CT Center for Patient Safety Newsletter

May 2015

In This Issue

The Power of Having Access to Your Own Medical Records

Telehealth...A new way of delivering health care

May Health Hints

Who is Who in your Doctor's office?

Who owns that Surgical Center?

Article Headline

The Power of Having Access to Your Own Medical Records

Isn't it interesting that often patients do not have easy access to their own medical records and provider notes? First, I do want to say that there are practices that do allow patients to see their full records - practices whose culture is very patient-centered. However, in the vast majority of cases, there are complex procedures that you must go through to obtain your records and they are often not accessible in real-time.

Imagine how differently your care might be, especially if there is a current medical issue, if you could view your notes as they are entered into your record, if you could know what your provider's thoughts are and if you could then enter your own thoughts, corrections or additional information. This would acknowledge that you are an equal member of your health care team, and it would value you as a person.

In a recent New York Times article, The Healing Power of Your Own Medical Records, Steven Keating talks about his experiences dealing with a brain tumor when he had access to his medical records. The short story is that a number of years ago, a "slight abnormality" in his brain was revealed. The doctor's decision was to "monitor" it, and that is what Steven did as well. From his own research he knew that the abnormality was near his brain's smell center so when he started smelling whiffs of vinegar, he thought that they might be "smell seizures." He shared his thoughts with his doctors and pushed for a brain MRI. Weeks later, a malignant tumor was removed from his brain.

Not only does this level of patient engagement often result in improvements in care, but also studies have shown that when patients better understand their health and medical conditions, they often adopt healthier habits and are more adherent with taking their medications.

Telehealth

A new way of delivering health care

According to the US Department of Health and Human Services, "Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration." A cluster of words that has many implications. More patients than ever are seeing their doctors through their phones and computers. This is a trend that is growing as hospitals and insurance companies use technology to deliver care in different, and often more cost-effective ways.

According to Kaiser Health News, the American Medical Association expects the telemedicine market nationally to grow from $1 billion next year to $6 billion by 2020.

USA Today writes that lawmakers throughout the country are also embracing telehealth. Nineteen states have laws on the books that require private insurers to cover certain telehealth services.

This has not been overlooked in Hartford where our lawmakers are working on bills during this legislative session involving the regulation and oversight of telehealth services in Connecticut. From patient's perspectives, it is often more time efficient and convenient without the long drives followed by the long waits when you go to an office visit. It is of particular interest with regard to providing health care services to residents living in rural areas or locations where there are problems accessing health care providers.

May Health Hints:

Nonprescription Medications are now SALES TAX FREE in Connecticut

Effective April 1, 2015, nonprescription drugs and medications are now exempt from sales tax in Connecticut. The state law was signed last year by Govenor Dannel Malloy. Prescriptions have been and will remain tax exempt.

Is it allergies or a cold?

In many cases, the symptoms are the same: coughing, sneezing, and a runny or stuffy nose. With a bad cold, you may also run a fever and have general aches and pains that you won't usually get with allergies. On the other hand, allergies often cause itchy eyes. In addition to reducing exposure to your allergy triggers, your doctor can suggest the best medications.

The common cold is caused by a virus, there is no cure and it usually lasts for 3 to 10 days. Symptoms can be relieved by a number of over-the-counter solutions. It is not caused by bacteria and will not be helped by antibiotics.

To reduce your chances of catching a cold, the US Centers for Disease Control and Prevention (CDC) recommends these steps:

Wash your hands often with soap and water.
Do not touch your eyes, nose, and mouth.
Stay away from people who are sick.

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Dear Members,

On April 8th the Connecticut Center for Patient Safety

co-hosted a round table discussion with Griffin Hospital focused on The Role of Patient-Centered Care in Patient Safety and Quality Health Care. This was the first in a series of very important discussions in Connecticut that we will continue to advance. Our group was comprised of various stakeholders, including patients, looking at patient-centered care from the patient's perspective. After identifying key components of quality care and patient safety, we tied these components to patient-centered care.

Some of the key factors that were discussed were

Lisa Freeman with Ilene Corina of PULSE NY

that patient-centered care recognizes values, choices and preferences. It is respectful of the appropriate choices of language realizing that words matter. It involves partnerships that recognize that care needs to be provided "with" and not "to" or "for" the patient, and it is a philosophy and a culture, not just a list of strategies.

Building on this, I am hopeful that as a group we will continue this exploration and discussion, leading to a higher level of meaningful patient-engagement at all locations when legislating, overseeing, and providing health care services statewide and nationally.

Lisa Freeman

Who is Who in your Doctor's office?

Have you noticed that your primary care provider's office operates differently than it used to? Years ago, the typical staff in an office consisted of a receptionist/office manager, a nurse and a physician. In recent years the types of practitioners who you will encounter has grown. Today, oftentimes the person who initially sees and weighs patients and takes their blood pressure is a medical assistant. In some offices patients are still seen by a nurse. Nowadays however, patient care is often rendered by a qualified medical professional who's not actually a doctor. Both Advanced Practice Nurses (APRN's) and Physician Assistants (PA's) now work side by side with physicians in many primary care settings. According to Who Will Provide Primary Care and How Will They Be Trained, studies have found that "Advanced practice nurses and physician assistants can provide care of equal quality for many of the conditions treated in primary care settings."

PA's conduct physical exams, take down medical histories, diagnose and treat illnesses, order and interpret tests, assist in surgery, and prescribe medicine. Their training includes an accredited post college program and passing a national certifying exam. Then they must complete 100 hours of continuing medical education every 2 years and pass a recertifying exam every 10 years.

Advanced Practice Nurses are registered nurses with master's degrees, or even doctorates. They perform and interpret lab work, xrays, and other tests; diagnose and treat infections, injuries,

and acute and chronic diseases; prescribe medicines and other treatments; manage patients' overall care. They also educate and counsel patients. In Connecticut, after an initial period of collaboration with a physician, APRN's can now set up their own independent practices.

Even though the next time you visit your doctor's office you may not be seen by your doctor, it does not necessarily mean that the level of care you are getting is any less - it might just be different.

Who owns that Surgical Center?

According to James Rickert, MD, founder of the Society for Patient Centered Orthopedic Surgery, many orthopedic surgeons "own part of the distributorships that sell the total hip or knee implants to the hospital ... Or they own the imaging center they send their patients to," or perhaps "they own a piece of the surgical center". This clearly creates a potential conflict of interest when it comes to the potential for overtreatment or the wrong treatment. According to the U.S Government Accountability Office, there are a "greater numbers of procedures referred by physicians who own providing businesses, compared with referrals from nonowners."

In a Medpage Today article, Orthopedists' Financial Conflicts Can Hurt Patients, Surgeon Says, a list of orthopedic procedures that was presented at the recent Lown Conference in San Diego by Dr. Rickert and Dr. Rob Rutherford, included what they say are those that are frequently performed,

usually unnecessary, high cost, and sometimes harmful. While there are no doubt many excellent
Orthopedic and other surgeons who remain unconflicted, one has to wonder if a surgeon has a financial interest of more than his fee in doing the procedure, will they always recommend what is in the patient's best interest especially when it might be doing nothing at all?

If you are going for a procedure at an outpatient surgical, dialysis or other center, it can never hurt to ask your provider if they have a financial interest in the center or the equipment being used. This is a necessary piece of shared decision-making and informed consent.

The Problem With Patient Satisfaction Based Reimbursement

As part of the reform and transformation of healthcare, a Centers for Medicare and Medicaid Services (CMS) policy basing up to 30% of a hospitals' Medicare reimbursement on patient satisfaction scores went into effect. It was expected that this would encourage high quality patient-centered care. These satisfaction scores (HCAHPS) are somewhat subjective and may be causing some hospitals to focus on making their patients happy, but not necessarily providing them with services that will lead to better health.

The basic presumption for this policy makes sense, and statistics support that effective patient-centered care leads to better health outcomes. Many hospitals are, for instance, focusing on strategies that include improving nurse communication with patients, making more frequent nursing check-ins, and requiring doctors to sit down and speak with patients at eye level. In some hospitals, housekeeping is being asked to ask patients if there are any missed areas in their rooms which has sometimes led to lowered infection rates. The problem comes when hospitals focus on changing patients televisions to flat screens to lift their scores or put mini waterfalls in patients' rooms for ambience, but perhaps do little to lower their infection rates or reduce their readmissions or surgical complication rates.

According to the Wall Street Journal, "Some hospitals say certain questions in the survey are at odds with other goals. The questionnaire asks, "How often did the hospital staff do everything they could to help you with your pain?" Executives say that conflicts with an effort to curb abuse of powerful pain drugs." Perhaps some of the questions need to be revisited, as suggested by the chief medical officer of CMS. Meantime, at many hospitals, good things are coming from the policy changes leading to an actual focus on patients bringing about more genuinely patient-centered care.

If you or a family member has had an experience in a hospital that you would be willing to share with us, please fill out a contact form on our website.

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