Posts filed under ‘General Info’
Kicking off the 17th Annual ICSI Colloquium on Health Care Transformation – May 5-7, 2014 at the Saint Paul RiverCentre — will be Craig Brammer, Chief Executive Officer of the combined operations of the Greater Cincinnati Health Council, the Health Collaborative and HealthBridge. He will share lessons learned from overseeing the strategy and coordination of that region’s community health improvement initiatives. A much sought-after innovator and speaker, Brammer was previously at the Office of the National Coordinator for Health Information Technology, where he focused on the intersection of technology and payment policy, and led a $260 million federal technology innovation program.
He joins Kerry Sparling, our other keynoter, who will provide a patient’s perspective on how to curtail the rapid rise in diabetes.
Looking for more reasons to attend? Keep an eye on our website’s Colloquium page for all the details as our program develops, including:
- New tracks
- Opportunity to win free trip to 2015 Colloquium
- Tuesday reception
- Mobile app – better than ever
The theme of ICSI’s next colloquium, set for the Saint Paul RiverCentre on May 5-7, 2014, is Building a Sustainable Health System.
Kerri Sparling has been announced as one of our keynote speakers. Ms. Sparling, who has had type 1 diabetes for more than 27 years, is the creator and author of Six Until Me, one of most widely read diabetes patient blogs. Her work as a writer and consultant can be found at diaTribe, dLife, and in diabetes outreach like JDRF’s Countdown magazine.
As many as one in three U.S. adults could have diabetes by 2050, according to the Centers for Disease Control and Prevention. Ms. Sparling will present an engaging patient perspective on how to best meet the needs of this expected tsunami of people living with diabetes. Here is what a past Colloquium Planning Committee Member, Ben Miller, PsyD, Department of Family Medicine, University of Colorado School of Medicine, has to say about Ms. Sparling:
“You want authenticity? You want a challenge? You want to be engaged? If the answer to all three of these questions is ‘yes’ then look no further than Kerri Sparling. Kerri picks an audience up by their lapels and shakes them around convincing them that there is a patient in healthcare who often gets lost and ignored. She reminds us all of the importance of being truly ‘patient-centered’ and dispels any myths that focusing on pieces rather than wholes is a good idea for our health. Very few leaders in healthcare are able to address such complicated issues in healthcare as Kerri; and, she does so with grace, precision, and passion.”
Save the date and watch for more details as the program develops.
A reception with Tom Frieden, MD, Director of the Centers for Disease Control and Prevention (CDC), was held at ICSI in September in conjunction with Dr. Frieden’s visit to our state to learn how Minnesota has achieved the best control of hypertension in the country. Learning Minnesota’s best practices, he noted, might help the CDC and the Centers for Medicare and Medicaid Services reach the goals of their co-led Million Hearts™ Campaign—prevent one million heart attacks and strokes by 2017 through improved clinical and community prevention, and increase the number of persons in the U.S. whose hypertension is under control by 10 million. Learn more.
ICSI brought together more than 60 stakeholders who have been involved with the DIAMOND and SBIRT programs for a learning action forum on September 26, 2013. The “Evolving Integrated Care” forum focused on three areas: celebrating the stakeholders’ accomplishments over the past seven years in integrating behavioral health and primary care; engaging stakeholders on the impact of their work to date and opportunities for improving depression and substance use care in primary care; and exploring innovative strategies to sustain successful integrated care moving forward. Learn more.
James L. Reinertsen Lecture
Leaders or Victims? Choices We Face in the Era of Accountable Care
October 24, 2013, 4:30 – 6 p.m. Reception, 6 – 7:30 p.m. Lecture
Minneapolis Marriott Southwest, Minnetonka, MN
Plan to join us for an extra-special James L. Reinertsen Lecture, delivered by Dr. Reinertsen himself. One of ICSI’s founders, he will help us celebrate our 20th anniversary and inspire us for the work we tackle during ICSI’s third decade. We expect a large crowd so please help us plan by registering. Find out more and register by October 17.
Shared by The Incidental Economist, an eight-minute video by John Green, a New York Times bestselling author who explains why U.S. health care costs are so high. It’s entertaining and understandable!
Janet Corrigan, PhD, MBA, previous President and CEO of the National Quality Forum, recently led a discussion with the ICSI Board of Directors on efforts to build a value-based measurement framework to help achieve the Triple Aim of better health, better care and better costs.
I’ve carried an MD degree proudly for over 40 years. Being of service to those in my community in improving their health has been a badge of pride I’ve worn proudly. But for the 26+ years of practice, and my 11+ years at ICSI, I’ve had the sense we could, and must, do better…. especially as the world around us has changed drastically.
By Thomas Kottke, MD, MSPH and Nico Pronk, PhD
The advances in the treatment of cardiovascular disease in the past 50 years are remarkable. Automated external defibrillators (AEDs), the devices you see in airports and other public places, change out-of-hospital cardiac arrest from a death sentence to an event with some chance of survival. Coronary angioplasty (ballooning the blockages in the arteries that feed the heart) during a heart attack reduces deaths by about 50%. Implantable devices that pace and shock the heart when a life-threatening heart beat occurs reduce the risk of death by more than 40%.1
These statistics and the current emphasis on individualized medicine might suggest that, if a community can afford high tech health care, it doesn’t need to invest in parks, bike ways, tobacco-free homes and workplaces, access to affordable fruits and vegetables, and the other health promoting environments.2 But the data demonstrate that the path to health for every community and every individual, rich and poor alike, requires health-promoting physical and social environments.
Let’s do the math for the high-tech treatments of heart disease and two of the fundamental determinants of health–physical activity and healthy food. The best estimate of what will happen to an individual is what will happen to others in their community. It is simple to calculate the community impact of any intervention if just four parameters are known: (1) the extent to which an intervention will reduce “event rates,” (2) the event rate for eligible individuals who participate in the intervention, (3) the number of eligible individuals who have not yet taken part in the intervention, and (4) the number of people in the community who are eligible for the intervention.
For example, using deaths that might be prevented or postponed (DPP) as “the event,” we can calculate the impact of meeting the physical activity guideline for healthy Americans.
For a population of 30-84 year-old Americans:
- The mortality rate of physically active individuals is 30% lower than the mortality rate for inactive individuals;
- The death rate is 1,007/100,000;
- 70% of those able to be active are currently not active;
- In a population of 100,000, the number of apparently healthy individuals is 90,024.
Therefore, the DPP that could be achieved if the entire healthy population were to become physically active is 0.30 x 0.01007 x 0.7 x 90,024, or 190.
In 2009, we published the expected DPPs for nutrition, physical activity, tobacco and several heart disease treatments.1 We calculated the impact of improving performance from current levels to achieving 100% goal attainment. We found that the number of deaths that might be prevented or postponed in a community of 100,000 adults ages 30-84 would be:
- 1.9 if AEDs were placed in all public places and people who worked there were trained in their use;
- 15.1 if all individuals with heart attacks received angioplasty;
- 63 if all individuals who met the criteria received an implantable defibrillator or biventricular pacemaker;
- 158 if everyone met the dietary goal of five servings of fruits and vegetables every day;
- 159 if no one smoked and no one were exposed to second-hand smoke, and
- 334 if everyone met the physical activity goal of 150 minutes per week.
We found that improving care for acute heart disease events could at most prevent or postpone 8% of deaths in the U.S. population ages 30-84. Taking full advantage of the benefits of good nutrition, adequate physical activity, and elimination of tobacco would prevent or postpone 49% of all deaths. If our calculations considered the impact of all community determinants of health on all ages, the predicted impact would be considerably larger.
It is indisputable that access to medical care saves lives, but the math demonstrates that, regardless of the resources that might be committed to health care, there is only one path to significantly healthier communities. That path is mobilizing action to improve the physical and social environments in which we live.
2. Mobilizing Action Toward Community Health (MATCH): Population Health Metrics, Solid Partnerships, and Real Incentives 2012; http://uwphi.pophealth.wisc.edu/. Accessed December 20, 2012.
It’s Not Automatically OK
It’s complicated. Changes are flying at us at an accelerating rate, clashing and clanging against what we thought was certain. Legislative measures that may or may not prevail, changes in how performance is evaluated, changes in reimbursement, changes in the roles of all involved – seemingly the only thing for certain is change. What will be the opposite and equal reaction?
Let’s take stock of the current situation. The anticipated shortfall of primary care physicians if the Affordable Care Act (ACA) remains in force is estimated to balloon to more than 60,000 by 2025. Whether or not the ACA remains in force, the active patient population will continue to grow as baby boomers age. This burgeoning patient population is adding to the strain caused by increasing multimorbidities and chronic conditions. Medicine, like aviation, is going to face greater demands and an increasing need for more experts.
This change in the environment will require changes in behavior. Parts 1 and 2 of this series explored how medicine learned from aviation’s work on changing behavior. It started with the checklist, moved into Cockpit Resource Management, and then evolved into Crew Resource Management. Aviation had made huge strides in recognizing that, in order to optimize resources in the work environment, it was essential for all crew members to be actively involved. With Crew Resource Management’s team approach widely implemented and on its way to being mastered, the fiercely competitive aviation industry (manufacturers and airlines) scanned the environment for a concept to leverage to lower training costs, improve safety and deal with the shrinking pool of already trained pilots from the military. And so they were seduced by the siren song of automation.
While automation has improved costs and safety, commercial aviation is now in the midst of the painful process of recognizing and adjusting to the unintended pitfalls of automation reliance. In a fascinating recording of an American Airlines pilot training session, Children of the Magenta, over-reliance on automation is the key concept. The trainer repeatedly demonstrates how pilots rely on automation even when they can clearly use manual controls. He cautions that “in 68% of accidents, automation dependency plays a critical part in leading crews… to allow their aircraft to get much closer to the [edge of the envelope] than they should have.” In other words, their reliance on automation has caused them to neglect their critical thinking.
Understanding why automation can lead to failure is important. One interesting study of automation’s surprises contained in Handbook of Human Factors & Ergonomics points out that the implicit promise of automation technology is that it increases precision and efficiencies while reducing the potential for human error. However, that promise can come up short because the human-machine interaction cannot replicate the “basic competencies” of human-human interaction. Humans have difficulty remaining actively engaged while monitoring – the place automation puts us. We disengage and lose situational awareness.
Moreover, automated systems tend to “switch off” in complex situations where they may be needed most. The person monitoring may not be sufficiently oriented to the situation to handle it effectively. Even worse, key bits of information can be masked by well meaning efforts to simplify matters for the human monitoring the process. One widely studied accident occurred in part because key information needed by the crew was masked.
Similarly, in medicine, technological advances have created opportunities to reduce the likelihood of error through systems design and processes. As the number and variety of ways to automate performance increases, so does the reliance on those mechanisms. Physician shortages and finite resources coupled with increasing demand create a pressure to do more with less. Automation may again seem to be the silver bullet. Aviation has learned that automation can help but it comes with its own pitfalls. Health care can avoid these potential pitfalls by learning from aviation’s experience.
So how are we in health care being seduced by automation? It’s easy to see how enticing high-tech diagnostic imaging and robotic surgery can be. Here are some more discrete real-life examples:
- Physicians increasingly request decision support to help them with clinical implementation. An example of this is clinical indicators by condition.
- Electronic medical records (EMR) are being designed so that the physician cannot digress from the protocol embedded in the EMR without documenting the reason.
- Workstations are being set up and work flows designed so that the clinician has a limited set of options for actions and activities.
Again, automation in itself is not inherently bad. It is when it is used so widely and extensively that critical thinking falls to the wayside that issues start to arise. Here are some examples of automation’s unintended consequences:
- Electronic dosing schedules that do not include maximum dosages can result in overdosing if there is an over-reliance on the system.
- When processes are developed to reduce error and ensure the clinician “does the right thing,” opportunities for critical thinking are being designed out of the process.
- Over-focus on the processes may cause the obvious to be missed. One patient shared her recent experience with a hospital room not being tended as it should. It escaped the floor nurse’s attention although the nurse’s station was in close proximity to the room because there was no “check room cleanliness” prompt on her computer screen.
Aviation and health care’s shared draw to automation and the potential for negative unintended consequences has not escaped notice of those straddling both industries. One such individual, a clinician from Sydney, pointed this out on a pilot’s forum. He commented, “You know, this is a broader cultural issue. We are seeing the exact same paradox in medicine. Everything is being reduced to autopilot with clinical pathways and guidelines. This approach inevitably de-emphasizes critical thinking, and clinical decision making skills are being lost as a result.”
The impact of a loss of focus on critical decision-making skills now may have a large impact in the future. The commenter continues by pointing out that medicine is like an apprentice system where students and junior physicians model their future practices after what they observe. They are likely to practice what they learn.
He points out that while the benefits of automation may be immediate, the true cost may not be realized for years, and cautions, “This is like aviation. All the airlines have followed this path for years – in part due to regulatory requirements, but also due to significant economic benefits. But people are now starting to question the consequences.”
The risk for error in both health care and aviation increases when the automation is highly complex or inconsistent. Additionally, the visual and tactile cues that can increase situational awareness are often casualties of automation design process. For example, debates have continued to wage for years about the value of a flight yoke versus a side stick because of the related loss of visual and tactile clues provided by the yoke to all the crew in the cockpit. Similarly, there are scores of unintended consequences from each design choice and philosophy. Perhaps one salient lesson is to design these cues in to the process instead of out.
Health care has benefited from incorporating aviation’s quality and safety improvement tactics into our industry, but often only after the long passage of time, many lost lives and wasted resources. We have an opportunity to head off the worst of automation’s unintended consequences by designing automation in a way that fosters critical thinking skills.