Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

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When I started working as a hospitalist in 1998, there were only a handful of such jobs available in the country. Hospitals were either thinking about starting a hospitalist medicine program or trying to decide if they even needed one. I started working as a hospitalist right out of my residency at Cook County Hospital outside of Chicago (which was an experience in itself). I was full of energy and knowledge, as I had just taken my ABIM boards, and thought I could handle anything. Well, my first few years were very humbling. I found out I had a lot to learn about medicine and life. It was a challenge to try to navigate patients’ end of life issues while figuring out if I really even wanted to be a hospitalist for the next 20+ years.  

I used to get comments from the PCPs that the hospitalist was just a highly paid resident, because if you were a real physician, you would take care of the patients in the clinic as well as when they were in the hospital. Or that a hospitalist was just a temporary phenomenon that would not last. And there was always the comment that hospitalists could not know a patient they were seeing for the first time as well as a PCP who had taken care of the same patient for years.

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4/26/2012 10:44:28 PM | 0 comments

Steve Jobs knew that the key to Apple’s success was simplicity.

Apple products are painstakingly designed for simplicity. Updated Apple products are always better than their predecessor. If you question this, visit an Apple store at the release of the next iPhone or iPad.

Quite the opposite is true in the EMR-healthcare arena. The result: hospital executives are pressured to buy systems that “fit” into their existing IT platform regardless of physician usability. My intention is not to pile-onto the existing discussions about the 15-30% drop in productivity when EMRs are implemented. Unfortunately, I can attest to those numbers within our own organization (thus, the development of the scribe program). 

The merits of the HITECH Act, the EHR Federal Mandate, and The Stimulus Package have been greatly discussed. I could argue that EMRs do not provide better patient care.

I want to know who will save physicians, hospitals and patients from the existing, pathetic breed of EMRs available today?

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4/24/2012 7:55:22 PM | 0 comments

Trying to predict the future is always dangerous ground; and payment for health care services in the context of health reform and huge budget deficits certainly qualifies as shifting sands, or perhaps more like landfill in an earthquake. And yet, how hospitals are compensated for services to patients in the ED or in other hospital service areas is likely to have a significant impact on how emergency physicians (EPs) practice, be they employed by hospitals or partners of an ED staffing group. 

In fact, this has always been the case, though this influence has not always been that obvious, or direct. Heard of P4P? Been watching your use of ASA in patients with chest pain? How about your patient satisfaction scores? How emergency physicians manage their patients depends to a significant degree on how, and whether, the hospital is reimbursed for that care, even though there is a clear legal requirement to treat everyone the same. This is not to say that physicians are being encouraged or influenced to treat certain patients one way, and other patients another: it is more along the lines of whether or not the hospital can afford to purchase that new, faster CT, or pay the ophthalmologists to be on call to the ED. How the hospital is paid clearly influences how emergency medicine is practiced in that hospital.

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4/20/2012 12:16:03 AM | 0 comments

Discount the posturing of politicians reaching for the healthcare issue that will attract attention and garner votes. Set aside the drama of the Supreme Court’s proceedings to determine the constitutionality of recent health care reform. Beneath that is something much more important. Don’t look at what politicians are saying, but watch what healthcare providers and insurers are doing.

Individuals, hospitals, insurers and others who are responsible for actually providing health care have already decided what they need to do. They are not waiting for the government to solve the health care crisis of the United States. During the debates that preceded the enactment of the Affordable Care Act, the providers and insurers saw the ugly and disjointed aspects of the American healthcare system : lack of end of life care for the burgeoning population of baby boomers, medical technology that seems to have no economy of scale, and the inability of the system to address wellness to reduce costs. In short, the horrendous expense without attendant increase in quality has been made apparent.

Most of those who understood the issues concluded that the current system is not sustainable. If we continue on this path, we will bankrupt the country. We simply can’t afford to have 40 million or so people without health insurance. Cost shifting their medical expenses onto the tax payers and private insurers has reached its limit. And, oh yes, don’t forget the national debt that must be paid down somehow.

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4/17/2012 11:05:37 PM | 3 comments


Mobile technology, and specifically the mobile phone, has become the new global platform of computing. This is creating significant sociological changes that will greatly impact the practice of healthcare. The unprecedented computing power available to billions in their coat pockets can be leveraged to improve medical practice and consumer health. However, the explosive growth of this modality also creates the potential for growing pains.

Because healthcare providers have a disproportionately higher rate of smartphone ownership, these devices are now increasingly finding their way into the highly regulated environment of hospitals and clinics. This has the potential to threaten patient privacy and the security of information, which are governed by Federal laws such as HIPAA – and violations already have made headlines with multimillion dollar fines.  Despite this risk, the majority of hospital Information Technology departments don’t even have robust mobile device use policies. 

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4/13/2012 5:09:44 PM | 0 comments
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