s admission to UCSF’s Benioff Children’s Hospital for a routine colonoscopy related to his NEMO deficiency syndrome, a rare genetic disease that affects the bowels. For his nightly medications that evening, the boy was supposed to take a single dose of Septra, a common antibiotic that hospitalists and internists across the nation routinely prescribe for urinary and skin infections.

But this boy took 38.5 doses, one pill at a time.

How could that possibly happen? Hospitalists might rightly ask.

Because the EHR told everyone involved that’s what the dose should be. So every physician, pharmacist, and nurse involved in the boy’s treatment carried out the order to a T, discovering the error only when the teenager later complained of anxiety, mild confusion, and tingling so acute he felt “numb all over.”

In an era when EHR is king, an adverse event such as a 39-fold overdose is just another example of the unintended consequences technology has foisted upon hospitalists and other providers in America’s massive healthcare system. It is the unfortunate underbelly of healthcare’s rapid-fire introduction to EHR, thanks to a flood of federal funding over the past 10 years, Dr. Wachter says.

“Most fields that go digital do so over the course of 10 or 20 years in a very organic way, with the early adopters, the rank and file, and then the laggards,” Dr. Wachter said at SHM’s 2015 annual meeting in Washington, D.C., where he recounted the UCSF overdose in a keynote address. “In that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them. What the federal intervention did was essentially turbocharge the digitization of healthcare.”

And with the relative speed of digitization comes unintended consequences, including:

• Unfriendly user interfaces that stymie and frustrate physicians accustomed to comparatively intuitive smartphones and tablets;
• Limited applicability of EHRs to quality improvement (QI) projects, as the systems are, in essence, first constructed as billing and coding constructs;
• Alert fatigue tied to EHRs and such medical devices as ventilators, blood pressure monitors, and electrocardiograms desensitize physicians to true concerns; and
• The “cut-and-paste” phenomenon of transferring daily notes or other orders that’s only growing as EHRs become more ubiquitous (see “CTRL-C + CTRL-V = DANGER”).

“Health IT [HIT] is not the panacea that many have touted it as, and it’s really a question of a reassessment of where exactly we are right now compared with where we thought we would be,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “I think our endpoint—that we’re going to get to—this is all going to result in better care. But we’re in that middle period of extreme danger right now where we could actually be doing harm to our patients but certainly are frustrating our providers.”

Funding Failure?

HIT’s rapid evolution starts with the creation of the Office of the National Coordinator for Health Information Technology (ONC) in 2004, which began receiving funding in 2009 to the tune of $30 billion to improve health information exchanges between physicians and institutions.

The money “spent in adoption should have been spent in innovation and development and research to show what works and what doesn’t well before you started pushing adoption,” Dr. Rogers says. “But at this stage, we can’t go backward … the plan is in flight, and we have to try to repair it in the air at this point.”

To that end, The Joint Commission in March 2015 issued a Sentinel Event Alert to highlight that the safest use of HIT still needs structural improvement. The Joint Commission analyzed 120 sentinel events (which it defines as unexpected occurrences involving death or serious physical or psychological injury or the risk thereof) that were HIT-related between Jan. 1, 2010, and June 30, 2013. Eighty percent were issues with human-computer interface, workflow and communication, or design or data issues tied to clinical content or decision support.

“As health IT adoption spreads and becomes a critical component of organizational infrastructure, the potential for health IT-related harm will likely increase unless risk-reducing measures are put into place,” the alert stated.

To that end, The Joint Commission recommends:

1. Focusing on creating and maintaining a safety culture;
2. Developing a proactive approach to process improvement that includes assessing patient safety risk; and
3. Enlisting physicians and administrators from multiple disciplines to oversee HIT planning, implementation, and evaluation.

Terry Edwards, chief executive officer of PerfectServe, a Knoxville, Tenn., firm that works on healthcare communications systems, says that a survey his firm conducted in 2015 found that, among clinicians needing to communicate with an in-house colleague about “complex or in-depth information,” an EHR is used 12% of the time. Just 8% of hospitalists surveyed used it. The rest used workarounds, face-to-face conversations, and myriad customized solutions to communicate.

“Workarounds happen all the time in healthcare because many of the tools and technologies impede rather than enhance a clinician’s efficiency,” Edwards says in an email to The Hospitalist. “It’s pretty clear that many physicians are frustrated by EHR technology.”

Backwards Revolution

The natural question around unintended consequences: Why didn’t physicians or others see them coming as EHRs and HIT were burgeoning the past decade? Dr. Rogers says that hospitalists and physicians weren’t involved enough on the front-end design of EHRs.

So instead of systems that have been built to be intuitive to the real-time workflow of hospitalists, nurse practitioners, and physician assistants, the systems are built more for back-office administrative functions, he adds.

“When we have programmers and non-clinical people trying to build products for us, they’re dictating our workflow,” Dr. Rogers says. “In many cases, they don’t understand our workflow, and in many more cases, our workflow differs from the last person or the last hospital they worked at.

“This is where we get into issues around usability.”

Take the overdose patient at UCSF. One wrong number typed into a single field led to the oversize dosage. Safety redundancies built in the system flagged the excessive dosage each time, but at each point, a human decided to keep the dosage at the incorrect size because, essentially, everyone trusted the EHR.

All of those red flags come with their own unintended consequence: alert fatigue.

“When people really get fatigued with all of these alerts, they start to ignore them,” says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. “So now here comes the question: How do we properly set the limit or threshold?”

In the airline industry, alerts are often tiered to give pilots an immediate sense of their importance. But Dr. Kao says the typical EHR interface is not that advanced, an often frustrating trait to younger physicians accustomed to user-friendly iPhones and web applications. The same frustration often is found with the litany of medical devices hospitalists interact with each day.

“Everything is a fundamental question: How do we set up an optimal environment for humans to interact with computers?” Dr. Kao adds. “We are talking about usability. We are talking about optimizing the IT system that blends into people’s daily workflow so they don’t feel disrupted and have to develop a workaround.”

Solutions Wanted

One EHR critic suggests that the proliferation of workarounds could be solved by a moratorium on further implementation and rollout of EHR systems.

“During that moratorium, there needs to be a complete rethinking of roles, i.e., who does what with these systems, and what needs to be severely rethought are the roles of who gets to do what, including data entry,” says Scot Silverstein, a health IT consultant in Philadelphia. “There’s just no way you can make entry of information into complex computer systems rapid with multiple computer screens that have to be navigated through ad infinitum. There’s just no way you can make that anywhere near as efficient, and you can’t make it less distracting and untiring compared to paper.

“I’m advocating not a return to paper but a consideration of where a paper intermediary—such as specialized forms—between clinicians and information system are appropriate.”

Silverstein says that the relatively rushed overlay of computer systems on medicine meant that corporate computing models were simply pushed into healthcare, a world that operates very differently than most other industries. He says that is why adverse events will continue to occur; why The Joint Commission felt the need to issue an alert; and why the ECRI Institute, a quasi-Consumer Reports organization for healthcare, listed “data integrity failures with health information technology systems” atop its Top 10 Patient Safety Concerns for 2014. Other EHR concerns have been on the list the past several years as well.

“The business computing model, which dates back to the days of card-punch tabulators that IBM developed in the 1920s and ’30s, really has a completely wrong model of medicine,” Silverstein adds. “Medicine is not a predictable, controlled, regular environment. It is an environment of emergencies, irregular events, unpredictability, poor boundaries. Every possible thing in the world can and does go wrong.”

Dr. Rogers agrees that HIT is not optimal, but he sees little point in a moratorium or trying to stop whatever positive progress has already occurred.

“The train has left,” he says. The best approach now is twofold.

First, Dr. Rogers urges hospitalists to formalize their HIT duties by seeing if they would qualify to take the exam for board certification in medical informatics, which was created in 2013 by the American Board of Medical Specialties (ABMS). The more hospitalists who are recognized for the work they already do with EHRs, the more they can then use their positions to help lobby their institutions for changes.

Second, Dr. Rogers wants hospitalists to work as much as possible with vendors, other clinical informaticians, and related stakeholders to help improve the existing system as much as possible. In particular, improvements could help EHRs integrate clinical decision support better, which could then serve as the foundation for research and quality improvement.

Dr. Rogers uses VTE prophylaxis as an example. Before digitalization, “we were able to build all those flow diagrams onto a sheet of paper that would have logical branching points.” Now, pull-down menus and long, one-dimensional order sets regiment what can be input, and medical logic is not the primary concern.

Often, EHR providers will say issues are tied to a lack of training.

“When a vendor repeatedly says this is a training issue, I guarantee that there is a design issue that can be improved,” Dr. Rogers says.

Instead, he and others urge third-party vendors be allowed to design programs and software that can help. He likens it to independent application developers building programs for iPhones and Androids, as opposed to firms like Apple saying that only their internally developed applications would be used.

“Apple would be nowhere right now” had they done that, Dr. Rogers says. “What made them successful was creating a marketplace that all of these individuals out there—thousands of people—could start designing innovations and applications that would fit what that population needed, no matter how small that population was.”

He says a single system, applicable across all healthcare settings, would make an “even playing field for third-party vendors.”

“I think we could get there much faster,” he says. “Within a five-year period of time, I think we could solve a lot of these issues that we’re having right now.” TH

Richard Quinn is a freelance writer in New Jersey.

CTRL-C + CTRL-V = DANGER

Cut-and-paste is as basic a technique as there is in word processing. But with electronic health records (EHRs), that simple maneuver is becoming a danger as repetitive orders, outdated diagnoses, and other inaccurate information is just moved forward unwittingly.

“It’s almost ubiquitous in many cases,” says Kendall Rogers, MD, CPE, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque and chair of SHM’s Information Technology Committee. “Certainly, almost every note that I see in our EHR has some portion of cut-and-paste in it.”

The phenomenon is one borne of a simple workaround. Much of the daily note input on an admitted patient’s screen is repetitive and time-consuming, says hospitalist Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine. So it might seem to make sense to reuse yesterday’s note today.

But if the note called for a test or a treatment, mistakes can happen.

“We are trying to create new note templates that allow extracting discrete data for billing and research purposes,” Dr. Kao says. “We don’t allow [users] to copy easily, but we do try to make it much easier for them to write a note. So they wouldn’t be copying exactly the same notes from yesterday, but in the meantime, they are able to put in some meaningful information each day.”

Put more simply: “When the right things are made easier to do, people tend to do the right thing. And that is our goal.”

Dr. Rogers suggests keeping the dangers of cut-and-paste errors front of mind and, similar to other EHR documentation issues, lobbying for improvements to the system itself.

“Copy-and-paste is our workaround for poorly designed documentation systems,” he adds. “That does not make it right to use it, but the way to eradicate it is to build better systems that allow documentation to become a part of providing care.”

—Richard Quinn

Spending on care of hospitalized patients is expected to pass $1 trillion in 2015, a new high. Thomas Selden, PhD, of the Agency for Healthcare Research and Quality recently asked where that money is likely to go. The answer: private insurers.

Dr. Selden and his colleagues report in Health Affairs this month that in 2012, private insurers’ payment rates for inpatient hospital stays were approximately 75% greater than Medicare’s payment rates, a sharp increase from the differential of approximately 10% percent during the period of 1996 to 2001. “We need to understand who’s paying what,” Dr. Selden says. “It’s the first step to a better understanding of public policy.”

The report found that “the predicted percentage difference between the rates of private insurers and those of Medicare has increased substantially over time.” In 1996, private insurers paid 106.1% of Medicare payment rates, a payment rate difference of 6.1% (95% CI: -3.2, 15.5). The difference climbed to 64.1% (95% CI: 48.3, 80.0) in 2011 and 75.3% (95% CI: 52.0, 98.6) in 2012. Medicaid payment rates averaged approximately 90% of Medicare payment rates throughout the study period.

Dr. Selden is hopeful that stakeholders will use the data his team collected to determine the impetus for the widening gap. He also plans to research whether payment differences affect quality metrics.

“Anytime you’re talking about a trillion dollars, it’s really important when a payment difference opens up of this magnitude,” he adds. “The difference is real … what the policy implications are is for the policy makers to decide.” TH

Visit our website for more information on healthcare payment models.

Spending on care of hospitalized patients is expected to pass $1 trillion in 2015, a new high. Thomas Selden, PhD, of the Agency for Healthcare Research and Quality recently asked where that money is likely to go. The answer: private insurers.

Dr. Selden and his colleagues report in Health Affairs this month that in 2012, private insurers’ payment rates for inpatient hospital stays were approximately 75% greater than Medicare’s payment rates, a sharp increase from the differential of approximately 10% percent during the period of 1996 to 2001. “We need to understand who’s paying what,” Dr. Selden says. “It’s the first step to a better understanding of public policy.”

The report found that “the predicted percentage difference between the rates of private insurers and those of Medicare has increased substantially over time.” In 1996, private insurers paid 106.1% of Medicare payment rates, a payment rate difference of 6.1% (95% CI: -3.2, 15.5). The difference climbed to 64.1% (95% CI: 48.3, 80.0) in 2011 and 75.3% (95% CI: 52.0, 98.6) in 2012. Medicaid payment rates averaged approximately 90% of Medicare payment rates throughout the study period.

Dr. Selden is hopeful that stakeholders will use the data his team collected to determine the impetus for the widening gap. He also plans to research whether payment differences affect quality metrics.

“Anytime you’re talking about a trillion dollars, it’s really important when a payment difference opens up of this magnitude,” he adds. “The difference is real … what the policy implications are is for the policy makers to decide.” TH

Visit our website for more information on healthcare payment models.

Spending on care of hospitalized patients is expected to pass $1 trillion in 2015, a new high. Thomas Selden, PhD, of the Agency for Healthcare Research and Quality recently asked where that money is likely to go. The answer: private insurers.

Dr. Selden and his colleagues report in Health Affairs this month that in 2012, private insurers’ payment rates for inpatient hospital stays were approximately 75% greater than Medicare’s payment rates, a sharp increase from the differential of approximately 10% percent during the period of 1996 to 2001. “We need to understand who’s paying what,” Dr. Selden says. “It’s the first step to a better understanding of public policy.”

The report found that “the predicted percentage difference between the rates of private insurers and those of Medicare has increased substantially over time.” In 1996, private insurers paid 106.1% of Medicare payment rates, a payment rate difference of 6.1% (95% CI: -3.2, 15.5). The difference climbed to 64.1% (95% CI: 48.3, 80.0) in 2011 and 75.3% (95% CI: 52.0, 98.6) in 2012. Medicaid payment rates averaged approximately 90% of Medicare payment rates throughout the study period.

Dr. Selden is hopeful that stakeholders will use the data his team collected to determine the impetus for the widening gap. He also plans to research whether payment differences affect quality metrics.

“Anytime you’re talking about a trillion dollars, it’s really important when a payment difference opens up of this magnitude,” he adds. “The difference is real … what the policy implications are is for the policy makers to decide.” TH

Visit our website for more information on healthcare payment models.

James Merlino, MD, president and CMO of Press Ganey's strategic consulting division, wants to convince physicians around the country that hospital medicine is good healthcare as a whole.

“[Hospitalists] are the holistic scorekeepers for a variety of medical conditions that a lot of physicians don’t understand and don’t treat very well,” says Dr. Merlino, whose company supports healthcare providers in improving the patient experience. “We know that when their model is allowed to foster, quality improves [and] safety improves. It’s a model that needs to be embraced so we can deliver better care for patients.”

Dr. Merlino recently talked with The Hospitalist:

Question: You say you’ve seen some specialists and primary care physicians disrespect hospitalists. Why do you believe that occurs?

Answer: It’s a relatively new model, and physicians who have patients in the hospital, nonhospitalists, don’t like to give up the autonomy and the control they feel they have or the responsibility they have to care for patients. The hospitalist model challenges that.

Q: How does healthcare develop a culture that prizes hospitalists and encourages teamwork?

A: Number one, people have to call it out and talk about it. What surprised me in one hospital I visited was [that] the hospitalists did not elevate the issue to leadership. The second thing that relates to changing physician culture is accountability of leadership. When medical staff leaders find out about this type of behavior, it must be addressed.

Q: Why does the challenge persist?

A: It’s leaders stepping up and holding people accountable for their actions. Leaders sometimes have a tendency to ignore behavior problems. When issues like lack of professionalism are identified, then medical leadership really needs to step in and deal with the individuals who are creating the problem. That is a gap in healthcare.

Q: What stops leaders from being accountable?

A: The problem is that physician leaders and other leaders tend to shy away from controversial problems. Pushing into a medical staff issue like this is complicated and difficult. Physicians are the engines of your organization. Leaders are working very hard to keep the medical staff in a steady state … and often there’s a reluctance to push into behavioral problems. TH

Visit our website for more information on multidisciplinary care.

James Merlino, MD, president and CMO of Press Ganey's strategic consulting division, wants to convince physicians around the country that hospital medicine is good healthcare as a whole.

“[Hospitalists] are the holistic scorekeepers for a variety of medical conditions that a lot of physicians don’t understand and don’t treat very well,” says Dr. Merlino, whose company supports healthcare providers in improving the patient experience. “We know that when their model is allowed to foster, quality improves [and] safety improves. It’s a model that needs to be embraced so we can deliver better care for patients.”

Dr. Merlino recently talked with The Hospitalist:

Question: You say you’ve seen some specialists and primary care physicians disrespect hospitalists. Why do you believe that occurs?

Answer: It’s a relatively new model, and physicians who have patients in the hospital, nonhospitalists, don’t like to give up the autonomy and the control they feel they have or the responsibility they have to care for patients. The hospitalist model challenges that.

Q: How does healthcare develop a culture that prizes hospitalists and encourages teamwork?

A: Number one, people have to call it out and talk about it. What surprised me in one hospital I visited was [that] the hospitalists did not elevate the issue to leadership. The second thing that relates to changing physician culture is accountability of leadership. When medical staff leaders find out about this type of behavior, it must be addressed.

Q: Why does the challenge persist?

A: It’s leaders stepping up and holding people accountable for their actions. Leaders sometimes have a tendency to ignore behavior problems. When issues like lack of professionalism are identified, then medical leadership really needs to step in and deal with the individuals who are creating the problem. That is a gap in healthcare.

Q: What stops leaders from being accountable?

A: The problem is that physician leaders and other leaders tend to shy away from controversial problems. Pushing into a medical staff issue like this is complicated and difficult. Physicians are the engines of your organization. Leaders are working very hard to keep the medical staff in a steady state … and often there’s a reluctance to push into behavioral problems. TH

Visit our website for more information on multidisciplinary care.

James Merlino, MD, president and CMO of Press Ganey's strategic consulting division, wants to convince physicians around the country that hospital medicine is good healthcare as a whole.

“[Hospitalists] are the holistic scorekeepers for a variety of medical conditions that a lot of physicians don’t understand and don’t treat very well,” says Dr. Merlino, whose company supports healthcare providers in improving the patient experience. “We know that when their model is allowed to foster, quality improves [and] safety improves. It’s a model that needs to be embraced so we can deliver better care for patients.”

Dr. Merlino recently talked with The Hospitalist:

Question: You say you’ve seen some specialists and primary care physicians disrespect hospitalists. Why do you believe that occurs?

Answer: It’s a relatively new model, and physicians who have patients in the hospital, nonhospitalists, don’t like to give up the autonomy and the control they feel they have or the responsibility they have to care for patients. The hospitalist model challenges that.

Q: How does healthcare develop a culture that prizes hospitalists and encourages teamwork?

A: Number one, people have to call it out and talk about it. What surprised me in one hospital I visited was [that] the hospitalists did not elevate the issue to leadership. The second thing that relates to changing physician culture is accountability of leadership. When medical staff leaders find out about this type of behavior, it must be addressed.

Q: Why does the challenge persist?

A: It’s leaders stepping up and holding people accountable for their actions. Leaders sometimes have a tendency to ignore behavior problems. When issues like lack of professionalism are identified, then medical leadership really needs to step in and deal with the individuals who are creating the problem. That is a gap in healthcare.

Q: What stops leaders from being accountable?

A: The problem is that physician leaders and other leaders tend to shy away from controversial problems. Pushing into a medical staff issue like this is complicated and difficult. Physicians are the engines of your organization. Leaders are working very hard to keep the medical staff in a steady state … and often there’s a reluctance to push into behavioral problems. TH

Visit our website for more information on multidisciplinary care.

From 2003 to 2007, Joshua LaBrin, MD, FACP, SFHM, completed his residency in the University of Pittsburgh’s internal medicine/pediatrics program. In his chief resident year, he began to look at fellowships.

So he started thinking about who he considered role models in medicine.

“And they were the hospitalists,” Dr. LaBrin says. “They were the ones on the wards. I was able to see their compassion for their patients, their ability to teach and mentor residents such as myself.

“Those are the people I looked up to, and that’s who I wanted to be.”

And with that, his career in HM began. A fellowship in the specialty followed at the Mayo Clinic in Rochester, Minn. Then a teaching position there. Then one at Vanderbilt University School of Medicine in Nashville. And last year, he became an academic hospitalist and assistant professor at the University of Utah School of Medicine.

Now, he’s one of seven new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: What got you involved in medicine in the first place?

Answer: I remember my pediatrician … putting me at ease during the visits, and then when I was in high school and had appendicitis and had to go through surgery. ... Each of the physicians caring for me left a different impact and served as an inspiration for me to follow in their footsteps.

Q: What was it about those who treated you that struck a nerve?

A: The fact that they cared for me and were able to either keep me well or get me better. The surgeons helped me through a pretty scary part in my life. [They] treated me as a person, rather than just another patient, even meeting me where I was at at that point. That was the kind of thing that resonated with me, and I wanted to do that for people as well.

Q: Did you have a mentor?

Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. —Dr. LaBrin

A: I had more than one mentor in residency and fellowship where I was able to really learn many lessons from them. And I think among the things that I learned, beyond hospital medicine, was the value of work-life balance. I’ve definitely been able to talk with them, even beyond fellowship, as I have moved and changed positions. That’s something I’ve been able to reflect on regularly. Especially as my family has grown, I continue to communicate with them, so I have always been grateful for their mentorship.

Q: Have you looked to mentor others?

A: That’s one of the things I’ve definitely enjoyed. I have been given opportunities to provide mentorship for new faculty or for residents, and it’s been a humbling experience and it’s been an honor to be able to do that.

Q: In terms of personal satisfaction, what do you enjoy most about your job?

A: I really enjoy working with the trainees, walking with them in their development, seeing them on the wards caring for inpatients and thinking more about issues germane to their patients. Seeing them grow as doctors, as physicians. That’s something I don’t think I’ll ever get tired of doing.

Q: No job is perfect. What do you like least about your job?

A: The most frustrating issue for me is when you are caring for patients and you’re really unable to provide an ideal discharge plan for them due to a financial or technical issue. For example, the three-midnight rule with Medicare sometimes limits you in what you are able to provide for your patients ... so I think that’s probably one of the frustrating things.

Q: What are the biggest changes you’d like to see in the field?

A: One of the big things I have seen over this past year is the whole MOC (Maintenance of Certification) path debate. As nebulous as it has been for internal medicine, in general, I think it is even more so for hospitalists. So having a kind of clear, more practical path for hospitalists would be one of the biggest changes I would like to see. I think the current discussion is healthy. I think it provides a good forum for, hopefully, some positive changes, and I hope that also translates into positive changes for hospitalists as well.

Q: Academic HM can be a real time crunch, between clinical care and classes. How do you balance?

A: Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. Obviously, the goal for me as an educator when I am on the wards is to help the trainees take better care of their patients.

So the more I can find ways to be able to provide great patient care, but do it in a way that also either allows the residents or students to learn to do that themselves or to be able to model that for them, then debrief with them afterwards, the more I can achieve that goal.

I have started to learn there are many different ways to be able to do that. And so being able to go into the day as prepared as you can be, and try to have a good plan in place with also plan B and plan C, if necessary, depending on how the day goes, I think is what has helped me.

From 2003 to 2007, Joshua LaBrin, MD, FACP, SFHM, completed his residency in the University of Pittsburgh’s internal medicine/pediatrics program. In his chief resident year, he began to look at fellowships.

So he started thinking about who he considered role models in medicine.

“And they were the hospitalists,” Dr. LaBrin says. “They were the ones on the wards. I was able to see their compassion for their patients, their ability to teach and mentor residents such as myself.

“Those are the people I looked up to, and that’s who I wanted to be.”

And with that, his career in HM began. A fellowship in the specialty followed at the Mayo Clinic in Rochester, Minn. Then a teaching position there. Then one at Vanderbilt University School of Medicine in Nashville. And last year, he became an academic hospitalist and assistant professor at the University of Utah School of Medicine.

Now, he’s one of seven new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: What got you involved in medicine in the first place?

Answer: I remember my pediatrician … putting me at ease during the visits, and then when I was in high school and had appendicitis and had to go through surgery. ... Each of the physicians caring for me left a different impact and served as an inspiration for me to follow in their footsteps.

Q: What was it about those who treated you that struck a nerve?

A: The fact that they cared for me and were able to either keep me well or get me better. The surgeons helped me through a pretty scary part in my life. [They] treated me as a person, rather than just another patient, even meeting me where I was at at that point. That was the kind of thing that resonated with me, and I wanted to do that for people as well.

Q: Did you have a mentor?

Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. —Dr. LaBrin

A: I had more than one mentor in residency and fellowship where I was able to really learn many lessons from them. And I think among the things that I learned, beyond hospital medicine, was the value of work-life balance. I’ve definitely been able to talk with them, even beyond fellowship, as I have moved and changed positions. That’s something I’ve been able to reflect on regularly. Especially as my family has grown, I continue to communicate with them, so I have always been grateful for their mentorship.

Q: Have you looked to mentor others?

A: That’s one of the things I’ve definitely enjoyed. I have been given opportunities to provide mentorship for new faculty or for residents, and it’s been a humbling experience and it’s been an honor to be able to do that.

Q: In terms of personal satisfaction, what do you enjoy most about your job?

A: I really enjoy working with the trainees, walking with them in their development, seeing them on the wards caring for inpatients and thinking more about issues germane to their patients. Seeing them grow as doctors, as physicians. That’s something I don’t think I’ll ever get tired of doing.

Q: No job is perfect. What do you like least about your job?

A: The most frustrating issue for me is when you are caring for patients and you’re really unable to provide an ideal discharge plan for them due to a financial or technical issue. For example, the three-midnight rule with Medicare sometimes limits you in what you are able to provide for your patients ... so I think that’s probably one of the frustrating things.

Q: What are the biggest changes you’d like to see in the field?

A: One of the big things I have seen over this past year is the whole MOC (Maintenance of Certification) path debate. As nebulous as it has been for internal medicine, in general, I think it is even more so for hospitalists. So having a kind of clear, more practical path for hospitalists would be one of the biggest changes I would like to see. I think the current discussion is healthy. I think it provides a good forum for, hopefully, some positive changes, and I hope that also translates into positive changes for hospitalists as well.

Q: Academic HM can be a real time crunch, between clinical care and classes. How do you balance?

A: Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. Obviously, the goal for me as an educator when I am on the wards is to help the trainees take better care of their patients.

So the more I can find ways to be able to provide great patient care, but do it in a way that also either allows the residents or students to learn to do that themselves or to be able to model that for them, then debrief with them afterwards, the more I can achieve that goal.

I have started to learn there are many different ways to be able to do that. And so being able to go into the day as prepared as you can be, and try to have a good plan in place with also plan B and plan C, if necessary, depending on how the day goes, I think is what has helped me.

From 2003 to 2007, Joshua LaBrin, MD, FACP, SFHM, completed his residency in the University of Pittsburgh’s internal medicine/pediatrics program. In his chief resident year, he began to look at fellowships.

So he started thinking about who he considered role models in medicine.

“And they were the hospitalists,” Dr. LaBrin says. “They were the ones on the wards. I was able to see their compassion for their patients, their ability to teach and mentor residents such as myself.

“Those are the people I looked up to, and that’s who I wanted to be.”

And with that, his career in HM began. A fellowship in the specialty followed at the Mayo Clinic in Rochester, Minn. Then a teaching position there. Then one at Vanderbilt University School of Medicine in Nashville. And last year, he became an academic hospitalist and assistant professor at the University of Utah School of Medicine.

Now, he’s one of seven new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: What got you involved in medicine in the first place?

Answer: I remember my pediatrician … putting me at ease during the visits, and then when I was in high school and had appendicitis and had to go through surgery. ... Each of the physicians caring for me left a different impact and served as an inspiration for me to follow in their footsteps.

Q: What was it about those who treated you that struck a nerve?

A: The fact that they cared for me and were able to either keep me well or get me better. The surgeons helped me through a pretty scary part in my life. [They] treated me as a person, rather than just another patient, even meeting me where I was at at that point. That was the kind of thing that resonated with me, and I wanted to do that for people as well.

Q: Did you have a mentor?

Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. —Dr. LaBrin

A: I had more than one mentor in residency and fellowship where I was able to really learn many lessons from them. And I think among the things that I learned, beyond hospital medicine, was the value of work-life balance. I’ve definitely been able to talk with them, even beyond fellowship, as I have moved and changed positions. That’s something I’ve been able to reflect on regularly. Especially as my family has grown, I continue to communicate with them, so I have always been grateful for their mentorship.

Q: Have you looked to mentor others?

A: That’s one of the things I’ve definitely enjoyed. I have been given opportunities to provide mentorship for new faculty or for residents, and it’s been a humbling experience and it’s been an honor to be able to do that.

Q: In terms of personal satisfaction, what do you enjoy most about your job?

A: I really enjoy working with the trainees, walking with them in their development, seeing them on the wards caring for inpatients and thinking more about issues germane to their patients. Seeing them grow as doctors, as physicians. That’s something I don’t think I’ll ever get tired of doing.

Q: No job is perfect. What do you like least about your job?

A: The most frustrating issue for me is when you are caring for patients and you’re really unable to provide an ideal discharge plan for them due to a financial or technical issue. For example, the three-midnight rule with Medicare sometimes limits you in what you are able to provide for your patients ... so I think that’s probably one of the frustrating things.

Q: What are the biggest changes you’d like to see in the field?

A: One of the big things I have seen over this past year is the whole MOC (Maintenance of Certification) path debate. As nebulous as it has been for internal medicine, in general, I think it is even more so for hospitalists. So having a kind of clear, more practical path for hospitalists would be one of the biggest changes I would like to see. I think the current discussion is healthy. I think it provides a good forum for, hopefully, some positive changes, and I hope that also translates into positive changes for hospitalists as well.

Q: Academic HM can be a real time crunch, between clinical care and classes. How do you balance?

A: Balancing patient care with teaching is one of the big struggles that educators find nowadays, and I think you have to get creative. Obviously, the goal for me as an educator when I am on the wards is to help the trainees take better care of their patients.

So the more I can find ways to be able to provide great patient care, but do it in a way that also either allows the residents or students to learn to do that themselves or to be able to model that for them, then debrief with them afterwards, the more I can achieve that goal.

I have started to learn there are many different ways to be able to do that. And so being able to go into the day as prepared as you can be, and try to have a good plan in place with also plan B and plan C, if necessary, depending on how the day goes, I think is what has helped me.

A recent patient satisfaction survey that ranked nursing care as the most important factor within inpatient pediatric care settings comes as no surprise to the chair of SHM’s Nurse Practitioner/Physician Assistant Committee.

Published online last month in the American Journal of Medical Quality, the retrospective study found that patient satisfaction for pediatric care varies widely depending on “which departmental setting patients receive treatment within a healthcare system,” study authors noted.

“Communication is one of the most important things,” says committee chair Tracy Cardin, ACNP-BC, FHM. “And nursing is sort of our designee sometimes in the communication of the plan of care. You can go over something with a patient and the family for a minute or so, or five, or even 10. But, really, it’s the nurses who reinforce the message.”

For the study, researchers at Nemours/Alfred I. duPont Hospital for Children in Delaware reviewed more than 27,000 patient satisfaction survey results over a three-year period at facilities of the Nemours Children’s Health System in the Delaware Valley and Jefferson University Hospitals in Philadelphia. Families rated their satisfaction on a five-point scale for various factors including physician care, nurse care, and personal concern.

The researchers say knowing what kinds of care expectations patients have in different settings, be it the emergency department or an inpatient ward, could help tailor interventions.

Cardin is hopeful that’s true, but she notes that patient satisfaction is a complex issue. A hospitalist could deliver perfect care, but if the patient had a bad experience at the hospital’s front door, the actual care delivery scores may be affected.

“It would be nice if there were just one variable to manipulate,” she says. “There are so many different impacts on [satisfaction]. What do we really have the ability to control?”

View our website for more information on inpatient satisfaction.

A recent patient satisfaction survey that ranked nursing care as the most important factor within inpatient pediatric care settings comes as no surprise to the chair of SHM’s Nurse Practitioner/Physician Assistant Committee.

Published online last month in the American Journal of Medical Quality, the retrospective study found that patient satisfaction for pediatric care varies widely depending on “which departmental setting patients receive treatment within a healthcare system,” study authors noted.

“Communication is one of the most important things,” says committee chair Tracy Cardin, ACNP-BC, FHM. “And nursing is sort of our designee sometimes in the communication of the plan of care. You can go over something with a patient and the family for a minute or so, or five, or even 10. But, really, it’s the nurses who reinforce the message.”

For the study, researchers at Nemours/Alfred I. duPont Hospital for Children in Delaware reviewed more than 27,000 patient satisfaction survey results over a three-year period at facilities of the Nemours Children’s Health System in the Delaware Valley and Jefferson University Hospitals in Philadelphia. Families rated their satisfaction on a five-point scale for various factors including physician care, nurse care, and personal concern.

The researchers say knowing what kinds of care expectations patients have in different settings, be it the emergency department or an inpatient ward, could help tailor interventions.

Cardin is hopeful that’s true, but she notes that patient satisfaction is a complex issue. A hospitalist could deliver perfect care, but if the patient had a bad experience at the hospital’s front door, the actual care delivery scores may be affected.

“It would be nice if there were just one variable to manipulate,” she says. “There are so many different impacts on [satisfaction]. What do we really have the ability to control?”

View our website for more information on inpatient satisfaction.

A recent patient satisfaction survey that ranked nursing care as the most important factor within inpatient pediatric care settings comes as no surprise to the chair of SHM’s Nurse Practitioner/Physician Assistant Committee.

Published online last month in the American Journal of Medical Quality, the retrospective study found that patient satisfaction for pediatric care varies widely depending on “which departmental setting patients receive treatment within a healthcare system,” study authors noted.

“Communication is one of the most important things,” says committee chair Tracy Cardin, ACNP-BC, FHM. “And nursing is sort of our designee sometimes in the communication of the plan of care. You can go over something with a patient and the family for a minute or so, or five, or even 10. But, really, it’s the nurses who reinforce the message.”

For the study, researchers at Nemours/Alfred I. duPont Hospital for Children in Delaware reviewed more than 27,000 patient satisfaction survey results over a three-year period at facilities of the Nemours Children’s Health System in the Delaware Valley and Jefferson University Hospitals in Philadelphia. Families rated their satisfaction on a five-point scale for various factors including physician care, nurse care, and personal concern.

The researchers say knowing what kinds of care expectations patients have in different settings, be it the emergency department or an inpatient ward, could help tailor interventions.

Cardin is hopeful that’s true, but she notes that patient satisfaction is a complex issue. A hospitalist could deliver perfect care, but if the patient had a bad experience at the hospital’s front door, the actual care delivery scores may be affected.

“It would be nice if there were just one variable to manipulate,” she says. “There are so many different impacts on [satisfaction]. What do we really have the ability to control?”

View our website for more information on inpatient satisfaction.

David Weidig, MD, was there at the beginning. He was one of the first internal medicine-trained physicians to adopt hospital-based practice. He was one of the first to proudly call himself a hospitalist. And, he was one of the first hospitalists to adapt and prosper as a hospitalist group director.

He graduated from the University of Wisconsin in 1987, completed medical school at Northwestern University in Chicago in 1991, and trained at Cleveland Clinic and Mercy Hospital in San Diego before taking a position with a “traditional” practice in 1995. It wasn’t long before the gravitational forces of hospital medicine pulled him in. He joined a hospitalist group a year later and assumed his first leadership position in 1998, as director of hospital medicine at Pacific Medical Group in Seattle.

“Hospital medicine was a new concept at the time,” he says. “There were only a few of us in the entire city.”

In 2007, he returned to the Midwest, to the HM group at Aurora Health Care, based in Milwaukee, Wis. As system director of hospital medicine at Aurora, he managed academic and community programs throughout the state, many of which are affiliated with his alma mater. When he joined Aurora, it was made up of one HM group and six full-time physicians. Today, it boasts 13 programs and more than 150 providers.

After eight years at Aurora, Dr. Weidig recently joined Tacoma, Wash.-based Sound Physicians. He will serve as director of their Evergreen Region.

During his two decades as a hospitalist, Dr. Weidig has seen massive changes in both the field of hospital medicine and healthcare. He’s witnessed firsthand the growth in the field, the shift to value and performance in healthcare, and the challenges faced by HM groups large and small, urban and rural, academic and community.

Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

—Dr. Weidig

“We have had successes and failures, and we have learned from our efforts,” he says, adding that his biggest professional reward is “having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.”

Dr. Weidig is a longtime SHM member, serving as the SHM Northwest Chapter president from 2005-2007, and currently as a member of SHM’s Multisite Hospitalist Leader Subcommittee. He also is one of seven new members of Team Hospitalist, the volunteer editorial board for The Hospitalist. We chatted with him recently about his interests in hospital medicine and beyond.

Question: Why did you choose a career in medicine?

Answer: Being able to help someone during a serious time of need was a strong initial draw. I was also fascinated by physiology in my undergrad studies, which fit well with the study of medicine.

Q: Was there a single moment you knew “I can do this hospital medicine thing?”

Answer: Honestly, I was a bit put off by the way medical school was taught and some of the attitudes I encountered. It was a much different feel than my undergrad experience, in biochemistry, which I very much enjoyed. I believe it was my fourth-year rotations where I hit a milestone, and a significant increase in confidence about caring for a patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the acute intervention to rapidly [hopefully] effect an improvement in the patient’s symptoms. I also enjoy the systematic, best-practice approach that the field has developed.

Q: What do you dislike most?

A: Poorly managed end-of-life care. I am a strong proponent of proper utilization of palliative care to maximize quality of life and minimize suffering, both for the patient and family members.

Q: What’s the best advice you ever received?

A: Focus and respond with thoughtfulness and empathy. Do not react with emotion.

Q: Did you have a mentor during training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: I had a biochemistry instructor in undergrad who was an all-around high quality individual. I had a great deal of respect for how he treated and interacted with others. I have always tried to emulate it.

Q: What’s the biggest change you’ve seen in HM in your career?

A: I started in the infancy of the field, so everything has changed. Acceptance and understanding of a team-based inpatient approach is possibly one of the biggest.

Q: What’s the biggest change you would like to see in HM?

A: Further understanding and promotion of the benefits of focused management of the inpatient population, as well as the benefits of more intensive transitional care after hospitalization.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: To stay in touch with what patients experience.

Q: What aspect of patient care is most rewarding?

A: An acutely ill patient who responds well to medical intervention and within hours to days is feeling dramatically better.

Q: What aspect of teaching medicine in the 21st century is most difficult? And what is most enjoyable?

A: Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

Q: What is your biggest professional reward?

A: Having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.

Q: What SHM event or meeting has made the most lasting impression on you?

A: I always feel that the annual Society of Hospital Medicine meeting has an amazing wealth of knowledge and experience to gain from.

Q: Where do you see yourself in 10 years?

A: Hopefully, working with quality outcomes and patient experience on a large scale.

Q: If you weren’t a doctor, what would you be doing right now?

A: Likely something in the area of biochemistry/genetics.

Q: When you aren’t working, what is important to you?

A: Family, friends, music, travel.

Q: PC or tablet?

A: Tablet.

Q: What’s the best book you’ve read recently?

A: Thinking Fast and Slow by Daniel Kahneman. It’s very deep and insightful in how we react to situations and make decisions. There are factors that have major effects on decisions that we can be completely unaware of unless we are cognizant of them. It significantly changed my approach to many situations and also applies well to the decision-making process in medicine.

Q: Apple or Android?

A: Apple.

David Weidig, MD, was there at the beginning. He was one of the first internal medicine-trained physicians to adopt hospital-based practice. He was one of the first to proudly call himself a hospitalist. And, he was one of the first hospitalists to adapt and prosper as a hospitalist group director.

He graduated from the University of Wisconsin in 1987, completed medical school at Northwestern University in Chicago in 1991, and trained at Cleveland Clinic and Mercy Hospital in San Diego before taking a position with a “traditional” practice in 1995. It wasn’t long before the gravitational forces of hospital medicine pulled him in. He joined a hospitalist group a year later and assumed his first leadership position in 1998, as director of hospital medicine at Pacific Medical Group in Seattle.

“Hospital medicine was a new concept at the time,” he says. “There were only a few of us in the entire city.”

In 2007, he returned to the Midwest, to the HM group at Aurora Health Care, based in Milwaukee, Wis. As system director of hospital medicine at Aurora, he managed academic and community programs throughout the state, many of which are affiliated with his alma mater. When he joined Aurora, it was made up of one HM group and six full-time physicians. Today, it boasts 13 programs and more than 150 providers.

After eight years at Aurora, Dr. Weidig recently joined Tacoma, Wash.-based Sound Physicians. He will serve as director of their Evergreen Region.

During his two decades as a hospitalist, Dr. Weidig has seen massive changes in both the field of hospital medicine and healthcare. He’s witnessed firsthand the growth in the field, the shift to value and performance in healthcare, and the challenges faced by HM groups large and small, urban and rural, academic and community.

Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

—Dr. Weidig

“We have had successes and failures, and we have learned from our efforts,” he says, adding that his biggest professional reward is “having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.”

Dr. Weidig is a longtime SHM member, serving as the SHM Northwest Chapter president from 2005-2007, and currently as a member of SHM’s Multisite Hospitalist Leader Subcommittee. He also is one of seven new members of Team Hospitalist, the volunteer editorial board for The Hospitalist. We chatted with him recently about his interests in hospital medicine and beyond.

Question: Why did you choose a career in medicine?

Answer: Being able to help someone during a serious time of need was a strong initial draw. I was also fascinated by physiology in my undergrad studies, which fit well with the study of medicine.

Q: Was there a single moment you knew “I can do this hospital medicine thing?”

Answer: Honestly, I was a bit put off by the way medical school was taught and some of the attitudes I encountered. It was a much different feel than my undergrad experience, in biochemistry, which I very much enjoyed. I believe it was my fourth-year rotations where I hit a milestone, and a significant increase in confidence about caring for a patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the acute intervention to rapidly [hopefully] effect an improvement in the patient’s symptoms. I also enjoy the systematic, best-practice approach that the field has developed.

Q: What do you dislike most?

A: Poorly managed end-of-life care. I am a strong proponent of proper utilization of palliative care to maximize quality of life and minimize suffering, both for the patient and family members.

Q: What’s the best advice you ever received?

A: Focus and respond with thoughtfulness and empathy. Do not react with emotion.

Q: Did you have a mentor during training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: I had a biochemistry instructor in undergrad who was an all-around high quality individual. I had a great deal of respect for how he treated and interacted with others. I have always tried to emulate it.

Q: What’s the biggest change you’ve seen in HM in your career?

A: I started in the infancy of the field, so everything has changed. Acceptance and understanding of a team-based inpatient approach is possibly one of the biggest.

Q: What’s the biggest change you would like to see in HM?

A: Further understanding and promotion of the benefits of focused management of the inpatient population, as well as the benefits of more intensive transitional care after hospitalization.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: To stay in touch with what patients experience.

Q: What aspect of patient care is most rewarding?

A: An acutely ill patient who responds well to medical intervention and within hours to days is feeling dramatically better.

Q: What aspect of teaching medicine in the 21st century is most difficult? And what is most enjoyable?

A: Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

Q: What is your biggest professional reward?

A: Having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.

Q: What SHM event or meeting has made the most lasting impression on you?

A: I always feel that the annual Society of Hospital Medicine meeting has an amazing wealth of knowledge and experience to gain from.

Q: Where do you see yourself in 10 years?

A: Hopefully, working with quality outcomes and patient experience on a large scale.

Q: If you weren’t a doctor, what would you be doing right now?

A: Likely something in the area of biochemistry/genetics.

Q: When you aren’t working, what is important to you?

A: Family, friends, music, travel.

Q: PC or tablet?

A: Tablet.

Q: What’s the best book you’ve read recently?

A: Thinking Fast and Slow by Daniel Kahneman. It’s very deep and insightful in how we react to situations and make decisions. There are factors that have major effects on decisions that we can be completely unaware of unless we are cognizant of them. It significantly changed my approach to many situations and also applies well to the decision-making process in medicine.

Q: Apple or Android?

A: Apple.

David Weidig, MD, was there at the beginning. He was one of the first internal medicine-trained physicians to adopt hospital-based practice. He was one of the first to proudly call himself a hospitalist. And, he was one of the first hospitalists to adapt and prosper as a hospitalist group director.

He graduated from the University of Wisconsin in 1987, completed medical school at Northwestern University in Chicago in 1991, and trained at Cleveland Clinic and Mercy Hospital in San Diego before taking a position with a “traditional” practice in 1995. It wasn’t long before the gravitational forces of hospital medicine pulled him in. He joined a hospitalist group a year later and assumed his first leadership position in 1998, as director of hospital medicine at Pacific Medical Group in Seattle.

“Hospital medicine was a new concept at the time,” he says. “There were only a few of us in the entire city.”

In 2007, he returned to the Midwest, to the HM group at Aurora Health Care, based in Milwaukee, Wis. As system director of hospital medicine at Aurora, he managed academic and community programs throughout the state, many of which are affiliated with his alma mater. When he joined Aurora, it was made up of one HM group and six full-time physicians. Today, it boasts 13 programs and more than 150 providers.

After eight years at Aurora, Dr. Weidig recently joined Tacoma, Wash.-based Sound Physicians. He will serve as director of their Evergreen Region.

During his two decades as a hospitalist, Dr. Weidig has seen massive changes in both the field of hospital medicine and healthcare. He’s witnessed firsthand the growth in the field, the shift to value and performance in healthcare, and the challenges faced by HM groups large and small, urban and rural, academic and community.

Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

—Dr. Weidig

“We have had successes and failures, and we have learned from our efforts,” he says, adding that his biggest professional reward is “having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.”

Dr. Weidig is a longtime SHM member, serving as the SHM Northwest Chapter president from 2005-2007, and currently as a member of SHM’s Multisite Hospitalist Leader Subcommittee. He also is one of seven new members of Team Hospitalist, the volunteer editorial board for The Hospitalist. We chatted with him recently about his interests in hospital medicine and beyond.

Question: Why did you choose a career in medicine?

Answer: Being able to help someone during a serious time of need was a strong initial draw. I was also fascinated by physiology in my undergrad studies, which fit well with the study of medicine.

Q: Was there a single moment you knew “I can do this hospital medicine thing?”

Answer: Honestly, I was a bit put off by the way medical school was taught and some of the attitudes I encountered. It was a much different feel than my undergrad experience, in biochemistry, which I very much enjoyed. I believe it was my fourth-year rotations where I hit a milestone, and a significant increase in confidence about caring for a patient.

Q: What do you like most about working as a hospitalist?

A: I enjoy the acute intervention to rapidly [hopefully] effect an improvement in the patient’s symptoms. I also enjoy the systematic, best-practice approach that the field has developed.

Q: What do you dislike most?

A: Poorly managed end-of-life care. I am a strong proponent of proper utilization of palliative care to maximize quality of life and minimize suffering, both for the patient and family members.

Q: What’s the best advice you ever received?

A: Focus and respond with thoughtfulness and empathy. Do not react with emotion.

Q: Did you have a mentor during training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: I had a biochemistry instructor in undergrad who was an all-around high quality individual. I had a great deal of respect for how he treated and interacted with others. I have always tried to emulate it.

Q: What’s the biggest change you’ve seen in HM in your career?

A: I started in the infancy of the field, so everything has changed. Acceptance and understanding of a team-based inpatient approach is possibly one of the biggest.

Q: What’s the biggest change you would like to see in HM?

A: Further understanding and promotion of the benefits of focused management of the inpatient population, as well as the benefits of more intensive transitional care after hospitalization.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: To stay in touch with what patients experience.

Q: What aspect of patient care is most rewarding?

A: An acutely ill patient who responds well to medical intervention and within hours to days is feeling dramatically better.

Q: What aspect of teaching medicine in the 21st century is most difficult? And what is most enjoyable?

A: Most difficult is managing the time to teach around other duties of the day. Most rewarding is teaching the concept of not just medicine, but team organization and leadership within the hospital setting.

Q: What is your biggest professional reward?

A: Having built a large hospital medicine system, along with the camaraderie and respect for the people who I worked with to do it.

Q: What SHM event or meeting has made the most lasting impression on you?

A: I always feel that the annual Society of Hospital Medicine meeting has an amazing wealth of knowledge and experience to gain from.

Q: Where do you see yourself in 10 years?

A: Hopefully, working with quality outcomes and patient experience on a large scale.

Q: If you weren’t a doctor, what would you be doing right now?

A: Likely something in the area of biochemistry/genetics.

Q: When you aren’t working, what is important to you?

A: Family, friends, music, travel.

Q: PC or tablet?

A: Tablet.

Q: What’s the best book you’ve read recently?

A: Thinking Fast and Slow by Daniel Kahneman. It’s very deep and insightful in how we react to situations and make decisions. There are factors that have major effects on decisions that we can be completely unaware of unless we are cognizant of them. It significantly changed my approach to many situations and also applies well to the decision-making process in medicine.

Q: Apple or Android?

A: Apple.

A study in the Journal of the American Medical Informatics Association found that giving hospitalized patients iPads with basic information about their care helped them engage more with physicians.

The patient portal application helped inpatients remember their doctors’ names, the study noted, but had no statistically significant impact on patients’ ability to remember scheduled procedures or active medications.

Hospitalist and lead author Kevin O’Leary, MD, MS, SFHM, of Northwestern University Feinberg School of Medicine in Chicago says the portals can be a way to improve the discharge process.

“We know that patients have a fairly poor comprehension of their care during hospitalization, which doesn’t set them up to do well after discharge,” says Dr. O’Leary, who has studied the potential of portals. “This patient portal has the opportunity to fill in the gaps.”

Although the study didn’t address qualitative issues around why patients didn’t have better recall of information about tests, procedures, or active medications, Dr. O’Leary says future work will address how to tweak portals to improve their efficacy.

“Our study had limited information purposely to just test the concept,” Dr. O’Leary says. “I predict that 10 years from now, this is going to be commonplace. Even five years from now, many hospitals will be offering portal access to inpatients.”

Dr. O’Leary says he believes that using the increasingly ubiquitous technology of smartphones and tablet computers to engage patients creates greater transparency, which could result in better retention of care instructions.

“You’re giving ownership to the patient over information, and it’s much earlier than right at discharge and then a phone call after discharge,” Dr. O’Leary adds. “Why not begin to educate the patient about their condition and their medications from the very first minute of their admission? And give them access to that information and have them identify their own needs and knowledge deficits?”

Visit our website for more information about iPad technology in medical practice.

A study in the Journal of the American Medical Informatics Association found that giving hospitalized patients iPads with basic information about their care helped them engage more with physicians.

The patient portal application helped inpatients remember their doctors’ names, the study noted, but had no statistically significant impact on patients’ ability to remember scheduled procedures or active medications.

Hospitalist and lead author Kevin O’Leary, MD, MS, SFHM, of Northwestern University Feinberg School of Medicine in Chicago says the portals can be a way to improve the discharge process.

“We know that patients have a fairly poor comprehension of their care during hospitalization, which doesn’t set them up to do well after discharge,” says Dr. O’Leary, who has studied the potential of portals. “This patient portal has the opportunity to fill in the gaps.”

Although the study didn’t address qualitative issues around why patients didn’t have better recall of information about tests, procedures, or active medications, Dr. O’Leary says future work will address how to tweak portals to improve their efficacy.

“Our study had limited information purposely to just test the concept,” Dr. O’Leary says. “I predict that 10 years from now, this is going to be commonplace. Even five years from now, many hospitals will be offering portal access to inpatients.”

Dr. O’Leary says he believes that using the increasingly ubiquitous technology of smartphones and tablet computers to engage patients creates greater transparency, which could result in better retention of care instructions.

“You’re giving ownership to the patient over information, and it’s much earlier than right at discharge and then a phone call after discharge,” Dr. O’Leary adds. “Why not begin to educate the patient about their condition and their medications from the very first minute of their admission? And give them access to that information and have them identify their own needs and knowledge deficits?”

Visit our website for more information about iPad technology in medical practice.

A study in the Journal of the American Medical Informatics Association found that giving hospitalized patients iPads with basic information about their care helped them engage more with physicians.

The patient portal application helped inpatients remember their doctors’ names, the study noted, but had no statistically significant impact on patients’ ability to remember scheduled procedures or active medications.

Hospitalist and lead author Kevin O’Leary, MD, MS, SFHM, of Northwestern University Feinberg School of Medicine in Chicago says the portals can be a way to improve the discharge process.

“We know that patients have a fairly poor comprehension of their care during hospitalization, which doesn’t set them up to do well after discharge,” says Dr. O’Leary, who has studied the potential of portals. “This patient portal has the opportunity to fill in the gaps.”

Although the study didn’t address qualitative issues around why patients didn’t have better recall of information about tests, procedures, or active medications, Dr. O’Leary says future work will address how to tweak portals to improve their efficacy.

“Our study had limited information purposely to just test the concept,” Dr. O’Leary says. “I predict that 10 years from now, this is going to be commonplace. Even five years from now, many hospitals will be offering portal access to inpatients.”

Dr. O’Leary says he believes that using the increasingly ubiquitous technology of smartphones and tablet computers to engage patients creates greater transparency, which could result in better retention of care instructions.

“You’re giving ownership to the patient over information, and it’s much earlier than right at discharge and then a phone call after discharge,” Dr. O’Leary adds. “Why not begin to educate the patient about their condition and their medications from the very first minute of their admission? And give them access to that information and have them identify their own needs and knowledge deficits?”

Visit our website for more information about iPad technology in medical practice.

A new study has found that a pharmacist-led intervention featuring three outreach phone calls in the 30-day postdischarge period can help reduce patients' readmissions and ED visits.

Recently published in the Journal of Hospital Medicine, the report found that 39% of patients who received only one postdischarge call at the end of the 30-day time frame were either readmitted to the hospital or visited the ED within 30 days of discharge. By comparison, 24.8% of patients who received three phone calls, at days 3, 14, and 30 postdischarge, had a readmission or ED visit.

"The unique thing about this is we added three postdischarge phone calls," says senior author Michael Postelnick, RPh, BCPS, senior infectious diseases pharmacist at Northwestern Memorial Hospital in Chicago. "Most studies look at one or, at most, two. But we thought of the midpoint of the 30-day period postdischarge as a very hazardous time, a time that would benefit from pharmacist contact to make sure that patients were continuing on their plan and not having any problems."

The research showed that the number of outreach calls in the 30-day postdischarge period did not significantly impact the number of adverse drug events or medication errors reported nor did it affect patients’ knowledge about their medications as measured by Hospital Consumer Assessment of Healthcare Providers and Systems scores.

Postelnick says he thinks a larger study may bear evidence that pharmacist-led interventions can impact those areas, as well. Either way, the research suggests that multiple "touch points" are needed to reinforce postdischarge instructions given at a "very chaotic time," he adds.

"All the [patient] education one does upon discharge, there's likely to be little retention of that," Postelnick adds. "As patients settle more into their usual routine, they become more receptive to learning about what they need to do to ensure that they can maintain their health. Even at 72 hours, they're starting to settle, but by the time you hit the 14-day period, you can have a good discussion with them."

Visit our website for more information on pharmacists and care transitions.

A new study has found that a pharmacist-led intervention featuring three outreach phone calls in the 30-day postdischarge period can help reduce patients' readmissions and ED visits.

Recently published in the Journal of Hospital Medicine, the report found that 39% of patients who received only one postdischarge call at the end of the 30-day time frame were either readmitted to the hospital or visited the ED within 30 days of discharge. By comparison, 24.8% of patients who received three phone calls, at days 3, 14, and 30 postdischarge, had a readmission or ED visit.

"The unique thing about this is we added three postdischarge phone calls," says senior author Michael Postelnick, RPh, BCPS, senior infectious diseases pharmacist at Northwestern Memorial Hospital in Chicago. "Most studies look at one or, at most, two. But we thought of the midpoint of the 30-day period postdischarge as a very hazardous time, a time that would benefit from pharmacist contact to make sure that patients were continuing on their plan and not having any problems."

The research showed that the number of outreach calls in the 30-day postdischarge period did not significantly impact the number of adverse drug events or medication errors reported nor did it affect patients’ knowledge about their medications as measured by Hospital Consumer Assessment of Healthcare Providers and Systems scores.

Postelnick says he thinks a larger study may bear evidence that pharmacist-led interventions can impact those areas, as well. Either way, the research suggests that multiple "touch points" are needed to reinforce postdischarge instructions given at a "very chaotic time," he adds.

"All the [patient] education one does upon discharge, there's likely to be little retention of that," Postelnick adds. "As patients settle more into their usual routine, they become more receptive to learning about what they need to do to ensure that they can maintain their health. Even at 72 hours, they're starting to settle, but by the time you hit the 14-day period, you can have a good discussion with them."

Visit our website for more information on pharmacists and care transitions.

A new study has found that a pharmacist-led intervention featuring three outreach phone calls in the 30-day postdischarge period can help reduce patients' readmissions and ED visits.

Recently published in the Journal of Hospital Medicine, the report found that 39% of patients who received only one postdischarge call at the end of the 30-day time frame were either readmitted to the hospital or visited the ED within 30 days of discharge. By comparison, 24.8% of patients who received three phone calls, at days 3, 14, and 30 postdischarge, had a readmission or ED visit.

"The unique thing about this is we added three postdischarge phone calls," says senior author Michael Postelnick, RPh, BCPS, senior infectious diseases pharmacist at Northwestern Memorial Hospital in Chicago. "Most studies look at one or, at most, two. But we thought of the midpoint of the 30-day period postdischarge as a very hazardous time, a time that would benefit from pharmacist contact to make sure that patients were continuing on their plan and not having any problems."

The research showed that the number of outreach calls in the 30-day postdischarge period did not significantly impact the number of adverse drug events or medication errors reported nor did it affect patients’ knowledge about their medications as measured by Hospital Consumer Assessment of Healthcare Providers and Systems scores.

Postelnick says he thinks a larger study may bear evidence that pharmacist-led interventions can impact those areas, as well. Either way, the research suggests that multiple "touch points" are needed to reinforce postdischarge instructions given at a "very chaotic time," he adds.

"All the [patient] education one does upon discharge, there's likely to be little retention of that," Postelnick adds. "As patients settle more into their usual routine, they become more receptive to learning about what they need to do to ensure that they can maintain their health. Even at 72 hours, they're starting to settle, but by the time you hit the 14-day period, you can have a good discussion with them."

Visit our website for more information on pharmacists and care transitions.