The Rape of Emergency Medicine, 2017 version

Summa Health, an Ohio Hospital system, recently changed ED contracts from their 40 year group to a new one. On FOUR DAYS’ NOTICE! Four days, over the Christmas/New Year’s Holiday. That sounds distinctly unsafe, beyond the gross lack of sense, or commitment to a 40 year partner.

In case you think this is going smoothly, here’s a post to the ACEP ED Informatics Section from one of their former doctors (reproduced here with permission in its entirety):

I wanted to inform you, my colleagues, about what is going on at my home institution.   You all know me as a colleague and a fierce advocate of patient safety in EHRs. I have published on EHR patient safety for ACEP task forces and I am heading up a new ACEP task force on EHR patient safety issue reporting. It is with sadness that I have to tell you what is going in right now at my home institution.  

Summa has gone to paper.  

About 36 hours ago, our contract was taken over by US Acute Care Solutions (USACS) formerly EMP, through a scandalous process, but they literally created no plan for EHR transition.  I was the director of informatics and I, along with the rest of the physicians, was notified 4 days before New Years Eve that we were out.  We were told that when the ball dropped, our contract was over.  The physicians coming in to take over were to arrive at the facility for the first time 1 hr before their shifts and we were to sign out to doctors that had no EHR access.  No access to old records, CPOE, PACS, etc.  They went the first 30 hours without access.  Nurses were asked to do triage protocols and put the orders in under the new medical director, the only one with an account.  This morning at 30 hrs into the process some were to start training.   Now, the only information I get now is hearsay.  We strongly believe the EMP/USACS has no chance of safely staffing our 5 EDs with a total of 175k volume using part-time docs who have other full time jobs.  Our 55 docs and 20 PAs are sitting at home right now, scared for the patients that show up at the hospitals where their group spent the last 4 decades saving lives.  As a board certified clinical informaticist, I offered my services up until midnight when our contract ended but they elected to move another direction.  To the patients of Summa, I’m sorry.

Anatomy of a takeover.

As all of you are emergency physicians, I thought you’d be interested in how something like this might happen.  It is sort of a tangent to the EHR story, but I’ll include it because it is so interesting.  I’ve attached various references and additional information about the ongoing issue.  In short, the wife of Dom Bagnoli (USACS/EMP’s CEO) is the individual our hospital assigned to work out the contract renewal.  USACS/EMP has long been our chief rival in the area, so this is an obvious conflict of interest. Summa has an ethics policy that against even perceived conflicts, so two of our ED physician executive recused themselves from the process although she did not.  EMP had former Summa contracts, but had poor quality, staffing issues, and bad EMS relationships and lost their contracts or sold them to other staffing companies.  The hospital system drug its feet on negotiations until the last minute.  Contract negotiations failed when Summa (the health system) wanted SEA (Summa Emergency associates-our physician group) to fund the residency core faculty hours and wanted us to continue staffing under-performing stand-alone ERs that were built in inappropriate markets.  We found out later that they had already been talking to EMP.  

EMP is offering $100k signon bonuses, and we have heard they are paying temporary doctors up to $1000 per hour during the first 2 week transition.  I do ask you as a colleague not to take advantage of this opportunity–it may benefit you this week, but it hurts us all in the long run.  

The hospital house staff council has voted no confidence against the CEO.  The EM residency director has pulled the EM residents from the ED to keep them from having to work with non-vetted, non-EM, and non-Board certified physicians.  He does not believe that it is safe for them and they should not be subject the undue service requirements of a hospital CEO’s bad decisions.  

We are hopeful that EMP/USACS will not be able to run the residency and the department, and that negotiation will resume to restore a safe emergency care in Akron.  

Sincerely,

Jeff Nielson

Newspaper Sources:

http://www.ohio.com/news/local/resident-physicians-at-summa-health-vote-no-confidence-in-system-president-1.737494

http://www.ohio.com/lifestyle/health/fire-chiefs-concerned-about-summa-health-system-emergency-room-plans-1.737312

http://www.ohio.com/news/break-news/summa-health-bringing-in-new-doctor-group-to-staff-its-ers-starting-new-year-s-day-1.737043

http://www.ohio.com/business/emergency-in-the-er-come-jan-1-it-s-unclear-which-doctors-will-be-staffing-summa-s-emergency-rooms-1.736916

While I have no dog in this fight individually, all ED docs need to be aware that this isn’t just happening in the Bad Old Days, it happened this year.

I feel worst for the 55 former physicians and 20 PA’s of the Summa ED’s who were so disrespected by Summa, and fellow Emergency Physicians. It will make it very hard for them to trust in their new employment, wherever that may be. I hope they don’t take the money bait and help bail these new contract holders out.

For those who aren’t familiar with the title of this post, here’s a link to the original book The Rape of Emergency Medicine as a free .pdf.

Steven DenBeste 1952-2016

I cannot say I knew anything of the man except from his writing in the early days of blogging, and it was usually terrific ( i never got the Animae, but to each his own). The USS Clueless was his vessel, and ironic title given how he had a pretty good handle on things.

And now I learn he’s died, way too young. I enjoyed the education he gave, and the erudition with which he brought it.

 

RIP.

TELCO types, I have a question

So, I figure someone out there knows the answer to this, and I’ll share my guess, but I can’t find an answer on the internet.

My Question: Why does my cell phone ignore (or add) a “1” with a phone call, but my POTS* line phone doesn’t. Not only does it not just ignore unnecessary “1”s, it makes the annoying tri-tone and tells me it’s not necessary to dial a 1.

Well, if you know it’s not necessary, why not ignore it and put the call through?

 

My guess: the equipment being used is so old it cannot be taught new ticks, but I’d be interested in an informed answer.

*Plain Old Telephone System (I found this when getting my first DSL line).

iPhone: turn off Amber Alerts

Yes, I’m a terrible human being. I turned off my Amber alerts.  (You can too).

Here’s the thing: If I were on the road a whole lot, Amber Alerts would be much more relevant: X is missing in Y vehicle from Z town. As I’m nearly always a) asleep or b) in my very remote near hideaway where nothing scary or even interesting happens, it’s literally alarming when these alerts come screaming through my iPhone. Disturbing, actually, in a literal sense. I feel like I should apologize more for this decision, so, I cannot imagine the heartbreak and fear involved in wondering where your child is, and I mean that. I apologize for opting out.

But, it’s the right thing for me, and it might be for you, too.

Here’s how, and it’s brutally simple:

iPhone: Notifications -> Government alerts

iPhone: Notifications -> Government alerts

Just so you know, even if you turn all the Government Alerts off, you’ll still get Presidential Level alerts.

So you know.

 

networking.answers.com

They found a dead link on the blog, alerted me to it, and asked for a little recognition if I changed it.

http://networking.answers.com/

So, there ya go.

Siri and the Three Laws of robotics

I’d have been much happier had they just come out straight…

IMG_0826

 

So, our future mechanical overlords will at least have some sense of humor…

Update: And, from Twitter via @whatImeantwas1 :4th Law

Great Moments in Amazon Kindle tech support

I want to preface this by saying the technical problem I had was of my own doing, and once I talked to someone who had a clue it was fixed in two minutes.
Then, there’s this unintentional comedy! I went to the Amazon Kindle support page, as I’d tried their email support and they couldn’t even be bothered to try, I got ‘please open a chat window’ as their response email.
A chat was begun:
You are now connected to Amazon from Amazon.com.
Me:my kindle fire DH 7″ seems to think it’s in the UK. The .com button in the lower right of the keyboard displays .co.uk, and when searching for websites it always offers the .co.uk ones as the recommended ones.

I’ve checked my country setting under manage my devices (US). Serial Number: ####

Amazon:Hello.. This is Sweety from the Digital Team.
Welcome to Amazon Digital Chat.
I am glad to help you.
I am very sorry to hear about this.
[pause]
Let me look into this.
[pause]
Since your query is regarding the Kindle, let me help you by transferring you to our Kindle Specialist. Please be on hold.
A Customer Service Associate will be with you in a moment.
[this is after telling the Amazon support page my problem is with a Kindle to start the chat…]
You are now connected to S*** from Amazon.com.
[I have changed this persons’ name so they won’t get abused like they should be]
S***: Hello, my name is S***. I’ll be happy to help you.
Me:hi
[long, long pause]
?
S***:I checked and see that your Kindle has been registered under Amazon.com.
Me:Good.
S***:Is there anything else I can do for you today ?
Me:Yes. Fix the problem, or even pretend you understand what it is.
S***:I’m sorry.
Could you please rephrase the above sentence?
Me:Here is my problem:
my kindle fire DH 7″ seems to think it’s in the UK. The .com button in the lower tright of the keyboard displays .co.uk, and when searching for websites it always offers the .co.uk ones as the recommended ones.
I’ve checked my country setting under manage my devices (US). Serial Number: ####
I want my kindle to understand its keyboard, and it itself aren’t in the UK, and to stop behaving that way.
S***:I can confirm that your Kindle is registered under Amazon.com. Your Kindle with serial #### is Kindle Fire HD.
Me:Would you be so kind as to transfer me to the next level or technical support please?
S***:Sure, [me].
Could you please provide me the best possible phone number to connect you right now?
Me:[a phone number]
S***:When your phone rings, please answer it.
You may hear ringing while we connect you to Customer Service.

Your call is now connected.

 

Yep. That happened.

I then spent 10 minutes on the phone with a first level tech person, and an escalation got me to ‘Todd’, who was sharp, and had my problem fixed in about 2 minutes.

Still. Comedy support gold.

What did we do before the internet again?

Tonight, another reminder of the wonder of the internet and the connected world.

My beautiful, super-cool iMac locked up tight. Nothing would respond. Nada. Had been its normal super-terrific 1 second before. No warning.

Waited a while, then finally had to do the power-button-off restart. When power restored: black screen, and nice long ‘boooooooop’ sounds, about 3 seconds apart. Pulled the power cord, waited a minute. Rinse/repeat.

Had this been more than a decade ago, I would have been stuck. Literally phone a friend (except I’m back on nights, and it’s 1:45AM, so not tonight), or pack it into the car tomorrow and take it to The Store.

It’s not a decade before it’s now, a time when we can drop big rovers on nearby planets (using the most Rube-Goldberg mechanism imaginable and still make it work), and the internet is available to me.

Unsurprisingly others have had my problem. After reading several posts on the topic, the common theme was ‘the RAM is either bad or needs to be reseated’. So, internet search for iMac RAM work, an easy online go-by, and 15 minutes later I’ve removed and reseated my RAM.

And the sucker started and ran like it was new.

I like our new world.

Pepid: Winning friends and influencing people

Pepid has some really good apps for medical professionals, the ones I’m familiar with are aimed at ER docs. They’re good.

Pepid is so good I gave them an unsolicited endorsement in 2007:

Yeah, that sounds very generic, so let me tell you about when I decided to convert from the free (14 day) trial and spend the bucks.  A patient presents feeling frankly terrible and with a diffuse vasculitic rash.  Very early in the history it’s determined the patient has been taking quite a lot more methotrexate than intended (mixup, not sure why) so I tried out my new Pepid: ‘methotrexate’ brings up not just the drug, but throws me a lifeline: ‘overdose’ is on the front-page drop down menu.  I clicked on that, and it took me to the antidote (Leucovorin AD, liquid folate, which I didn’t remember), and then, tells me it’s dosed based on body surface area, then offers a calculator, all in serial – sequential clicks.  Amazing, and terrific.

That paragraph contains their Achilles heel: The Bucks. It’s never been cheap, and it’s not getting cheaper.

This year I elected to forgo renewing Pepid. It’s not that it’s not good (it is), it’s that the difference between the excellent free medical apps (Epocrates) (Medscape) plus now ubiquitous online resources (UpToDate supplied by my Corporate Overlords) minus their requested yearly rate for my iPhone ($264/year) wasn’t worth it. That’s just for the iPhone app, if you wan their iPad app you’ll have to buy that separately. Really, for only $264 they can’t just throw in the iPad app.

Imagine if you were to accidentally order the 3 year plan: $694. Sticker shock. Wow. So, if you asked them for a downgrade to the one year of the program, they’d do that, right? Sucker…

That’s right. My friend Rick (A terrific Physician Executive, Coach and pioneering blogger) accidentally clicked the 3 year button, immediately asked for a downgrade, and was told no. Pepid was more interested in his money than his loyalty or the customer experience.

Beware: Pepid screwed this doctor. Are you feeling lucky?

 

 

Trying out embedding a Tweet

[blackbirdpie url=”http://twitter.com/gruntdoc/statuses/144972802682916864″]

FYI: I’m on Twitter, and if you hit ‘Reply” above, it only replies on Twitter, not here on the blog…

 

 

OSx Lion reverse scroll wheel direction

I’m a mac-o-phile, and a late arrival. Lion on the MacBook Air? Awesome!

On my iMac? HATE that they decided my scroll wheel needed to change directions so my hand motions mimic those of the touchpad. Even though I’ve used a scroll wheel for about a decade, and have to use one on PC’s, so don’t need the cognitive dissonance. And I’m old and dislike fundamental change.

Here’s how to get back to reality:

“System preferences”  -> “Mouse” -> see the pic:

And, normalcy is restored. Life is back to normal. The horizon is righted.

(Hat Tip to Nick Genes, who turned his back on Jobs just to tell me about this).

Medical Apps? There’s a Doc for That

When emergency physician Harvey Castro asked a nurse to start a dopamine dose for a hypotensive patient one day, he watched the nurse leave the room, find the book that could guide her to the titratable dose, look in the index and then flip through until she found what she needed. Castro wondered, Isn’t there a more efficient way?

via Medical Apps? There’s a Doc for That.

A fellow DFW doc who’s done well in the Medical App world ( Deep Pocket Series ).

Dr. Castro was nice enough to let me play with some of his apps about a year ago, and while I never found a big use for them (my practice style, no knock on him) they were well done and approachable for me.

Kudos to Dr. Castro!

Doximity

This is a pretty neat tool for docs.  I’ve signed up (free), have it on my iPhone, and will see if it’s super-useful.  Maybe not for an EM doc, but time will tell.  It’s at Doximity.com

The biggest plus I see right off is the HIPAA compliant SMS texting, which would make some communications available we just cannot now.

At any rate, check it out and see if you like it.  I find the web interface easier for adding colleagues, but maybe that’s just me.

YouTube – Doximity.

One happy thing I got from this is a list of all my medschool classmates, and where they are now.  A surprising number are in my area, and more than a few are in EM!

Fixing Firefox 3.6’s tab blunder: Blogs – Null Pointer – ZDNet Australia

I’ve been playing around with a beta build of Firefox's 3.6 browser for some time, and while it’s been completely stable, its new tab behaviour has annoyed me.
via Fixing Firefox 3.6’s tab blunder: Blogs – Null Pointer – ZDNet Australia.

It’s the one think I don’t like about the newest Firefox release (3.6), opening a link from a tab puts it right next to the one you were reading, rather than off the right end like it used to (which I liked…).  Here’s a fix.

A like it: it’s simple and it works.

Locked iPhone ICE information: an App to fix

Recently I asked if people were still putting ICE (In Case of Emergency) information in their cellphones.  (The surprising answer was yes, showing that it’s an idea that resonates, at least with my audience).

I lamented that I have that information in my iPhone, but since it’s passcoded no rescuer would be able to access my dutifully entered ICE contact information.  (I then had delusions of retiring on just such an app).

There is a solution.  It’s brilliantly simple, and works. Polka have written an iPhone app called “Close Call” that fits the bill perfectly.  And it’s free!

I made one for this review, using a picture in my camera:

060

Many thanks to Ramona for finding this!

 

FTC disclaimer: this was completely voluntary.  I paid for my own free app.

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