2014 Report finds the U.S. ranks last among 11 countries for Health Care Quality

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The Commonwealth Fund (TCF), a private foundation headquarted in New York City and started by a woman philanthropist Anna M. Harkness and established in 1918, aims to promote (TCF 2014) “a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.”

The TCF produces more than 100 publications a year. In its 2014 edition of Mirror, Mirror, a study entitled “Mirror, Mirror on the Wall” reports data analysed from 11 western, industrialised nations which incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. Researchers had analysed in each of those countries that related to five overall performance areas relating to Health, Quality, Efficiency, Access,and Equity.

Once again, even in the 2014 “Mirror, Mirror on the Wall” report, the U.S. health care system has shown that it underperformed relative to the other 11 countries surveyed, and ranked last among them despite the U.S. spending far more on health care per capita and been the most expensive in the world.

The chart below shows how the overall rankings (click on the image to open a new tab of your current browser window to view a larger image).

How the U.S. Health Care System Compares Internationally 2014

Image credit : The Commonwealth Fund

Combing through the report, I found the following references to health information systems:

  1. timely information not reaching doctors, thus affecting health outcomes, quality, and efficiency;
  2. adoption of modern health information systems and meaningful use of health information technology systems can encourage the efficient organisation and delivery of health care; and
  3. medical records or administrative data capture important dimensions of effectiveness or efficiency, thus in any attempt to assess the relative performance of countries, medical records or administrative data captured must be included to minimise inherent limitations in similar studies when only patients’ and physicians’ assessments are used, since patients’ and physicians’ experiences and expectations which could differ by country and culture, and thus could affect findings from such studies.

References:

  1. The Commonwealth Fund (TCF) 2014, About Us, viewed 18 June 2014, <http://www.commonwealthfund.org/about-us>
  2. The Commonwealth Fund (TCF) 2014, Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, viewed 18 June 2014, <http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror?utm_source=twitter&utm_medium=social&utm_campaign=>
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Patient Medical Record Review Form – JCI Hospital Survey Process Guide, 5th Edition, Part 1

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Millions of football (soccer) fans around the world have been waiting four years for the 2014 FIFA World Cup which is the 20th FIFA World Cup, an international men’s football tournament which began on Thursday, 12 June 2014 and currently taking place in Brazil.

I am sure many readers already know that football might seem pretty straightforward. You will also surely know that a match of soccer has two teams of eleven players on a field (called a pitch), both trying to put a spherical ball into the other team’s goal. They can use any part of their body besides their arms or hands to do so, except the goalie (called a keeper), who can use his hands as long as he’s within a box in front of his own net.to play one man down for the rest of the match.

A team is made up of ten defenders, midfielders, and forwards — with varying numbers of each for strategic reasons — plus one keeper. Different coaches use all sorts of different numbers and formations of the first three: currently, the 4-2-3-1 formation (four defenders, two defensive midfielders, three attacking midfielders, and a forward) is especially popular.

Readers, this post if actually about the Patient Medical Record Review Form (MRRF) found in the Joint Commission International (JCI) Hospital Survey Process Guide (HSPG), Fifth Edition manual. This form is used during a Closed Patient Medical Records session to determine whether or not relevant documentation requirements for relevant standards from the JCI Hospital Accreditation Standards (HAS), Fifth Edition have been met.

As the more burning topic of interest for the next couple of weeks is the World Cup 2014 now under way, I decided to graphically represent a total of 61 JCI HAS found in this form as an Infographic showing a football match played by two teams each consisting of not more than eleven players (standards) – one of whom is the goalkeeper, using the 4-2-3-1 formation.

Just as a match of football might seem pretty straightforward, the implementation and use of the Patient MRRF during a Closed Patient Medical Records (CPMR) session is not that straightforward.

This post is the first part of a series of posts on the Patient MRRF.

As a brief overview, a total of sixty-one (61) JCI HAS are now included in this form. Several JCI HAS have been dropped from the Patient MRRF based on the JCI HSPG, Fourth Edition.. New HAS have been included based on the JCI HAS, Fifth Edition. The Standards in the JCI HAS, Fifth Edition have been rearranged and modified; as such some JCI HAS found in the Patient MMRF based on the JCI HSPG, Fourth Edition.have been given new Standards Number(s).

For a start, below is an infographic showing some twenty-two (22) JCI HAS from the total of 61 JCI HAS found in the Patient MMRF of the JCI HSPG, Fifth Edition. Click on the image which will open a new tab of your current browser window, and to view a larger image just click on the magnifying glass which appears over the image.

MMRF-football-pitch-Team-A-vs-Team-B

The subsequent post on this series will bring you more infograhics and on the changes in the Patient MMRF found in the JCI HSPG, Fifth Edition effective 1 April 2014.

References:

  1. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
  2. Joint Commission International, 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA
  3. Joint Commission International, 2010, Hospital Survey Process Guide (HSPG), 4thd edn, JCI, USA
  4. Joint Commission International, 2014, Hospital Survey Process Guide (HSPG), 5th edn, JCI, USA
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Understanding reasons for making a request to change the medical record

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It is rare to find any research topic ever published on why requests are made by patients who want to make changes to their medical record. I found one recently, and here to share with you what researchers discovered as the main reasons for making a request to change the medical record, and what types of information they wanted changed, and whether they result in modifications to the medical record.

In their qualitative research, the researchers studied content analysis of all patient-initiated amendment requests, an ‘amendment request’ defined as the process by which patients ask for changes to be made to their records, received over a 7-year period.

Readers can now view the infographic below (click on the infographic to view a larger image in a new tab of your current window) which shows a summary of all relevant findings from this research.

Medical-Records-Amendment-Requests-Study

Also from this study, I deduced that when patients were given the opportunity to further participate in their care by allowing them to review their medical record, their medical record accuracy could lead to improvement after the identification and correction of errors or omissions.

I agree with the authors that doctors can make mistakes in the medical record, and that it is necessary to correct these mistakes at some point This is especially true when a patient discovers any mistake or omission upon reviewing his or her own medical record. However, it is uncommon when a patient will not want any information there anyway but such requests must be expected.

An ‘amendment request’ is a rare request as most patients, in the developing and under-developed world and even perhaps in the developed countries are unaware of the basic right to review their own medical record and the absence of any policy to grant patients the right to make an ‘amendment request’.

References:

  1. David A Hanauer, Rebecca Preib, Kai Zheng, Sung W Choi 2014, Patient-initiated electronic health record amendment requests, J Am Med Inform Assoc amiajnl-2013-002574 Published Online First: 26 May 2014 doi:10.1136/amiajnl-2013-002574, viewed 1 June 2014, <http://medicalresearch.com/author-interviews/electronic-medical-records-study-examines-patient-initiated-amendment-requests/5721/>
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MRPM.VOW.02.14: Healthcare’s four-letter word? It’s ‘silo

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MRPM-VOW-placer-video-projector-icon-psd

To continue the series of videos for 2014, this week’s Video of the Week (VOW) pick is about the change that must evolve when it is common practice that hospitals, clinics and doctor’s offices, digital health devices and services all continue to keep close tabs on their information and silo their data.

Those of you who have been following the trends at healthcare conferences and exhibitions for some time will recognise it is common at one after another conference and exhibition when we see vendors show off systems that work great, but we soon realise that they don’t get along with each other. I think it has become less of a desire to acquire new systems and more of a requirement in the rapidly changing healthcare industry, keeping up with new technologies and innovations.

You would also already been aware that departments within the hospital or health network, digital health devices and services all keep close tabs on their information and have control over a certain subset of data that they’re not into sharing, they just all seem to silo their data.

And for those of you who are familiar with mHealth, surely are all too familiar that mHealth devices continue to over-emphasize the collection of vital signs and real-time transmission to healthcare providers.

Enters Patrick Soon-Shiong, a South African-born surgeon who is pushing for a vision of integrated healthcare through a network of digital, genomic and clinical solutions. He envisions a future healthcare system as an integrated system that connects all the dots which follows a human being through the continuum of life serving a patient throughout his or her life, not just in sickness.

In the accompanying video (click on http://bcove.me/2cwzbmrg to watch the video, which will open in a new tab of your current browser window), watch and listen to Soon-Shiong discoursing among other things the following views:

  • healthcare has to break the rule of capturing vital signs at all times and focus more on gathering data and identifying trends;
  • likens a health journey much like a long plane trip, during which a true operating system which encompasses clinical decision support, machine learning and “adaptive amplified intelligence” pulls in data from all sources that “integrates pieces of the puzzle” and gives you inputs from the consumer so that the caretaker can plot a course, and adjust that course as things happen and manage outputs;
  • that the Electronic Medical Record (EMR) is “basically a flight log” that needs to be tapped for information at times which could be a part of that solution, but not the whole solution;
  • he believes that healthcare isn’t being held back by technology as a barrier, rather the real problem is a workflow management problem since technology is not been used properly, and is falling behind other industries like banking and entertainment;
  • nobody is taking the trouble of taking each of their siloed pieces and integrating them into a single healthcare system; and
  • he concludes that change management as the next challenge while taking advantage of the fear to resist wholesale change in healthcare.

References:

  1. Healthcare’s four-letter word? It’s ‘silo’, mHealth News, viewed 28 April 2014, <http://www.mhealthnews.com/news/healthcares-four-letter-word-its-silo?single-page=true>

  2. Healthcare’s four-letter word? It’s ‘silo’, mHealth News, viewed 28 April 2014, <http://bcove.me/2cwzbmrg>

JCI Hospital Accreditation Decision Rules

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The Joint Commission International (JCI) had announced the updated Accreditation Decision Rules for Hospitals as was published on their webiste.on 13 March 2014.

By and large a Health Information Management (HIM) / Medical Records (MR) practitioner in a hospital setting will not be briefed about everything hospital accreditation, especially matters like how the decision is made to accredit a hospital. That notwithstanding, If you are working at a hospital which is already JCI accredited or seeking JCI accreditation status or undergoing re-survey for accreditation status, I think it is important to be aware on how all information from the initial or triennial full JCI and any required follow-up focused survey are used to make the decision regarding a hospital accreditation.

The hospital must meet five (5) conditions to be accredited. The conditions requires that the hospital must be able to demonstrate that there is acceptable compliance with each standard, there is acceptable compliance with the standards in each chapter, there is overall acceptable compliance,  the total number of measurable elements (MEs) found to be “Not Met” or “Partially Met” is not above the mean (three or more standard deviations) for a hospital surveyed under the hospital accreditation standards within the previous 24 months, and the ME in the International Patient Safety Goals ( IPSG) is scored “Not Met”.

Since the 5 conditions encompass the relevant standards that HIM / MR practitioners manage in the daily routine management of health information management / medical records management in a hospital setting, he or she must be made aware of by circulars or at least briefed on these 5 conditions to be accredited.

If the HIM / MR practitioners in their practice fail to comply with any relevant standard, any relevant standards in each chapter, and contribute to non-compliance of MEs found to be “Not Met” or “Partially Met” is not above the mean (3 or more standard deviations) for a hospital surveyed under the hospital accreditation standards within the previous 24 months, than he or she would be deemed to be contributing negatively to the overall performance during the hospital survey process and towards accreditation been denied!

The HIM / MR practitioner is advised to be aware of At Risk for Denial of Accreditation conditions, especially the 5 conditions regarding relevant standards and MEs.

Below is a flowchart (click on the flowchart below and it will open in a new tab of your current window; click on the resulting image in this new tab for a larger view of the flowchart image – zoom to see bigger fonts or simply print to read) showing all the decision rules that will be taken by the JCI Accreditation Committee to validate if your hospital meets the criteria for accreditation. From the chart, there are two potential outcomes. The outcomes may be that the hospital meets the criteria for accreditation or does not meet the criteria and is denied accreditation. The charts also shows At Risk for Denial of Accreditation conditions.

accreditation-decision-rules

References:

  1. Joint Commission International, 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA
  2. Joint Commission International, 2014, JCI Announces Updated Accreditation Decision Rules for Hospitals,  viewed 31 March 2014, <http://www.jointcommissioninternational.org/jci-announces-updated-accreditation-decision-rules-for-hospitals/>