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Wednesday, November 05, 2008 9:00 AM

Newscast: Health IT - Using Technology to Improve Transitional Care

(opening music)

Rand: This is Healthcare 411 for the week of November 5, 2008.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Rand: I’m Rand Gardner.

Debra: And I’m Debra James.

Rand: This week on Healthcare 411: bloodstream infections. What are they and what is AHRQ doing to help prevent them?

Debra: Plus, a health care provider in Hawaii tells us how they use technology to connect patients and doctors and improve continuity of care.

Rand: And AHRQ Director Dr. Carolyn Clancy offers advice for navigating the health care system. This week’s topic: staying healthy when the economy is not.

Debra: It’s all coming up on Healthcare 411.


[Begin PSA: Know What Your Results Are and What They Mean]

Narrator: Here’s another health tip from AHRQ, the U.S. Agency for Healthcare Research and Quality.

Have you ever had a medical test and realized that you never got the results? If your doctor recommends a medical test, make sure to ask when the office will call you with the results. If you haven’t heard back by then, don’t assume "no news is good news." Call and ask for your test results, then discuss them with your doctor as you plan the next steps for your health care.

Learn more at healthcare411.org. A message from AHRQ: Information for better health.

[End PSA]


Rand: Bloodstream infections are a serious and potentially deadly complication. These infections can occur when a central line catheter is placed into a large vein in a patient’s neck, chest or groin area to administer medication or fluids, or to collect blood samples. About a quarter of a million hospital patients get a bloodstream infection each year in the U.S., and up to 62,000 die as a result. Finding ways to reduce and prevent bloodstream infections is critical to saving lives. That’s why AHRQ has awarded nearly $3 million for a contract to help reduce central line-associated bloodstream infections in hospital intensive care units in at least ten states. The three year project will continue work started by the Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association, where a similar program helped to reduce infection rates to zero in more than 50 hospital intensive care units within three months.

Debra: Connecting patients and doctors on Hawaii’s six major islands is no small task, but that’s just what leaders at the Holomua Project to Improve Transitional Care in Hawaii had in mind when they launched a four-year initiative to help community health centers and hospitals improve care for their shared patients. The project’s principal investigator, Christine Sakuda of the Hawaii Primary Care Association joins us to talk about her experiences using technology to connect patients and doctors in Hawaii. Ms. Sakuda, welcome. Let’s start out with an overview of the Holomua Project. How did you get started on this initiative, and more importantly, why take this project on?

Ms. Sakuda: Well, we face a major challenge here in Hawaii and that’s continuity of care. When patients are seen in one health care facility and then go to a different health care facility, their records often don’t follow them. So, health care providers can’t get to critical medical information. Making matters worse, many of these patients come from islands across the Pacific and do not speak English as their first language. Back in 2005, the Hawaii Primary Care Association began developing what’s known as a Master Visit Registry. It is a record locator system designed to help doctors locate a patient’s history of visits, show what type of care they received and who provided that care.

Debra: Tell me how the registry works?

Ms. Sakuda: Using the Master Visit Registry, health care providers can view patient’s medical visit information compiled from multiple health care facilities, such as the date of their last visit, and physicians they saw at the community health centers or hospitals. This lets the provider know which facility the patient visited, the type of visit and something about their diagnosis. Users can access the registry from their workstation within the clinic or the hospital.

Debra: What was the biggest challenge in helping these facilities use the technology?
Ms. Sakuda: Well, part of the challenge was standardizing the way we retrieve and store patient data, such as people’s names and their type of visits. As you can imagine, it was very important to make sure the data were accurate, and that we were keeping patient information secure and private. But we were able to work together and get agreement among all four participating facilities on these challenges.

Debra: So where are you today with the Holomua Project, and where do you envision it heading in the future?

Ms. Sakuda: The Holomua Project now has data on 450,000 patient visits from the previous year, which equates to roughly 220,000 patients. In the future, we want to use this project as a basis for larger statewide health information exchange that would connect hospitals, clinics, physician offices, labs and health insurance companies, for example. Eventually, we’d like to give patients the ability to access their own records. Ultimately, we want to make care safer and more coordinated for all Hawaii’s patients and, in particular, for the state’s most vulnerable patients. And we want to do this by using health information technology to improve the link between patients, families, community health centers and hospitals.

Debra: Ms. Sakuda, thank you for joining us to talk about the Holomua Project to Improve Transitional Care. More information is available online at www.healthit.ahrq.gov.
Up next, health care advice for navigating the health care system.


Rand: How do you stay healthy when the economy is not? Many Americans are looking for ways to save money; some even considering ways to cut personal health care costs. But how can you do that without hurting your health? AHRQ Director Dr. Carolyn Clancy is with us to tackle the tough questions. Dr. Clancy, thank you so much for being with us.

Dr. Clancy: Thank you.

Rand: Is it true that people - everyday Americans - are looking at ways to cut their own personal health care costs?

Dr. Clancy: Well, a recent Kaiser Family Foundation Survey showed nearly a third of American families say they’ve had problems paying medical bills over the past year. I’ve personally heard many examples of people skipping medicines, not refilling prescriptions and not seeing their doctors, as a way to save money. As a physician, I worry when I hear these stories. Cutting back on health care, especially without consulting your doctor, is a risky choice. And it could end up costing you more, in financial terms as well as your overall health.

Rand: Are there any areas of health care where people are being especially risky?

Dr. Clancy: Yes, it is extremely risky to play with your medications. It can be harmful to stop taking medicines that have been prescribed by a doctor. Likewise, people should never try to extend the life of a prescription by skipping doses or cutting pills in half. It’s also unwise to borrow someone else’s medicine. Never take medications that haven’t been prescribed to you.

Rand: Well, are there some areas where people can cut back?

Dr. Clancy: Possibly. For example, there are some health care services can be safely skipped or delayed. Not all tests or screenings are absolutely necessary. And not all health care appointments are essential. But the take-home message here is that you should not make these decisions on your own. Talk to your doctor - someone who knows your health circumstances and can help you take quality and value into account while making decisions about your health care.

Rand: Dr. Clancy, are there any other tips for those feeling the crunch?

Dr. Clancy: Well, when it comes to medication costs, one option would be talking to your doctor about switching to generic medications. Also, look into programs that might be available in your community to help with medication and other health care expenses. Know what’s available and how to use it to your advantage. Also, if you have health insurance, take a good look at your policy. Does it meet your needs? Are you taking advantage of options such as flexible spending accounts? These are a good way to pay for those out-of-pocket expenses with pre-tax dollars. And, finally, don’t forget the everyday healthy lifestyle choices. Being physically active, eating right, maintaining a healthy weight, are all important strategies to maintaining good health. I’m Dr. Carolyn Clancy and that’s my advice for navigating the health care system.


Debra: That’s it for this week. For more information on these and other health-related stories and topics, go to healthcare411.ahrq.gov.

Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Debra James, I’m Rand Gardner. Please join us for the next edition of Healthcare 411.

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