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Fistulas Begone

December 6, 2010
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What HIT leadership can learn from Grey’s Anatomy evidenced-based care

I was watching Grey’s Anatomy last week (my guilty pleasure), and actually saw a very interesting example of evidenced based medicine at work. Dr. Miranda Bailey, the spunky, sagely attending challenged her residents to figure out a medical protocol to eradicate fistulas in her post-op patients. The resident to come up with this winning protocol would be able to take the lead on the next laparoscopic gallbladder surgery. While all of the residents scurried off to figure out the best protocol, Dr. Bailey started analyzing the post-op patients of a particular hunky nurse (who ended up asking her out at the end of the episode-go Dr. Bailey!).

Nurse Eli's patients had a very low percentage of fistulas, and Dr. Bailey found the one commonality among the patients was that Eli would take out their drain on Day 3, instead of the standard protocol Day 5. Dr. Bailey crowed her achievement to the chief of medicine, and the episode was over. But as we know in healthcare, the work doesn’t stop after identifying correct protocol. Healthcare IT leadership has to make those evidence-based practices available in core clinical information systems, and most importantly, they need to get the buy-in from their clinicians.

Dr. Bailey’s dive into evidenced-based medicine is exactly the method that Peter Basch, M.D., medical director of ambulatory EHR and health IT policy at MedStar Health used in his organization. In an interview a few months ago, Dr. Basch said that his regional healthcare system (a network of nine hospitals and 20 other health-related businesses across Maryland and Washington, D.C.) used quality reporting to identify top performing clinicians. He added that “through either observation, survey, or conversation [we] find out what it is that those providers are doing differently about their practices, or how their practice interoperates with patients, or how their patients perceive their own health, and so on. So, that’s a really interesting way to looking at reports not just for quality improvement, but for quantum quality improvement.”

As HCI Editor-in-Chief Mark Hagland reports in his January cover story, which will come out later this month, hospitals and medical groups are increasingly turning to commercially-sponsored evidence-based offerings. And the drive for CPOE adoption has also hastened the need for evidence-based order sets and clinical decision support. Hagland also reports how many organizations are further customizing these order sets to meet their specific needs and situations.




Thanks for your thoughts. I agree with the notion that, of course dental (and related) need to be part of the PHR. Otherwise, it's not integrated. Your reference to paying medical bills made me stop and think about Star Trek, an evolved future model where, not only are transactions cashless, money isn't the model used to influence consumption. It's interesting to see the variety of experiments today - full pay, co-pay, no-pay, HSAs, mandatory insurance, etc. ... 2060 ?

Your blog reminded me of a story told by C Everett Koop, at the end of his lectures to get a chuckle and end on a humble note, perhaps 20 years ago. I'm paraphrasing and working entirely from memory:

Koop passes away, after a long, productive, good life. He reaches heaven, meets god, and asks "When will the healthcare delivery system be fixed." God replies: "Not in my lifetime."

Excellent Post!!! Couldn't agree more!

I wrote a blog a while back titled "What Will Medicine Be Like in 2060" ( ) and it kinda takes evidence based medicine a bit further. Scary part is maybe predicting it for 2060 may be too far out!

Keep up the great posts and have a very Merry Christmas!

Excellent post, Jennifer! It is interesting that the mainstream entertainment media are just beginning to catch on that something's going on in medicine and in clinical healthcare (what took them so long??!). What I think will be fascinating will be to see how the mainstream news and entertainment media begin to explain phenomena like evidence-based care and pay for performance/quality-based purchasing, as those concepts become more embedded in the healthcare field generally. I totally disagree with those who say that the entertainment media can't teach a few things while telling a story I've seen numerous TV medical dramas that have explained concepts like medical malpractice liability and its impact on clinicians, through well-written storylines and intelligent dialogue. Maybe they should hire us as consultants to a few of those shows...??? "It couldn't hurt!"!

Great Post.

Stories and narratives are indeed very important and very powerful. I attended a lecture by Johns Hopkins critical care specialist Peter Pronovost. If memory serves, he said that every organization should develop their own (true) Josie King story; these stories are a critical ingredient of quantum quality improvement efforts.

Personal stories are, of course, extremely potent. Most readers are familiar with Don Berwick's stories, whether his wife's care a decade ago (Escape Fire, the Mann Gulch Fire), his "Right Knee" plenary urging quality disclosures, or countless other true stories used by Don and the IHI.  The inspiration of the fifty thousand lives campaign comes to mind as another.

As is pointed out by another TV show, The Daily Show with John Stewart, or blog posts like my recent Plucked post , a danger lies in taking true factual observations and using them to concoct a false story. Like other tools, Evidence (as in EBM) can be used carefully for good or in a variety of ways for ill. Like light:

"There are two kinds of light - the glow that illuminates, and the glare that obscures." - James Thurber