Using Meetings At Hospitals

meetings in a hospitalSmall team meetings are a great way to both improve communication between staffers and set goals to deal with problems at the workplace, whether it’s in a hospital or a more traditional office.  For example, the Boston Medical Center internist teams meet every Friday morning to talk about issues specific to their groups, and once a month all of the teams come together for a larger meeting for big announcements and to celebrate successful efforts.  Such meetings help break down barriers and make improvement projects more effective by giving different team members a stronger voice in the decision-making process.  

In addition, meetings offer all team members a chance to show why certain changes are necessary; for example, the physician might not know why the front desk does things a certain way, and vice versa.  Team meetings are a great way to clear up any “mystery” with that.  Poor communication is a major problem in a hospital workplace, and practice managers sometimes offer directives that are unclear, unspecific or don’t properly convey the urgency.  On average, ineffective communication takes up 40 minutes of an employee’s day, costing about $5,200 a year for each staff member at a large hospital.  

The American Medical Association has a “STEPS Forward module”, which offers several ways for practice managers to effectively structure and schedule meetings.  These include scheduling meetings when patient care is least likely to conflict, limiting group size to make sure everybody has a voice, keeping meetings focused on the issues at hand and sticking to a consistent agenda.  For projects coming out of practice meetings, assign a point person who will coordinate the efforts and then report back to the group later.  But also make sure that you conduct regular follow-ups on goals and issues discussed during these meetings.  

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New Pathology Center at Mount Sinai

Mount Sinai medical centerThe department of pathology at the Icahn School of Medicine at Mount Sinai has just established the Center for Computational and Systems Pathology, with the goal of using advanced computer science, mathematical techniques, cutting-edge microscope technology and AI to revolutionize pathology practice.  This new facility will explore efforts to more accurately classify diseases and guide treatment with computer vision and machine learning techniques.  It will also serve as a hub for the development of new tests, partnering with Mount Sinai-based “Precise Medical Diagnostics” (Precise MD).  

The new center will be overseen by Carlos Cordon-Cardo, MD PhD, and will be continuing his role as chair of the department of pathology at the Mount Sinai Health System and professor at the Icahn School of Medicine.  Associate professor Gerardo Fernandez, MD will be the medical director, working closely with pathology research professor Michael Donovan, MD PhD and Jack Zeineh, MD, director of technology for Precise MD.  Precise MD is developing new approaches to characterizing an individual’s cancer through combining multiple data sources and then using mathematical algorithms to analyze them, offering a more sophisticated alternative to standard approaches.  

In its initial phase this summer, Precise MD will complete a test used for patients who have had prostatectomies at Mount Sinai Health System to determine which of them are more likely to have a recurrence of cancer and may need additional therapy.  The approach will give researchers an in-depth knowledge about the biological behavior about prostate cancer, which will allow them to choose the appropriate patients for active surveillance.  A second test will follow next year, which will be used to characterize prostate cancer in newly-diagnosed patients, by which time all prostate cancer patients at Mount Sinai will have the chance to receive this test.  

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The Rise of Telemedicine

The Rise of TelemedicineA recent survey has found that telemedicine has continued to evolve into a mainstream technology service, with a growing number of healthcare professionals viewing it as a top priority.  The 2016 Telemedicine Industry Benchmark Survey by the telemedicine software company Reach Health surveyed some 390 healthcare professionals, including executives, physicians, nurses and other professionals, gathering input on their priorities, objectives and challenges, telemedicine program models and management structures, service lines and settings.  Reach Health compared these findings to the results of last year’s survey in an effort to better understand the trends and changes in telemedicine.

Among the survey’s key findings was that nearly two-thirds of its participants viewed telemedicine as a top priority, representing a 10 percent increase from last year.  When surveyed about top objectives for telemedicine programs, patient-oriented objectives occupy the top three positions for most common objectives.  When asked to rate their success in achieving telemedicine program objectives, respondents indicated a high degree of success with those same top three objectives.  Respondents said that their highest degree of success came with providing remote or rural patients with access to specialists.

The survey report also took a look at telemedicine attributes that are most highly correlated with success.  The survey report authors said that some attributes exhibit a strong correlation with success, such as the priority of the telemedicine program as ranked among other hospital priorities.  For example, telemedicine programs ranked as a top priority are 62 percent more likely to be highly successful thank those who ranked it as a low priority.  If these telemedicine programs do have a dedicated program manager or coordinator, then they’re 43 percent more likely to be highly successful than those with a less focused program manager.

The survey also addressed telemedicine program challenges and survey participants identified, ranking their challenges in terms of those that remain unaddressed, partially addressed, fully addressed or not a challenge.  Issues tied in with reimbursement and electronic medical record systems were listed as the main challenges to telemedicine.  Determining ROI was also acknowledged as a challenge, although the survey authors noted that improving financial return was least frequently cited as a top objective.  Although compensation for physicians remains relatively high on the list of challenges, physician acceptance has improved compared to last year, and is fairly low on the list of challenges.

As the telemedicine industry comes of age, hospitals and healthcare systems have been exhibiting a rising trend toward an enterprise approach, with larger systems moving more quickly in this direction than smaller hospitals.  If you’d like to learn more, you can click here!

Brain Mysteries

Brain picture

In new research that’s been published in Proceedings of the National Academy of Sciences (PNAS), a team of scientists from the Hebrew University Hadassah Medical School unraveled a longstanding mystery of a fundamental property of the brain.  For a long time now, it’s been known that the brain uses topographic organization, or that parts of the brain that make similar types of computations are situated close to each other.  Yet in the case of pathology, these topographies may undergo reorganization.  Researchers have now shown that the continuity of these brain maps is being disturbed, and this continuity can be quantified, which allows them to be used as a biomarker for detecting neuropsychiatric disease.

To understand this relationship, the researchers investigated the role of topographic organizational continuity.  With functional MRI, they studied two types of unique populations: patients with injury to one side of the spinal cord that enabled comparison of disturbed and non-disturbed body sides, and patients going through surgical repair.  Such an approach enabled direct comparison in human patients with respect to their own self or before and after surgical intervention.  Instead of inducing lesions in animals, the team was able to repair the human patients and check them both before and after.  Unlike animals, patients were able to report their subjective experience, which is crucial for understanding high cognitive functions and neuropsychiatry.

The researchers have developed an algorithm that quantifies continuity of the patients’ brain maps.  Their results showed that in each individual patient, pathological processing was reflected by a discontinuity of topographic maps, as opposed to signal reduction.  Such findings have suggested that continuity is a primary principle in brain computation, although in pathological states, the brain could give up on this principle to retrieve as much information as possible, helping this serve as a biomarker for neurological pathologies.  The researchers are now trying to fine-tune their findings in neurosurgical patients in an effort to enable a better, patient-tailored diagnosis and follow-up.  They’ve also been extending their findings to other parts of brain processing, including vision, hearing, number processing and memory.  If you’d like to learn more about what they’ve been doing, feel free to click here!

A Lab in a Needle

While working alongside collaborators from two major institutions in Singapore, researchers at a lab in a needleHouston Methodist have developed a lab in a needle device that could provide instant results to routine lab tests to accelerate treatment and diagnosis by days.  One place where this device will be effective is in quickly detecting liver toxicity, a common side effect of chemotherapy.  It will test toxicity in 30 minutes; compare that to the several days it takes to currently perform the same test due to the multiple steps required before a physician interprets the test results and communicates them to the patient.

Developed by Houston Methodist, NTU Singapore, SIMTech and A*STAR, this invention was explained in the most recent issue of the Royal Society of Chemistry’s Lab on a Chip.  Investigators demonstrated that two important steps of the lab in a needle approach accurately detected liver toxicity in AST and ALT.  The proteins that these indicators represent are among the most sensitive and widely-used liver enyzmes in all liver function tests today.  The joint research group were looking to develop a new class of device to collect patient samples, prepare them for testing, evaluate toxicity and display results in one easy-to-use process that would allow doctors and patients to immediately discuss treatment options.

Sample preparation was accomplished on one chip that incorporated a miniature motor and microfluidics, while amplification was performed on a second connected chip.  Evaluations in the two examined gene markers of liver toxicity were then accurately detected and consistent with previously-known changes, indicating that lab in a needle is an appropriate diagnostic option.  According to the researchers, the next step is to integrate the sample preparation and analysis chips into a miniaturized device.  Both A*STAR and SIMTECH have manufacturing process capabilities to develop a cost effective lab in needle device that can be scaled for mass production.

This study outcome represents the first time that all processes involved in the lab in a needle were integrated together successfully, and represents an important step in bringing a new real-time, easy-to-use diagnostic to the clinic and field with an immediate potential to improve patient outcomes and quality of life.  If you’d like to learn more, you can click here!

Manipulating Pollen

Ragweed plant

Also known as Ambrosia, the ragweed plant is known for its aggressive pollen.

Recently, scientists at Helmholtz Zentrum in Munich have discovered that pollen of the common ragweed has higher concentrations of allergen when exposed to NO2 exhaust gases.  The study also indicates the presence of a possible new allergen in the plant.  Researchers of the Institute of Biochemical Plant Pathology (BIOP) studied how nitrogen oxides affect the pollen of the plant, specifically by fumigating the plants with various concentrations of NO2, which is generated during combustion processes of fuel.

The data from the study revealed that the stress on the plant caused by NO2 modulated the protein composition of the pollen, with different isoforms of the known allergen Amb a 1 being significantly elevated.  In addition, scientists observed that the pollen from NO2-treated plants have a significantly increased binding capacity to specific IgE antibodies of individuals who are allergic to ragweed, which frequently starts an allergic reaction in humans.  The plant researchers also identified a protein, not previously known to be an allergen in ragweed, that was present when NO2 levels were elevated.  It has a strong similarity with a protein form a rubber tree, in which context it was previously described as an allergen whose effect was also seen in fungi and other plants.

Due to air pollution, it is expected that the already aggressive ragweed pollen will become even more allergenic in the future.  Originating in the Americas, ragweed is believed to have come to Europe through imported birdseed, and due to climate change, it’s become widely dispersed across the continent.  Ragweed pollen is very aggressive, and since it doesn’t bloom until late summer, it lengthens the “season” for those who are allergic to it.  Studies have already shown that ragweed plants growing along highways are clearly more allergenic than those growing away from road traffic.  The researchers plan on doing further studies in the future, where they plan on showing that pollen only treated with NO2 can also elicit stronger in vivo reactions.

The Problem with UHC’s New Program

Out in Florida, the battle rages on between one of the country’s largest health insurance corporations and physicians, clinical laboratory managers and pathologists.  This fight started because of the restrictive, burdensome requirements imposed last fall by UnitedHealthcare (UHC) and administered by BeaconLBS on medical laboratory test ordering.  For one Florida rheumatologist, Olga Kromo, this new decision-support system that physicians currently have to use when ordering clinical laboratory tests is highly flawed.

Michael Weilert MD Ogla Kromo

Olga Kromo, the physician who has become an outspoken opponent of the new system imposed by UHC.

Other Florida physicians have begun to rally around Kromo, pointing out that the new system is time-consuming, onerous and difficult to use.  Kromo, however, has gone even further, claiming that the BeaconLBS system could have an adverse effect on patient care and increase negative outcomes across the board.  In a recent interview with “The Dark Report”, Kromo has explained that patients with connective tissue disease are at higher risk for other serious health conditions such as lymphoma.  This is true for patients with systemic lupus and Sjögren’s syndrome.  If ordering medical laboratory tests is overly complicated or time-consuming, she said, then patients may not get tested as much as needed for their physician to properly identify complications and spot the signs of ailments such as lymphoma early on.  Kromo is one of four doctors at the Arthritis and Rheumatic Care Center in Miami.

Among patients with lupus and Sjögren’s, Kromo says, there’s a high risk of developing lymphoma.  A clinical laboratory test is recommended for timely monitoring these patients, although UHC says that BeaconLBS needs to pre-authorize the test before doctors can run it.  If long-established clinical guidelines specify that a test is recommended for lupus patients with Sjögren’s, Kromo argues, why would physicians need to request authorization from a health insurer?  Kromo’s argument has raised a serious issue as to why UHS and its contractor, BeaconLBS, are interposing themselves between physicians and patients when physicians are ready to order medical lab tests that UHC requires to be pre-authorized.  Various state and national medical societies have written letters to UHC objecting to this interference with established medical standards of practice.

It takes a particularly long time to use the newly-required system and, since there’s a limited number of electronic interfaces between BeaconLBS and electronic health record systems, physicians need to enter orders for tests twice: once to obtain pre-notification ,and a second time to enter the order in the EHR.  As well as patient care concerns, Kromo has found the BeaconLBS system to be so difficult that those in her four-physician practice aren’t even using it, and instead are having a workaround with another lab.  If Kromo’s practice were to use the BeaconLBS system, she estimated that the phlebotomist on her team would need to stay an extra hour or two every day; just the paperwork for Beacon tests takes about 20 minutes per patient.  And since such a large percentage of Kromo’s patients (95%) need lab tests on almost every visit, this system significantly disrupts patient flow.

5 Steps To a “Learning Health System”

Michael weilert MD Amy Abernethy

Amy Abernethy

I recently came across an article by Dr. Amy Abernethy, who delivered the opening keynote address at the American Medical Informatics Association’s (AMIA) annual symposium.  Without good data to back it up, she says, patient-centeredness is nothing more than a buzzword.  And without a patient-centered focus and proper organization, data tends to be pretty useless.  Comparing the flood of data now available to the Amazon River, Abernethy declared the need for a vision for a way forward, called a learning health system.  This needs to be powered by a “river of data”, with a “North Star” to guide operations.  To Janet, this North Star is a 37 year-old patient with melanoma named Janet.

While speaking with Janet on the risks of interferon treatment, Abernethy pulled in records from various data streams that formed rivulets, which dumped into a large river of data.  Informaticians, as members of the AMIA call themselves, face two challenges: exploring all of this data now available to them and explaining it to practitioners, payers, administrators and patients.  According to Abernethy, the vernacular in informatics doesn’t align with that in other parts of healthcare, meaning that there needs to be a common language.  As healthcare professionals think about trying to bridge the communication gap, people find it safer to keep on their sides and not talk to each other, despite the fact that they could be learning so much.  Abernethy spoke of the need to get better at bringing data to standard clinical practice, and outlined five recommendations to do so:

1. Putting the patient at the center.  Patients are the anchors of Medical Informatics, and their stories help clinicians work better with data.

2. Having meaningful data by putting the information into the right context.  This information, says Abernethy, should be taken as more than just a snapshot in time, so that it can be repurposed for research.

3. Improve data quality by putting that data to use.  Informaticians need to use data to make sure that it’s accurate.  They care deeply about data’s quality, sanctity, security and validity.

4. Data needs to be trustworthy.  To get information from patients over time, there needs to be a system of trust, so that the data is valid.

5. Data must be interoperable.  Talking about Janet, Abernethy said that even if her disease does return, through her data, Informaticians can learn more about these diseases.  Abernethy noted that the Cancer Biomedical Informatics Grid (CaBIG) failed partially due to a breakdown in communications, since communicating the language and culture of informatics to clinical care at the time was nearly impossible.

Truman Medical Centers

Recently, the Kansas City-based Truman Medical Centers (TMC) has won two separate awards from the health IT community for its use of IT to improve health care.  Last month, they were recognized by the College of Healthcare Information Management Executives (CHIME) as the winners of the 2014 CHIME-AHA Transformational Leadership Award winner.  CHIME gives this award once a year to an organization that has excelled in developing and deploying transformational IT that improves the delivery of care and streamlines administrative services.

An impressive institution indeed, TMC is made up of two academic acute care facilities with a total of 600 beds, a Michael Weilert MD Truman Medical Centersbehavioral health program, over 50 outpatient clinics, the Jackson County health department and a long-term care facility.  TMC serves a large number of low income, high-risk patients, providing 11% of all uncompensated care within the state of Missouri.  TMC is also a participant in the Partnership for Patients, which was established by the Centers for Medicare & Medicaid Services (CMS) to make hospital care safer, cheaper and more reliable.  Over the past few years, the organization has launched a system-wide initiative called the Q6, designed to drive quality improvement at TMC.  Q6 then led to the formation of multidisciplinary committees to help drive quality improvement across clinical workflow, IT and business processes using actionable data from the organization’s electronic health record (EHR).

TMC has also been named a 2014 HIMSS Enterprise Davies Award recipient, which promotes EHR-enabled improvement in patient outcomes through sharing case studies and lessons learned on implementation strategies, workflow design, best practice adherence and patient engagement.  Through a comprehensive EHR-enabled quality improvement strategy that focuses on adhering to the best practice protocols and heavy technology-enabled patient engagement strategies, TMC have sustained exceptional care coordination while maintaining an exceptional level of care delivery that ranks significantly higher above national benchmarks.

Through their use of an EHR-enabled automated interpreter requests and streamlined workflow, TMC has been able to provide a more personalized care experience for each patient while simultaneously providing proper care.  This has resulted in a significant reduction in the number of episodes of venous thromboembolism and hospital-acquired pressure ulcers, resulting in nearly $8 million in reduced costs.  Since much of TMC’s care is uncompensated, reducing costs is an essential part of their model.


Paper-Based Medical Technology

Michael weilert MD synthetic biology

Recently, researchers in synthetic biology have been bringing together science, engineering and computing to understand and copy biological life to help achieve new breakthroughs.  There were recently two studies published in the journal Cell, which show how advances in synthetic biology could eventually lead to cheap, reliable diagnostics for diseases such as Ebola, which could be done quickly in the field using only drops of blood or saliva on strips of paper embedded with synthetic biology circuits.

In the first of these studies, scientists from Harvard describe how they brought lab-testing ability to pocket-sized slips of paper by embedding them with synthetic gene networks.  They also spoke about how they created various diagnostics, including strain-specific Ebola virus sensors.  Until recently, progress in synthetic biology has been limited, since scientists were only able to develop synthetic mechanisms within living cells.  However, the research team was able to create a system that allowed them to design synthetic versions of biological mechanisms outside of cells.  The researchers explain how they’ve harnessed the genetic machinery of cells, and then embedded them in the fiber matrix of paper, which can then be freeze-dried for storage and transport, allowing researchers to take synthetic biology out of the lab setting and use it anywhere.

Through their work, the researchers have developed a wide range of diagnostics and biosensors, which incorporate proteins that fluoresce and change color to show that they’re working.  Once they’ve been freeze-dried, these paper-based tools can be stored for up to a year.  To be activated, all you need to do is add water.  When used in a laboratory, this technology allows researchers to save both time and costs compared to conventional methods; certain procedures that would typically take between 2 and 3 days can now be done in as little time as 90 minutes.

For their second study, the researchers created an Ebola sensor through the “toehold switch”, a flexible and highly programmable system for controlling gene expression.  While the toehold switch was originally used to work inside living cells, the team was able to change its function to their signature freeze-dried paper method.  The toehold switch can be programmed to switch on the production of a specific protein after detecting the proper sequence of genetic code.  According to the team, it’s also possible to link multiple toehold switches to each other and create a complex circuit to carry out a series of steps, such as detecting a pathogen and then delivering the appropriate therapy.