Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

Our findings affirm that preventable patient harm is a serious problem across medical care settings. Priority areas are the mitigation of major sources of preventable patient harm (such as drug incidents) and greater focus on advanced medical specialties. It is equally imperative to build evidence across specialties such as primary care and psychiatry, vulnerable patient groups, and developing countries. Improving the assessment and reporting standards of preventability in future studies is critical for reducing patient harm in medical care settings.

The full article can be downloaded below.  

By Targeting Each Patient's Unique Tumor, Precision Medicine Is Crushing Once-Untreatable Cancers. But Only a Fraction of Patients Currently Benefit. Can Medicine Close the Gap?

The days when cancer patients received one-size-fits-all regimens of chemotherapy and radiation may soon be a thing of the past. Instead, doctors are taking a far more nuanced view of what drugs and treatments will work on which patients and on what different kinds of cancers. The idea of this so-called precision medicine, or personalized medicine, is that ultimately doctors will use genetic tests—of both the patient and the cancer tumor—to determine the exact drugs or treatments that have the best chance of working.

The full Newsweek article can be viewed at this link.  

Replacing an EHR comes with many challenges and costs

The vast majority of healthcare provider organizations use electronic health records and physician practice management systems to manage the care they give to patients.

Over time, functionality in the EHR and PPM systems can’t keep up with emerging demands, often compelling an organization to initiate a search for new systems. Often idyllically viewed as an easy answer to emerging challenges, switching systems often offers a gauntlet of challenges.

As healthcare organizations rethink their original—or even second or third—system choices, they often take on new—and sometimes, unexpected—problems and costs.

The full Health Data Management article can be viewed at this link.  

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids

In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.

The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities.

The full article can be downloaded below.  

User-centered design of contingency management for implementation in opioid treatment programs: a qualitative study

Contingency management (CM) is one of the only behavioral interventions shown to be effective for the treatment of opioid use disorders when delivered alone and in combination with pharmacotherapy. Despite extensive empirical support, uptake of CM in community settings remains abysmally low. The current study applied user-centered design principles to gather qualitative data on familiarity with CM, current clinical practice, and preferences regarding the implementation of CM in community-based opioid treatment programs.

Participants were 21 leaders and 22 front-line counselors from 11 community-based opioid treatment programs. Semi-structured interviews were about 45 min long. Transcripts from each interview were coded by independent raters and analyzed using a reflexive team approach. Frequencies of responses were tallied, and queries were run in NVivo to identify exemplar quotes for each code.

Results indicated low familiarity with CM, with less than half of the respondents defining CM correctly and over 40% of respondents declining to answer/ did not know. Abstinence was the most commonly recommended CM target, yet over 70% of respondents indicated that urine screens only occurred monthly. Attendance was also a popular recommendation, with respondents suggesting a range of possible indices including counseling, dosing, and/or case management sessions. Regarding the ideal role to administer CM prizes, program directors and supervisors were most commonly recommended, closely followed by front-line counselors. The most commonly suggested strategies to afford CM incentives included soliciting community donations and offering non-financial incentives.

User design principles to understand workflow constraints, target user needs, and simplify the intervention guided this qualitative investigation of CM implementation in opioid treatment programs. Findings highlighted the potential value of flexible, organization-specific definitions of CM attendance and non-financial incentives, as well as active involvement of clinical leaders and supervisors to promote buy in among staff/patients. Respondents were generally optimistic about their ability to fundraise or solicit donations to overcome cost-related barriers of CM. Implications for CM implementation strategies, including the use of targeted leadership coaching focused on sustainability, are explored.

The full article can be downloaded below.  

Protecting healing relationships in the age of electronic health records: report from an international conference

We present findings of an international conference of diverse participants exploring the influence of electronic health records (EHRs) on the patient–practitioner relationship. Attendees united around a belief in the primacy of this relationship and the importance of undistracted attention. They explored administrative, regulatory, and financial requirements that have guided United States (US) EHR design and challenged patient-care documentation, usability, user satisfaction, interconnectivity, and data sharing. The United States experience was contrasted with those of other nations, many of which have prioritized patient-care documentation rather than billing requirements and experienced high user satisfaction. Conference participants examined educational methods to teach diverse learners effective patient-centered EHR use, including alternative models of care delivery and documentation, and explored novel ways to involve patients as healthcare partners like health-data uploading, chart co-creation, shared practitioner notes, applications, and telehealth. Future best practices must preserve human relationships, while building an effective patient–practitioner (or team)-EHR triad.

The full article can be downloaded below.  

As Healthcare Goes Digital, Consumer Engagement And Experience Improve

The healthcare industry in the United States has long been a dichotomy in its embrace of – and resistance to – technology. While some of the world's finest technology is used to diagnose and treat all manner of illness, patients often have to complete paper forms in the waiting room and many doctors still take notes on paper medical charts.

The move to digital has been well under way in most other industries, creating an expectation of a consumer experience in which healthcare has fallen behind. After all, today's competition is every other experience the customer has had recently.

In the second of a three-part series, I interview several leaders in the healthcare industry who are approaching the digitization of healthcare from different angles. Thomas Swanson is the Head of Industry Strategy and Marketing in the Health and Life Sciences division of Adobe. Geeta Wilson is the founder and CEO of Consumer Society, an early-stage tech and experience design company building an enterprise experience management technology platform to connect all of the major industry players – insurance companies, healthcare professionals and consumers. Richard McCreary is the Vice President of Product Development for Consumer Society after working at health insurer Humana for nearly 14 years.

The full Forbes article can be viewed at this link.  

Estimating Implicit and Explicit Gender Bias Among Health Care Professionals and Surgeons

The main contribution of this work is an initial estimate of the extent of implicit gender bias within health care. Future research could examine implications of implicit gender biases on gender inequality and discrimination. Other research already provides some interventions for addressing gender bias regardless of whether it comes from implicit bias or other sources. For example, increasing transparency of hiring and promotion policies, considering diversity as a performance metric for organizations, and promoting flexible leave all serve to increase the success of female physicians and trainees. Further documentation of implicit associations and other potential psychological obstacles to women’s success will be important for determining the most effective interventions to reduce gender inequality. It is important to also intentionally study the effects of bias on individuals who hold more than one minority identity, such as black or Hispanic women. Such research will benefit current medical students who will become our physicians tomorrow.

The full article can be downloaded below.  

Doctors Slow To Adopt Tech Tools That Might Save Patients Money On Drugs

When Mary Kay Gilbert saw her doctor in May for a skin infection on her leg, she wasn't surprised to receive a prescription for an antibiotic cream.

But Gilbert, 54, a nurse and health consultant, was shocked when her physician clicked on the desktop computer and told Gilbert the medicine would cost $30 on her Blue Cross and Blue Shield plan.

"I was like, 'Wow — that's pretty cool that you know that information,' " she recalled telling the doctor in Edina, Minn.

Allina Health, the large Minnesota-based hospital network Gilbert's doctor belongs to, is one of a growing number of health systems and insurers providing real-time drug pricing information to physicians so they can help patients avoid "sticker shock" at the pharmacy.

The pricing tool, which is embedded in each participating physician's electronic health records and prescribing system, shows how much patients can expect to pay out of pocket, based on their insurance and the pharmacy they choose.

It also allows the doctor to find a cheaper alternative, when possible, and start the process of getting authorization for a drug, if the insurer requires that.

The full Forbes article can be viewed at this link.