Monday, October 12, 2009

Monday morning quarterback: The Little 2

The world of patient safety did not shake with high-profile standards, policy, or funding changes communicated via Twitter last week. But I found a few nuggets to pass along, things that promise both hope for the future and also suggest that past missteps may continue to hobble patient safety.

First, a smile:

Ilene Corina, a patient safety advocate, recounts what she found impressive at the National Patient Safety Institute's second annual Lucian Leape Institute gala. The changes in medical education previewed in one roundtable Ilene attended suggest that "reward what you value" is beginning to inform medical students' experiences. Changes which would enhance medical students' exposure to patient safety are in draft.

The recommendations put forth in forums such as this one serve as a "pulse check" for major patient safety initiatives. Ilene noted, with some dismay, how slowly patient safety-sensitive changes take hold in high stakes venues, like academia. She's right when she says the public assumes we are much further along, as my experience this weekend revealed.

My brother-in-law, an engineer, nearly choked on his steak Saturday night when I told him there were 4,000 wrong-site surgeries reported in the U.S. last year. (His number-crunching mind grasped the defect quotient this number represented before the meat bolus had cleared his trachea.) So a take-way corollary--learned not in a seminar but in a Houston steakhouse--is this: In the interest of patient safety, don't share disturbing facts when a healthcare consumer has a mouthful.

And something that rankles:

Brian Ahier wrote a short must-read piece You don't have to use EHR, in which he quotes Dr. David Blumenthal, National Coordinator of Healthcare IT at HHS. Brian puts the facts out, so I'll simply ask this follow-up question: "Would any other contemporary high consequence industry contemplate operations that bypassed electronic transmission of high-stakes data?"

In healthcare, when we finally get a Model T, we immediately tie an ass to the bumper. Here we go again.

My guess is that Dr. Blumenthal is hand-patting those who have fears, probably legitimate, about the misuse of health data. But he would be better served to act to shore up the security of EHRs. Providers cannot be responsive given the complexity modern healthcare absent data automation. Outcomes will suffer until the data-sink is resolved. People who are hand-patting about security concerns should take a turn alongside the clinical people who hand-pat the families of people who die as a result of lousy communication.

What I'm watching this week:

Grand Rounds, the weekly blog carnival, is taking on participatory healthcare this week. I expect to learn more about the power of patients to shape healthcare and improve safety.

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