Friday, December 18, 2015
The system's leaders said their central goal was to teach Kaiser's model of integrated care to a new generation of doctors who will be under pressure to improve health outcomes and control costs by working in teams and using technology.
"Health care is evolving at a very, very rapid pace in our country and we have a model of care that's increasingly being looked to as an answer," said Dr. Edward M. Ellison, executive medical director for the Southern California Permanente Medical Group, who is helping to oversee the medical school's creation.
Kaiser already trains about 600 medical residents in its own program, and several thousand more complete a portion of their training in it each year. But its medical school, planned for Southern California, would be one of the first run by an integrated health system without an academic partner, said Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, which encourages innovation in medical schools.
"If health care is increasingly going to take place in integrated systems," Dr. Thibault said, "a large part of the medical education experience should be what it's like to work in a system like that: the efficiencies and the processes and the ways in which patient care is benefited."
Dr. Thibault added that while Kaiser would not be the only integrated health system involved in medical education, it is "larger than any of them, has greater reach than any of them, greater resources."
Kaiser runs 38 hospitals in eight states and the District of Columbia, with 18,000 doctors working for its affiliated medical groups and more than 10 million patients, mostly in California. It receives a fixed amount for medical care per member, so there is a strong financial incentive to keep people healthy and out of the hospital, a model that Kaiser pioneered and that is now being followed around the country.
Dr. Ellison said Kaiser's use of technology, through electronic medical records and new types of telemedicine that allow patients to receive "care anywhere in a way that's safe and effective," will also be crucial to its medical school curriculum.
Humans repeatedly fail where computers — or humans behaving a little bit more like computers — can help. Even doctors, some of the smartest and best-trained professionals, can be forgetful, fallible and prone to distraction. These statistics might be disquieting for anyone scheduled for surgery: One in about 100,000 operations is on the wrong body part. In one in 10,000, a foreign object — like a surgical tool — is accidentally left inside the body.
Something as simple as a checklist — a very low tech-type of automation — can reduce such errors. For example, in a wide range of settings, surgical complications and mortality fell after implementation of a basic checklistincluding verification of patient identity and body part for surgery, confirmation of sterility of the surgical environment and equipment, and post-surgical accounting for all medical tools. Though simple procedureswould all but eliminate certain sources of infections in hospitals, thousands of patients suffer from them in American hospitals every year.
What she couldn't survive was 11 weeks in Florida hospitals.
Schulte, 64, was living an engaged life—staying in touch daily with her daughter, Stephanie Sinclair, a photojournalist, and taking afternoon drives with her husband, Joe. When she suffered an unexpected bout of seizures in August 2012, doctors said she would need only a short hospital stay until the drugs kicked in to remedy things.
Instead, her treatment triggered a cascade of medical mistakes.
Wednesday, December 16, 2015
The Lancet: Women’s Contribution to Healthcare Constitutes Nearly 5% of Global GDP, but Nearly Half Is Unpaid and Unrecognized
Tuesday, December 15, 2015
A national campaign for electronic health records is driving business for at least 20 companies with thousands of workers ready to help stressed doctors log the details of their patients' care – for a price. Perhaps 1 in 5 physicians now employ medical scribes, many provided by a vendor, who join doctors and patients in examination rooms. They enter relevant information they hear about patients' ailments and doctors' advice in a computer, the preferred successor to jotting notes on a clipboard as doctors universally once did.
The U.S. has 15,000 scribes today and their numbers will reach 100,000 by 2020, estimates ScribeAmerica, the largest competitor in the business. After buying three rivals this year, it employs 10,000 scribes working in 1,200 locations.
Regulation and training are not rigorous. Scribes are not licensed. About a third of them are certified and that's voluntary, according to the sole professional body for scribes. The American College of Scribe Specialists was created by ScribeAmerica's founders in 2010.
"This is literally an exploding industry, filling a perceived gap, but there is no regulation or oversight at all," says George Gellert, regional chief medical informatics officer at Christus Santa Rosa Health System in San Antonio, which uses scribes.
Others suggest that scribes can be a benefit to doctors and patients by shouldering the minutia of recording many of the details on a computer. "They're capturing the story of a patient's encounter – and afterword, doctors make sure everything is accurate. That way the doctor can focus on interacting with the patient and give them good bedside manner," says Angela Rose, a director at the American Health Information Management Association, a professional group that has published a set of best practices for scribes.
Sunday, December 13, 2015
He encouraged her to choose hospice care. Two weeks later, he said to me, his patient's hospice aide came up to him on the ward. "She told me that my patient made her promise that the day she died, she would come find me and tell me. She said my patient wanted to thank me for encouraging her to die the way she wanted to."
I thought of this story at various points while reading "The Death of Cancer," Vincent DeVita Jr.'s fascinating if hubristically titled new book, co-authored with his daughter, Elizabeth DeVita-Raeburn, a science writer. Today, more than four decades after President Nixon declared war on cancer and with so many new weapons in our arsenal supported by big budgets and a decidedly aggressive posture, when is it O.K. to give up? When is it best to surrender?