ORQA blog

Here is a great blog post from Peter Neupert, VP of healthcare over at Microsoft.  He's testifying in the Senate this week on IT investment in healthcare.  He makes some excellent points.  He ends with, "health enterprises should invest in building and sharing health data assets that enable them to have a culture of process improvement over time."

 

Interesting article.  Airlines have moved over a billion people in this economy without a single fatality.  Healthcare still has a lot to learn from the airlines.  The last sentence is amazing, a child today is more likely to become President than die in a plane crash. 

http://www.cnn.com/2009/TRAVEL/01/12/us.air.safety/index.html?iref=mpstoryview

The results of this AHRQ-funded survey that was carried out by the gov't think tank RAND, strongly confirms what I've known for quite some time and is specifically why ORQA was founded.  However, until now I'd been unable to quantify how extensive the lack of physician participation in adverse event reporting really is.   Seeing these results  is stunning to me and is unfortunate for our healthcare system, but on the positive side it justifies ORQA's mission and business model.

The real kicker is the numbers are based on voluntary submission from Risk Managers, so as poor as they are, the paper clearly states the numbers are likely overly-optimistic. 

At ORQA, our services and software are designed to remove barriers to physician participation in quality and safety initiatives and build a culture of safety and mindfulness. 

Adverse-event-reporting practices by US hospitals: results of a national survey. 
Farley DO, Haviland A, Champagne S, et al. Qual Saf Health Care. 2008;17:416-423. 

http://psnet.ahrq.gov/resource.aspx?resourceID=8883&sourceID=2&emailID=18857 

Greetings!

We've made a demo of our Peer Review solution available online without pre-registering.

This coincides with special end-of-year pricing for a Peer Review only solution.

Please be sure to click both the Integrated Solution Link as well as the full application login to access the dashboard and perform searches, etc. 

 

• To see an example of how our Peer Review Solution works, click here.  Clicking the link would be similar to selecting a menu item or hotkey on your PACS to create a Peer Review record of the active study. 
• To access the demo, navigate to https://demo.orqa.biz and log in as 'demodr' and a password of 'orqapass'

 

You can access the Peer Review module either from the Shortcuts menu on.the Dashboard, or click the Main Menu>Communications>Rad Peer Review

Click the here for a Quickstart Guide, or Quick Guide Toolbar button on the main toolbar once you login.

 To see any of the nearly 200 other modules, please contact ORQA for a demo at 888-406-8886 or info@orqa.org 

Well, I'm in Chicago for RSNA 2008.  I'm really excited about being here this year.  Although I'd hoped last year that ORQA would be exhibiting this year, we spent most of our marketing budget at a few smaller shows and just didn't see the return so I decided to hold off this year.

It's been a great week for us, so I'm really looking forward to sharing all our progress.  I have some great meetings lined up.  Also, thanks to the guys at Active Agenda, we've rolled out an upgrade to support the new national standard for patient safety event reporting, aka "Common Formats". 

Also, we're very pleased to report that Dr. Peter Pronovost has given us permission to embed his famous central line "Checklist" in our app as a module.  Keep an eye out for that in the coming weeks on a soon-to-be-added downloads area on the web site.

If you're in Chicago for RSNA, give me a call or drop me an email at momeara@orqa.org

Mike

Check out this video

They're obviously talking about the presidential election, but the commentator exactly nailed what ORQA is all about.  For many health care IT projects, a centralized top down "enterprise standard" is considered best practice for large organizations, basically the cathedral approach described.  It has its benefits for very large organizations for establishing a standard of care, as well as the implementation and support are more efficient.  

However, when it comes to organizational culture, especially in areas of safety, quality, and risk management, top-down/force-fed solutions may not always be the best way, and will often backfire or be ineffective.

True cultural shifts and innovations often occur in the departments, at the point of care, and having to wait for an "enterprise" project to make a change often takes too long and the fire burns itself out.

That's why our Web 2.0 tools are based on open source, do not require capital funding, can be deployed without a major IT project, and can be easily customized to match any need in almost any department.  We truly beleive that the major innovations in health care quality and safety start at the bottom.

The economic crisis has created quite a whirlwind in radiology.  Combine that with the news that the DRA has effectively cut imaging reimbursements by $1.7B, and we're all looking for ways to eliminate waste in imaging.

ORQA's core software is designed for use by financial institutions, and many of our modules were designed to be  Basel II compliant for managing Operational Risk (OpRisk).  Basel II is an international standard for determining how much capital banks are required to keep on hand to guard against financial and operational risks.  Some large banks in the EU are currently using our core software to manage their risk, and ORQA passes on these features to our customers in healthcare.  Unfortunately, Basel II did not address Liquidity Risk in depth, which seems to be what was overlooked by most of the failing banks in the US.  Keep an eye out for Basel III.

 Most of our modules allow a cost to be associated with almost all our records, whether they document a risk, opportunity, event, or just a suggestion.  These costs can all roll up to quantify the "Total Cost of Risk" that any organization faces, allowing executive leadership to make much more informed decisions than they'd be able to with silos of data  

 The ability to rapidly leverage best practices from other industries is truly what ORQA is all about.

Greetings, I picked up an Asus eee micro-notebook (aka netbook) today with the hopes of a lighter load for doing demos and presentations on the road. It was a breeze to install eee-ubuntu and get our application core installed and running on this little thing. I'm even writing this blog entry on the miniature keyboard.

Take care,

Mike

This argument is as old as PACS itself, and I've seen my fair share of battles over the years.  However, in this latest iteration of the argument bubbling up by Dr. Chang and Dr. Channin's discussion at SIIM, I'd have to argue that their perspectives are a bit different than the majority of hospitals.  In an academic setting, the school of medicine has an academic mission to be on the bleeding edge of technology, test new hypotheses, be the early adopter.  They serve the needs of the greater healthcare provider community by sharing their lessons learned, publishing papers, etc.  This mission brings some inherent risk that most hospitals, especially for-profit and faith-based healthcare organizations, are not willing to accept.  Dr. Channin brings a very valid argument that suits Northwestern and its academic mission.  Combine the mission aspect with the $$$ situation in academia by way of grant money materializing out of what seems to be thin air from various vendors and agencies, you typically have projects going on where a central IT department is neither included in planning nor privvy to any of the grant money.  I'd hypothesize the real problem Dr. Channin is facing is not a matter of ownership, but one of hospital administration and IT not being fully on board with the academic side of the mission. 

Dr. Chang's perspective and what he's accomplished at UofC is much more in line with what many large healthcare organizations are doing.
The other posts have it right, the hospital owns PACS.  The hospital owns radiology as well, for that matter.  Diagnostic imaging is a value-added service to the patient to improve their treatment experience.  PACS is a technology investment to improve the diagnostic imaging service.

As more and more healthcare organizations start to adopt High Reliability Organization tenets, key concepts such as deference to expertise and sensitive to operations will kick in and hopefully create a culture where the organization as a whole has "ownership", but different stakeholders in their area of expertise have the accountability for the success of PACS.  The IT folks should accountable for ensuring the Imaging IT systems (PACS, RIS, VR, etc) are available as close to 100% of the time as possible, and work to remove all techological barriers to successful operation of the system.  The clinical folks should be accountable to ensure the workflow meets their needs and that the system is used to its full potential.  The business managers in radiology and administration need to be accountable for quantifying how they will realize a return on their investment in PACS.  The goals of each domain inherently contradict each other and it's up to the collective team to compromise on solutions that work for everyone.

In most truly successful PACS implementations I've come across, a formal team consisting of stakeholders from each domain of expertise is who "owns" PACS, and that team is held accountable to the CXO/Board of Directors of the organization.  If hospital politics or hidden agendas prevent the formation of an effective cross-functional team, then there are much deeper organizational issues than "who owns PACS"...



Regards,
Mike O'Meara, CIIP
President
ORQA, LLC
momeara@orqa.org

The AHRQ (Agency for Healthcare Research and Quality) has posted a great document on implementing High Reliability Organization concepts in a healthcare environment. They did a great job explaining the vision around which our tools are built. ORQA's solutions enable the execution of these concepts in a way that aims to break down silos of information and promote open communication.