Category: hospital

A Turn to Normal

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May 3, 2020

by Steve Stofka

Deaths from the Covid-19 virus passed a milestone this week. More people have died from the virus than the number of Americans who died fighting the Vietnam War (Strochlic, 2020). I wanted to compare that with other gruesome milestones.

One hundred years ago, the Spanish flu killed 675,000 Americans (CDC, 2019). 62,000 were World War 1 soldiers, more than the number of war casualties (Gilbert, 1998). That is our next milestone. The flu was called the Spanish flu only because newspapers in neutral Spain first reported the disease (Flanagan, 2020). Under wartime restrictions, the media in other countries were not allowed to report the casualties.

Some talking heads have portrayed this disease as just a bad flu. Is it? During the moderately bad 2018-2019 flu season there were 490,000 people hospitalized (CDC, 2019/01). The 2017-2018 flu season was severe. The CDC estimates that 800,000 people were hospitalized for that season’s flu (CDC, 2019/11).  The agency reports 136,000 people hospitalized for Covid-19 (CDC, 2020). That doesn’t sound too bad, does it?

 New York City has about 40,000 Covid-19 hospitalizations, 3/8ths of those in the entire country (NYC, 2020). A 2012 survey by the city identified about 26,000 hospital beds (NYC-IBO, 2012). Large city mayors around the country look in horror at the refrigerated trucks parked outside some NYC hospitals to hold the dead bodies.  

Nine million people live in NYC. The Census Bureau estimates that there are 327 million Americans, more than 30 times the number living in NYC. I will use a 20x multiplier instead of 30x. Multiplying 136,000 Covid-19 hospitalizations by 20 produces 2.7 million hospitalizations, 3-1/2 times the severe flu season of 2017-18.

The American Hospital Association estimates that there are about one million beds in the U.S. (AHA, 2020). In an emergency, hospitals can increase their bed count but not when the emergency is a highly infectious disease. Areas of the hospital must be set aside exclusively for Covid-19 patients.

The first wave of the Spanish flu epidemic washed over the U.S. in the spring of 1918. The tsunami – the killing wave – came in the fall of that year, when many people thought the worst had passed.  We all want to get back to normal, even if that is a new normal. We hope that normal does not invite abnormal.

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Notes:

Photo by 丁亦然 on Unsplash

AHA. (2020, February). Fast Facts on U.S. Hospitals, 2020: AHA. Retrieved from https://www.aha.org/statistics/fast-facts-us-hospitals

CDC. (2020, January 8). Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States – 2018–2019 influenza season. Retrieved from https://www.cdc.gov/flu/about/burden/2018-2019.html

CDC. (2019, March 20). 1918 Pandemic (H1N1 virus). Retrieved from https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

CDC. (2019, November 22). Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States – 2017–2018 influenza season. Retrieved from https://www.cdc.gov/flu/about/burden/2017-2018.htm

CDC. (2020, April 24). COVID-View Weekly Summary. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Flanagan, E. (2020, March 14). Spanish flu: How Belfast newspapers reported 1918 pandemic. Retrieved from https://www.bbc.com/news/uk-northern-ireland-51818777

Gilbert, M. (1998). A history of the twentieth century. London: HarperCollins. (p. 532).

NYC. (2020, May 1). COVID-19: Data. Retrieved from https://www1.nyc.gov/site/doh/covid/covid-19-data.page

NYC-IBO. (2012, November 15). How Many of the City’s Hospitals, and Hospital Beds, Were at Risk During Hurricane Sandy. Retrieved from https://ibo.nyc.ny.us/iboreports/printnycbtn5.pdf

Strochlic, N. (2020, April 28). U.S. coronavirus deaths now surpass fatalities in the Vietnam War. National Geographic. Retrieved from https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

Medical Records

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In a 4/30/09 WSJ “Currents” feature, Laura Landro examines the state of medical records at the nations hospitals. Only 1.5% of 5000 U.S. hospitals have full electronic records. The most widespread adoption of electronic records are in lab results where 77% of hospitals show full adoption.

In every other category – medication lists, nursing assessments, doctors notes, diagnostic tests, drug allergy and dosages – adoption is less than 50% of hospitals. Approximately a third of hospitals have started to implement digitization of records.

The Federal Government has “earmarked nearly $20B in stimulus funds ..for hospitals to use electronic records by 2011.” Starting in 2015, the Feds will progressively reduce Medicare reimbursement to those hospitals who haven’t made the switch to digital. For a 500 bed hospital, that could mean a $3.2M yearly loss. By 2015, a hospital could get an additional $6M annually for a fully implemented system.

Part of the problem is the cost of implementing this shift to electronic records. “Hospitals say they haven’t been able to afford the cost of the systems, which range from $20M to $100M.” A disadvantage of these systems are that they are proprietary, making it difficult or impossible for one hospital to share information with another.

A solution is an open source software system, “VistA”, already in place at the Veterans Administration (VA). The downside of this system is that it accomplishes its task, recording and coordinating medical information, but does not have a billing or financial function, which must be added on. Software vendors who sell proprietary systems say that the cost of implementing the VA system with billing and financial add-on modules adds up to about the same cost as a fully integrated system from one of the software vendors.

Recent start up companies which specialize in adapting the VistA system for commercial use dispute that. Medsphere implemented a VistA modified system, “OpenVistA”, for Midland Memorial Hospital in Texas for less than $7M. It’s chairman, a former undersecretary at the VA, says that the OpenVistA system “can be installed in one-third of the time and at one-third the cost” of proprietary systems sold by McKesson and Cerner.

What is the benefit for patients? Lower medication errors and deaths, lower rates of bed sores, and a 88% drop in infection rates, Midland discovered after 18 months of using the new system.
I worked in a large NYC hospital for 6 years, in x-ray, medical records and the ER. Reading the handwriting of some doctors is a learned art, and a mis-reading of a word can be critical.

Some doctors and nurses will resist the change but change it must. As the “Boomer” generation matures, the load on the medical system will increase. Hospitals around the country are fighting a number of challenges to stay viable. Non-profit hospitals have long been a public/private partnership. Now is the time for a public investment in hospitals to achieve some long range goals.