e-HealthExpert.org - Primum non nocere

The HIMSS sponsored Journal of Healthcare Information Management ( J Healthc Inf Manag.) has, in its 2005 Winter issue, a very interesting article by Bahensky et. al. about Lean techniques, Sigma concepts and the use of the Kaizen breakthrough methodology in the healthcare environment.
The authors concluded that those methodologies could be advantageously applied to healthcare institutions:
"The manufacturing industry has been using Lean Sigma for years in pursuit of continuous improvement to obtain a competitive advantage. The objectives of these efforts are:

• Use the Lean techniques for reducing cycle times;
• Use the Six Sigma concepts for reducing product defects;

The Iowa Business Council with several advocates worked with the University of Iowa Hospital and Clinics (UIHC) and two other Iowa hospitals to determine whether Lean Sigma is adaptable in healthcare.
A team of 15 people at UIHC used the Kaizen Breakthrough Methodology over a five-day period in an aggressive identification and elimination of non-value added activities in Radiology CT scanning.
The results exceeded the initial project objectives and indicated that:

• Lean Six Sigma is applicable in healthcare.
• the Lean Six Sigma project increased revenue by approximately $750,000 per year.
• The Kaizen process proved to be successful and interesting.
• Within three days, the team installed new work flow processes.

This Implementation-Oriented Approach is what differentiates Lean Six Sigma from other Quality Improvement processes."

The article is indexed at PubMed as: 'Lean sigma - will it work for healthcare?'.

A heterogeneous group of people from the MIT, Tufts NEMC, Childrens Hospital (Boston) has been working in a very interesting project named the Guardian Angel Personal Lifelong Active Medical Assistant.
The BMJ has an 2001 article from that group named Public standards and patients control how to keep electronic medical records accessible but private, which is freely available for download, in .pdf format, from: Public standards and patients control.
The "Guardian Angel" project has threee main areas of development: PING (Personal Internetworked Notary and Guardian), HealthConnect and W3-EMRS (World Wide Web based Electronic Medical Record System).

Thanks to ivaldes, reporting for Linux Medical News for this link.
There is an NYT Magazine in-depth article on different ways of looking at health care reform that take into account that rising health costs also yield more health benefits.
Health-IT is mentioned starting on page 6:
'...Many doctors still write prescriptions and keep records manually, and Cutler says that digitizing the health-care system would save considerable administrative expense and improve quality. It would minimize prescription errors, speed paperwork and make a patient's medical history portable. But the big kick is what information technology could do for the doctor's understanding of his own performance.

The recent JAMA article on Computerized Physician Order Entry ("Role of Computerized Physician Order Entry Systems in facilitating Medication Errors") seems to have created controversy: Health-IT World, March 15, 2005 Debate Swirls Around JAMA Article Critical of CPOE

Excerpts from my response are at: Scot Silverstein's response to Health-IT World, March 15, 2005 Debate

The British Medical Journal published an article [BMJ 2005;330:581 (12 March)] by Garrido et al. reporting the results of a retrospective, serial, cross sectional study on the effect of electronic health records (EHR) in ambulatory care.
They concluded that readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive
See the full article at: Effect of EHR in ambulatory care.

My response in the Healthcare Renewal blog to a recent article in the Journal of the American Medical Association, "Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors” (JAMA, March 9, 2005, http://jama.ama-assn.org/cgi/content/full/293/10/1197 ) may be of interest to readers. It may be found here: Scot Silverstein's response

Regards,
Scot Silverstein, MD

The Journal of American Medical Association (JAMA) just published an article by Koppel et al. about the impact of a widely used computerized physician order entry (CPOE) system in facilitating medication errors at a hospital:
This study identified 22 situations in which CPOE increased the probability of prescribing errors.

See the full article at: Role of CPOES in Facilitating Medication Errors.

Harvard Business School professor Clayton Christensen has gained a reputation for his work on "Disruptive Innovations":

• Christensen's research explains why established companies - even those competently managed by smart people - have such trouble countering or embracing disruptive innovations that are on the horizon.
• His theory says that organizations customarily develop mind-sets and processes that revolve around doing what they already know.
• Once that pattern becomes established, managers have great difficulty justifying to others or even themselves the need to turn their processes upside down to respond to a barely emergent market change.
• By the time the threat is apparent, however, it's usually too late; upstart companies have seized a substantial lead.

See the full article at: Disruption is good

The Healthcare Informatics Online magazine has an article by Peter Groen (director of the Veterans Health Administration's Health IT Sharing program), were he talks about the Health IT Sharing Program, a four phase program to improve collaboration among healthcare organizations.
In that author's perspective that plan could be an effective means to pool resources to work on Health Information Systems (HIS) and develop mutually beneficial initiatives that, most likely, neither organization could accomplish on its own.

The full article is at: The Health IT Sharing Project

David A. Wheeler presents in his site Why Open Source Software a thorough analysis on why you should seriously consider to use Open Source Software in your organization.