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Systems engineering in the hospital
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Systems-engineering expert James Benneyan, PhD, doesn’t want hospitalists to look at poorly working processes in their institutions and think, “I should try to tweak this process to improve it.”
Instead, he wants them to walk out of his HM17 session at 8 a.m. Thursday – appropriately titled, “Systems Engineering in the Hospital: What Is in Your Toolkit?” – thinking like engineers, which means designing a solution, analyzing how well that process works, and then optimizing it for improvements. If that means not just tweaking a process, but redesigning it from scratch, so be it.
“Systems engineering studies the performance and how to improve the performance of complex systems, particularly sociotechnical systems,” said Dr. Benneyan, who runs the Healthcare Systems Engineering Institute at Northeastern University in Boston, which encompasses four research centers. “Health care is a perfect example … systems engineering can really help to understand and improve complex processes, whether it’s patient flow, safety, on-time discharge [or] better discharge.”
Dr. Benneyan says that systems engineering is, first and foremost, a mindset. It’s an approach to problem solving that’s different, if related, to quality improvement. Both have tremendous value, but they are based on different philosophies, tools, and work styles.
For example, many hospital operating rooms measure how many days the first procedure of the day begins on time. But instead of using that as a yardstick for quality, Dr. Benneyan said a better approach would be designing a system that can adapt to situations when the first case starts late. He compared the process to a delayed flight at an airport. An airline doesn’t back up every plane’s departure when one plane is running behind. Instead, it has systems that adapt to circumstances.
“There are methods and then there are philosophies,” Dr. Benneyan said. “I don’t think people in health care realize what my field did in the airline industry. We didn’t design things that worked and clicked properly. We designed things that … react to daily events and [everything] going on and perform pretty well.”
Dr. Benneyan says that, while health care is an incredibly complex system, other fields with similar levels of technical expertise have used systems engineering much more effectively. Manufacturing, logistics, and global distribution networks are all precise industries requiring hundreds of individual processes to ensure success.
“These are really complicated processes,” he said. “The real barrier is a cultural barrier. Health care is not the most challenging environment to work in. … I think something that people in health care have to have an appreciation for is that the process of doing this work is different from doing their other work. Systems engineering is not the same as quality improvement and can achieve fundamental breakthroughs in cases where QI has not – but also tends to take more work.”
Still, Dr. Benneyan believes his field has lessons that complement quality initiatives. To wit, health care advocates – including the Institute of Medicine, the Agency for Healthcare Research and Quality, the National Institutes of Health, and the National Science Foundation – have all pushed for greater application of systems engineering in medicine with the goal of improving how well health care does its job.
While he hopes hospitalists and other HM17 attendees at his session walk away with a newfound respect for and understanding of what systems engineering can do, he doesn’t want them to think it’s too easy.
“There’s a lack of appreciation of the process of engineering and how it’s different,” he said. “It’s a big challenge, partnering clinician with engineers. … We think differently even though we’re both scientifically trained.
“I hope hospitalists take away an appreciation for how this toolkit can be useful in their world.”
Systems Engineering in the Hospital: What Is in Your Toolkit?
Thursday, 8:00–9:30 a.m.
Diabetes specialist to offer disease management tips
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
Diabetes is a persistent presence in the hospital, and hospitalists must remain up to date on the latest in disease management.
An endocrinologist will walk the audience through four major points on caring for diabetes patients in a talk to be given Thursday at HM17. The session, “Inpatient Diabetes Management for the Hospitalist,” will begin at 7:40 a.m.
Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine, director of the clinical research center and section of diabetes and metabolism at Emory University, Atlanta, and section head of diabetes and endocrinology at Grady Health System, also in Atlanta, said that, “in most patients, diabetes is a comorbidity that has a serious impact on the outcome of patients with cardiovascular disease or malignancies or surgery.
“Hyperglycemia in patients with or without diabetes can be 30%-40%,” he said. “There are somewhere around 8 to 10 million hospital discharges with diabetes every year in the United States.”
Dr. Umpierrez intends to discuss the following topics in his presentation:
• Intensive insulin therapy. “There is no evidence that intensive insulin therapy aiming to normalize blood glucose [leads to] improvement in outcome and could even [worsen] outcome because of the risk of hypoglycemia. This is true for patients in intensive care and the regular floor.”
• Treatment other than insulin. Guidelines say that using insulin is the only way to manage diabetic patients in the hospital, but evidence is growing that this might not be ideal in some cases, he said.
“Recent evidence in the past 5 years has shown that maybe a one-size-fits-all approach is wrong because using insulin, especially the basal-bolus insulin regimen” – with long-lasting insulin between meals and bolus insulin at mealtime – “can be an overtreatment for some patients with multiple complications and patients with mild hyperglycemia.” In many patients, the administration of a single basal insulin dose (glargine or detemir) is sufficient to achieve reasonable glucose control. In addition, patients with blood glucose less than 180 to 200 mg/dL could benefit from the use of incretin therapy with or without insulin to “at least minimize the risk of hypoglycemia.”
• Limitations for sliding-scale insulin therapy. This approach, in which mealtime bolus insulin is based on blood-sugar level before meals and which has dominated diabetes management over the past 80 years, can bring problems, according to the latest literature, Dr. Umpierrez said.
“Now we have excessive evidence, both in the ICU and non-ICU, that the use of sliding-scale insulin therapy … is associated with higher blood glucose levels [and a] higher rate of complications compared to the use of basal insulin. So, I think that physicians are becoming more aware that sliding scale is not the only way to manage patients in the hospital.”
• Insulin at discharge. The belief that all patients need to go home with insulin might be misguided, he said. “This could be an overtreatment associated with increased risk of hypoglycemia with no benefit in outcome.”
• The use of computer-guided algorithms on insulin therapy. “Are they better than the standard insulin drip protocols that we have? Not clear,” he said. Many commercial versions and institution-generated versions have been developed, but there is uncertainty about their value, he added.
“They may reduce the risk of hypoglycemia,” Dr. Umpierrez said. “We don’t have any evidence that they are better in reducing complications in the hospital. And they can be costly. So the physician has to be aware of the cost. But, it’s an option for some institutions that have very little support from hospitalists or intensivists in their hospital to adjust insulin therapy in the rapidly changing environment in critically ill patients in the ICU.”
Inpatient Diabetes Management for the Hospitalist
Thursday, 7:40–8:15 a.m.
On Tap Wednesday
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
HM17 kicks off today with the presentation of the annual SHM Awards of Excellence, which honor work done in service to HM. A nod to the past, as it were. As those physicians are honored, others will be given their prizes as the winners of the Best of Research and Innovations in 2017, a nod to the present state of HM’s investigative spirit.
“We’re in the midst ... of a lot of change in the health care system,” said HM17 course director Lenny Feldman, MD, FACP, FAAP, SFHM. “To be able to hear from Dr. Conway as to how the priorities of CMS might be changing and what this all means to us in the future is an amazing opportunity. There is no better time to hear from Pat Conway. I’m really looking forward to it.”
A new highlight this year is Wednesday’s track of Repeated Sessions, something organizers added to ensure that some of the most-popular sessions – “Updates and Pearls in Infectious Diseases,” and “Non-Evidence Based Medicine: Things We Do for No Reason” – are available to as many attendees as possible.
“We’ve added that in this year because we know there are sessions that are standing room only on a regular basis,” Dr. Feldman said. “People should not have to stand.
“I’m hoping that these repeated sessions will be well received and will allow folks to be able to go to some other sessions they might not have in fear they were going to miss some of these typically ‘standing room only’ sessions.”
Telehospitalists can expand capability, capacity
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
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“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
[[{"fid":"194482","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Talbot \\\u0022Mac\u0022 McCormick, Eagle telemedicine, Atlanta","height":"220","width":"157","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":""}}}]]Copresenter Shannon Carpenter, BS, MBA, vice president at Charlotte, N.C.–based Carolinas Healthcare System, said telemedicine is a “relevancy issue.”
“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
The cost of health care is on the lips of everyone, from the thousands of HM17 attendees to congressional leaders to President Donald Trump. Yet, one long-promoted answer – telemedicine practiced by telehospitalists – is not as widely adopted as its proponents say it should be. After Wednesday’s session, “Foundations of a Hospital Medicine Telemedicine Program,” which begins at 4:15 p.m., at least a few more physicians will see it as an option.
“The timing is there,” said copresenter Talbot “Mac” McCormick, MD, president and chief executive officer of Eagle Telemedicine of Atlanta. “Telemedicine has come of age.”
[[{"fid":"194482","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Talbot \\\u0022Mac\u0022 McCormick, Eagle telemedicine, Atlanta","height":"220","width":"157","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Talbot \u0022Mac\u0022 McCormick","field_file_image_credit[und][0][value]":""}}}]]Copresenter Shannon Carpenter, BS, MBA, vice president at Charlotte, N.C.–based Carolinas Healthcare System, said telemedicine is a “relevancy issue.”
“We are hearing so much about a need for an alternative care model, [and] the virtual-care model is incredibly relevant in today’s environment,” Ms. Carpenter said. Adding to telemedicine’s basic advantage is its ability to help alleviate staffing issues.
“Telemedicine and telehospitalists can support and fill out gaps [and] can expand capability and capacity,” Dr. McCormick added. “Then, the other part is economy of scale. You can share a telehospitalist amongst a couple of small hospitals ... an advantage over each one trying to do it themselves.”
For example, individual institutions might not be able to keep a hospitalist busy 12 hours a night, but a nocturnist is still a requirement.
“When they need somebody, they sure need them,” Dr. McCormick said. “So, you get an economy of scale that several small hospitals effectively can share one physician because the space continuum – not necessarily the time continuum – but the space continuum and the geographic continuum is different engaging telemedicine versus people physically on the ground.”
Ms. Carpenter said that one of the obstacles to telemedicine is simply getting physicians to change habits.
“The biggest hurdles that we experienced were with buy-in for the care-delivery model,” she said. “Surprisingly, it’s not from the patients’ perspectives. It’s from either from the physicians who should be providing the service and/or from the staff in the hospital who aren’t used to the technology or the method of care delivery. To avoid this, it’s just like anything else: over-communication, education, and an ability to explain why and how care will be delivered.”
In addition to the difficulty of changing the culture, integration failures are another potential pitfall, according to Dr. McCormick.
“I think that communication gets to part of that,” he said. “I think [telemedicine should be viewed] ... not [as] a segmented silo of a hospitalist team – to be functional and to work well, it has to be integrated with the team so that it’s just a seamless part of the care team of the doctors, the nurses, the nurse practitioners.”
Both presenters agree that, as value-based payments and alternative payment models proliferate in the coming years, telemedicine will only grow as hospitals and hospitalist group leaders look for cost efficiencies. It will also be broader than just nocturnist services.
Ms. Carpenter said future uses could include expansion to ambulatory clinics for transitioning patients from acute care back to their medical home environment or to telehospitalists supporting paramedics on home visits.
“The use of tools and technology like this can allow care to bridge across these multiple geographic locations of care and do it in a way that provides continuity, economy of scale, consistent and high quality care,” Dr. McCormick said.
Foundations of a Hospital Medicine Telemedicine Program
Wednesday, 4:15–5:20 p.m.
Available via HM17 On Demand
Welcome to Annual Meeting Day 2
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Day 1 has already raised the bar for the SHM Annual Meeting. Day 2, Wednesday, will set a whole new standard with courses, speakers, content, and perspective.
Leading off the day will be the presentation of the best of Research and Innovations. This year, we had hundreds of submissions, and the kickoff of Day 2 will showcase the very best of the best! Following immediately, we will recognize the winners of the SHM Awards of Excellence.
Then, off to the main meeting!
This year, we anticipated that some sessions would be so hot that we would have to hold them twice to meet the demand. These sessions are labeled with their own track and include my own personal favorite – and ironically named – series at SHM, “Things We Do for No Reason.” So if you missed this or any of the other talks – heart failure, pulmonary embolism, infectious diseases, delirium, and syncope – here’s your second chance!
But wait – there’s more! This year, for the first time, we have Maintenance of Certification credit available for attendees of the MOC-Clinical Updates sessions and the Rapid Fire Sessions. So, go right ahead and get the MOC credits while you catch up on the latest evidence.
Every year, hospitalists, residents, and students from all over submit hundreds of insightful clinical vignettes posters. Lunch and learn in the Exhibit Hall and peruse the great cases while the judges debate over the absolute best. Afterward is the can’t- miss feature at every Annual Meeting: the Update in Hospital Medicine – this year being delivered by a pair of hospitalist leaders from the heartland, Rachel Thompson, MD, MPH, SFHM and Chad Miller, MD, FHM. Come for Rachel and Chad’s interpretation of the most important and relevant recent literature in adult hospital medicine.
Resident or medical student? You’re in good company at HM17. We have more trainees here than ever before. At 5:30 p.m., we’re holding a special session for you: A skills workshop on “Mastering the Job Interview.” We don’t learn these things in medical or residency – learn them at HM17!
A few other key sessions close out Day 2: Ron Greeno, MD, FCCP, MHM, and Nasim Afsar, MD, SFHM, present on the role hospitalists can (and must) play in the rollout and management of Alternative Payment Models. Then, there’s the mysteriously titled “Myths, Misunderstandings, Medicare & Money: PA/NP and Physician Teams in Hospital Medicine.”
Finally, wind down and see what’s new in the pediatrics world with the Pediatric Hospital Medicine Update with Akshata Hopkins, MD, and Amit Singh, MD.
If yesterday set the tone and tomorrow is the wrap up, Day 2 – today – is the middle act of HM17 and is sure to be educational, provocative, exciting, and an exceptional learning experience. Be sure to take time to walk through the exhibit hall. Please also stop by the SHM Booth to meet the hardworking SHM staff who have made this meeting a great success and introduce yourself to members of the Board who will be present in the booth during the course of the meeting!
Dr. Harte is outgoing president of SHM and president of Cleveland Clinic Akron General and Southern Region.
Hospitalists can do better at end-of-life care, expert says
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
As a 99-year-old friend neared the end of her life, she offered a lesson for the health care world, said Deborah Korenstein, MD, chief of general internal medicine and director of clinical effectiveness at Memorial Sloan Kettering Cancer Center, N.Y., in the Tuesday session “Finding High Value Inpatient Care at the End of Life.”
The woman, nicknamed “Mitch,” had bluntly made her preference clear, Dr. Korenstein said: “She wanted to live independently as long as she could, and then, she wanted to be dead.”
But when a pathology report showed urothelial cancer, that preference didn’t stop an oncology urologist from suggesting that Mitch enter a clinical trial on an unproven therapy. Worse, Mitch initially said “yes” to this idea, seemingly because she thought that’s what she was expected to say.
It was only when Dr. Korenstein spoke with her that she changed her mind, entered inpatient hospice care, and died peacefully.
“I think it’s a cautionary tale about when a patient is crystal clear about their wishes,” she said. “The wave of the medical system kind of pushes them along in a particular direction that may go against their wishes.”
Dr. Korenstein said U.S. health care system does fairly well in some areas – for instance, research shows that about 60% of people die in their preferred location, whether at home or somewhere else. But it does not do so well in others – a 2013 Journal of General Internal Medicine study found that, during 2002-2008, Medicare beneficiaries typically spent $39,000 out of pocket on their medical care, and in 25% of cases, what they spent exceeded the total value of their assets.
As far as individual preferences, these tend to correlate poorly with the care that people actually get, Dr. Korenstein said. Patients often don’t express their wishes, doctors are poor judges of what matters to individual people, and care is largely driven by physician preferences and by the care setting involved, she said.
Given those problems, she said, “we cannot possibly be providing high-value individualized care.”
Hospitalists are well positioned to help patients’ preferences align with care, she added. Sometimes, a sustained relationship with a patient, while generally a positive thing, might lead a provider to become invested in their care in “ways that are not always rational.” So a hospitalist can have a helpful vantage point.
VIDEO: Policy-focused SHM president thinks hospitalists can impact global, systems change
An original member of the Society of Hospital Medicine, new SHM Board President Ron Greeno, MD, MHM, is excited about helping to guide hospitalists into a new era of health system transformation.
The former chair of SHM’s Public Policy Committee, Dr. Greeno believes payment reforms like MACRA will have a “huge impact” on both hospitalists and the hospitals/health systems they work in. He expects hospital medicine, as a field, is well positioned for such changes and can play a vital role in systems change at the global level.
“In order to impact those things, hospitalists have to be ready to help change systems,” he said after his plenary address Tuesday at HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
An original member of the Society of Hospital Medicine, new SHM Board President Ron Greeno, MD, MHM, is excited about helping to guide hospitalists into a new era of health system transformation.
The former chair of SHM’s Public Policy Committee, Dr. Greeno believes payment reforms like MACRA will have a “huge impact” on both hospitalists and the hospitals/health systems they work in. He expects hospital medicine, as a field, is well positioned for such changes and can play a vital role in systems change at the global level.
“In order to impact those things, hospitalists have to be ready to help change systems,” he said after his plenary address Tuesday at HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
An original member of the Society of Hospital Medicine, new SHM Board President Ron Greeno, MD, MHM, is excited about helping to guide hospitalists into a new era of health system transformation.
The former chair of SHM’s Public Policy Committee, Dr. Greeno believes payment reforms like MACRA will have a “huge impact” on both hospitalists and the hospitals/health systems they work in. He expects hospital medicine, as a field, is well positioned for such changes and can play a vital role in systems change at the global level.
“In order to impact those things, hospitalists have to be ready to help change systems,” he said after his plenary address Tuesday at HM17.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
DeSalvo: HM needs holistic approach to health care
LAS VEGAS – To deliver her message of inclusion Tuesday morning, former acting assistant secretary for health in the U.S. Department of Health and Human Services (HHS) Karen DeSalvo, MD, MPH, MSc, could think of “no finer group” than those assembled before her at HM17.
The thousands of hospitalists gathered to hear her keynote address, “Rethinking Health: The Vital Role of Hospitals and the Hospitalist,” listened as she talked about including more than just the best medical care in HM’s scope of practice. The job must evolve to include a focus on such social issues as economic stability, neighborhood and physical environment, education, and access to healthy options for food.
In other words, Dr. DeSalvo wondered aloud, what good is treating a grandmother’s heart failure over and over if she’s always going to return to the hospital because her home, her neighborhood, or her finances mean she is unable to prevent recurring health issues? [[{"fid":"195561","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Brian Harte conducts an interveiw with Dr. Karen DeSalvo duing the opening plenary Tuesday at HM17.","height":"147","width":"220","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott"}}}]]
Hospitalists “have been at the center of change, not only in building a new field and showing us that medicine doesn’t have to always be the way it always was,” she said. “You have been at the forefront of seeing that we’re getting better value out of our health care system and, though that work must continue, you must also begin to broaden our thinking and understand that the drivers of health are much more than [just] health care. There are social determinants, social factors.”
Dr. DeSalvo, an internist by training, understands that dealing with social issues may seem like a role for others, but she said that the implications of those factors directly impact hospitalists and their institutions via issues such as readmissions.
“These things … don’t just matter conceptually,” she said. “They [have] direct relationships with mortality and morbidity and cost. They are literally affecting people’s lives in this country every day. When we begin to adjust them, to impact them, you can see that it also affects the health care system.”
On the front lines, Dr. DeSalvo said that hospitalists and others can work to take advantage of their hospital’s existing tools to link their patients to available resources, partner with local public health offices, and push to make their hospitals “anchor institutions to build community capacity to address these social determinants.”
Dr. DeSalvo also praised HM as a field that has already embraced value-based payment (VBP) models. She said that ability to anticipate and adapt to health care’s changing needs positions the field well as the Medicare Access and CHIP Reauthorization Act (MACRA) moves health care from fee-for-service to payment models that seek to manage risk and penalize mistakes.
LAS VEGAS – To deliver her message of inclusion Tuesday morning, former acting assistant secretary for health in the U.S. Department of Health and Human Services (HHS) Karen DeSalvo, MD, MPH, MSc, could think of “no finer group” than those assembled before her at HM17.
The thousands of hospitalists gathered to hear her keynote address, “Rethinking Health: The Vital Role of Hospitals and the Hospitalist,” listened as she talked about including more than just the best medical care in HM’s scope of practice. The job must evolve to include a focus on such social issues as economic stability, neighborhood and physical environment, education, and access to healthy options for food.
In other words, Dr. DeSalvo wondered aloud, what good is treating a grandmother’s heart failure over and over if she’s always going to return to the hospital because her home, her neighborhood, or her finances mean she is unable to prevent recurring health issues? [[{"fid":"195561","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Brian Harte conducts an interveiw with Dr. Karen DeSalvo duing the opening plenary Tuesday at HM17.","height":"147","width":"220","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott"}}}]]
Hospitalists “have been at the center of change, not only in building a new field and showing us that medicine doesn’t have to always be the way it always was,” she said. “You have been at the forefront of seeing that we’re getting better value out of our health care system and, though that work must continue, you must also begin to broaden our thinking and understand that the drivers of health are much more than [just] health care. There are social determinants, social factors.”
Dr. DeSalvo, an internist by training, understands that dealing with social issues may seem like a role for others, but she said that the implications of those factors directly impact hospitalists and their institutions via issues such as readmissions.
“These things … don’t just matter conceptually,” she said. “They [have] direct relationships with mortality and morbidity and cost. They are literally affecting people’s lives in this country every day. When we begin to adjust them, to impact them, you can see that it also affects the health care system.”
On the front lines, Dr. DeSalvo said that hospitalists and others can work to take advantage of their hospital’s existing tools to link their patients to available resources, partner with local public health offices, and push to make their hospitals “anchor institutions to build community capacity to address these social determinants.”
Dr. DeSalvo also praised HM as a field that has already embraced value-based payment (VBP) models. She said that ability to anticipate and adapt to health care’s changing needs positions the field well as the Medicare Access and CHIP Reauthorization Act (MACRA) moves health care from fee-for-service to payment models that seek to manage risk and penalize mistakes.
LAS VEGAS – To deliver her message of inclusion Tuesday morning, former acting assistant secretary for health in the U.S. Department of Health and Human Services (HHS) Karen DeSalvo, MD, MPH, MSc, could think of “no finer group” than those assembled before her at HM17.
The thousands of hospitalists gathered to hear her keynote address, “Rethinking Health: The Vital Role of Hospitals and the Hospitalist,” listened as she talked about including more than just the best medical care in HM’s scope of practice. The job must evolve to include a focus on such social issues as economic stability, neighborhood and physical environment, education, and access to healthy options for food.
In other words, Dr. DeSalvo wondered aloud, what good is treating a grandmother’s heart failure over and over if she’s always going to return to the hospital because her home, her neighborhood, or her finances mean she is unable to prevent recurring health issues? [[{"fid":"195561","view_mode":"medstat_image_flush_left","attributes":{"alt":"Dr. Brian Harte conducts an interveiw with Dr. Karen DeSalvo duing the opening plenary Tuesday at HM17.","height":"147","width":"220","class":"media-element file-medstat-image-flush-left","data-delta":"1"},"fields":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_left","field_file_image_caption[und][0][value]":"Dr. Brian Harte conducts an interview with Dr. Karen DeSalvo during the opening plenary Tuesday at HM17.","field_file_image_credit[und][0][value]":"Darnell Scott"}}}]]
Hospitalists “have been at the center of change, not only in building a new field and showing us that medicine doesn’t have to always be the way it always was,” she said. “You have been at the forefront of seeing that we’re getting better value out of our health care system and, though that work must continue, you must also begin to broaden our thinking and understand that the drivers of health are much more than [just] health care. There are social determinants, social factors.”
Dr. DeSalvo, an internist by training, understands that dealing with social issues may seem like a role for others, but she said that the implications of those factors directly impact hospitalists and their institutions via issues such as readmissions.
“These things … don’t just matter conceptually,” she said. “They [have] direct relationships with mortality and morbidity and cost. They are literally affecting people’s lives in this country every day. When we begin to adjust them, to impact them, you can see that it also affects the health care system.”
On the front lines, Dr. DeSalvo said that hospitalists and others can work to take advantage of their hospital’s existing tools to link their patients to available resources, partner with local public health offices, and push to make their hospitals “anchor institutions to build community capacity to address these social determinants.”
Dr. DeSalvo also praised HM as a field that has already embraced value-based payment (VBP) models. She said that ability to anticipate and adapt to health care’s changing needs positions the field well as the Medicare Access and CHIP Reauthorization Act (MACRA) moves health care from fee-for-service to payment models that seek to manage risk and penalize mistakes.
Rapid-fire session troubleshoots mechanical ventilation
Troubleshooting problems with mechanical ventilation starts with assessing how much control one has over specific variables, according to an expert at HM17.
“You want to be in charge of everything when you’re dealing with a ventilator, but you have to acknowledge that you only get to be in charge of some stuff,” said Peter Clardy, MD, an assistant professor of medicine at Harvard University in Cambridge, Mass., and its affiliate, Mount Auburn Hospital. He made his remarks during a rapid-fire science session at HM17.
Since successful algorithms for acute mechanical ventilation require control over many independent variables, knowing what is most stable and going from there can allow the physician to develop a workable plan of action, according to Dr. Clardy.
“It’s really good to be explicit about what is dependent and what is independent,” he said. Independent variables might be those specific to the ventilator, but will always include the positive end-expiratory pressure and the fraction of inspired oxygen. Other independent variables will depend on the mode of ventilation – either fully assisted, partially assisted, or noninvasive.
“If you’re in charge of volume, you have to worry about pressure,” he noted. “If you’re in charge of pressure you have to worry about volume.”
Dependent variables also can vary by mode of ventilation. Once the independent and dependent variables are mapped, it is easier to glean more information about the respiratory mechanics of the situation and the physiologic processes, such as the metabolic cost of breathing and whether it can be reduced, what can be done to prevent ventilator-induced lung injury, and how gas exchange can be supported.
Understanding the independent/dependent variable ratio can also help provide valuable clinical information, such as whether reversing hypoxemia and/or hypercarbia is necessary, or if there are signs of respiratory distress or dyspnea. Other clinical indications might include whether there is a need to prevent or reverse atelectasis, or reduce ventilatory muscle fatigue. Additionally, it will be easier to know whether sedation is possible, or if a neuromuscular blockade should be used. Such information can help determine whether to protect the airway.
“Respiratory distress in a patient who is already ventilated is quite common, so having a routinized way to assess these patients and their stability can help you think about what your moves are right there while you’re in the room,” Dr. Clardy explained. “All of that can be incredibly helpful.”
Dr. Clardy had no relevant financial disclosures.
Troubleshooting problems with mechanical ventilation starts with assessing how much control one has over specific variables, according to an expert at HM17.
“You want to be in charge of everything when you’re dealing with a ventilator, but you have to acknowledge that you only get to be in charge of some stuff,” said Peter Clardy, MD, an assistant professor of medicine at Harvard University in Cambridge, Mass., and its affiliate, Mount Auburn Hospital. He made his remarks during a rapid-fire science session at HM17.
Since successful algorithms for acute mechanical ventilation require control over many independent variables, knowing what is most stable and going from there can allow the physician to develop a workable plan of action, according to Dr. Clardy.
“It’s really good to be explicit about what is dependent and what is independent,” he said. Independent variables might be those specific to the ventilator, but will always include the positive end-expiratory pressure and the fraction of inspired oxygen. Other independent variables will depend on the mode of ventilation – either fully assisted, partially assisted, or noninvasive.
“If you’re in charge of volume, you have to worry about pressure,” he noted. “If you’re in charge of pressure you have to worry about volume.”
Dependent variables also can vary by mode of ventilation. Once the independent and dependent variables are mapped, it is easier to glean more information about the respiratory mechanics of the situation and the physiologic processes, such as the metabolic cost of breathing and whether it can be reduced, what can be done to prevent ventilator-induced lung injury, and how gas exchange can be supported.
Understanding the independent/dependent variable ratio can also help provide valuable clinical information, such as whether reversing hypoxemia and/or hypercarbia is necessary, or if there are signs of respiratory distress or dyspnea. Other clinical indications might include whether there is a need to prevent or reverse atelectasis, or reduce ventilatory muscle fatigue. Additionally, it will be easier to know whether sedation is possible, or if a neuromuscular blockade should be used. Such information can help determine whether to protect the airway.
“Respiratory distress in a patient who is already ventilated is quite common, so having a routinized way to assess these patients and their stability can help you think about what your moves are right there while you’re in the room,” Dr. Clardy explained. “All of that can be incredibly helpful.”
Dr. Clardy had no relevant financial disclosures.
Troubleshooting problems with mechanical ventilation starts with assessing how much control one has over specific variables, according to an expert at HM17.
“You want to be in charge of everything when you’re dealing with a ventilator, but you have to acknowledge that you only get to be in charge of some stuff,” said Peter Clardy, MD, an assistant professor of medicine at Harvard University in Cambridge, Mass., and its affiliate, Mount Auburn Hospital. He made his remarks during a rapid-fire science session at HM17.
Since successful algorithms for acute mechanical ventilation require control over many independent variables, knowing what is most stable and going from there can allow the physician to develop a workable plan of action, according to Dr. Clardy.
“It’s really good to be explicit about what is dependent and what is independent,” he said. Independent variables might be those specific to the ventilator, but will always include the positive end-expiratory pressure and the fraction of inspired oxygen. Other independent variables will depend on the mode of ventilation – either fully assisted, partially assisted, or noninvasive.
“If you’re in charge of volume, you have to worry about pressure,” he noted. “If you’re in charge of pressure you have to worry about volume.”
Dependent variables also can vary by mode of ventilation. Once the independent and dependent variables are mapped, it is easier to glean more information about the respiratory mechanics of the situation and the physiologic processes, such as the metabolic cost of breathing and whether it can be reduced, what can be done to prevent ventilator-induced lung injury, and how gas exchange can be supported.
Understanding the independent/dependent variable ratio can also help provide valuable clinical information, such as whether reversing hypoxemia and/or hypercarbia is necessary, or if there are signs of respiratory distress or dyspnea. Other clinical indications might include whether there is a need to prevent or reverse atelectasis, or reduce ventilatory muscle fatigue. Additionally, it will be easier to know whether sedation is possible, or if a neuromuscular blockade should be used. Such information can help determine whether to protect the airway.
“Respiratory distress in a patient who is already ventilated is quite common, so having a routinized way to assess these patients and their stability can help you think about what your moves are right there while you’re in the room,” Dr. Clardy explained. “All of that can be incredibly helpful.”
Dr. Clardy had no relevant financial disclosures.
VIDEO: Advocacy efforts spur CMS to drop HCAHPS pain domain assessment
How pain management is evaluated in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is changing, thanks in part to the advocacy efforts of the Society of Hospital Medicine’s public policy committee.
Based on input from SHM and other organizations, the Centers for Medicare & Medicaid Services decided that the way the survey was worded concerning pain management could be leading to unintended consequences, particularly in light of the opioid epidemic.
In a video interview recorded during HM17, John Biebelhausen, MD, MBA, discussed how SHM worked with the CMS to help “improve the HCAHPS survey to make a better patient satisfaction tool for our assessments and also eliminate some of the competing pressures the physician might face.”
Dr. Biebelhausen is a hospitalist and physician lead for quality reporting at Virginia Mason Hospital in Seattle. He had no relevant disclosures.hospitalist and Physician Lead for Quality Reporting.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
How pain management is evaluated in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is changing, thanks in part to the advocacy efforts of the Society of Hospital Medicine’s public policy committee.
Based on input from SHM and other organizations, the Centers for Medicare & Medicaid Services decided that the way the survey was worded concerning pain management could be leading to unintended consequences, particularly in light of the opioid epidemic.
In a video interview recorded during HM17, John Biebelhausen, MD, MBA, discussed how SHM worked with the CMS to help “improve the HCAHPS survey to make a better patient satisfaction tool for our assessments and also eliminate some of the competing pressures the physician might face.”
Dr. Biebelhausen is a hospitalist and physician lead for quality reporting at Virginia Mason Hospital in Seattle. He had no relevant disclosures.hospitalist and Physician Lead for Quality Reporting.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
How pain management is evaluated in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is changing, thanks in part to the advocacy efforts of the Society of Hospital Medicine’s public policy committee.
Based on input from SHM and other organizations, the Centers for Medicare & Medicaid Services decided that the way the survey was worded concerning pain management could be leading to unintended consequences, particularly in light of the opioid epidemic.
In a video interview recorded during HM17, John Biebelhausen, MD, MBA, discussed how SHM worked with the CMS to help “improve the HCAHPS survey to make a better patient satisfaction tool for our assessments and also eliminate some of the competing pressures the physician might face.”
Dr. Biebelhausen is a hospitalist and physician lead for quality reporting at Virginia Mason Hospital in Seattle. He had no relevant disclosures.hospitalist and Physician Lead for Quality Reporting.
