Grand Rounds: Leveling the Field

Welcome to Grand Rounds! It's officially summertime, and Flo & Bo are taking you out to the ballgame! At Florence dot com, Bo, a seasoned nurse with an engineer's mind, channels Florence Nightingale, a systems thinker whose interest in public health and service gave rise to modern nursing. (Flo favors cricket, but this is Bo's gig.)

We make commentary about health, health care, and healing, a pursuit that, like baseball, often reveals motivated players, talented coaches, amazing facilities, and enthusiastic fans. But the game we follow is highly variable and outcomes don't always match the raw potential of the franchise. Maybe you have a team like this in your town?

Grand Rounds gave us an opportunity to ask people who blog about health care, "What's meaningful to you?" We were particularly interested in how IT solutions should be put to work to improve population health, individual health, and system efficiency.

We've appointed one of the USA's premier health care quality experts, Don Berwick, to be our honorary commissioner and have seated this week's submissions according to Berwick's four levels of interest. You'll find the experience of patients and families in the A position. The people and processes touching them are at Level B. Organizations where care is delivered are Level C, and other stakeholders and interests make noise from Level D.

The game is made all the more interesting because this group rarely stays in their assigned seats: players talk strategy; owners become players; players become owners; and fans have multiple allegiances. Got it? Good.

Now, let's play ball!

Throwing out the first pitch is e-Patient Dave who provides a compelling description of Meaningful Use: A pivotal definition of new-wave medical records systems. (Dave's vision may render advice for dealing with computer-related aches and pains obsolete, but if you need some while awaiting the "meaningful use" revolution, you can find it at Are Computers a Pain in the Neck (and Head)?)

Level A: The Players' Line-up

Laurie Edwards leads off with a hit Talking Health Reform with President Clinton. Edwards is a veteran patient-blogger determined to see patients' perspectives included in healthcare reform in a meaningful way.

Next up, Novel Patient shares how weighing the risks and benefits of potentially dangerous medication is a high-stakes wager for many patients in The Rituxan Gamble. It's early in the game, and we're reminded that, for many people, access to cutting-edge treatment is a hard-fought opportunity to bat, not the assurance of a run.

Batting 3rd is Amy Tenderich from DiabetesMine, the switch-hitter patient-entrepreneur, sharing submissions from this year's $10,000 DiabetesMine Design Challenge in Even More Bright Diabetes Ideas: A Little Help from Your Friends. Tenderich widens the players' circle, noting that her innovators frequently utilized patients' family and friends, valuable resources that have remained largely untapped in chronic disease management.

And in the power hitting position comes Duncan Cross, with a new blog round-up publishing patient-centered posts in Patients for a Moment: First-Ever Edition.

Next at bat:

Barbara Kivowitz takes a swing at discriminatory laws in Kept From a Dying Partner's bedside. What gets family into the game anyway?

Alison demos how new technology has made substantial improvements in her ability to manage diabetes, a claim she backs up with impressive data in her post Every picture tells a story.

Gold Glove Award Winners:

Dale Ann Micalizzi, a national champion for transparency and disclosure in the aftermath of her son's death, offers "The Power of Apology" by Dr. Marie Bismark." Dale writes, "After 8 years of searching for peace and answers, we received an apology last week from the physician who was an expert for the hospital and reviewed Justin's chart. The apology mattered and was appreciated beyond words even though it took so long."

Player/manager, WellRoundedType2 translates Changes in the way diabetes is diagnosed, for her team members, individuals she describes as interested in "Health at Every Size."

7th Inning Stretch:

Players' interests have been represented for a long time, and Disruptive Women in Healthcare introduces the May Man of the Month -- Charlie Inlander, who shares his lifelong experience as a patient advocate.

Bottom of the 9th:

Pinch-hitting for safe medication use and people at-risk for adverse drug events is Mona Johnson, with Anticholinergic medicines and memory loss.

Dean Moyer, someone with first-hand knowledge of back pain, offers a low tech method to obtain meaningful relief of neck pain in Neck Pain, Massage Therapy and Ice.

And Kerri Sparling, wearing number 6 (or Six Until Me), makes a fast call on a play, balancing the need for privacy with the urge to network in Do I Have the Right?

Level B: The trainers, managers, and coaches

Honorary team physician Daryl A. Rosenbaum MD wants players (and their parents!) to understand the limitations--and possible hazards--of mass production sports physicals in 10 Reasons Why Sports Physicals Need an Appointment.

Reality Rounds analyzes a case involving incarceration of an HIV+ pregnant patient in Get Ye to the Stockade, Ye Pregnant, HIV+ Wench! Knowledge of infectious disease, public policy, law, and a big dose of advocacy. If it's not an agent, it must be a nurse!

Catcher turned coach Amy Romano, MSN, CNM shares what happens when consumers and providers pursue evidence-based answers in "Flip Flop: How we (or at least Canada) went to routine cesarean for breech and back again in the era of evidence-based medicine."

Captain Atopic, a seasoned professional in the midst of changing roles in healthcare, reflects on his evolving perspective in Not My First Surgery. Flo & Bo appreciate the Captain's nod to how others see the game. Baseball culture, healthcare culture, it's all about culture.

Teen Health expert Nancy L. Brown, PhD shares survey results about teens' perceptions and offers advice for Giving Teens Purpose and Hope for the Future. (Bo, remembering teen behavior from her days as a perinatal nurse, is trying to figure out which base to have Dr. Brown coach. While this issue is taken to various stakeholder groups, go ahead and pass the link to Teen Health 411 along.)

Thrown out of the game?

The Jobbing Doctor reports the anonymity of bloggers is under threat in the UK by a combination of the London Times and a maverick judge in Who is the mystery man?

Back in the US, Evan Falchuk, writing for Team See First, advocates for accurate diagnosis of what ails health care as a necessary step for effecting meaningful reform in Some of My Best Friends are Doctors.

A Mom and Apple Pie Issue?

Dr. Linda Brodsky calls for stories related to gender inequality in health care for a multi-author book project in Hear Ye, Hear Ye!. Brodsky, another seasoned vet, puts questions of gender inequality and its impact on the quality of health care in the US in play.

Level C: The Organizations

CEO Paul Levy is Running a Hospital, a highly transparent one in Red Sox territory, where his blog is used for daily communication, shaping culture, opinions, and policy along the way. In Caller-Outer of the Month Award #6, he shares how the wisdom of frontline clinicians is utilized and recognized.

Rita Schwab effectively explains why the game should be understood by all people at all levels. Read past the opening nod to Health Care Risk Management Week and find a useful scorecard to help you determine if "patient safety" is a wild pitch or an intentional walk in the organizations you frequent.

The fitness of any organization is influenced by its infrastructure. Joseph Kim, MD, MPH shares findings from a research study, examining How many nursing homes use Electronic Health Records (EHRs)?

Level D: The Fans (and other interests that shape how the game is played)

Ever get to your seat at the ballpark and discover you (or someone in your party) has apparently offended the Ticketmaster God? Healthcare's another arena where people from very different places come to watch--and try to influence--how the game is played.

DrRich, a versatile manager-turner-agent, now with The Covert Rationing Blog, illustrates how mature medical technology (unlike mature consumer technology) often remains excessively expensive in Why Implantable Defibrillators Are Still So Expensive.

In The Economics of Health Care, Bob Vineyard of InsureBlog explores health care economics, advocating that reform measures include greater personal responsibility.

Louise and Jay, health insurance professionals, take a turn as players this inning, sharing what they know about Removing an Exclusion Rider on Our Policy in hopes of helping others. Alvaro Fernandez, of SharpBrains fame, is in the stands Debunking 10 Brain Training/Cognitive Health Myths.

Finally, The Cockroach Catcher's Dr Am Ang Zhang writes up Winter’s Tale: Blood, Entrails & Hansard and finds the collapsing of parliamentary record in a Shakespearean comedy to be a strong metaphor in the United Kingdom. (Bo sees the Curse of the Bambino being somewhat analogous on this side of the pond, although perhaps not a tale that portends health care woes in quite the same way.)

Thanks for coming, folks! This one's in the books. Next week, Grand Rounds is hosted at Edwin Leape.

Special thanks to my son, Luke Dixon, a real-time sports oracle and blogger at PucksNStuff, for providing enough baseball factoids to get this game played!