Friday, August 26, 2005

Red Lights, IT, and Mayo Clinic

The August 16, 2005 issue of the Omaha World Herald carried a story about a new system for dealing with traffic light violations in Council Bluffs, Iowa, Omaha’s sister city just across the Missouri River.

The new system involves the use of cameras to monitor traffic-lighted intersections. Violations are detected by means of a device that knows when the light is red and senses cars going too fast to stop for it. When a violation is detected, a ten-second film is taken of the car, its license plate, the intersection, and the red light. Owners of violating vehicles are sent tickets. Those wishing to contest the accusation can go to the company’s web site and see the violation.

The article did not mention how fines were paid, but I assume it is possible to do that on line as well.

The system is operated by its developer, Redflex Traffic Systems of Scottsdale, Arizona.

There has been a significant increase in the number of tickets issued for red light violations and a reduction in the portion challenged. At the device-equipped intersections, no police officers are needed to monitor traffic light obedience. So it would seem that information technology has been used to improve performance and lower cost for the traffic section of the Council Bluffs police department.

The next day, I had occasion to suggest that a friend seeking medical attention go to the Mayo Clinic in Rochester, Minnesota. Since the friend is not skilled using Internet, I volunteered to go to the Mayo web page and find out how to get an appointment.

I assumed there would be a way to do it on line. Not so. You have to telephone, send a letter, or have your physician do it. So I can visualize a bank of clerks in Rochester tediously entering into Mayo’s computer a lot of information we would happily have entered for nothing (and perhaps more accurately).

Then on the day following that, while traveling back to Massachusetts, I noted in the Northwest Airline magazine an article by Mayo Clinic about a new drug that has proved to be effective in treating a common type of breast cancer.

Mayo may be at the cutting edge when it comes to treating breast cancer and we can all be thankful for that.

But when it comes to using information technology to improve its operations, it could learn something from the Council Bluffs police department.

Wednesday, August 17, 2005

More on Animal vs. Human Health Care

Daughter Eleanor’s comparison of health care for animals with that provided for humans stimulated a small flurry of responses.

Friend Bill Busby’s recitation of experiences with human care is copied in a separate posting.

Friend Gail Price thinks that animal care is still focused on healing while human care is obsessed with profit.

Consultant Paul Hoffman suspects that “the reason we will not be seeing any meaningful comparison between veterinary and human medicine or their respective hospitals is the results would be far too embarrassing.”

Larry Mathis, retired CEO of Methodist in Houston, “loved it.”

Dennis O’Leary, CEO of the Joint Commission on the Accreditation of Health Care Organizations, and Tom McNulty, retired CFO of Ford in Detroit, suspect that the gap may be closing – unfortunately in the wrong direction. Both suggested that the vets are learning how to pad the bill by ordering services of questionable value and charging for every little thing (such as for the use of an IV stand).

O’Leary also pointed out that it is now harder to get into vet school than into medical school.

There must be something here worth looking into.

Saturday, August 13, 2005

Don’t Get Sick or Hurt During a Weekend

Among the responses to daughter Eleanor’s comparison of human and animal care was the below from long-time friend Bill Busby.

Everybody knows of, or has experienced, this kind of horror story, but it is probably good to make special note on occasion, just to remind us that there are things that need fixing.

Your daughter's experience at the Stanford hospital is not at all unique.

For example, when wife Virginia was dying, I took her in an ambulance to the largest hospital – Presbyterian - in Albuquerque. We got there about 8:00 PM on a Saturday night. She was already mostly blind and deaf from lack of adequate sustenance (she couldn't swallow because of her post-polio syndrome--a condition doctors had pooh-poohed for years).

They put her on a bed and left her, crying and thrashing with leg pain. I looked all over for someone to help her but there was no one. After a couple of hours, our primary physician happened through the ER, took one look and prescribed a pain killer. But it was about 5 hours after that before she got relief, and only after the hospitalist prescribed another pain killer for her

For seven hours she lay on that bed thrashing and crying in pain. The excuse? The whole staff was attending to some unhelmeted kid who, drunk, had an accident on his motorcycle.

My late brother-in-law was a volunteer EMT in Southwest Kansas. One Saturday evening, he was called to help when a small car took on an 18-wheeler west of town and lost. Phil said they finally peeled the driver off the pavement, put a neck brace on him and transferred him to a back board.

Phil drove the ambulance at top speed with siren blaring all the way to Wichita where they put their patient on a gurney in a hospital corridor. Phil said the guy was still laying on the same gurney on the same back board when he went back the next morning to retrieve his backboard and neck brace. Phil could just as well have driven at a leisurely pace and stopped for an early breakfast.

It don't pay to get hurt or be sick on a weekend.

Thursday, August 11, 2005

On Trustees and Hysterectomies

Last Monday’s (August 8, 2005) Boston Globe carried a long article about unnecessary hysterectomies.

I sent an e-mail to the reporter, congratulating her on a fine piece of journalism and asking two questions:

- Did the trustees of the hospitals in which the unnecessary hysterectomies were performed have any responsibility for seeing to it that action was taken to prevent them and, if so
- Why was that never mentioned in articles like this?

She responded quickly. After thanking me for the congratulations, she said

- My question was interesting.
- She didn’t know the answer.
- She would try to find out.

We’ll see.

Thursday, August 04, 2005

Cause for Taking Heart

Those who have been discouraged about the prospects of reforming our system of health care can take heart at the Surgical Care Improvement Project (SCIP) announced in the July 28, 2005 issue of AHA News Now, the e-mail newsletter of the American Hospital Association.

The goal of the project is to reduce surgical complications by 25% by 2010. The ten national sponsoring organizations are:

The American Hospital Association
The American College of Surgeons
The U.S. Veteran’s Administration
The Institute for Healthcare Improvement
The American Society of Anesthesiologists
The Association of periOperative Registered Nurses
The Joint Commission on the Accreditation of Health Care Organizations
The U.S. Centers for Medicare and Medicaid Services
The U.S. Agency for Healthcare Research and Quality
The U.S. Centers for Disease Control

An editorial in the July 25, 2005 issue of AHA News, the Association’s print newsletter, said that SCIP would offer “….evidence-based educational and clinical management tools that have been proven to dramatically reduce the most common surgical complications – surgical wound infections, blood clots, post-surgery heart attack and pneumonia.” The appropriate use of antibiotics near the time of surgery and the use of beta blockers were given as examples.

This project is truly remarkable in that it is an overt attempt by non-physician interests – in collaboration with physician interests, to be sure - to influence how surgeons do their work, and to do so through hospitals. In recent memory such a thing would have been condemned as lay interference in the practice of medicine.

The promise held out by SCIP is that health care institutions will at long last become able to manage and, one hopes, improve health care processes in their entirety, unhampered by the cultural barriers that have in the past separated their otherwise indivisible professional (i.e., medical) and institutional (e.g., hospital) components.

In other words, it points to hospitals openly accepting overall responsibility and accountability for the quality and cost of health care in our communities.

If that isn’t radical health care reform, I don’t know what is.

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