A Black Box for the Operating Room

Surgical 'black box' could reduce errors According to Dr. Chethan Sathya, Special to CNN ;

Airliners have them, trains have them, and now,even automobiles have them. How many 

times have we heard about the search for the black box?

It may be coming to an operating room near you.

Researchers in Canada have created a surgical "black box" that tracks surgeons' movements during an operation

  So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.  Teodor Grantcharov, a minimally invasive surgeon at St. Michael's Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters occur, the surgical black box Grantcharov is creating will be used proactively to prevent major patient complications.

 Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

Read the entire article 

A work in progress

Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating room microphones and cameras that record the surgery, the surgeon's movements and details about team dynamics.

It will allow surgeons to hone in on exactly what went wrong and why.

The black box will eventually assess everything from how surgeons stitch to how delicately they handle organs and communicate with nurses during high-stress situations. Error-analysis software within the black box will help surgeons identify when they are "deviating" from the norm or using techniques linked to higher rates of complications.

So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.

The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in the next few months. Talks are also under way with a number of American hospitals.

If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug Administration.

But the litigious medical environment may make its implementation problematic. If the recordings were used in court, they could open the floodgates to a new wave of malpractice concerns, which would be counterproductive to surgeons and patients, Grantcharov says.

"We have to ensure the black box is used as an educational tool to help surgeons evaluate their performance and improve," he says.

Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made me a safer surgeon and a better teacher."

Read the entire article 

Hidden Costs of the Affordable Care Act

HEALTHCARE.GOV COST $1.7 BILLION

"The federal government issued sixty contracts from 2009 to 2014 in efforts to build Healthcare.gov, the federal insurance marketplace. According to a report issued today by the inspector general (OIG) of the Department of Health and Human Services (HHS), the government had already paid out just under half a billion dollars by February 2014, five months after the beginning of open enrollment. The government is already under obligation for another $300 million, and the estimated value of the sixty contracts totals $1.7 billion. The OIG provided a summary of its findings:
“The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.”
A few familiar names appear on the list of contracts, such as Northrop Grumman and Lockheed Martin. Also appearing are CGI Federal, widely blamed for the botched roll out of the site last October, and Accenture Federal Services, which has taken over for CGI in hopes that this year’s open enrollment will go better than 2013.

An Analysis of the Affordable Care Act Enrollments

Health insurance exchanges in 2015: 



Health Insurance exchanges are very new in to the marketplace. Previous exchanges were largely private and individualized without strict guidelines.  The Affordable  Care Act mandated a total revision and set rigid giuidelines for these exchanges and  great emphasis was placed on the initial enrollment deadline without a mature online registration system.  The rush led to frustration, disappointment, and worse, a total lack of faith and trust in the Affordable Care Act.

How to boost success

We must thank those volunteers who were and still are essential to this process. Many are from non-profit organizations who were not  formerly involved with healthcare.  Our government placed much of the enrollment process on volunteers.

Health Train Express will outline plans to improve enrollment and the functioning of health exchanges

A Webinar sponsored by Enroll America #soe2014 and supported by  

State of Enrollment: Getting America Covered 2014

More than 800 health coverage leaders came together for our State of Enrollment: Getting America Covered conference in June 2014 to share, learn, and plan after the first open enrollment period under the Affordable Care Act.

We took a critical look at what worked, what barriers consumers continue to face, and how we could all work together to sustain and build momentum for the ongoing effort to get America covered (click here to download the full conference program).

A compilation of resources for Getting America Covered 2014

Watch the Plenary Webcasts

Click here to watch recordings of the five plenary sessions.

Download Slides from the Workshop Presentations

Volunteers Matter: Building and Sustaining a Volunteer Program

Health Insurance Literacy: Helping Consumers Understand Their Coverage Options As it turned out this was one of the most important issues for a previously uninsured population totally unfamililar with terms and the workings of health insurance coverage 

Evaluate Your Outreach: Efforts to Improve Results

Referral Networks: Essential for Enrollment Success

Using Personal Stories to Motivate Consumers

Phonebank Your Way to Success: Consumers Need to Hear from You Over the Phone

Getting to Yes: Resources, Tips, and Lessons for an Effective Fundraising Pitch

Facilitating Productive Coalition Communication – The North Carolina Model

Outside the Box: Innovative Ways Tax Preparation Can Maximize Enrollment

Equipping Enrollment Assisters to be Successful

Keys to Enrollment: Leading States Speak Out

Effective Outreach and Organizing Strategies in an Open Enrollment Environment

Strategies to Fast-Track Medicaid Enrollment

What Worked and How Do We Know?

The Conference Agenda: (Downloadable pdf)

All or most of these actions took place during the initial enrollment period of  2013-2014. The next open enrollment period will beginning October 2015.

Supported  by   

Doctors would rather be Penalized than go along with Meaningful Use

 HHS defines Meaningful use              Wikipedia defines Meaningful Use


Meaningful use is a term (MU) coined by CMS and HHS to describe their mandated information system for analysis of electronic health records.   Meaningful use has nothing to do with patient care or the usefulness of electronic health records for care givers. The term is highly misleading, implying something which it is not, nor designed to accomplish. In additon, it's mandated use is required to gain incentive patients for purchasing electronic medical record systemsThe main components of Meaningful Use are:

• The use of a certified EHR in a meaningful manner, such as e-prescribing.
• The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
• The use of certified EHR technology to submit clinical quality ot

In other words, providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.^[131]

The meaningful use of EHRs intended by the US government incentives is categorized as follows:

• Improve care coordination
• Reduce healthcare disparities
• Engage patients and their families
• Improve population and public health
• Ensure adequate privacy and security

The Obama Administration's Health IT program intends to use federal investments to stimulate the market of electronic health records:

• Incentives: to providers who use IT
• Strict and open standards: To ensure users and sellers of EHRs work towards the same goal
• Certification of software: To provide assurance that the EHRs meet basic quality, safety, and efficiency standards

The detailed definition of "meaningful use" is to be rolled out in 3 stages over a period of time until 2017. Details of each stage are hotly debated by various groups.^[132

Thousands of eligible providers are working diligently toward EHR incentive payments, but some practices are choosing a different route: abandoning meaningful use altogether in favor of their own solutions, and finding ways to make up for the penalties they’ll incur down the road.

Some 6 percent of physicians, in fact, will be “abandoning meaningful use after meeting it in previous years,” according to the Medscape report on EHR use in 2014. In surveying nearly 20,000 doctors, Medscape found another 16 percent admitting that they would never be attesting to meaningful use in any capacity. 

More about Meaningful Use and why physicians find it counterproductive and a barrier to patient care.
The Barriers to Meaningful Use  

Arguments about Physician Reimbursement

Medpage Today posted an interesting commentary about how Physicians are reimbursed. Their conclusion was that physicians can make more money speaking,and/or consulting for pharmaceutical companies, as well as in executive positions. Why treat patients?

CardioBuzz: Toward the $500 an Hour Physician

How does an ULTRA-MARATHON sound to you?

A new and growing challenge for extreme sports is the  ultramarathon.  A normal marathon which is just over 26 miles long is a piddling distance compared to the ultramarathon, that is four times as long. The most common distances are 50 kilometres (31.069 mi), 100 kilometres (62.137 mi), 50 miles (80.4672 km), and 100 miles (160.9344 km), although many races have other distances. The 100 kilometers is recognized as an official world record event by the International Association of Athletics Federations (IAAF)

A recent ultramarathon which attracted about a dozen runners lasted 24 to 48 hours as well as an elevation change of 17,000 feet.

A standard typical marathon presents some dangers to unconditioned athletes. Extending the distance increases the liklihood of serious complications. These include  hyponatremia, edema of the extremities and life threatening pulmonary edema.  These are caused by a fluid shift from the extracellular space to the cell resulting in swelling of the cells.

There is some evidence that extreme runs can produce some heart scarring, however suprisingly joints seem to do well. Each runner must develop their skill carefully and tailored to the feedback they receive from their body.  Fluid balance and caloric intake are critical. Some runners experience gastrointestinal cramping during runs.

Science Friday Podcast:

There have been no long term studies on the effects of these extreme runs.  So if you are bored with it all, ramp things up after studying the longer events. However, extend your distances gradually, allowing your physiology to condition itself .

Try to keep up with me.....hehehe


                                                                                                  Pedal Edema= Swelling of Ankles
                                                                                                 

Uber: House calls on demand? Uhhhh...

New App Requests Physician House Calls

 A new service called Pager - similar to Uber and Lyft - has launched in New York City where a person can request a house call with a physician.  Currently it is cash only, ranging between $199-$299 per visit depending on the time of day; the physician keeps 80% of each visit while the company who created the mobile app gets the rest.  However, the company is hoping to negotiate with insurance companies in the future so that patients would only be responsible for a copay at the time of the visit. 

More:   http://www.post-gazette.com/business/technology...

Comments from Sermo MD Social Media Web Site:

flagyn4

Obstetrics & Gynecology

Posted via iPhone August 01, 2014 - 08:17AM EDT

This is a great service, but should start at $500.

Mark this comment helpful  |  13 physicians found this comment helpful

steeldoc

Obstetrics & Gynecology

Posted August 01, 2014 - 08:37AM EDT

Right, let capitalism thrive. Spoke with a Brit, a wealthy brit last night. Their secondary market for health care for those with money is doing just fine. Great service and docs get paid.

Mark this comment helpful  |  9 physicians found this comment helpful

DrNikki11

Family Medicine / Practice (FP)

Posted via iPhone August 01, 2014 - 08:43AM EDT

I think I like it.

Mark this comment helpful  |  2 physicians found this comment helpful

drspuds

Physical Medicine & Rehabilitation (Physiatry)

Posted via iPhone August 01, 2014 - 08:57AM EDT

Low overhead, but travel expenses. I can imagine getting one call for one side of town and the next on the other side, then back again.

Inevitably, there will be people who need to go to UC or ER, or even just an regular office for equipment or tests not carried around. Then they will be upset that they didn't get what they wanted through the home visit and want their money back.

Mark this comment helpful  |  11 physicians found this comment helpful

imsahagun

Pediatrics (excluding surgery)

Posted August 01, 2014 - 08:59AM EDT

I would have more of a concern for the physician's safety.

Mark this comment helpful  |  17 physicians found this comment helpful

Blasier

Orthopedic Surgery

Posted August 01, 2014 - 09:03AM EDT

I have done house-calls in Detroit, and now in a small rural town.
No fee, as these are always post-op patients in the 90 day global period.
I do it for patients who are more-than-average home-bound by their injury.
Patients love it.
In Detroit, the patients could barely believe that I would do it!

I would never do this for a non-op or pre-op patient.

Mark this comment helpful  |  7 physicians found this comment helpful

AZdrydoc

Family Medicine / Practice (FP)

Posted August 01, 2014 - 09:20AM EDT

Wealthy new parent with a fussy baby? Call to break up fecal impaction hanging in a 90 y/o DuPont?

This "service" calls for abuse on both sides of the bargain -- not a good idea, IMO; plus being a monumental waste of physician resources (thus calling for mid-levels to do it cheaper).

Both thumbs down.

Mark this comment helpful  |  7 physicians found this comment helpful

mdesio

Neurology

Posted August 01, 2014 - 09:22AM EDT

Some will think that there is a disparity because of wealth because the medicare and medicaid will suffer discrimination. Can you imagine opening this up to the medicaid crowd- calls every2 minutes to make house call for colds or stubbed toes at 3am for$18? Hell no.

Mark this comment helpful  |  4 physicians found this comment helpful

signaturedoc

Internal Medicine

Workforce in Medicine

The Affordable Care Act is expected to  influence Graduate Medical Education funding in many ways that are unexpected.

Our sister publication, Digital Health Space has covered relevant information about the influence of GME upon provider accessibility, which remains a major concern regarding the success of the Affordable Care Act. More  here and here

Federal Graduate Medical Education  funding has largely been appropriated to big eastern institutions in Boston, New  York, and the Eastern United States. Expected changes will include a more equitable distribution of federal GME funding, as well as prioritizing the primary care physician workforce.

Hospitals pay to use U.S. News 'Best Hospitals' logo

In some sort of Machiavellian scheme, some U.S. hospitals will pay U.S. News for the right to use their logo if they are ranked among  'U.S. Best Hospitals'.  

The same skepticism about motive applies to Health grades.Healthgrades They portray themselves as the ultimate arbiter of hospital and physician quality but they are just out to sell hospitals the right to proclaim themselves a Healthgrades champion and and to sell ad clicks on their physician rating pages, while providing out of date information from public databases.

Children's Mercy Hospitals and Clinics pays $42,000 a year to use the logo, 

No, hospitals do not pay to be ranked in the U.S. Best Hospitals annual ranking, But some organizations won't reveal how much they spend

U.S. News releases 2014-15 Best Hospitals rankings

New methodology increases weight of patient safety, decreases reputation

This edition of RANKINGS marks the first time the publication assembled the list using a new methodology, according to U.S. News. Not only did the publication double the weight of patient safety in 12 specialties from 5 to 10 percent of the hospital's overall score, it reduced the weight of hospital reputation for those specialties from 32.5 to 27.5 percent.

U.S. News credits the methodology change to increased public reporting of "rigorously studied" hospital quality measures. A study released earlier this year criticized what it called U.S. News' out sized emphasis on hospital reputations in its previous methodology, noting a weak correlation between hospital prices and reputations, and patient outcomes.

The top 10 hospitals on this year's Honor Roll were:

1. Mayo Clinic in Rochester, Minnesota
2. Massachusetts General Hospital in Boston
3. Johns Hopkins Hospital in Baltimore
4. Cleveland Clinic
5. UCLA Medical Center in Los Angeles
6. New York-Presbyterian University Hospital of Columbia and Cornell in New York City
7. Hospitals of the University of Pennsylvania-Penn Presbyterian in Philadelphia
8. UCSF Medical Center in San Francisco
9. Brigham and Women's Hospital in Boston
10. Northwestern Memorial Hospital in Chicago

Big name, expensive hospitals don't necessarily provide best care

Hospitals' reputations and prices have little bearing on their care quality, according to a new study published in Health Affairs.

For the study, researchers analyzed almost 25,000 insurance claims from current and retired autoworkers in 10 metropolitan areas: Cleveland; Detroit; Indianapolis; Kansas City; St. Louis; Flint, Mich.; Warren, Mich.; Toledo, Ohio; Youngstown, Ohio and Buffalo, N.Y. The workers visited 110 hospitals, divided into three categories:

• Thirty "low-price" hospitals, where prices were at least 10 percent below average;
• Fifty "medium-price" hospitals, which were not defined in the study; and 
• Thirty "high-price" hospitals, where prices were 10 percent or more above average.

High-priced hospitals were twice the size of low-priced ones, and had three times their market share, according to the researchers, led by Chapin White of the RAND Corporation. The expensive hospitals were also much more likely to be included inU.S. News & World Report's national hospital rankings. Twenty-five percent of high-priced hospitals appeared in the U.S. News rankings, while none of the low-priced ones appeared on any of the publication's lists, according to the study

Attribution:

Whipple Procedure....One Place to Go

              

   Advances in General Surgery  reduce morbidity and mortality

The Whipple procedure, a surgery in which a tumor is removed from the pancreas, used to have a mortality rate of 25 percent 25 years ago, says Dr. John Cameron, the Alfred Blalock Distinguished Service Professor of Surgery atThe Johns Hopkins University School of Medicine. The procedure involves surgeons removing a third of the pancreas, most of a part of the small intestine, a portion of the bile duct, the gallbladder and associated lymph nodes. 

It takes about six hours to complete, and most patients stay in the hospital for one to two weeks afterward. Hopkins performs more pancreas cancer surgeries than any other institution in the country, and has brought the mortality rate down to 2 percent, according to its website. Cameron has performed more Whipple procedures than anyone in the world. "It's the only operation I do," he says.

Attribution ( U.S.News )