TAG: "Health information technology"

Four UC health systems named among nation’s most wired


List includes Davis, Irvine, UCLA, San Diego.

UC Davis, UC Irvine, UCLA and UC San Diego health systems have been designated among the nation’s information technology leaders, according to the 2014 Health Care’s Most Wired Survey that appears in the July issue of Hospitals & Health Networks magazine.

UC San Diego earned the Most Wired designation for the ninth consecutive year, UC Davis for the fourth consecutive year, UCLA for the second straight time and UC Irvine for the first time. They are among only 17 institutions in California designated Most Wired in this year’s assessment. UC San Diego Health System was the only California facility named to the Most Wired Advanced list.

Health Care’s Most Wired Survey, now in its 16th year, asked hospitals and health systems nationwide to answer questions regarding their IT initiatives. Respondents completed 680 surveys, representing 1,900 hospitals. A full list of award winners can be found online at www.hhnmostwired.com.

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Sen. Boxer highlights efforts to prevent medical errors


She visits UCSF Medical Center.

U.S. Sen. Barbara Boxer (second from right) tours UCSF Medical Center on July 2 to learn how it is working to reduce preventable deaths. Susan Barbour (left), R.N., talks about pressure ulcer prevention. (Photo by Cindy Chew)

Every year, between 210,000 and 440,000 Americans die as a result of preventable errors in hospitals, according to a special report released at UC San Francisco by Democratic Sen. Barbara Boxer.

She presented the updated report detailing the most common and harmful errors at our nation’s hospitals and highlighted what UCSF Medical Center is doing to prevent them.

“We have the opportunity to save not just one life, but to save hundreds of thousands of lives,” Senator Boxer said during her visit to UCSF Medical Center on July 2. “Many people will be shocked to hear this, but medical errors are one of the leading causes of death in America today. These deaths are all the more heartbreaking for families because they are preventable.”

Boxer said she is grateful to UCSF for the steps it has taken to save patients’ lives.

“If we all work together – doctors, nurses, hospital administrators, patients, patient advocates, medical technology pioneers, public health experts and federal officials – we can prevent so much heartbreak for families and stop these tragedies before they occur,” said Boxer at a press conference following a tour of UCSF Medical Center.

Preventable errors in hospitals, such as hospital-acquired infections, adverse drug reactions, patient falls and bedsores, total $19.5 billion annually and that the economic costs of medical errors, including lost productivity, could be as much as $1 trillion a year, according to Boxer’s report.

“We’re one of the nation’s top hospitals,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “But that is meaningful only as it relates to every single patient who walks through our doors, and how we administer their care, follow up and safety. We’re proud of the great strides we’ve made as a leader in patient safety and to partner with Senator Boxer to help all hospitals become places where safe care is offered to every patient, every day.”

While touring UCSF Medical Center, Senator Boxer was shown the interdisciplinary approach UCSF takes to address major hospital issues such as sepsis, ulcer prevention, medication errors and hand hygiene.

As part of its interdisciplinary approach, UCSF creates teams comprised of nurses, pharmacists, doctors and medical center leaders, in addition to staff in medical records and environmental services. Those teams focus on understanding the underlying causes that may have allowed an error to occur and on collaborative problem solving. An open discussion ends with a clear action plan, which might involve implementing a new system, purchasing a piece of equipment, or training doctors and nurses in communication strategies.

UCSF processes and results for sepsis prevention

Sepsis is a potentially fatal, full-body inflammation caused by infection, and one of the main sources of sepsis is hospitals themselves.

“At UCSF we now treat sepsis as a true emergency with a focus on immediate interventions proven to help patients,” said Joshua Adler, M.D., chief medical officer at UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This approach has involved innovations in our electronic health record systems, use of rapid response personnel, novel nursing protocols, and continuous evaluation of our performance.”

UCSF’s electronic sepsis surveillance system continuously searches for warning signs, alerts clinicians to the potential presence of sepsis, and provides a means to activate “Code Sepsis”. The Code Sepsis team – a rapid response team, critical care nurse practitioner, and pharmacist – has helped UCSF to treat sepsis as an emergent situation requiring immediate attention and action. “With this approach we have reduced the mortality rate for sepsis by nearly 25 percent since 2012,” Adler said.

Processes and results for ulcer prevention

Ulcers resulting from being bedridden, and thus immobile for a lengthy time, are an ongoing challenge for hospitals. In addition, to training all patient care providers in pressure ulcer prevention, UCSF conducts quarterly pressure-ulcer prevalence study days. On these days, every patient in the hospital is examined for evidence of a pressure ulcer. The total number of pressure ulcers counted is divided by the total number of patients examined to obtain a percentage of patients with pressure ulcers.

UCSF has reduced the rate of hospital acquired pressure ulcers among adult and pediatric patients by 79 percent, from 4.98 percent in fiscal year 2008 to 1.03 percent in fiscal year 2014.

Preventing inpatient medication errors

In 2011, UCSF launched what is believed to be the nation’s most comprehensive automated hospital robotic pharmacy that is designed to prepare and track medications, with the goal of improving patient safety. The pharmacy operation is now linked to the electronic health record system, creating an end-to-end electronic system in which a nurse at the bedside scans the barcode on the patient’s wristband, scans the medication and then scans the bar code on his/her own ID badge. Only after confirming all the information matches is the medication administered. UCSF administers over 10,000 doses of medication daily.

“The barcoding system is a way to minimize the potential for an error at every step of the medication delivery process,” said Laret.

Hand hygiene training and surveillance

Hand hygiene is considered one of the most effective approaches for reducing hospital-related infections. In July 2010, UCSF implemented a hand hygiene education and surveillance program. Since then the rate of hand hygiene has improved from 75 percent to about 92 percent each month. The data are collected and monitored by cameras in some hospital areas, and a daily report is distributed. Some floors even feature real-time monitoring that displays hand hygiene compliance rates.

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Effort to improve medical computing gets $3M boost


NSF, Intel join to support UCLA’s work to improve care, reduce patient exposure to radiation.

A group led by UCLA engineering researchers that designs high-performance, customizable computer technologies to improve health care has received a $3 million grant from a public-private partnership between the National Science Foundation and semiconductor giant Intel Corp.

The award will help further the long-term efforts of the group, which aims to speed up the computing side of medicine through innovations in what is known as domain-specific computing. Their research has the potential to reduce dangerous radiation exposure during CT scans and lead to the development of patient-specific cancer treatments.

Headed by Jason Cong of UCLA’s Henry Samueli School of Engineering and Applied Science, the group includes experts in computer science and engineering, electrical engineering, and medicine from UCLA, Rice University, and Oregon Health and Science University. The majority of the team is from the UCLA-based Center for Domain-Specific Computing (CDSC), which in 2009 was awarded a five-year, $10 million grant by the NSF’s Directorate for Computer and Information Science and Engineering.

The new funding, which extends support for the CDSC for another three years, comes from Intel and the NSF’s Innovation Transition (InTrans) program, which was launched in 2013 to address the gulf between government-funded research and industry support for prototypes and products — frequently referred to in research circles as the “valley of death.”

“The Center for Domain-Specific Computing has already done groundbreaking interdisciplinary work,” said Vijay Dhir, dean of UCLA Engineering. “The public-private partnership between Intel and NSF to extend funding for the center promises to lead to new innovations that will help address critical health care challenges.”

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Tweet your way to better health


UCSF study of social media shows potential to convey health messages.

Eleni Linos, UC San Francisco

Twitter and other social media should be better utilized to convey public health messages, especially to young adults, according to a new analysis by researchers at UC San Francisco.

The analysis focused on public conversations on the social media site Twitter around one health issue: indoor tanning beds, which are associated with an increased risk of skin cancer. The researchers assessed the frequency of Twitter mentions related to indoor tanning and tanning health risks during a two week period in 2013. During that timeframe, more than 154,000 tweets (English language) mentioned indoor tanning – amounting to 7.7 tweets per minute. But fewer than 10 percent mentioned any of the health risks, such as skin cancer, that have been linked to indoor tanning.

That offers a potentially valuable forum for conveying important health information directly to the people who might benefit the most from it, but the authors said further research is needed to explore whether that would be effective.

The analysis will be published as an editorial letter in the July 12 issue of The Lancet

“The numbers are staggering,” said senior author Eleni Linos, M.D., Dr.P.H., an assistant professor in the UCSF Department of Dermatology. “With 500 million tweets sent each day and over 1 billion Facebook users, it is clear that social media platforms are the way to go for public health campaigns, especially those focused on young adults.”

Linos has previously published influential research on the harms of indoor tanning beds. The research found that indoor tanning beds can cause non-melanoma skin cancer, with the risk rising the earlier one starts tanning. Indoor tanning has already been established as a risk factor for malignant melanoma, the deadliest form of skin cancer.

In their social media study, the researchers used a Twitter programming application to collect in real time all tweets that mentioned indoor tanning, tanning beds, tanning booths and tanning salons. During the study period in March and April 2013, more than 120,000 people posted at least one tweet about indoor tanning. Altogether, more than 113 million Twitter “followers” were potentially exposed to tweets about indoor tanning, the authors reported.

“Indoor tanning has reached alarming rates among young people,” said Linos. “And tanning beds account for hundreds of thousands of skin cancers each year. Through social media, we now have an opportunity to talk about these health risks directly with young people.”

Co-authors include Mackenzie R. Wehner, a Doris Duke Research Fellow at UCSF; Mary-Margaret Chren, M.D., professor of dermatology at UCSF; Melissa L. Shive, a medical student at UCSF; and Jack S. Resneck Jr., M.D., associate professor and vice chair of the UCSF Department of Dermatology.

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$10M grant to bring online respite to dementia caregivers


UCSF, UNMC to offer education, support and care.

Katherine Possin, UC San Francisco

UC San Francisco and the University of Nebraska Medical Center have been awarded a $10 million grant from the Centers for Medicare & Medicaid Innovation to create a new Web-based model of dementia care. It will provide around-the-clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.

The Dementia Care Ecosystem will not replace clinicians, but rather bring educational resources developed over the last decade by the UCSF Memory and Aging Center (MAC) to patients and their families, while enabling clinicians to monitor their patients from afar.

“Our hope is this is going to radically improve the way dementia patients are cared for,” said Katherine Possin, Ph.D., who is an assistant professor of neuropsychology at UCSF. “We hope we’ll show this works, and that it can be adopted nationwide.”

Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard, created with the help of Salesforce. Navigators will be people without a formal medical degree and will be supervised closely by nurses, social workers and pharmacists with expertise in dementia care.

These navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall. Meanwhile, patients and their families will be able to get training online to help make financial plans and work through tough medical decisions before their loved ones have reached a crisis stage.

Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs. If caregivers learn to cope better, patients may be able to remain at home longer before moving into assisted living. Last year, according to the Alzheimer’s Association, about 15.5 million people in the United States were caring for friends and family members with dementia. Nearly 60 percent said the work was highly stressful and more than a third reported symptoms of depression.

Bruce Miller, UC San Francisco

“Our ecosystem will have wisdom and experience continuously piped in every day to caregivers who are overwhelmed,” said Bruce Miller, M.D., director of the MAC, who holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at UCSF. “Typically, these people have a hard time getting through to anyone in the medical system.”

Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home. And a small number will have sensors placed inside their homes to detect behavior changes that could signal the onset of a health problem, like being up all night, staying in bed all day or going to the bathroom more times than usual.

“If someone, instead of getting up two times a night, is getting up four or five times a night, we might send a nurse the next morning to their home to get a urine sample, and if it’s bad start the patient on antibiotics,” said Steve Bonasera, M.D., Ph.D., an associate professor of geriatrics at UNMC, who did his fellowship at UCSF. “We’re going to be monitoring people who are a seven- or eight-hour drive from my office in Omaha.”

The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.

Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months. This is projected to save $4.3 million over the three years of the grant.

The MAC already has a well developed website that attracts traffic from around the world. Some of the center’s recorded lectures on caring for people with dementia have been viewed hundreds of thousands of times. Researchers said that once families have easy access to educational resources, office visits will become less pressured and patients and their families will be able to take more time to absorb information and make important decisions.

“The idea of 24/7 telephone access to clinicians with expertise in dementia has really resonated with caregivers,” said Jennifer Merrilees, R.N., Ph.D., a clinical nurse specialist at the MAC who will oversee the care that is dispensed online. “That’s what’s really made their faces light up when I’ve described it to them.”

Beginning this fall, 2,100 patients, all diagnosed with varying stages of dementia, will be enrolled through San Francisco General Hospital and Trauma Center, UCSF Medical Center and the UCSF MAC clinics and Chinatown Clinics, as well as UNMC and other service organizations in Nebraska serving the elderly.

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UC participating in Innovation HealthJam


Free online event to take place June 17-19.

UC Davis, UC San Francisco and UC’s Center for Information Technology Research in the Interest of Society (CITRIS) are among the sponsors of Innovation HealthJam, a three-day virtual conference, which starts June 17. It is hosted by Panasonic Corp. of North America with eight health care-related topic areas.

The virtual conference will engage health care experts from academia, private industry and the nonprofit sector.

UC Davis is bringing together experts from its Center for Health and Technology and a variety of other state and national organizations to lead a three-day series of interactive discussions dedicated to telehealth and telemedicine.

UCSF is hosting an online discussion of how to use technology to serve the health care needs of the underserved, both abroad and at home.

Anyone can participate. Real-time text analysis and data mining will highlight emerging trends and identify potential actions. The event is free, but attendees must register to participate. Details on specific discussion times and participants are available at www.innovationhealthjam.com/innovation-healthjam-complete-schedule.

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App paired with sensor measures stress, delivers advice to cope in real time


ParentGuardian designed to identify stressful moments, remind parents of coping strategies.

Laura Pina, UC San Diego

Computer scientists at Microsoft Research and UC San Diego have developed a system that combines a mobile application and sensor to detect stress in parents and delivers research-based strategies to help decrease their stress during emotionally charged interactions with their children. The system was initially tested on a small group of parents of children with attention deficit hyperactivity disorder (ADHD).

The system, called ParentGuardian, is the first to detect stress and present interventions in real time — at the right time and in the right place. It combines a sensor worn on the wrist with a smartphone and tablet, as well as a server that analyses the data from the sensor.

Laura Pina, a Ph.D. student in computer science at UC San Diego and former intern at Microsoft Research, presented her work at the 8th International Conference on Pervasive Computing Technologies for Healthcare May 20 to 23 in Germany.

The interventions are based on parenting behavioral therapy, which has been shown to be effective in addressing the needs of children with ADHD and their parents. The therapy teaches parents the skills they need to work on and has been shown to have long-term effects for both parent and child. It has been shown to improve self-control and self-awareness in children and reduce parental stress. Traditionally, parents are taught when or how to use these strategies with their children. But sticking with the therapy is difficult, especially during times of the day that are particularly stressful.

ParentGuardian was designed to identify these stressful moments and remind parents of these strategies, which they sometimes forget in the heat of the moment.

“Instead of focusing an individual in need we are looking at how to build and design technology for the family as a whole and what’s beneficial for them,” Pina said. “We wanted to help parents to be the parents they want to be.”

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Health Data Exploration network to spur research using personal health data


Calit2 project supported by the Robert Wood Johnson Foundation.

The Health Data Exploration project from UC San Diego and UC Irvine has been awarded a $1.9 million grant from the Robert Wood Johnson Foundation (RWJF), to create a network of researchers, scientists, companies and others to catalyze the use of personal health data for the public good. The network will be spotlighted today (June 2) in a presentation at Health Datapalooza by Matthew Bietz, Ph.D., lead co-investigator for the Health Data Exploration project.

The Health Data Exploration project’s recent report Personal Data for the Public Good, found that many people who track health-related data are interested in sharing that data with researchers in medical and public health — provided adequate privacy controls exist.

The network will bring together companies that collect and store personal health data, captured through the use of wearable devices, smartphone apps and social media, with researchers who mine these data for patterns and trends and other strategic partners. Through a set of research projects using personal health data, the network will identify policies and best practices for using these new forms of data to produce transformative knowledge about health.

“Our preliminary explorations in this area demonstrated an extraordinary set of complementary experience, skills and assets among these groups,” said Kevin Patrick, M.D., M.S., director of the Health Data Exploration project and a professor of family and preventive medicine in the UC San Diego School of Medicine. “The network will bring together these partners to strategize, coordinate and experiment with using personal data to understand health.”

Unlike traditional research data, personal health data is often spread across many different companies and repositories, making it difficult for researchers to identify, locate and access. Furthermore, few consumer-level devices have been validated for research-level data collection. As the network explores ways to address these challenges through its research studies, it will update existing policies and procedures for managing risks and privacy as well as techniques for analyzing and interpreting this “big data.”

“We have high hopes that personal health data will provide a unique window onto the many factors that influence health on a daily basis,” said Alonzo Plough, Ph.D., M.P.H., vice president for research-evaluation-learning and chief science officer at RWJF. “By addressing the barriers to using these new forms of data in research, we expect that the work of the network will help put us on a path to a better understanding of health and how we can build a national culture of health.”

The network is seeking researchers and companies to participate in the network. Click here for more information.

Commenting on the huge potential of personal health data for research, advisory board member for the Health Data Exploration project, Linda Avey, co-founder of 23andMe and personal data aggregator Curious Inc., said “New sources of personal health data have the potential to transform our understanding of individual and population health. To this end, people are expressing interest in tracking and exploring their personal data in order to answer their own health questions and then share with others, including physicians and researchers. With the advent of wearable technologies, access to growing sources of bio-data and environmental feeds, it won’t be long before the notion of ‘big’ personal data is a reality.”

In commending the network as a way to catalyze the use of personal data for the public good, Deborah Estrin, a professor of computer science at Cornell Tech and a professor of public health at Weill Cornell Medical College, said that “the ‘digital footprints’ people are leaving behind with wearable devices, shopping behaviors and a host of other data streams provide a novel perspective on human health and well-being. Personal health data can reveal the ways that everyday activities promote health or lead to disease and yield insights about the long-term, cumulative health effects of environment and lifestyle. When multiple data streams converge, personal health data can provide a more holistic view of the richness of human lives.”

The Health Data Exploration project is affiliated with the California Institute for Telecommunications and Information Technology (Calit2), which is based at both UC San Diego and UC Irvine. Patrick and Bietz are researchers at Calit2 at UC San Diego and the UC Irvine Department of Informatics, respectively.

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Solution to helping teens with chronic disease may be at fingertips


Study shows technology improves transition into adulthood for teens with chronic disease.

Adolescents with chronic diseases (ACD), such as cystic fibrosis, gastrointestinal disorders (including Crohn’s disease) and Type 1 diabetes, often find the transition of managing their health care needs into adulthood to be challenging. Preparations for this transition are often clinic-based, costly and do not fully or effectively engage with this patient population. A new study by researchers at the UC San Diego School of Medicine found the answer to developing independent, self-management skills in ACD could be right at the patient’s fingertips.

The study is published in the June issue of Pediatrics.

Eighty-one patients, ranging from 12-to-20-years-old, participated in the eight-month study. Those assigned to the intervention group received an Internet and mobile phone system. Patients were asked to use a secure website weekly to receive theme-based materials and lifestyle tips. Automated text messages were also sent three to five times a week to help patients perform a variety of tasks, such as monitoring symptoms, keeping appointments and interpreting medical bills.

“Parents usually take a leading role when treating adolescents with chronic disease, but we want teenage patients to have a voice and become advocates for their own health,” said principal investigator Jeannie Huang, M.D., with the Department of Pediatrics at UC San Diego School of Medicine and Rady Children’s Hospital-San Diego. “The goal of the program is ultimately to improve communications between affected teens and their doctors.”

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UC Irvine to integrate Google Glass in med school curriculum


Wearable computing technology will transform training of future doctors.

Dr. Warren Wiechmann, assistant clinical professor of emergency medicine and associate dean of instructional technologies, will oversee implementation of the Google Glass four-year program at UC Irvine.

As physicians and surgeons explore how to use Google Glass, the UC Irvine School of Medicine is taking steps to become the first in the nation to integrate the wearable computer into its four-year curriculum – from first- and second-year anatomy courses and clinical skills training to third- and fourth-year hospital rotations.

Leaders of the medical school have confidence that faculty and students will benefit from Glass’s unique ability to display information in a smartphone-like, hands-free format; being able to communicate with the Internet via voice commands; and being able to securely broadcast and record patient care and student training activities using proprietary software compliant with the 1996 federal Health Insurance Portability & Accountability Act.

“I believe digital technology will let us bring a more impactful and relevant clinical learning experience to our students,” said Dr. Ralph V. Clayman, dean of medicine. “Our use of Google Glass is in keeping with our pioneering efforts to enhance student education with digital technologies – such as our iPad-based iMedEd Initiative, point-of-care ultrasound training and medical simulation. Enabling our students to become adept at a variety of digital technologies fits perfectly into the ongoing evolution of health care into a more personalized, participatory, home-based and digitally driven endeavor.”

While other medical schools have been experimenting with Glass in medical practice and education, UC Irvine’s comprehensive employment of the device will elevate the student experience unlike anything ever before, added Dr. Warren Wiechmann, assistant clinical professor of emergency medicine and associate dean of instructional technologies, who will oversee implementation of the Google Glass four-year program.

The effort will start this month – as the academic year begins for third- and fourth-year students – with 10 pairs of Glass. Preliminary plans are to utilize them in the operating room and emergency department. Integrating the devices into medical education complements the ongoing clinical use of Glass at UC Irvine Medical Center, where the technology has already been piloted in operating rooms, intensive care units and the emergency department in order to assess its impact on physician efficiency and patient safety.

An additional 20 to 30 pairs of Google Glass will be acquired and deployed in August, when first- and second-year students begin course work. They will be incorporated into anatomy labs, the medical simulation center, the ultrasound institute, the Clinical Skills Center and even the basic science lecture hall. Here, Glass will be used to transmit real-time patient-physician encounters in specific disease areas to augment the basic science lecture; the transmission will occur over the 16 miles between the medical center’s Orange campus and a lecture hall in Irvine.

“Medical education has always been very visual and very demonstrative, and Glass has enormous potential to positively impact the way we can educate physicians in real time,” Wiechmann said. “Indeed, all of medicine is based on ‘seeing,’ not ‘reading,’ the patient.”

When faculty wear Google Glass for instruction, he added, it gives students an unprecedented first-person perspective. Conversely, when students are wearing Glass, they can take advantage of pertinent information delivered directly into their line of sight by faculty members, who can see exactly what a student sees and thus better guide a dissection or simulation exercise.

“The most promising part is having patients wear Glass so that our students can view themselves through the patients’ eyes, experience patient care from the patients’ perspective, and learn from that information to become more empathic and engaging physicians,” Wiechmann said.

Google Glass joins other technologies at the core of the iMedEd Initiative in the School of Medicine. Launched in August 2010, the initiative involves an iPad-based education platform – every medical student is equipped with an iPad filled with electronic medical texts, podcasts, reference materials and notes for all course work and clinical experiences – along with training on point-of-care ultrasound devices and state-of-the-art medical simulation. UC Irvine’s medical school was the first to employ tablet computing in the curriculum and the second to include point-of-care ultrasound training.

Clayman said that the iMedEd Initiative appears to have enhanced student learning. He pointed to scores on Step 1 of the U.S. Medical Licensing Examination – taken at the end of the second year of medical school – as an example. The first two classes participating in the iMedEd Initiative scored an average of 23 percent higher than previous classes, despite having similar incoming GPAs and scores on the Medical College Admission Test.

The iMedEd Initiative is fully supported by philanthropic contributions.

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Athena is first network to adopt electronic data sharing standard for cancer


Guide will help UC network improve patient care.

The five University of California medical centers and their affiliates participating in the Athena Breast Health Network are using a new guide for sharing electronic data for breast cancer treatment. Developed by the American Society of Clinical Oncology (ASCO) and approved through ASCO’s Health Level Seven International committee (HL7), the guide will become a national data exchange standard. With the guide, Athena can utilize structured data capture tools for coordination of care, registry submission and research.

“ASCO applauds the leadership of both Athena and the Institute for Population Health Improvement in adopting this data sharing treatment plan and guide,” said ASCO President Clifford A. Hudis.“Their use of these standards will help physicians and practices move towards secure sharing of electronic information, so that they can improve patient care.” through the Athena Breast Health Network.

Electronic health records often contain data that cannot easily be shared among physicians or contributed to quality improvement, public health reporting or analytics. In addition, the current exchange standards did not include disease-specific templates needed for continuity of cancer care. To fill this void, ASCO hosted a Data Interoperability Standards Summit in February 2013 to encourage collaboration in developing standards that will overcome these barriers. The society selected adjuvant treatment for breast cancer as the focus for the first oncology standard. The draft standard was approved by open ballot through HL7, an accredited Standards Developing Organization (SDO) and the leading global SDO focused solely on health care, in May 2013.

Athena’s Breast Health Network participated in the larger Interoperability to Support Practice Improvement (INSPIRE) project, sponsored by the UC Davis Institute for Population Health Improvement (IPHI) and the California Office of Health Information Integrity (CalOHII). INSPIRE will produce breast cancer treatment plans and summaries for the Health Information Home, a patient-centered repository supporting care coordination. Integrated into the patient history, the information can support clinical care, registry reporting, and ultimately streamline clinical trials and quality improvement. In adopting this guide, Athena can now use a standardized format to transmit data across the systems supporting the project. The project is sending test data and expects to initiate transmission of patient data starting in the summer of 2014.

“It was critical to understand clinician work flow and to simplify data collection at the point of care,” said Michael Hogarth, professor of medicine at UC Davis. “We investigated clinician workflows and systems that would identify opportunities for structured data capture. We selected the widely implemented CDA standard as a foundation for the data exchange piece of our demonstration project. This is a strong step toward our goal of continuous improvement.”

ASCO is now expanding the guide for electronic data sharing with data relevant to the treatment of colon cancer and plans to submit the expanded guide to HL7 for review and approval in the fall 2014.

Project INSPIRE is funded as part of the Department of Health and Human Services Grant #90HT0029/01-02 (ARRA) to California Health and Human Services Agency in collaboration with UC Davis Institute for Population Health Improvement (IPHI) and California Health eQuality (CHeQ).

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Sen. Boxer praises UC efforts to prevent medical errors


She tours UCLA, notes its safety measures.

Sen. Barbara Boxer observes two nurses demonstrating a bar code scanning safety procedure at Ronald Reagan UCLA Medical Center.

Every year, 325,000 patients die in the United States due to medical errors, a number that would fill the Rose Bowl nearly four times, according to a special report released today (April 25) at a UCLA news conference by U.S. Sen. Barbara Boxer (D-Calif.).

Boxer presented the findings of her report at Ronald Reagan UCLA Medical Center and noted steps UCLA already takes to prevent medical errors and that could serve as models for other hospitals around the country. Boxer’s report also highlighted efforts by UC Davis to reduce ventilator-associated pneumonia and by UC San Diego to reduce blood clots and central line bloodstream infections.

“These deaths are all the more heartbreaking because they’re preventable,” Boxer said after she toured the medical center with Dr. David Feinberg, president and chief executive officer of the UCLA Health System, so she could see for herself two systems being used to prevent medical errors. “This is not the time to sit back and do nothing. I will not turn away from this challenge when I have the opportunity to pull back 325,000 people from disaster every year simply by preventing medical errors.”

The third leading cause of death in the country, medical errors can be avoided by something as simple as washing your hands. These errors commonly result in hospital-acquired infections, bedsores, patient falls, adverse drug reactions, sepsis, blood clots, catheter-related urinary tract infections, ventilator-related pneumonias and surgical site infections. In addition to saving lives, preventing medical errors could save up to $19.5 billion annually, Boxer said.

While touring the seventh floor, Boxer was first was shown the bar code technology and electronic medical records system used at UCLA to ensure patients receive the right medications in the right doses at the correct times. The process begins with a medication dispenser that operates much like a vending machine, providing one dose of drug at a time. A nurse logs in to the patient’s medical record to determine what medications are due and accesses them from the dispenser.

Once in the patient’s room, a nurse logs into a bedside computer and scans a bar code on the patient’s armband that automatically opens up his or her electronic medical record. The nurse then scans the medication, which is individually wrapped and bar-coded for that specific patient. If the medication’s bar code isn’t recognized as belonging to the patient’s medication profile, a warning will flash on the computer screen. After giving the patient the medication, the nurse selects the “administer” button, which instantly updates the medical record that the medication has been administered.

UCLA nurses were heavily involved the development of the bar code system, said Renee Appleby, director for the seven west cardiothoracic telemetry unit. The nurses first studied the errors to determine what was going wrong, and then participated in the creation of a safer system.

Boxer called the bar code and electronic medical record system “exciting, an enormous change for the better,” and said it must give the UCLA medical team more peace of mind.

“As a nurse, it makes me feel safe,” nurse Megan Kelly told Boxer.

Prior to the installation of the bar code system, the medical center was making two to four medication errors a month. Since the new system has been in place, no medical errors have been made, Appleby said.

That’s an impressive accomplishment, since the medical center dispenses five million doses of medication a year, said Cathy Ward, UCLA’s chief nursing officer.

“You’re really doing everything you can to save lives,” Boxer said. “Congratulations.”

Boxer then went to the seventh floor ICU to see the medical center’s ultraviolet disinfection system in action. The medical center has two Xenex machines, which can disinfect a hospital room in five minutes. The Star Wars-like robots use a Xenon bulb, a powerful form of UV light, combined with technology that generates high intensity pulses of light that are effective against 22 pathogens, including MRSA.

“The light kills micro-organisms by breaking down the cell walls of bacteria and fungus,” said Dr. Daniel Uslan, assistant clinical professor of medicine in the division of infectious disease.

“This is amazing technology that will help save lives,” Boxer said.

Feinberg said he is proud of UCLA’s commitment to patient safety and he looks forward to partnering with Boxer to find new and effective ways to ensure patients remain safe.

The report was compiled after Boxer wrote to 283 California acute care hospitals asking them to respond with the actions they are taking to reduce medical errors. Of those, 149 hospitals responded.

All of hospitals that responded reported taking at least some steps to address the most common medical errors, Boxer said. The report includes some common approaches to combating medical errors, such as using bar code technology and electronic health records to ensure patients receive proper medications to avoid adverse drug events. This technology is currently in use at Ronald Reagan UCLA Medical Center.

Other common approaches to preventing medical errors in the report included maintaining hand hygiene, using central line anti-microbial port covers, assessing all patients for bedsores prior to and upon admission, assessing patients for blood clot risks preoperatively and elevating the heads of patients on ventilators from 30 to 45 degrees.

Boxer’s report, which will be sent to the 283 hospitals initially queried, made six recommendations to improve patient safety, including:

  • Requiring all federal programs designed to reduce medical errors to work off a single list where appropriate, specifically the Partnership for Prevention’s list of the nine most common medical errors.
  • Having the Department of Health and Human Services report to Congress the time it takes for quality measures to be developed, endorsed and implemented in programs related to medical error reduction.
  • Creating a standard way of reporting medical errors, allowing hospitals and researchers to better collect data on errors, their frequency and where they are occurring.
  • Evaluation of information collected by hospitals when assessing whether medical centers are meeting the requirement to track and report adverse events as a condition of participation in Medicare.
  • Have Congress review the adequacy of whistleblower protections to ensure health care providers are able to report errors.
  • Have the Office of the Inspector General examine the Hospital Patient Safety Initiative’s new surveyor tools and analyze their impact on increasing staff reporting of medical errors.

“If we work together, we can prevent these needless tragedies,” the report states. “If we ensure that doctors, nurses, hospital administrators, medical technology leaders, federal officials and patient advocates are all focused on this common goal, we can make great progress in preventing avoidable deaths and ending the epidemic of medical errors in this country.”

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