Meaningful Use of Electronic Health Records by Doctors

In the past few weeks, my mother, mother-in-law, son, and daughter have had doctors' visits in which the doctor gave them a number of instructions. In each case, they would have benefited from a printed list of doctors' orders, which should be well within the capabilities of their doctors' systems. They won't go to the Internet to see their medical records, because of the seniors' limited use of the internet, or adolescent disinterest.

Yet our dog's veterinarians print out their orders routinely and immediately, which can be very helpful.

Let's insist on getting medical care as good as our dogs get! Stay tuned to this page for instructions on how to give your input to the Federal rule-makers who are now in Stage 2 of defining the minimum requirements for a doctor's "meaningful use" of an electronic health record. Your input will be helpful now, and in setting the agenda early on for Stage 3.

Our comments will pertain to Sections 170.314(e)(1) and 170.314(e)(2) of RIN 0991-AB82 of the proposed rule, as noted at 77 FR 13838-41 and 77 FR 18856-57.

You can see the entire specifications by the Office of the National Coordinator for Health Information Technology for meaningful use.

The Opposite of Rocky: Hospitals' Use of Social Media

As a grown man, this hurts to admit, but I cry at movies. Some of them. A little. Like when the very battered and bloodied underdog, Sylvester Stallone, having gone all out to become a contender but of course, having lost nobly, cries out for his loyal girlfriend Adrian! to comfort him in the ring. And she, overcoming shyness and any prissiness at getting her nice coat soaked with blood and other bodily fluids, struggles up to comfort him there.

Now, even at that moment, while tearing up, I also feel some self-disgust, for I know Sylvester has been toying with me, peppering me throughout the movie with left jabs (she's homely but he loves her anyway!) and rights (they took away the big lunk's locker!) to set me up for the emotional knockout. And then I fall for it.

That scene came to mind after my recent research for a white paper on hospitals' use of social media. I came across one of the Facebook pages of Children's Hospital of Boston. The page shows at least 69 comments by family members, thanking Children's Hospital for caring for their children. It was my job to read all of them, moving me to tears more than once. These children overcame dreaded diseases, through their grit, and the skill and compassion of their doctors and nurses. Most of them had improbable Hollywood endings. May the others rest in peace, in loving memory.

That page has been liked by 700,000 people. The hospital's leaders recognize the importance of creating a favorable public impression among the parents of sick children. If the hospital's reputation is spread far and wide, the staff will be able to treat and save the lives of even more children. That's good for business, too. They've topped the page with the US News & World Report's headline that Children's ranked #1 in more specialties than any other hospital. That's fine; if you were in their place, you'd do the same thing. They've also used some tricks of the trade that Sylvester might admire. For example, to even get to some of the pages, you have to Like them first. That boosts the number of Likes, the coin of the realm.

Yet I admire Children's, and Sylvester. What's not to Like?

To read the free, three-page white paper with examples of hospitals' use of social media to improve patient safety, go to Swisslog's Facebook page.

Thanks to Swisslog for sponsoring the research.

25th anniversary of ACT UP: A tribe in desperate trouble

This month marks 25 years since the the start-up in 1987 of ACT Up (AIDS Coalition to Unleash Power), the coalition of gay activists that transformed health care for AIDS. The changes they won in funding to fight AIDS, in the ways medical research is performed, etc., marked an historic event in consumerism: the first major victory won by the grassroots efforts of citizens at risk of a particular disease.

My gay college friend Don may be alive because the gay community acted up since then to safeguard themselves, and to speed the development of anti-retroviral drugs that kept many of his friends healthy.

I hope we in the patient advocate community can one day be equally successful in promoting safer care. As Frank Bruni wrote in the NY Times on March 17: "a tribe in desperate trouble...elected self-reliance over self-pity, tapping its own reserves of intellect, ingenuity and grit to make sure its members were cared for."

Choice of a healthcare proxy: By the flip of a coin

A close friend recently described the anguish he felt during his father's final days. His father had appointed both my friend and his older brother as co-proxies, not wanting to show favoritism. Unfortunately, the two sons couldn't agree on hospice care for their father. In the face of their disagreement, hospital staff assumed that by default, they should continue aggressive efforts to save the patient's life, and did so.

Advice to seniors: Choose one of your adult children to act as your proxy in case you are not able to inform hospital staff about your decision for care near the end of life. If you have two children, you can flip a coin, and notify the preferred proxy that s/he won a coin toss. (You may have to flip the coin more than once.) Tell the preferred proxy you'd expect him to consult the other family members prior to making a decision using the living will as a guide (unless the decision needs to be made quickly). That way, they'd gain the benefit of others' thinking, but will still speak with one voice to all the health care providers, to give them clarity about what they should do.

This should prevent any resentment from the child you have not chosen as the proxy.

See a story about a simple living will.