Tuesday, March 29, 2011

On Health Reform Innovation Now

How will an increasing number of people get quality care at a cost the nation can afford? The answer isn’t hard to figure out. It’s innovation.

Laura Landro, “The Time To Innovate is Now," Wall Street Journal, March 28, 2011

Innovation is an elusive thing. Everybody knows it is the right thing to do. It is the creative way out of difficult situations. But nobody knows quite how to do it.

Do you think outside the box? Do you do it from the top-down, as in the Centers for Medicare and Medicaid Innovation? Do you do it from bottom-up by forming innovation incubators and recruiting venture capitalists? Do you do it out of a sense of desperation to stay in business by bringing down medical costs? Or do you do it by publicizing successful innovation ventures and spreading the word?

Laura Landro, a veteran reporter for the Wall Street Journal, has chosen the latter route by publishing a special section in the Journal featuring six success stories.

These stories are:

One, Critical (Re) Thinking - This report is about how Montefiore Medical Center in the Bronx has brought down the mortality rates in its ICU and the time spent there. The hospital does it by carefully evaluating who belongs in the ICU before patients arrive. They have also done it by assembling a team of critical care doctors who daily assess who should stay in the ICU and by telling loved one that further ICU care may not help, and that comfort and having the family around is more important.

Two, Medicine on the Move - This story concerns the use of wireless mobile devices to diagnose disease and to monitor it, often from a distance without the physical presence of a doctor. Mobile tools allow doctors to monitor vital signs, note changes in activity levels, verify if medications have been take, and make diagnoses over IPhones without ever seeing the patient. Most of the devices being deployed come from entrepreneurs seeking to fill a void, help humankind, and make money while doing it.

Three, The Model of the Future? - Are Accountable Care Organizations and Primary Care Medical Homes the wave of the future. Will these organizations, built on the belief that primary care doctors working in teams and with hospitals, save money and improve care, work? The government thinks so. So do policy wonks. But doctors,who tend not to trust hospital with their money, aren’t so sure. Hospitals, who stand to lose money through reduced admissions, are skeptical. And most patients are unaware of either ACOs or medical homes.

Four, Delivering Results – The idea here is have an obstetrical team work together through training drills and best practice protocols and using robots as well as video cameras to review what steps to take to reduce birth injuries and deaths. Team members are encouraged to speak up and to be critical should they sense something wrong. It is all about training through simulation to enhance communication in stressful situations.

Five, Making Clinical Trials Less of a Tribulation - Only about 3 to 5% of cancer patients participate in clinical trials. But if a health system has a system-wide EHR, the case with Geisinger Health System and Kaiser Permanente, patients can be promptly identified and recruited for clinical trials. EHRs make patient searches faster and more methodical – allowing patients to recruit patients for trials from day one of their treatments and to keep them within the system.

Six – How Can You Help the Medicine Go Down?
Medications can do great things for people – but only if they take itehm- and as many as 50% don’t. One study shows nearly 90,000 patients die prematurely in the US because of failing to take their medicine. Tracking down patient who don’t take their medication relies on electronic records. But it also involves getting pharmacists and patients involved.

What do these six innovations share in common? That’s easy – teamwork, information technologies, and organized systematic, purposeful approaches within large organizations. But the solutions nationwide are not easy, for 80% of care is provided outside large organizations. Perhaps wireless technologies in the hands of individual physicians and related health professionals and creating more “virtual” organizations will bridge the innovation gap, but we are not there yet.

Source: The Journal Report: Innovations: Health Care, “The Time to Innovate is Now,” Wall Street Journal, March 28, 2011.

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