The study was published in the International Journal “Translational and Clinical Pharmacology”.

Dr. Ameet Patki, the trial’s principal investigator of the study says, “Male infertility is solely responsible for 20–30% of overall infertility cases. Male factor infertility is a clinical challenge. Abnormalities in semen such as Oligospermia (low sperm count), Asthenozoospermia (sperm motility), and Teratozoospermia (group of abnormal sperm) are most frequently linked with infertility in males. Surgical procedures, hormonal and drug therapy are available treatment options for male infertility but these methods also have special concerns like higher cost, uncertain clinical effectiveness and side effects. Antioxidants have acquired increasing interest amongst clinicians & researchers for boosting parameters of male fertility. Sperm DNA fragmentation is known to be higher in infertile men. If it exceeds 30% than normal value, it implies sperm quality is significantly reduced. The uniqueness of this trial lies in inclusion of DFI as one of the assessment factor before & after the treatment.

Mr. Rohit Shelatkar, Vice-President of Meyer Vitabiotics says, “Infertility is a serious concern worldwide. As per the earlier published comprehensives it is reinforced that there is vital role of diet and antioxidant supplementation in male factor infertility. The limitations of current treatment options calls for a convenient, less costly and yet clinically effective option. Considering the gaining interest in antioxidant therapy and the need for systematic scientific evidence, the present study was proposed to evaluate the efficacy of antioxidant blend in sub-fertile males. The experiential use of antioxidants in male infertility is aimed at improving semen parameters and DNA Fragmentation Index (DFI), enhancing the probability of conception. The frequently prescribed compounds include vitamins E & C, carnitine, N-acetyl cysteine, selenium, and zinc. Interventional antioxidant blend through a single tablet of Oligocare forte plus, also called Wellman Conception in the UK, is a combination of micronutrients, essential amino acids, antioxidants, and vitamins that are essential for the male reproductive system”.

The clinical trial, was aimed to evaluate the safety, efficacy, and tolerability of Oligocare forte plus in sub-fertile males. Along with Dr. Ameet Patki, Dr. Monica singh, Dr. Sweta Agarwal, Dr. Venugopal M, Dr. Shashikant Umbardand, Dr. Apoorva Reddy, Dr. Priya Kannan, Dr. Srilatha gorthi, Dr. Gautam Khastgir, Dr. Anita Kulshreshtha were the investigators at other sites. Their dedication and efforts remarkably contributed to achieve study objectives and gain valuable insights into this research.

The study involved 300 participants who met the eligibility criteria and the results obtained have been highly promising. It was one of its kind multi-centric trial in sub-fertile male population conducted with meticulous adherence to good clinical practices (GCP) and all relevant regulations and guidelines.

The study, entitled PatientPay 2022, found 63% of respondents indicated they were experiencing staffing shortages in their revenue cycle departments, which can lead to less predictability in revenue streams. As a result, there is heightened interest from healthcare providers to work with third-party financial partners to support their business and patient management needs. Providers are particularly looking for help improving the patient experience, with only 42% feeling satisfied with their current patient payment solutions. Providers are focusing on improving check-in and payment capabilities, also known as the “digital front end,” to provide a more seamless and retail-like payment experience for their patients.

“We designed this study to get providers’ point of view on their patient payment needs, to better understand how technology supports payments processes, and to learn more about how the procurement of those services occurs,” said David Stievater, Partner, CWH Advisors. “Overall, our research found that providers work hard to balance their financial goals of accelerating cash flow and reducing debt with offering excellent service and flexible payment options to patients.”

Other key survey findings included:

• All organizations surveyed indicated patient payments are a “high” or “moderate” priority for their organization.
• Exactly 68% of providers ranked excellent customer service in their top three priorities for selecting an external patient payment solution.
• Additionally, 59% of providers assessed patient financial literacy as “poor” despite investments in educational collateral and additional front-line financial counselors.

“The research illustrates providers’ need to improve cash flow with faster, more reliable payments and patients’ desire for modern care financing options,” said Tim Donovan, SVP, Health & Wellness, Synchrony. “Third-party financial partners, like Synchrony, can help patients obtain the care they need and improve their overall customer service experience, while accelerating cash flow and reducing bad debt for providers. Our services ultimately provide a frictionless, simplified payment system for the organizations with whom we work.”

Synchrony, a company with a 90-year heritage in consumer lending and more than 35 years of experience in healthcare finance through its CareCredit healthcare credit card, offers educational resources to help patients learn more about healthcare costs and the financial solutions that can help patients plan and pay for care. CareCredit is a health and wellness credit card that patients can use to pay for deductibles, for treatments and procedures that are partially covered or not covered by insurance, and for other health and wellness services for individuals and their pets. It is accepted at more than 260,000 provider and retail locations nationwide.

Enter Buzz from Skyscape
Higher Standards co-founder Christina Wise-Orlowski eventually discovered Buzz and, after convincing her staff to give it a chance, has never looked back. Luckily, the Higher Standards Director of Nursing and Assistant Director of Nursing quickly realized that Buzz was unlike their last technology partner. The Buzz team was genuinely invested in their success and provded hands-on support to ensure every staff member could get the most from the product.

HIPAA-Compliance Has Some Surprising Benefits
Buzz also produces a HIPAA-secure, searchable record of care which is not only useful in the field, but also for compliance. When a state auditor paid Higher Standards a visit and inquired about the care of a particular patient, the clinical staff was able to recall information with ease, leading the surveyor to remark “All agencies need to use a tool like this.”

Buzz helped them secure their first zero-deficiency designation in their state/federal survey. Buzz was there to save the day!

Home health groups are tasked with stewarding sensitive information from diagnosis codes to patient histories. Sharing that information over text or unencrypted email—standard practices in the industry—is not only a violation of patient trust, it’s an act that puts your license at risk.

Work/Life Balance
The group’s nurses have also taken advantage of Buzz video calling to teach and learn from each other—building new clinical skill sets. If a new hire is inexperienced with a particular form of wound care, for example, another team member can walk her through the process, answering questions and providing visual demos.

This level of collaboration also extends to logistics. Staff frequently use Buzz to see if other clinicians can cover shifts, leading to better work/life balance and lower burnout.

Caregivers leaving their agencies to work directly for other agencies or even patients, perhaps for steadier hours or higher pay, has long been an industry trend. According to a recent survey, this trend will pick up in 2023, and this is unfortunate news for agency owners. According to Higher Standards, fostering a sense of community makes caregivers want to stay.

Key Takeaways

• Mobile communication platforms are highly efficient modes of information sharing that directly impact patient outcomes, rehospitalizations, staff turnover, and organizational costs.
• Mobile communication platforms must be versatile in order to facilitate optimal cooperation and information.
• Implementation of mobile technology should be organization-wide, from administrative staff to medical staff.
• Technology can automate large swatchs of work, creating major time and cost savings.
• Mobile communication can help organizations prepare for and adapt to changes in home health, becoming a powerful point of differentiation from peers.
• When platform developrs and home health agencies work together to design new features, they make new modes of care possible.

THE ISSUE

Patients frequently require assistance after discharge to recognise their symptoms and caution flags. Patients can have their blood pressure, weight, oxygen saturation, symptoms, and medication adherence monitored in real time at home by a specialised nurse practitioner who actively outreaches to patients as needed.

During the trial, MaineGeneral Health discovered that monitoring and following up with patients requires additional clinical time. As a result, it employed a full-time professional to oversee the patient panel. As the programme developed to over 100 patients, the organisation extended to accepting referrals for individuals with any chronic disease or COVID-19 and employing more clinical staff.

When COVID-19 hit, individuals avoided coming into the clinic whenever possible, said Laura Mrazik, MaineGeneral Health’s telemedicine coordinator. When virtual care was appropriate, patients required a way to communicate with their primary care doctors for chronic or acute care requirements.

They turned their focus to finding a user-friendly option for their outpatient offices to implement virtual visits, she explained. Patients with COVID-19 indications were able to avoid being exposed at the office for standard chronic illness follow-ups.

PROPOSAL

Prior to COVID-19, MaineGeneral had already chosen the RPM vendor. However, the epidemic heightened the need, particularly when patients began to postpone treatment. Patients are taught to monitor while in the hospital, Mrazik explained. When they are discharged, a member of the care team goes to their home and sets up the unit for them, which contains a data-enabled tablet that is only programmed for the vendor’s application, as well as a Bluetooth-connected heart rate monitor, pulse oximeter, and scale.

Units are loaded with disease-specific survey questions to highlight high-risk symptoms, as well as daily reminder alerts to take prescriptions and record vital signs, she continued. Early treatment by RNs on staff has resulted in the avoidance of readmissions through early medication modifications, the identification of a pacemaker’s dead battery, the discovery of a patient’s need for hypertensive medicine, and more.

MaineGeneral chose HIPAA-compliant Zoom as the video conferencing feature for virtual treatment in outpatient settings in an attempt to find a video technology that was user-friendly for patients. Virtual visits were deployed across all general practice, integrated mental health, and paediatric behavioural health service lines.

Mrazik explained that this financing also provided pills for hospital patients who weren’t able to visit with their families because of the new no-visitor policy. They used Zoom-enabled tablets to allow patients to communicate with friends and relatives while in the hospital.

To address the need to restrict patient exposure and engage with patients digitally, MaineGeneral designed workflows, purchased equipment, enhanced processes, and increased telemedicine technology in remote health monitoring and online visits in the outpatient context, she continued.

In the current health IT market, there are numerous suppliers offering telemedicine technology and services.

CONQUERING THE TROUBLE

As individuals record their data for remote monitoring, the data is immediately sent to a centralised care team. If a problem is found, the team can offer immediate assistance by holding virtual meetings with the patient, educating them, or speaking with the patient’s primary or specialty care physician to ascertain whether a clinical intervention such as a medication change, for example, is required.

Prior to their departure from the programme, patients are followed up on by MaineGeneral Health for an average of 90 days. The majority of patients range in age from 61 to 90.

According to Mrazik, the programme has expanded from managing 25 active cases to now overseeing 225 patients concurrently. MaineGeneral initially had 50 units for patients with CHF alone, but as time went on, 300 units were kept in rotation to monitor patients with any chronic illness, or COVID-19.

Care teams refer patients from their outpatient practise, inpatient stay, or home care, she added. She stated that they follow patients with CHF in the majority, with COPD, hypertension, pneumonia, and COVID-19 as the other most common observed diseases.

MaineGeneral was able to commit staff time thanks to funding from the FCC and increase the number of active patients while still upholding the integrity of the programme. In order for home care to actively see vitals, notes, and interventions, the organisation connected Health Recovery Solutions with Homecare’s electronic medical record system.

Including primary care clinics, practitioners of integrated behavioural health, and the paediatric behavioural health specialist practise, Mrazik said that they deployed 500 Zoom subscriptions across care settings. When necessary for chronic or urgent care requirements, patients electronically engage with their care team by joining a visit booked through MaineGeneral’s Zoom licence. Zoom and Stratus have been integrated to allow patients to have on-demand access to interpretation services during a virtual appointment.

INFERENCE

Although MaineGeneral examines patients with any chronic disease, CHF is the most common condition among programme participants. The company standardised CHF education and post-discharge follow-up to assist the readmission reduction efforts in tandem with the program’s RPM expansion. This included giving outpatient care managers a link to Health Recovery Solutions while they monitor patients for 30 days after discharge.

According to Mrazik, MaineGeneral has accomplished a CMS-CHF readmission rate of 0% in May and June 2022, compared with 20% and 26.7% in the same months last year. Additionally, in four of the previous nine months, the overall CHF readmission rate was zero.

The influence that qualified clinical staff and a solid vendor relationship have on a telehealth programme has been observed by the company, which places patient outcomes at the forefront of its decision-making, she continued.

She said that MaineGeneral’s compliance rates for taking vitals, blood pressure, weight, and O2 saturation have continuously maintained an average greater than the vendor’s book of business. The vendor’s clinician portal, which divides patients who have already taken their vital signs into groups according to normal or abnormal measurements, and those who have not yet reported for the day, is monitored by MaineGeneral RNs.

She added that if a patient hasn’t been documented, RNs phone patients every day. High patient satisfaction levels are another benefit of staff and technology synergy. 90% of RPM patients, according to MaineGeneral’s most recent RPM satisfaction levels, are pleased or extremely pleased with the program’s impact and their ability to take an active role in their health.

FCC AWARD FUNDS USE

With the use of video conferencing all-in-one workstations and remote patient monitoring tools, MaineGeneral Health will be able to perform virtual visits and lower exposure.

The patient information tablet and Bluetooth-enabled peripherals, such as a blood pressure cuff, scale, and pulse oximeter, are all parts of the RPM equipment that they were leasing, according to Mrazik. The FCC money bought remote patient monitoring units and paid for 200 units’ annual licence fees, enabling MaineGeneral to swiftly expand their operations.

They intend to keep expanding the RPM programme until they have 300 individuals enrolled in it, she said. In order to expand this service, MaineGeneral has been able to invest in the clinical staff, putting up units in patient residences and monitoring and evaluating vitals and following up as necessary.

The expansion of telehealth services was made possible by Zoom licencing and IT hardware for virtual visits- all-in-one desktop PCs and web cams. She went on to say that the FCC financing was a crucial component of MaineGeneral’s efforts to develop a sustainable telehealth programme as the company works to improve procedures, add new integrations, and broaden offerings to better serve the community and care teams.

It was one of just three Los Angeles hospitals to obtain the Health Care’s Most Wired award, which recognises excellence in a hospital’s use of information technology, after it opened in 2015. ASIS International also presented the hospital with an Outstanding Security Performance Award.

THE ISSUE

Malicious actors are increasingly focusing on healthcare networks due to the rise in ransomware attacks, cybersecurity problems, and data breaches.

According to Mark Reed, director of support services at Martin Luther King Jr. Community Hospital, whilst also continuing to work with the IT team to identify potential security advancements to safeguard personal identifying information and protected health information, they recognised their IDF and server rooms were susceptible to a physical breach.

He continued, if someone broke into a data-sensitive sector, one would have exposure to everything. Let’s say malicious individuals gain access to a hospital’s data centre. In such circumstances, it is crucial that users secure their physical areas through improved access control as they have access to the inner workings of the entire firm.

In response, hospital administration carried out a thorough risk analysis and found that the facility required more stringent security measures for its IT system and other sensitive locations. The ID badge-based admission system, though, raised questions about potential risks and weaknesses in the event that ID credentials were misplaced or stolen. As a result, Reed explained, they pursued biometric security and access control solutions to compliment the existing access control solution offered by AMAG Technology Symmetry Access Control in order to increase the security posture.

THE PROPOSAL

To strengthen on-site security, hospital administration and security staff began studying various biometric-based access control systems. They recognised they needed a solution that would help them achieve their security goals and protect their people.

They determined that the vendor Alcatraz AI best met their requirements.

Alcatraz AI, according to Reed, exhibits a remarkable rate of success for its authentication. The hands-free face authentication approach had very few limitations, such as soiled fingerprint readers or malfunctioning sensors that affected other security devices.

The fact that facial authentication followed a routine that many people currently use to activate their phones appealed to the employees as an access control mechanism, he continued. The technology proved familiar, simple to use, and efficient; as authorised personnel reached a door, it instantly unlocked, resulting in a seamless workflow that satisfied security and functional needs. The hospital was pleased with the results after testing the product and evaluating its efficacy.

CONQUERING THE STRUGGLES

The Rock, a vendor’s product, was tested at the security operations centre of Martin Luther King Jr. Community Hospital. The most sensitive or classified systems and security employees are housed there, enabling staff to test The Rock for five months. Reed said, they did everything to make the machine break. People tried to deceive the authentication by hiding their faces and using other techniques, but the system was flawless.

The security team installed it in the sensitive spaces, notably IDF closets, server rooms, and other hospital sites where private data or crucial technology are housed, after utilising it every day for five months, he added. As more employees used The Rock, the team started getting requests from other employees to install The Rock in other places since it improved access control procedures and streamlined workflows.

According to Reed, The Rock is now completely connected with their AMAG access control system and AML systems. The procedure is simple.

THE RESULTS

According to Reed, The Rock tightened security in vulnerable places and assisted in making sure there were no security lapses at the hospital. The additional security measures helped make data protection an extension of the patient care mission because even one breach would be catastrophic for activities and patients, he continued.

Notably, he observed, the system hasn’t experienced any downtime since The Rock was installed, and it’s functioned with 100% dependability, making it a key component of their comprehensive security operations.

It also assisted them in obtaining HITRUST Certification, which confirms that a company has gone through a thorough review of its information security procedures. For applying necessary administrative, technical, and physical protection, the programme provides prescribed and quantifiable criteria and objectives.

HITRUST is widely regarded in the industry as a best practise for healthcare systems conforming to the highest data security requirements, but it does not substitute or supplement HIPAA compliance processes.

A study by a team of researchers from the University of Wollongong (UOW), St George Hospital and the Illawarra Health and Medical Research Institute (IHMRI) has found a high prevalence of anxiety and depression among healthcare workers around the world during the COVID-19 pandemic.

The researchers found that depression was common among doctors, while nurses experienced high levels of anxiety. The prevalence of depression among doctors was 40.4 per cent, with 17 per cent and 19.8 per cent reporting symptoms of anxiety.

The prevalence of depression though, was lower among nurses than doctors, but still high at 28 per cent. At the same time, nurses were more likely to experience symptoms of anxiety than doctors were, with the prevalence of anxiety among nurses between 22.8 per cent and 27 per cent.

The results suggest that strategies to reduce the incidence of anxiety and depression among frontline healthcare workers are urgently required.

The study, a comprehensive umbrella review of research conducted around the world, analysed data from 10 systematic reviews and 100 unique studies which included 169,157 healthcare workers from 35 countries. The results are published in BMJ Open

The study’s lead author, Professor Ritin Fernandez from UOW’s School of Nursing and St George Hospital, said the review demonstrated the need for greater support for frontline healthcare workers, particularly nurses and doctors.

“The study’s results highlight the need for nurses and doctors to be provided with urgent support to assist them with coping while working in high stress environments, especially during disaster conditions,” Professor Fernandez said.

“Healthcare workers need to be well supported with time away from the workplace, as this review has demonstrated that their mental wellbeing is suffering. This could lead to burnout and mass exit from the profession if staff wellbeing is not addressed.

“Nurses and doctors are not robots and are prone to psychological distress, just like any other worker. Strategies need to be implemented to reduce their fear of social stigma which is still attached to saying that mental health support is needed.”

While anxiety increased among the general population during the pandemic, frontline healthcare workers experienced heightened emotional responses as they were more frequently exposed to the virus and to very sick people.

Professor Fernandez said nurses and doctors experienced many challenges in accessing personal protective equipment, felt added job stress due to increased work demands and lack of effective treatment, and were working under rapidly changing COVID-19 protocols.

“Frontline health workers were witnessing a decline in their own immunity as a result of physical and mental exhaustion. Those looking after the sick were getting sick,” Professor Fernandez added.

“In this regard, healthcare workers need to be acknowledged for the work that they did and are still doing.”

Professor Fernandez offered some strategies to support frontline healthcare workers.

“Most healthcare workers also have families, some are trying to juggle home schooling and work commitments. To know that their children could be cared for at the hospital during their shifts would alleviate some of their stress,” she said.

“Providing health care workers with free parking, nutritional meals and coffee, as well as monetary benefits, would also assist in a practical way.

“Additionally, having psychological support services readily available and other interventions such as a time out room with mindfulness activities and a place for them to express how they feel would also assist healthcare workers.”

ABOUT THE RESEARCH

“Anxiety and depression among healthcare workers during the COVID-19 pandemic: a systematic umbrella review of the global evidence” by Ritin Fernandez, Nqobile Sikhosana, Heidi Green, Elizabeth J Halcomb, Rebekkah Middleton, Ibrahim Alananzeh, Stamatia Trakis and Lorna Moxham is published in BMJ Open.

The research, recently published in the European Journal of Cancer, highlights how the repurposing of health systems and implementation of social distancing measures, including national lockdowns, have had negative effects on patients with cancer. These effects included delays in urgent referrals and patients having their cancer treatment, such as chemotherapy postponed, or surgery being delayed.

Cancer is a common disease, with over 3.7 million new diagnoses in Europe each year and over 1.9 million deaths. The researchers highlight how this 1.9 million figure may increase significantly, directly as a result of the current crisis. Recent data from Wuhan in China, the original epicentre of the pandemic, shows that there has been a greater than 20% drop in the use of cancer drugs in the first quarter of 2020. The British Society of Gastroenterology also recommends that no endoscopic procedures, which are used to screen for bowel/colorectal cancer, can be performed for at least the next 3 months.

Professor Mark Lawler, Associate Pro-Vice-Chancellor and Professor of Digital Health, Queen’s University Belfast, and Scientific Lead, DATA-CAN, the UK Health Data Research Hub for Cancer and Senior Author on the paper said: “We are already seeing the indirect effects of the COVID-19 crisis on cancer care. Urgent referral numbers are dropping, endoscopies and other surgical procedures are being postponed and many cancer specialists are being redirected to COVID-19 specific care. If we don’t act, we risk the unintended consequence of the current COVID019 pandemic precipitating a future cancer epidemic.”

The research also highlights that as more people are worrying about the signs and symptoms of COVID-19, less people are seeking advice on new symptoms of a possible cancer, including abnormal bleeding or new lumps on the body.

Professor Eduard Vrdoljak, Department of Oncology, Clinical Hospital Centre Split, and the University of Split, Croatia and Lead Author on the paper said: “I am extremely worried. We are experiencing significant challenges. People’s fear of attending any health facility, coupled with their minds being more focused towards COVID-19 symptoms, mean that they may down-play rectal or bladder bleeding, a lump in the breast or other signs of cancer that otherwise would lead them immediately to consult their doctor. We are starting to see people who may be at risk of developing cancer fearing a COVID-19 diagnosis more than a cancer diagnosis.”

Professor Richard Sullivan, Director of the Institute of Cancer Policy, King’s College London and author on the paper said: “The focus on COVID-19 through 24-hour news cycle and social media, has dramatically changed our emotional and social infrastructure. At the scientific level, the modelling on which public health measures are being taken is entirely focused on COVID-19 mortality and morbidity, with little or no consideration for the impact of control measures on increasing morbidity and mortality in cancer, or indeed any other health condition.”

Margaret Grayson, Chair of the Northern Ireland Cancer Research Consumer Forum, said: “Patients, especially cancer patients, are extremely worried at this difficult time. Governments and health systems need to reassure patients and citizens, but they also need to act, to ensure that the care of cancer patients is not compromised.”

Professor Vrdoljak added: “In transitioning nations in Central and Eastern Europe, and more widely in low- and middle-income countries globally, we are already significantly challenged in our fight against cancer. Let’s not make the situation worse by ignoring cancer in the current crisis.”

Professor Lawler concludes: “We must encourage cancer patients, or citizens who are worried that they may have cancer symptoms, to continue to access health systems and we must ensure that those health systems are fit for purpose to support them. Cancer must be firmly in our cross wires, so that we avoid adding the lost lives of cancer patients to the COVID-19 death toll.”

Geographic cohorting –- restricting or localizing hospitalists and their patients to one or two inpatient units rather than having hospitalists travel from floor to floor, across wings or between buildings to care for patients –- is becoming increasingly popular with health care systems and hospitals. But what is the impact of this method of staffing?

The new time-motion study found potential benefits from geographic cohorting such as increased number of bedside visits and time spent by the hospitalist with patients, yet the researchers also reported that geographically cohorted hospitalists were observed to be interrupted more frequently than hospitalists caring for patients spread across the hospital. Cohorted hospitalists were also observed spending more time working on a computer.

“We found that there are definitely tradeoffs in having hospitalists focus on patients in one or two units rather than care for patients throughout the hospital,” said study senior author and Regenstrief Institute research scientist Michael Weiner, M.D., MPH. “While patients and their families may be pleased that geographically cohorted hospitalists are not too far away so the doctor can spend time examining and evaluating the patient, explaining and engaging in shared decision-making, hospitalists assigned to only one or two units may not be working optimally as they are frequently interrupted because they are frequently present.

“Intriguingly, we don’t yet know why geographically cohorted hospitalists spend more time on the computer than non-geographically cohorted counterparts,” Dr. Weiner, a health services researcher, noted.

Much of the meaningful work that a hospitalist must accomplish takes time — reviewing diagnostic test results, consulting with colleagues, conversing with nurses. It occurs away from the patient and requires the hospitalist to determine an appropriate balance between direct care at the bedside and indirect care during which the patient is not present. A significant percentage of hospitalists work an intense schedule of one week on followed by one week off and are often assigned 12-hour shifts.

Hospital medicine is the fastest growing medical specialty with more and more hospitals and health care systems employing hospitalists, physicians who work exclusively in hospitals, to care for inpatients.

“Our study paints a unique picture that we need to be aware of, explore and address to make the maturing specialty of hospital medicine better for patients and hospitalists,” said study corresponding author Areeba Kara, M.D., M.S., an IU School of Medicine assistant professor of clinical medicine. “Knowing what goes on during the workday of geographically cohorted hospitalists and contrasting that with what non-geographically restricted hospitalists encounter on the job will help researchers and administrators enable hospitalists to carry out their patient care missions at the highest level possible.” Dr. Kara has been a hospitalist with IU Health since 2003.

“A Time Motion Study Evaluating the Impact of Geographic Cohorting of Hospitalists” is published online ahead of print in Journal of Hospital Medicine.

The study was supported by IU School of Medicine’s Advanced Scholarship Program for Internists in Research and Education (ASPIRE). Dr. Kara was a 2017-18 ASPIRE Scholar mentored by study coauthors Dr. Weiner and Regenstrief Institute Research Scientist Kurt Kroenke, M.D, an IUPUI Chancellor’s Professor and professor of medicine at IU School of Medicine.

Other co-authors of the study are Mindy Flanagan and Rachel Gruber of Regenstrief Institute, and Kathleen Lane and Na Bo of IU School of Medicine, Department of Biostatistics.

About Michael Weiner, M.D., MPH
In addition to his role as a Regenstrief research scientist, Dr. Weiner is associate director of the William M. Tierney Center for Health Services Research at Regenstrief; principal investigator and director of the VA HSR&D Center for Health Information and Communication at Richard L. Roudebush VA Medical Center; and a professor of medicine at IU School of Medicine.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. The Regenstrief Institute and its researchers are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating of models of care that inform practice and improve the lives of patients around the globe.

A key research partner to Indiana University, Regenstrief Institute is celebrating 50 years of healthcare innovation. Sam Regenstrief, a successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

The situation is so dire that the doctors involved with the John Hopkins study even asked the CDC to mandate a change to how death certificates are used for data collection purposes, to make it easier to spot irregularities; we are still waiting for that change to happen.

Cases Happen in Any City

The city of Easton, Pennsylvania is where Crayola crayons are manufactured, and it scores high on its livability rating. It’s perhaps it’s the last place you’d expect to find issues with medical malpractice, but it can happen anywhere.

Also, it’s worth pointing out that malpractice can occur in a hospital, a clinic, a nursing home and many other places where care is provided to a patient. Take childbirth, for instance. There are many injuries to the newborn during childbirth that are completely unnecessary. Easton personal injury lawyer Matthew Trapani suggests that parents stay alert during the birthing process for anything untoward and subsequently look for issues resulting from a bad procedure.

Birth defects from errors in the delivery room can leave a child with brain damage due to a lack of oxygen, prolonged nerve damage into adulthood, or suffering from stunted growth or debilitating cerebral palsy. In the worst cases, parents can lose their baby.

Humans Make Mistakes. How Can This Be Reduced in Healthcare?

Human beings make mistakes. It’s natural and to some extent, a fundamental part of the human condition and by extension, the healthcare profession. But there is much that can be done to remove errors from the system and improve overall levels of care.

For instance, Doctor Atul Gawande wrote The Checklist Manifesto discussing the issue of avoidable mistakes within hospitals and other healthcare facilities and how he’s worked to address the problem directly. Using the idea of medical checklists for doctors and nurses in an operating theater, he was able to reduce the incidence of careless errors like leaving a scalpel inside a patient or double-checking that the anesthesia was being correctly administered.

As readers of Gawande’s book soon learned, implementing simple checklists right down to counting the number of needles and scalpels present at the beginning and end of an operation prevented errors that potentially would have led to more negative outcomes for patients.

Is It a Problem with the System?

Deaths are tallied and categorized by the CDC under an overly restrictive construct. They’re grouped under “injuries, diseases, and morbid conditions.” Doing so makes it more difficult to analyze deaths when looking for causality and/or cases of medical malpractice.

It’s felt that this leads to an under reporting of the severity of medical malpractice in the system. Currently, over 9% of cases from the John Hopkins study from 2016(over 250,000 medical error cases out of 35 million admittances) were found to be possible malpractice cases. However, with clearer reporting and analysis of deaths, and as reported elsewhere, the annual number could be significantly higher.

Perhaps, with acknowledgment of the sheer scale of the malpractice problem, better systems can be implemented, such as checklists,to reduce this number significantly. In the meantime, people who find their family or they themselves have suffered through a bad medical procedure should seek legal representation to review the case. Indeed, perhaps it is only through legitimate legal claims made against healthcare organizations that they will see fit to make the changes necessary to properly address this systemic issue.

“Private hospitals in South East Asia operate in a highly competitive environment where they need to differentiate themselves to attract patients with high expectations and wanting the best clinical care,” said Kerry Stratton, Managing Director, South East Asia at InterSystems.

“With digital transformation private hospitals can innovate and stand out from the competition by providing a superior patient experience and the highest levels of clinical excellence.”

Survey Highlights

Drivers for Digital Transformation

• Internal process efficiencies – 78%
• The need to innovate – 75%
• Patient expectations – 73%

Barriers to Digital Transformation

• Change management challenges – 61%
• System interoperability challenges – 55%
• Lack of qualified staff – 45%

Changes in System Capabilities in 5 years

• Real-time big data analysis – up from 13% to 69%
• Artificial intelligence – up from 5% to 56%
• Use of paper records – down from 56% to 6%

Transformational Changes in 5 years

• Value-based care initiatives – up from 16% to 64%
• Care coordination with outside organizations – up from 22% to 58%
• Analysis of clinical information about groups of patients – up from 19% to 52%

New Digital Technology Capabilities
Many hospitals claim to be digital today, thanks to the adoption of electronic medical records (EMRs), which provide the foundation for digital transformation. But according to the InterSystems survey, Taking the Pulse of Digital Transformation in Healthcare – South East Asia, most Asian private hospitals are still in the process of phasing out paper records and need to make additional investments for data to flow across the continuum of health and care.

Private hospitals will almost completely end the use of paper-based records in favor of fully digital systems within five years, however. While 56% of survey respondents said they currently use paper-based records, the figure is expected to fall to only 6% of private hospitals in five years.

The move to the full digitization of health information will pave the way for a range of new digital technology capabilities. The survey found that most Asian private hospitals expect to implement real-time big data analysis capabilities over the next five years, with the proportion increasing from 13% of hospitals currently to 69% in five years.

Around half of private hospitals surveyed expect to implement artificial intelligence (AI) capabilities, with the figure rising from 5% currently to 56% in five years. Nearly half of private hospitals will implement support for remote patient monitoring systems (e.g. in-home devices), with the percentage increasing from 6% currently to 53% in five years.

Transformational Changes
The InterSystems survey found that new digital technology capabilities will enable many transformational changes at private hospitals. The biggest is expected to be a move to support value-based care initiatives – an alternative to fee-for-service reimbursement. Currently only 16% of Asian hospitals’ digital systems support value-based care initiatives, a figure expected to quadruple to 64% in five years.

The second-biggest change is expected to be supporting care coordination with outside organizations, rising from 22% currently to 58% in five years. The third was ability to analyze clinical information about groups (cohorts) of patients, increasing from 19% currently to 52% of private hospitals in five years. The fourth-biggest change was the ability to support patient wellness strategies, up from 36% currently to 63% in the same time period.

“The entire customer experience needs to be taken into account while planning a hospital’s digital transformation, and the good news is that this is starting to happen,” said Stratton. “The most common transformational changes that Asian private hospitals expect to make – whether improving the value they receive, better targeted treatments, improved care coordination, or wellness strategies – all have a strong focus on the patient.”

To create the survey, 70 senior executives were polled at 28 leading private hospitals across Asian countries including Indonesia, Malaysia, the Philippines and Thailand. You can download the full Taking the Pulse of Digital Transformation in Healthcare – South East Asia survey report here

About InterSystems
InterSystems is the information engine that powers some of the world’s most important applications. In healthcare, business, government, and other sectors where lives and livelihoods are at stake, InterSystems has been a strategic technology provider since 1978. InterSystems is a privately held company headquartered in Cambridge, Massachusetts (USA), with offices worldwide, and its software products are used daily by millions of people in more than 80 countries. For more information, please visit http://www.intersystems.com/.