Wednesday, December 12, 2012

Hospital Health, Digital Stealth and When Software Isn’t the Solution

During the last month I have spent a fair bit of time in hospitals, but not as a patient.  The first occasion was to visit a friend from Italy who was stricken while in San Francisco and hospitalized.  This true Gentleman from Verona is now home in one piece, having left a part of his colon on the West Coast.  The second occasion was with a family member in New York, stricken with a similar complaint, but recovering nicely.

After  I was sure both friend and loved one would be alright, I paid more attention to my surroundings and how important digital had become healthcare, from electronically monitoring medications and potential interactions to bringing technology, such as X-ray equipment, to bedside for quick results.  In both instances, digital initiatives seemed to have compressed healthcare into a shorter time span and the long wait for tests and additional opinions was almost immediate.  The family member had to go to another floor for a CT-scan, but within minutes the doctor had the results on a computer terminal outside her room for immediate analysis.  And this was not a secret confab in some dark ante-room; I could actually ask questions.  In this instance, surgery was necessary but the run-up allowed the patient to be much more of a participant and I know this lowered her level of stress.

Most noticeable was the absence of paper, especially in New York.  Each nurse had a mobile computer terminal that he or she wheeled into hospital rooms and recorded on-site vital signs, anecdotal observations, and concerns from patient and family.  A software program translated the data into a content framework common to the hospital.

This effort to digitize medical records is the result of $4 billion in funding to 83,000 professionals and 1,500 hospitals that was a little known part of the 2009 Stimulus Bill designed to jumpstart the transition to Electronic Health Records (EHR).  So far, so good.  However, the Office of the Inspector General for the Department of Health and Human Services reports, anecdotal evidence aside, that this program is based on self-reporting and participants do not as of yet collect supporting documents that verify the actual shift to EHR.  So every new technology has a shadow side and this example might be the least of it.

Through September 2012, more than one billion dollars has been invested in digital health initiatives, primarily involving the smartphone, with apps that can check heart rate, pregnancy, suspicious moles, questionable pills, saliva, flu symptoms and so on.  Theoretically, smartphone apps can be used as a tool in everyday health care and for more exotic application.  The Washington Post reports that AliveCor is seeking FDA approval for an app that will provide an EKG by simply pressing an iPhone to the chest.

After my friend and loved one were in the hospital more than a few days, I began to worry about opportunistic infections.   While I was very satisfied with the hospitals in San Francisco and Nyack, New York, I’m well aware that the more digitized hospital services become, the more opportunity for abuse.  Professor Amitai Etzioni, George Washington University, writes in the Huffington Post about the digital fraud in the system, using the Health Management Associates (HMA) as an example (60 Minutes looked at this issue in its December 2, 2012, broadcast).

“According to its own ER doctors, HMA requires that 20 percent of people who step into the ER are admitted to one of HMA’s hospitals—and 50% of seniors.  When a person visits an HMA Emergency Room, company software loaded onto the ER computer automatically orders a bunch of tests, whether they are needed or not, before the person is even seen by a doctor.  When doctors try to discharge a patient from the ER, the computer intervenes, presenting them with a warning that a patient is a candidate for admission.”

My friend from Verona, an Englishman who speaks fluent Italian, was lucky enough to have a doctor in San Francisco who also spoke Italian.  At Nyack Hospital we happened to have a doctor who was a friend of our extended family.  That made all the difference.

The Institute of Medicine estimates that Medicare fraud and abuse range from $75 billion to $98 billion annually.  This number is not surprising because Medicare is required by law to issue payment within 15 to 30 days and there is little time to scrutinize invoices.

This is a problem crying out for a technology solution.

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