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August 30, 2010
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IN
THIS ISSUE
Editor's Column:
The Forecast And The Perspective
In My Opinion: Do Computers Improve Patient
Care
Electronic Recordkeeping Boosts Patient
Safety At DMC
Justice Resignation Reinforces Need
To Keep Justice Young On Bench
WSU Med Student To Study Tropical Medicine
In London
Oakwood Extends Partnership With HOPE
Clinic
WCMS Foundation Holiday Party Kicks
Off Fundraising Drive
Michigan Occupational
Health Conference
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Editor's
Column: The Forecast And The Perspective
By
JOSEPH WEISS, MD
The forecast: because of increasing technology people will live longer,
force up the cost of care as death may be thwarted and delayed, but
not outwitted. Perspective may trump the charts, graphs and curves
that forecasters use to support their argument.
My
patient Grace E. explained the perspective in the following
manner: “I will not linger if I cannot live.”
She
made this comment after seeing her husband die from lung
cancer. For 18 months she and the family carried him through
the conventional drug protocols and then the experimental
ones. The medical effort may have given Mr. E. some months
of life that death without treatment would have denied
him. Mrs. E questioned the price.
Those
Detroit Medical News readers born before World War II likely
have memories that a death in the family most often meant
an old person dying, usually upstairs, in an old
house, usually their home.
After
WWII, death and dying occurred much more away from home.
The rise of technology meant the elderly ill went to hospitals
because the monitors and ventilators that could possibly
save their lives were there. If saved, the old person went
to a nursing home because the custodial care needed was
too difficult for the family to provide. Then the person
received care in the nursing home until death. A disconnect
developed between those people living in their daily settings
and the elderly ill lingering and then passing away in
nursing institutions.
Now,
means exist that allows the elderly individual to stay
at home and receive chemotherapy, dialysis, and IV infusions.
These procedures are possible in outpatient settings, or
even at home. Emergencies may send the patient to a hospital
and then to a rehabilitation center, usually a former nursing
home. But eventually with help from technology, the patient
goes home again. At some point hospice care begins, and
the person dies on the first floor in a hospital bed.
These
days the surviving husband, wife, or adult children bear
witness and make personal judgments as to what the dying
person gained or lost using the best medicine and technology
available to stay alive. That evaluation causes many people
to decide that using all means to keep alive will not be
their choice.
There
will be no future need to make certain end-of-life modalities
such as dialysis, coronary bypass or peripheral vascular
stenting come with a cut-off age or set of conditions for
permitting the procedure. Enough people are gaining experience
to what are the complete costs of clinging to life, and
what alternative benefits hospice gives.
The
nation is unlikely to have an ever growing burden of expense
and sorrow because individuals choose not to live but linger.
For many people, the success of modern medicine has revealed
its limits.
DR.
ADELMAN’S COMMENTS
To the extent that families make use of hospice and home care options,
this is true. To the extent that they cannot or will not, their loved
one will remain in the throes of often excessive care at the end
of life.
The
problem with protocols for the distribution of services
is that people are different. To be fair, the argument
against doing a transplant for someone in a nursing home
should not influence the rationale for offering one to
an active person out in society.
Many
other factors come into play: other illnesses and conditions,
psychological health, ability of the patient to follow
salient instructions, living circumstances, family and
friend support mechanisms, whether or not the patient is
a support person for others in the family, ability to afford
ancillary care that may not be covered by insurance, proximity
to a hospital, , competing demands for the organ or service,
capacity of the medical institution that will perform the
service, quality of the information made available to the
person making the a decision.
Bureaucrats
tend to write rules that oversimplify all this, because
it is too complicated otherwise. That is the way rules
can crop up restricting all kidney transplants to patients
under age 55, for instance. That is our challenge.
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In
My Opinion: Do Computers Improve Patient Care?
By
CLAUS PETERMANN, MD
Working in the trenches as a busy internist in one of the Detroit
hospitals I fail to comprehend how medical care can be done efficiently
when a computer has become the center of attention instead of a sick
patient who not only needs our tender loving care, but who also needs
to be listened to very carefully and examined very thoroughly. It
now takes me twice the time to see a patient in the hospital and
I find myself spending only half as much time at the bedside interacting
with the patient. All the important medical reports are scattered
through a computer landscape and no one ever gets the feeling fort
the entire case of one’s patient. Computer printouts in the hospital
record would easily solve part of the problem, but we are told our
hospital records have to be completely paperless! Therefore to open
a hospital record has become a waste of time.
Since
all physicians experience the same problem and have less
and less time to write appropriate progress notes following
the established format of the good progress note, namely
S(symptoms) O(objective) A(analysis) P(plan what to do
about it), the communication between physicians involved
in a patient’s care has practically broken down.
The
discharge summary, the most important document about a
patient’s problem summarizing all the important facts of
the hospital stay, and guiding the future management of
a patient with complicated problems, have become a seven-page
computer joke containing nothing to help a clinician to
make decisions in the office at the follow-up visit after
a hospital stay. There is absolutely no question that the
quality of care we owe our patients has seriously deteriorated
and patients will suffer and may even die because of it.
Having
many unsatisfied patients also will translate into more
malpractice suits. The present system is a violation of
the sacred Hippocratic Oath, it forces us to render less
than the best possible care for a patient.
Having
computer printouts in the hospital record would solve,
to a large extent, the present dilemma: We again would
be able to practice medicine at the bedside efficiently
and we still would be able to look for additional information
in the computer, if necessary.
The
nurses are also distracted by the computer, barely making
eye contact with a sick patient, but busy filling out computer
questions. Their morale and dedication has reached a terrifying
low. I know that the vast majority of my colleagues have
the same concerns, therefore this problem should be discussed
and addressed on a national level.
The
present system also raises the question of whether the
art of practicing medicine still can be preserved. The
art of medicine, one could argue, consists of intuitively
finding a therapeutic solution for a sick patient. This
requires a vast knowledge of medical facts in the physician’s
mind and being able to interact intensely at the bedside
with the patient as an individual, talking and thoroughly
examining the patient and at the same time having all the
pertinent test results directly at the bedside and not
in a computer down the hallway.
E.A.
Stead, Jr., once wrote: “No greater opportunity, responsibility
or obligation can fall to the lot of a human being than
to become a physician.” Therefore, let us preserve the
art of practicing medicine for the benefit and wellbeing
of our patients and let us pass on this art to future generations
of physicians.
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Electronic
Recordkeeping Boosts Patient Safety At DMC
The
Detroit Medical Center (DMC) reports it has achieved significant
improvements in patient safety and quality of care, while
also saving more than $5 million in costs last year, thanks
to efficiencies created by its system-wide Electronic Medical
Record (EMR). This system manages nearly all of the DMC’s
patient health information via new computer-based technology.
For
the eight hospitals in the DMC system, it was the second
year in a row in which computer-based health care information
processing created major improvements in quality of care
and cost-savings.
The
windfall in savings – triggered by highly effective electronic
monitoring of such crucially important hospital tasks as
treating pressure ulcers and preventing medication errors – was
clear evidence that the DMC’s EMR system is providing a
healthy return on investment, according to DMC officials.
DMC
caregivers said they were greatly encouraged by the striking
cost-savings from EMR. The $50 million system has gone
online throughout the DMC in gradual stages over a 12-year
period, starting in 1998.
“The
latest numbers are in, and we continue to see great strides
in improving quality, treating patients more quickly and
preventing error, which translates to dollar savings as
well. This work with these results is very exciting,” said
DMC Chief Nursing Officer Patricia Natale, RN, after reviewing
the results of a system-wide study showing the impact of
EMR on both costs and patient care.
“The
savings are only part of the story,” she added, “because
EMR is also a major step forward on the road to better
quality of patient care. Thanks to EMR, we’re now seeing
a dramatic reduction in the length of hospital stays due
to pressure sores, along with a dramatic reduction of drug
errors through EMR-enabled medication scanning.
“EMR
isn’t just about saving money; it’s also about improving
the quality of care we provide for patients, and that’s
our primary mission.”
Other
key leaders at the DMC were equally enthusiastic about
the upgrades in quality care that are now flowing from “leveraging” the
EMR. “The latest surveys show that EMR has helped to reduce
medication errors by up to 75 percent,” said DMC Chief
Medical Information Officer Dr. Leland Babitch. “Obviously,
that’s a major gain for patients – especially given the
fact that medication errors account for the majority of
accidental deaths and injuries at US hospitals.”
The
US Institute of Medicine has estimated that up to 100,000
patients die as a result of hospital errors annually.
The
impact of EMR on treatment of pressure ulcers was especially
noticeable, said DMC quality-of-care administrators. They
noted that the chronic sores often require extended hospital
stays and thus drive up costs. But the most recent DMC
Patient Care Services study of severe pressure ulcer cases
showed that close EMR monitoring of bedsores reduced the
average length of stay required to treat them by nearly
three full days last year . . . compared to the average
length of ulcer-triggered stays before EMR monitoring of
the problem began in 2008.
The
DMC study concluded that the reduction in the length of
pressure ulcer-related hospital stays – in a system that
admits more than 75,000 patients each year – was now helping
to generate more than $4.5 million in yearly cost savings.
“The
data on Electronic Medical Records and patient safety and
quality of care are clear and convincing by now,” said
DMC Vice President for Quality and Safety Michelle Schreiber,
MD. “Those data demonstrate beyond a reasonable doubt that
EMR is an extremely powerful tool when it comes to protecting
patients from hospital errors.
“But
EMR is also proving to be an effective method for promoting
quality of care – and the new numbers on bedsores and length
of stays show how computer-based recordkeeping helps caregivers
to take better care of patients day in and day out.”
The
hospital cost-savings are especially significant, said
DMC caregivers, because the soaring cost of health care
in this country each year (more than $2.5 trillion) is
now equal to 17.3 percent of the nation’s entire Gross
Domestic Product.
In
spite of the savings to be had from hospital-based EMR,
however, recent studies show that the majority of US hospitals
have either failed to implement top-to-bottom EMR systems – or
are cutting back on information technology (IT) programs
already in place.
As
of August 2010, less than 4 percent of US hospitals had
implemented the level of system-wide electronic patient
recordkeeping that is now in place at the DMC. In addition,
a recent study at the University of Michigan School of
Medicine showed that more than one-fourth of the nation’s
recession-affected hospitals have been cutting back on
their already existing IT programs.
The
cash-strapped hospitals were slashing IT budgets, reported
the study in the Journal of Hospital Medicine, in spite
of the fact that the Obama administration has recently
made available more than $2.73 billion in Medicare/Medicaid
bonuses for clinicians and hospitals that spend to improve
their electronic medical records systems.
“Installing
and upgrading effective EMR systems makes very good sense
for both hospitals and their patients today,” said Michael
Duggan, President and CEO of the Detroit Medical Center. “The
data contained in our new Patient Care Services study show
clearly that EMR can lower hospital costs significantly,
even as they greatly improve the quality of care.
“The
DMC has spent $50 million on building a powerful EMR system
over the past five or six years, and we did it because
we like to think of ourselves as the ‘hospital of the future’ – as
a state-of-the-art healing center where patients know they
can get the best healthcare available anywhere today.
“At
the same time, the ability to greatly reduce healthcare
costs via electronic medical records is an added bonus – which
makes implementing EMR a win-win situation for everyone
involved.”
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Justice
Resignation Reinforces Need To Keep Justice Young On
Bench
(Editor's
Note: The following is from MSMS) Now that the Michigan
Supreme Court has a new majority upon the resignation of
Justice Elizabeth Weaver, it's more important than ever
to keep Justice Robert Young on the bench. Endorsed by
MDPAC, Justice Young has a record of upholding existing
laws--such as out tort reform laws--instead of legislating
from the bench. This is especially important because our
hard-fought-for tort reforms continue to face court challenges,
and recent rulings have signaled the Court majority's willingness
to take positions that weaken these laws. If Justice Young
is not re-elected in November, the Court's new majority
will become more powerful, making tort reform laws even
more vulnerable to attacks. This could drive physicians
out of Michigan at a time when we already face a physician
shortage.
Do
you part to keep him on the bench: vote to retain Justice
Young and join MDPAC.
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WSU
Medical Student To Study Tropical Medicine In London
A
fourth-year medical student at the Wayne State University
School of Medicine will put her medical education on hold
for one year to study for a master’s degree in Public Health
at the London School of Hygiene and Tropical Medicine in
England.
“I
believe that health care is a right and I want to help
break down the barriers to access to health care,” said
Suzanne McGoey, of Grosse Pointe Woods. “I would like to
learn how to solve these problems on a larger scale, to
improve health care access globally through policy change
and innovative solutions.”
The
London School of Hygiene and Tropical Medicine, Britain’s
national school of public health, is the 2009 recipient
of the Gates Award for Global Health. The highly rated
research institution includes collaboration with more than
100 countries.
“The
opportunity to learn from staff and work with students
from all over the world will allow me to forge those international
relationships that will be an invaluable resource in a
career in global health care,” said McGoey, 25.
That
experience, she explained, will assist in her future plans
to continue fighting health care discrepancies around the
world by establishing clinics in developing countries.
The
program will take a year to complete, with 10 months of
coursework and two months of research. McGoey hopes to
complete her research in Botswana or Tanzania.
McGoey
completed her undergraduate studies at Yale University,
where she received a bachelor’s degree in psychology. Her
interest in health care began at age 16, when she volunteered
to work at a camp for children with neuromuscular disorders.
There, she was paired with a 10-year-old, Andre, who depended
upon her for his personal care.
“He
opened up and let me into his life, trusting me and teaching
me how to work with him,” she said. “I grew to understand
the obligations and responsibilities that came with the
trust he placed in me. I discovered the relationship you
develop when you care for someone, and it was at that moment
that I knew medicine was the field for me.”
Andre
has since died, but McGoey has returned to the camp annually
for the past 10 years, reinforcing her career decision.
After
completing her Public Health degree, McGoey plans to return
to WSU to finish her fourth year of medical school, followed
by a combined residency in medicine and dermatology. Ultimately,
she would like to work at an academic institution in an
urban setting where she can teach, as well as care for
the local community and work abroad.
McGoey
said she elected to attend the WSU School of Medicine because
of its unique learning environment and the attitude of
its physicians and students.
“There
is an expectation for all to do their part and contribute
to the community. As early as first year, I was able to
get involved in the community, working with patients, realizing
that the people of this city are incredible; they are resilient,
caring and compassionate,” she said. “Students learn firsthand
from attending physicians and residents how to advocate
for their patients. People who work with Wayne State medical
students are very passionate about their work, and I am
proud to learn from them.”
As
a WSU student, McGoey has volunteered at the Cass Clinic
since her first year of medical school. During her third
year, her role transitioned to teaching younger students
how to take a medical history and perform a physical exam. “This
helped reinforce my desire to remain in an academic setting
later in my career,” she said.
She
has also volunteered at Covenant House, tutoring people
in the community, including runaway teens and those recently
released from prison, to attain their GED. She is a member
of the American Medical Association and was a student state
delegate of the Michigan State Medical Society. When she
isn’t studying or volunteering, McGoey laces up her skates
as a member of a hockey team consisting of medical students
and residents.
“Life
as a medical student is busy, trying to balance a heavy
course load as a first- and second-year student or hospital
work as a third- and fourth-year medical student with study
and the necessary preparation for school exams and national
board licensing exams. Yet students here still find time
to contribute in whatever way they can,” McGoey said. “Student
organizations go to schools and tutor about sexually transmitted
diseases, they tutor elementary school students in reading,
they welcome future doctors to the school and show them
what hard work and education can do for them, they create
a farmers market in the summer in the middle of one of
the poorest areas as a temporary solution to a lack of
a major grocery chain, they volunteer in student-run health
clinics providing health care to people who cannot afford
insurance. It is an incredible environment to be a part
of.”
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Oakwood
Extends Partnership With HOPE Clinic
Oakwood’s
mission to provide excellence, healing and health to the
individuals and communities it serves recently took another
step forward.
Officials
from the City of Wayne joined with staff and volunteers
of the HOPE Clinic to celebrate the opening of their new
clinic on Chestnut Street just off Wayne Road. The HOPE
Clinic, founded 25 years ago in Ypsilanti, opened its first
satellite office in Wayne three years ago. Through the
clinic, volunteer physicians and nurses from Oakwood Healthcare,
Inc (OHI), bring medical, dental and counseling services
to individuals who would not otherwise be able to afford
it.
The
new clinic has space for four examination rooms—twice as
many as at the former location, which was in the lower
level of the Lighthouse Ministry Church. It is open on
Saturdays for walk-in appointments. Follow up appoints
can be scheduled after an initial consultation.
Lisa
Rutledge, Corporate Director for Community Outreach for
OHI, said the partnership is an important one.
“Oakwood
believes that patients come first, and has some key partners
in our community to assist people to access primary health
care,” she said. “We are proud to help HOPE clinic offer
free medical care at their Wayne clinic.”
The
clinic has also joined the Oakwood Circles of Care group
in Western Wayne county—a group of faith based clergy and
leaders who work with people in the health care and social
services industries to help improve the health and well
being of people in their congregations and their communities.
“They
are a vital link in this chain,” said Rutledge. “This has
been a great partnership for us.”
For
more information about the HOPE Clinic, visit www.thehopeclinic.org.
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WCMS
Foundation Holiday Party Kicks Off Fundraising Drive
(Editor’s
Note: The following is a letter from WCMS Chairman Joseph
Beals, MD, kicking off this year’s fund drive. To view
this year’s contribution form, click
here.)
Dear
Colleague:
The
Wayne County Medical Society Foundation has already begun
its preparations for the 25th Annual Holiday Party for
underprivileged children to be held on Saturday, December
11, 2010, at the Detroit Science Center.
Can
you believe that it has been 25 years? Let’s give the kids
a party to remember as we celebrate this anniversary event.
Last
year was a wonderful experience for the children. They
viewed the IMAX, “Santa vs. the Snowman”, toured the Center’s
science exhibits, had lunch and received Santa’s gifts,
including a new winter jacket, a science book, a board
game, plus a new toothbrush.
This
event is possible only because of your contributions. In
past years you have been extremely generous and I am appealing
to you again in this anniversary year to give from your
heart for these kids.
Sincerely,
Joseph M. Beals, MD
Chairman
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Michigan
Occupational Health Conference
(Editor’s
Note: The following is a letter from MOEMA President Peter
Metropoulos, DO, MPH regarding the 2010 Michigan Occupational
Health Conference. Please click
here for more brochure containing more information.) www.moema.org
Dear
colleagues:
I
would like to invite all physicians, nurses, other healthcare
providers, and individuals with an interest in occupational
health, to the Michigan Occupational Health Conference
2010, which brings together MOEMA and MAOHN for a joint
conference this year.
As
President of the MOEMA, I personally wish to extend an
invitation for your attendance. Please review the attached
brochure and registration form for details of the conference
curriculum. We are bringing to you important topics in
occupational and environmental health that we trust will
be applicable to your daily medical practice. Come join
all of the physicians, nurses, physician assistants, nurse
practitioners, industrial hygienists, nurse case managers,
and other health professionals attending the Michigan Occupational
Health Conference.
The
Michigan Occupational Health Conference is on Friday and
Saturday, October 1st and 2nd, 2010, in Port Huron, Michigan.
Come
and enjoy a relaxing educational venue and stay at the
Thomas Edison Inn along the St Clair River. For those unable
to stay at the Inn, Port Huron is an easy and quick commute
from most of southeastern Michigan and Ontario, Canada.
Lastly,
I would like to encourage all of you to apply for membership
to ACOEM and MOEMA if not already a member. As a member,
you benefit from the invaluable educational support provided
to members. Please go to www.acoem.org for full details
on membership, or click the link below to go directly to
the application section. For anyone treating working men
and women, ACOEM & MOEMA provide an invaluable resource
to the occupational health specialist as well as for health
professionals providing care to working patients. So please
click on the link below or cut and paste the link in your
Internet browser and apply for membership today.
www.acoem.org/JoinToday.aspx
Membership
categories include Regular membership available to doctors
of medicine or osteopathic medicine who have an interest
in occupational and/or environmental medicine; Associate
membership for those who are non-physicians, who have attained
the doctorate level degree of PhD, ScD, DrPH, or EdD in
occupational and environmental health disciplines; Affiliate
membership for those non-physicians with a masters-level
degree working in a field related to occupational and environmental
medicine, certified Physician Assistants (PA), licensed
Nurse Practitioners (NP), or Certified Occupational Health
Nurses (COHN); and Medical Student/Resident Membership
open to full-time medical students, interns, or residents
with an interest in occupational and environmental medicine.
Sincerely,
Peter E. Metropoulos, DO, MPH, FACOEM
MOEMA President
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