February 2011: Does E-Health Stand a Remote Chance?
As technology advances and costs fall, the use of telemedicine expands, but obstacles to achieving e-health success remain.
Kathleen Webster, MD, had her keys in her hand and was on her way out the door—about to make the 30-minute commute to the Loyola University Medical Center in Maywood, IL, where she is the director for pediatric critical care and the medical director for the pediatric ICU—when a nurse called to say one of her patients had arrested. “Get the cart and bring it into the room,” Webster said. The nurse was bemused—of course the code cart was already in the patient’s room.
“Not the code cart,” Webster said. “The telemedicine cart.”
Instead of racing to the hospital while talking to the care team on her cell phone, Webster opened up her laptop and was at the bedside—virtually—in minutes. “I can do everything but touch the patient,” she says. “I see a lot of the studies that say telemedicine is equivalent to being there. But I actually think there is a case for saying at times telemedicine is better than being there.” It’s faster and easier (and safer than driving and talking on the phone). And a high-definition monitor and digital stethoscope allow her to see and hear better than she could if she were in the room.
Advancing technology—the availability of faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquity of mobile devices—is creating a foundation for a system of virtual healthcare where neither patient nor caregiver need be in the same place—or even in a clinical setting at all. And the programs are rising in popularity: In the 2011 HealthLeaders Media Industry Survey of technology leaders, 46% of respondents said they have one or more telemedicine programs in place. Another 41% say they’ll have one in place in one to five years.
Call it telemedicine, telehealth, e-health, mobile health, m-health, or remote healthcare, some predict that using technology to deliver care over a distance will improve access, ease physician shortages, create new revenue streams and increase volume for healthcare organizations by expanding market reach, and improve quality of care. (
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David Blumenthal, MD, isn't very well known outside of the healthcare industry.
But among healthcare providers—especially IT leaders—he's kind of a rock star. When he speaks at healthcare conferences (he is a popular keynote choice) attendees line up afterward to have photos taken with him.
If you've ever attended one of Blumenthal's speeches, then you've heard the story of how he ended his long-time love affair with his paper prescription pad and embraced electronic health systems, eventually becoming their biggest champion in 2009, when President Barack Obama appointed him as the national coordinator for health information technology and charged him with building a nationwide health information system and supporting the widespread meaningful use of health information technology.
The story goes like this.
In 2002, as a practicing primary care physician at Boston's Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Blumenthal met his first electronic health record.
"It was not a match made in heaven," he admits. But he saw that his younger colleagues liked the EHR. And they expected he would use it, too. So one day he was using the EHR to order a prescription for a sulfur-based medicine for a patient with a urinary tract infection. The patient, it turns out, was allergic to sulfur.
Maybe the pharmacy would have caught the potentially fatal error. Maybe the patient would have said something. But the EHR's red-letter alert meant that Blumenthal didn't have to depend on maybes that day.
When asked what it is about that story that resonates with physicians and healthcare leaders, Blumenthal's response is as carefully phrased as his speeches and has the clipped intonation of the busy physician that he is.
"I don't know if it's effective," he says. "I tell it because it's true. It at least enables me as a physician to talk to other physicians, other nurses, and to show that, A, I understand what they're going through and, B, I think there's value in going through the effort of learning how to use an electronic health system."
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May 2010: Time to Put Patients First
How America's hospitals have lost touch with their top priority—and what healthcare leaders are doing to fix it.
At the core, healthcare has just one mission: caring for patients. And yet it still fails them along the entire spectrum of care. Americans can't understand why they must wait months for an appointment with a specialist. They continually hear horror stories about wrong-site surgeries and hospital-acquired infections. They have trouble getting their physicians, specialists, and alternative providers to talk to each other—let alone communicate effectively with them. And then they get a bill for it all that they can't understand.
While no universal fix has been found to address these and other challenges, some healthcare industry innovators are leading change.
They're putting in place programs and strategies to truly put the patient at the center of everything they do. They are making renewed efforts to move patient care to the bedside, coordinating healthcare among disparate providers, and changing how they hire and deploy staff. In the process, they've improved quality, outcomes, and patient safety. They've reduced length of stay, improved accessibility, reputation, profitability, and volume. And they've begun to address the seemingly never-ending list of complaints that the public has about the U.S. healthcare system.
The academic medical center: Calling all executives
Healthcare is a team sport that includes the patient and his or her family, says David T. Feinberg, MD, CEO of the UCLA Hospital System. You can't have good outcomes without engaging patients, without helping them to be compliant. Patient-centered care is not about high thread-count sheets, private rooms, spectacular views, or room service-style meals, he says. Patient-centered care is safe, compassionate care delivered with the highest quality and level of patient safety.
"Patient-centered care means care that I would want for myself and my family. To me, that's the ultimate standard," he says. "We put the patient in the center of everything we do." (
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March, 2010: Medical Breakthroughs That Will Change Healthcare (PDF)
The devices, treatments, and procedures that will change the delivery—and the business—of healthcare.
Forget flying cars, cities crisscrossed with moving sidewalks, and unisex body suits made of silver lamé. Instead, get ready for an explosion in smart medical devices, infection-fighting nanotechnology, virtual biopsies and colonoscopies, bionic organs, and operating rooms that could serve as a backdrop for a science fiction movie. These and other medical breakthroughs are more than cool. They're going to change the way hospitals provide care to their patients and how they do business.
New and emerging technology will dramatically improve outcomes, save money, reduce readmission rates, help hospitals recruit and retain physicians, build your organization's reputation, and more.
OK, they're pretty cool, too.
Smart medicine
These days it seems everything is smart. There's the ubiquitous smartphone, of course. But soon there will also be smart bandages that monitor vital signs, smart prescription bottles that remind the patient when to take a pill, and smart pedometers that count the patient's steps and, like smart little tattletales, send the results to the physical therapist. But perhaps the best example of smart technology is the smart OR. Previously found in just a few large academic medical centers, the technology is starting to show up in community hospitals, too.
The array of tools in the smart surgical suite at the 344-licensed-bed Sacred Heart Hospital in Eau Claire, WI, includes a navigational device that's like GPS for the brain and four 57-inch plasma screens that allow the whole team to see what's going on at any stage of the operation—in high-def 3-D.
"We're relying on technology much more than we ever have before [with the] singular purpose of making brain and spine surgery more effective," says Kamal Thapar, MD, director of the brain and spine institute and director for tertiary care at Sacred Heart, as well as a neurosurgeon with Marshfield Clinic. "It's had a profound impact on patient care." (View PDF.)
September, 2009: The Patient of the Future
Physicians suggest. Patients ignore. Technology alone won't bring them together. But a new relationship just might.
A patient enters the waiting room and is greeted warmly by her personal navigator, who hands her a tablet-sized computer preloaded with her personal demographic information and health records. She answers a series of questions and the computer compiles a list of possible diagnoses for her physician. In his office, the physician is reading an e-mail from a patient who has forwarded an interesting study about his particular medical condition. The physician forwards the study to the rest of the patient's care team, including the patient's acupuncturist. In the exam room, a specialist and patient sit together in front of a computer—the physician is showing the patient which sites have the most reliable medical information that she can use to learn more about her recent diagnosis. Next door, a physician is talking to a patient who has unusual symptoms; the doctor consults her PDA, which is loaded with a decision-support application. (Read more.)
November, 2007: 20 People Who Make Healthcare Better (contributor).
Dorothy Wooddell, volunteer
Volunteers who make beds and deliver flowers? So old school. Today's hospital volunteers are serious multi-taskers. They're quality assurance inspectors, patient satisfaction ambassadors, customer service specialists and brand champions.
"They are really representing the hospital," says Linda O'Keefe, customer relations supervisor at Huntington Hospital in Pasadena, CA. "It's a friendly face, but it's more than just a friendly face." One of those friendly faces is Dorothy Wooddell, 69, a retired schoolteacher and one of 30 volunteers in the patient relations department at the 525-licensed-bed hospital.
"The hospital is very proactive in making sure that they take really good care of people, and that's what my job is--to make sure people are being taken care of," she says. Trash overflowing? Can't figure out the new room service menu? Worried that the nurses aren't washing their hands? Wooddell and her fellow volunteers help uncover problems and find ways to resolve them before patients go home and complain about a negative experience to friends, family, and neighbors, says O'Keefe. Going to the hospital can be less than pleasant, admits Wooddell. But as a volunteer, she tries to make it "as pleasant as possible" for patients—and give the hospital's patient satisfaction scores, reputation, and word-of-mouth referrals a boost along the way.
Cover healthcare clinical and information technology and write general assignment stories for HealthLeaders magazine, a monthly business-to-business publication for healthcare executives. Develop technology story assignments for freelance reporters. 
Surgical services are under increasing pressure to be as clinically and operationally efficient as possible. Given a reimbursement model based on outcomes, not volume, only those surgical services that can deliver state-of the-art care, value, and an outstanding patient experience will survive. 
David Blumenthal, MD, isn't very well known outside of the healthcare industry. 
At the core, healthcare has just one mission: caring for patients. And yet it still fails them along the entire spectrum of care. Americans can't understand why they must wait months for an appointment with a specialist. They continually hear horror stories about wrong-site surgeries and hospital-acquired infections. They have trouble getting their physicians, specialists, and alternative providers to talk to each other—let alone communicate effectively with them. And then they get a bill for it all that they can't understand.
Forget flying cars, cities crisscrossed with moving sidewalks, and unisex body suits made of silver lamé. Instead, get ready for an explosion in smart medical devices, infection-fighting nanotechnology, virtual biopsies and colonoscopies, bionic organs, and operating rooms that could serve as a backdrop for a science fiction movie. These and other medical breakthroughs are more than cool. They're going to change the way hospitals provide care to their patients and how they do business. 
Dorothy Wooddell, volunteer 
