Studies have shown in recent years that the quality of data in many electronic medical records is often not very good. According to Peter Witonsky, president and chief sales officer at iSirona, this is largely due to simple inaccuracies that occur more often than we think.

"A lot of these fall into the same category, in my mind, but it's different ways of getting to that category," said said Witonsky. "That latency of data is terrible. We have customers, prior to us, with eight to 10 hours in latency of data, and that's not uncommon. It's not the end of the world, but there are tons and tons of examples of what latency of data will do to decision making on the other side."

Witonsky highlights five reasons why data inaccuracies occur in EMRs.

1.Simple miskeying. Although it may be easy and "quite common," said Witonsky, the main way data inaccuracies tend to occur is because of simple miskeying. "If you look at any nurse of any floor, there's about 1,000 or over 1,000 data elements a shift that person is responsible for," he said. "So if you're an ICU nurse, and you're taking vitals and other critical information every 15 minutes, or if you're a low acuity nurse and you have for patients to be responsible for, it seems to average out just north of 1,000 data elements." And to expect a nurse to key in those elements with 100 percent accuracy isn't a realistic goal, Witonsky said. "The idea any person [can do that] is ludicrous," he said. 

2.Miscommunication from the patient. Bad information or miscommunication from the patient is another all-too-common way these inaccuracies can occur, said Witonsky. And this can include the patient not telling which drugs they're on, not knowing the name of the drug or the dosage or even the patient lying about his or her weight. "So it's sort of a garbage in, garbage out theory," said Witonsky. "If you don't tell me that you're allergic [to a drug] and I give you Penicillin and it's a bad result, again, that's bad data in the EMR." It's for that reason, he pointed out, that most of today's EMRs have allergies highlighted at the top of every patient screen.

3.Wrong entry or lack of entering device data. Looking back to simple miskeying, said Witonsky, 1,000 data elements, over time, is "an awful lot of work," he said. "So you have something called smoothing, [which is] a long practice of smoothing data where a nurse of physician is expecting to see normal [results], and they put in normal regardless of what the device is telling you." These generic readings tend to bring out inconsistencies in data, he continued, which wouldn't occur if the person inputting data took the actual information from the device. "That's not intended to be a knock," he said. "That's intended to say, in performing the hardest job on the planet, if they knew [a patient] was healthy, they leave all the vitals on the machine and may choose to put [the patient] in as a normal patient, as opposed to the exact answers."

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Saginaw County paramedics and hospitals are more prepared for a 100-car pileup on the Zilwaukee Bridge in a snowstorm. About 200 students from local high schools and Saginaw Valley State University participated in the exercise, volunteering to play victims with varying injuries. The disaster simulation was at Servpro, 470 Adams, underneath the bridge.

Volunteers applied makeup to the students displaying their assigned injuries. Some students were given injuries such as broken bones and lacerations.

"We're preparing for things that you don't want to prepare for because you don't want it to happen. But it sharpens our skills in case this ever does happen. It prepares us all and it's good for all of the communities to work together," said Zilwaukee City Administrator Jeff Zittel.

Several vehicles from a wrecking lot were strewed around as if they had crashed and slid. Students scattered themselves around and in between the cars. There were about 12 organizations participating including the Zilwaukee police and fire departments, Buena Vista Fire Department, Frankenmuth Fire Department and the Saginaw County Sheriff's Department.  Covenant Medical Center, St. Mary's of Michigan, LifeNet and several other agencies will transported victims to hospitals by ambulance, bus and helicopter.

"It makes it realistic for the firefighters and medics when the students get into their roles," said Kay Lapp, Covenant Healthcare Safety Officer.

Firefighters practiced extrication from the vehicles with crash-test bodies once students were cleared from around the cars.

Rachel Little, of Midland, is a SVSU nursing student who participated in the drill. Her assigned injury was a forehead laceration. "It's been fun all morning. The disaster is just getting started so I'm excited," she said. Her classmate, Brittany Fales, said her injury was severe leg pain. She pointed out she was trying to hold back laughter at a woman assigned to act like a drunken mother looking for her daughter.

Homeland Security Region 3 Information Coordinator Rick Lively said these exercises are important to the entire region. "We need to make sure we have a plan, and that the plan is accurate and will work. This simulation allows us to review and address any weaknesses or problems we see throughout the day," Lively said. Hospitals were preparing for the large amount of patients while the medics were at the scene, Lapp said.

The disaster scenario was decided Feb. 9, just hours before a snowstorm caused about 65 car crashes on Interstate 75 near the Zilwaukee Bridge.

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Register now for the 2nd Annual "Inside The Simulation Studio" Conference!  A day of networking, teaching and learning about the "art of human simulations."

When and Where
- May 14 - Villanova University, College of Nursing, Villanova / Philadelphia
- May 17 - NYIT Auditorium on Broadway, Manhattan
- June 18 - Samuel Merritt University, Oakland / San Francisco

Who should attend  - SPs, SP educators, mannequin-based educators, psychotherapists, lawyers and university educators. Join us for a day to network, discuss and demonstrate the diversity of human simulation.

ISS 2012 Theme - "The Art of Human Simulation: Innovative Takes on an Emerging Field." What is "the art of human simulation?" Beyond technology, it is where your expertise and experience combine with self-expression. Performing a role, preparing SPs, fiction contracting, moulaging, debriefing learners. Making a simulation look and feel like reality.

To Register
If you have not yet registered - Email your name, job title(s), where you work and which conference(s) you would like to attend to: register.simstudio@gmail.com

ISS 2012 Scheduled Presentations
- Children as Standardized Patients
- Psychologists simulating families to engender empathy
- Standardized Patient challenges
- Legal simulations
- Hybrid simulations
- Teamwork through simulations
- Simulations to prepare teachers in higher education
- Global health simulations
And more!

Follow The Simulation Studio blog - discover the diversity of simulation work - Click here: http://simulationstudio.org

Memorial Hermann-Texas Medical Center in Houston plans to live tweet brain surgery today. Under the Twitter handle @houstonhospital, the hospital will provide a "rapid play-by-play" removal of a brain tumor for about four hours using the hashtag #MHbrain on Wednesday, May 9 from 7:30 a.m. to 11:30 a.m. CT.

The surgery will be led by Dr. Dong Kim, neurosurgeon and Director of the Mischer Neuroscience Institute in Houston. Dr. Kim was the neurosurgeon who oversaw Rep. Gabrielle Giffords' care at the hospital after she was shot in the head in January 2011.

Medical personnel will live tweet all the steps of the tumor removal procedure, including prep, removal of the bone flap, resection of the brain tumor and closing of the surgical site. In addition to tweets, users will see pictures and videos live via Dr. Kim's microscope video feed. The first incision is expected to start at 9:00 a.m. CT (10:00 a.m. ET).

"What will come out of this is a detailed, real-time sequence of what happens in a brain surgery through all the stages from preparation, to shaving the hair, to making the incision, to draping," Dr. Kim told Mashable. "People are very anxious and want to know what goes on in a brain surgery like this."

Dr. Scott Shepard, a brain tumor specialist at the hospital and Director of the Gamma Knife Radiosurgery program will respond to questions online from outside the operating room during the Twittercast.

Natalie Camarata, Memorial Hermann's digital marketing manager, told Mashable the hospital decided to live tweet brain surgery following a successful live tweeting of open-heart surgery several weeks earlier, which was viewed an estimated 125 million times through Twitter and other platforms.

According to Mashable, video clips from the surgery will be posted to YouTube, photos will be shared on Pinterest, and recaps of each hour of the surgery will be available on Storify.

To find out more, visit Memorial Hermann-Texas Medical Center.

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For decades, the attempts at health care reform have aimed to increase access. The United States is one of the few industrialized nations in the world that does not provide universal health care to its citizens. And repeatedly, those who oppose it have been forced to argue that access isn't the problem some make it out to be. Why?

That, of course, is not true.

It's not even close. Let's start with the idea that emergency rooms must provide you care.

What's important to remember is that you can't be refused emergency care. That's because the Emergency Medical Treatment and Active Labor Act (EMTALA) requires that any hospital that takes Medicare or Medicaid must check you for emergent conditions and treat them if they exist. Since nearly every hospital in the country takes federal funds from one of these programs, nearly all hospitals are subject to EMTALA.

But "emergency medical condition" has a pretty narrow definition. It includes active labor for women and acute conditions that would cause death, serious bodily organ harm or serious bodily function impairment if they were not treated right away.

If politicians are meaning to say that women have universal access to delivery care, then I suppose there's an element of truth to that. But there's no guarantee of prenatal care in the emergency department. If they are saying that we have universal access if we're acutely having a heart attack, then I suppose there's truth to that as well. But there's no such access for lipid panels, stress tests or prescriptions for cholesterol medications that might help you avoid the heart attack in the first place. If you're acutely obstructed by massively advanced colon cancer, it's likely you can get emergency surgery to end the blockage. But your cancer is likely too far advanced to cure at that point. Moreover, you're not going to get chemotherapy in the emergency department nor could you have gotten the colonoscopy that might have detected the cancer far earlier.

You can't get preventive care in the emergency department. You can't get screened for a host of disorders. You can't get treatment for your depression there or really for any chronic mental disorders. You can't get help with your child's autism, ADHD or developmental delay. And even if you could, it wouldn't be free.

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When doctors, nurses, first responders and other health care personnel are trained, it makes obvious sense for them to practice on simulators, not human beings.

From that premise, Education Management Solutions (EMS) in Exton has evolved into a fast-growing provider of software and audio-video devices used for training, evaluation and documentation by medical and nursing schools, hospitals, testing boards, allied health programs and counseling centers.

Anurag Singh founded the company as a one-man consultancy in 1994. Since then the workforce has grown exponentially, up 78 percent between 2009 and 2011. As of March, EMS's workforce was up another eight percent; now at more than 80, Singh expects to reach 100 by year's end.  To accommodate the growth, the company recently relocated to a new 37,000-square-foot headquarters.

EMS software, cameras and video recorders provide a high-tech solution for learning everything from routine tasks to "replicating a problem they may or may never see" in actual practice, Singh explains.

Moreover, he adds, "the best way to learn in any environment is to reflect on what you did right and what you did wrong. So the whole process being recorded and having experts evaluate your performance and give feedback, that is applicable in any industry."

The demand for patient safety and patient care has driven EMS's rapid growth, with sales up 153 percent in three years.  Now Singh has his sights on the international market, where he sees opportunity for continued expansion -- a s(t)imulating possibility.

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Sleep-deprived surgeons can perform a previously learned task or learn a new task as well as surgeons who are rested, according to Penn State College of Medicine researchers. However, in sleep-deprived surgeons, the brain must work harder, which could lead to problems during unexpected events.

The researchers reached these conclusions using simulations to study the effects of sleepiness on surgeons.

"Particularly in surgery, simulation has become the introduction to many procedures for new residents," said Jonathan Tomasko, M.D., a research fellow involved in surgical resident training. "Coupled with an 80-hour work week restriction, simulation is becoming increasingly important to ensure an adequate level of skill prior to operation on a patient."

While published research using simulation to determine the effects of sleep deprivation on surgical skill exists, the results do not agree with each other.

"Interestingly, these reports conflict with the results of sleep disruption on non-medical simulated tasks," Tomasko said. "The ability to fly a plane, operate a locomotive and drive an automobile have all been shown in studies to be significantly affected by sleep disruptions. Two such studies showed impairment in simulated performance equivalent to moderate blood alcohol levels."

Researchers in this study, published in American Journal of Surgery, tested two groups of medical students -- one sleep deprived and the other rested -- over two days. All study participants were shown how to use a virtual reality simulator on the first three levels of difficulty. They practiced for no more than 45 minutes a day. Researchers instructed study participants to get a full night's rest and then tested the subjects on the first three levels of the simulator.

The researchers introduced an unexpected task in the test to increase the brain's workload. Students were asked to count the flashes of a yellow disc on the screen while performing the task and then report the number of flashes at the end of the round.

Participants returned for a second day of testing either fully rested -- no less than six hours sleep -- or sleep deprived -- less than two hours of sleep. A majority of participants scheduled their testing on a pre-arranged, 24-hour call shift during their surgery rotation to better approximate the effects of performing surgery at night while sleepy.

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PHILADELPHIA — Having a virtual copy of a patient’s blood in a computer would be a boon to researchers and doctors. They could examine a simulated heart attack caused by blood clotting in a diseased coronary artery and see if a drug like aspirin would be effective in reducing the size of such a clot.

Now, a team of biomedical engineers and hematologists at the University of Pennsylvania has made large-scale, patient-specific simulations of blood function under the flow conditions found in blood vessels, using robots to run hundreds of tests on human platelets responding to combinations of activating agents that cause clotting.

Their work was published in the journal Blood.

Patient-specific information on how platelets form blood clots can be a vital part of care. Normally, clots prevent bleeding, but they can also cause heart attacks when they form in plaque-laden coronary arteries. Several drugs, including aspirin, are used to reduce the size of such clots and prevent heart attacks, but, as platelets differ from person to person, the efficacy of such drugs differs as well.

“Blood platelets are like computers in that they integrate many signals and make a complex decision of what to do,” said senior author Scott Diamond, professor of chemical and biomolecular engineering in the School of Engineering and Applied Science. “We were interested to learn if we could make enough measurements in the lab to detect the small differences that make each of us unique.  It would be impossible to do this with the cells of the liver, heart or brain. But we can easily obtain a tube of blood from each donor and run tests of platelet calcium release.”

When blood platelets are exposed to the conditions of a cut or, in a more dangerous situation, a ruptured atherosclerotic plaque, they respond by elevating their internal calcium, which causes release of two chemicals, thromboxane and ADP.  These two activating agents further enhance calcium levels and are the targets of common anti-platelet drugs such as aspirin or clopidogrel, also known as Plavix.  By preventing platelets from increasing their calcium levels, these drugs make them less able to stick together and block blood vessels, decreasing the likelihood of a heart attack.

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This is an exclusive, free event for EMS customers and users of the Arcadia and SIMXpress systems. The only expense will be your travel and accommodation. Plan to join your colleagues, other Arcadia and SIMXpressusers, content experts, and guest speakers as you participate in workshops, sessions, and hands-on learning.

Date: August 8-9, 2012
Venue: Texas Tech University Health Sciences Center, The F. Marie Hall SimLife Center, Lubbock, Texas
Keynote Address: Sharon Decker, PhD, RN, ANEF, Director, The F. Marie SimLifeCenter
Pre-Summit Workshop: Experiential TeamSTEPPS Instructor Training
Summit Registration: https://www.surveymonkey.com/s/EMS_Annual_Summit_2012

Thomson Reuters has released its annual study identifying the 100 best U.S. hospitals based on overall organizational performance.

The Thomson Reuters 100 Top Hospitals study evaluates performance in 10 areas: mortality, medical complications, patient safety, average patient stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, post-discharge mortality and readmission rates for acute myocardial infarction, heart failure and pneumonia. The study has been conducted annually since 1993.

For the fourth year, Thomson Reuters has also recognized the 100 Top Hospitals Everest Award winners — those hospitals among the 100 winners that delivered the greatest rate of improvement over five years.

This year, 12 hospitals received the Everest designation: Banner Boswell Medical Center, Sun City, Ariz.; UC San Diego Medical Center-Hillcrest; French Hospital Medical Center, San Luis Obispo, Calif.; Sarasota (Fla.) Memorial Hospital; Morton Plant Hospital, Clearwater, Fla.; Doctors Hospital of Sarasota (Fla.); Delray Medical Center, Delray Beach, Fla.; Ochsner Medical Center, New Orleans; St. Joseph Health System, Tawas City, Mich.; Clara Maass Medical Center, Belleville, N.J.; Augusta Health, Fishersville, Va.; and Bon Secours St. Mary’s Hospital, Richmond, Va.

To conduct the 100 Top Hospitals study, researchers evaluated 2,886 short-term, acute-care, non-federal hospitals. They used public information: Medicare cost reports, Medicare Provider Analysis and Review data and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services' Hospital Compare website. Hospitals do not apply for the award, and winners do not pay to market the honor.

If all Medicare inpatients received the same level of care as those treated in the award-winning facilities, according to the study, more than 186,000 additional lives could be saved; approximately 56,000 additional patients could be complication-free; more than $4.3 billion could be saved; and the average patient stay would decrease by nearly half a day.

To view the full list, visit www.100tophospitals.com/top-national-hospitals.

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