Governor Patrick Launches Phase Two of Mass HIway at BIDMC
Innovative technology allows clinicians to pull health information from participating providers
How are care decisions made when a patient arrives in a hospital’s emergency room sick and disoriented, without a family member, and unable to provide details of his own medical condition? That was the scenario played out in Beth Israel Deaconess Medical Center’s Carl J. Shapiro Simulation and Skills Center to demonstrate the power of the Mass HIway, the new statewide Health Information Exchange (HIE).
Massachusetts governor Deval Patrick and Secretary of Health and Human Services John Polanowicz joined BIDMC President and CEO Kevin Tabb, MD; Chief Information Officer John Halamka, MD; Emergency Medicine physician Kevin Ban, MD; Emergency Department nurse Amelia Nelson, RN; and actor Angelo Nargi for a live demonstration of phase two of the Mass HIway. This innovative tool allows providers to locate, request and retrieve medical information from participating healthcare institutions across the Commonwealth on a secure, interconnected system.
“I’ve long said that Massachusetts leads the country in healthcare delivery reform, and this is especially true in the area of healthcare IT,” says Tabb. “The exchange of vital and accurate health information via the Mass HIway represents an important step toward providing patients the best and safest care possible, whether it’s at our hospital or a small community practice.”
In the simulation, Halamka and the team were able to input a small amount of information from the patient into the Mass HIway database and see that the patient had consented to share records held at Atrius Health, Tufts Medical Center, and Holyoke Medical Center. Information requested and received in real time from these institutions included a detailed medical history, a recent MRI, and a full list of medications and allergies. This medical data allowed Ban to quickly reassess the patient and devise a faster and safer treatment plan.
“It’s not uncommon for us to care for patients for whom we have very little health information,” says Ban. “This could dramatically change the way we deliver care in the emergency department and elsewhere.”
“You can very clearly see how the HIway could help avoid a whole lot of unnecessary tests and potentially save a life,” says Patrick.
“And it will only work better and better the more clinical data we have,” adds Polanowicz.
Massachusetts was the first state in the nation to receive federal funding through the Center for Medicare and Medicaid Services to develop the Health Information Exchange as part of the Patrick Administration’s efforts to improve health care quality and outcomes for all Massachusetts residents.
Phase one of the Mass HIway opened in October 2012 with 55 institutions connecting in the first year. The initial phase allowed medical facilities to “push” information from one provider to another directly from the electronic health record via secure e-mail. This capability provides an easy way for medical information to follow a patient, for example, from an emergency visit back to the primary care doctor who is providing ongoing care.
Phase two expands the capability of the HIway by allowing providers to “pull” health information from participating institutions. It’s expected that the functionality of this next phase will evolve and improve over time as more providers and patients sign on to the service.
“It is our hope, as we work diligently over the next year, that we will have more institutions on the HIway allowing us to provide seamless, interconnectivity of medical information for better coordinated care,” says Halamka, a longtime member of the Executive Office of Health and Human Services’ Health Information Technology Council responsible for deployment of the Mass HIWay.
“The secret of any great system is constant improvement,” says Patrick “I’m looking ahead, of course, and I’d like to see this scale up, wisely and thoughtfully to more facilities, even going beyond the state of Massachusetts.”
Study: Information, Medication Equally Important for Treatment of Migraine Pain
Findings show patients also report pain relief even when they know they are receiving a placebo
The information that clinicians provide to patients when prescribing treatments has long been thought to play a role in the way that patients respond to drug therapies. Now an innovative study of migraine headache confirms that patients’ expectations — positive, negative or neutral — influence the effects of both a medication and a placebo.
Led by a research team at Beth Israel Deaconess Medical Center and published online in the journal Science Translational Medicine, the study, for the first time, quantifies how much pain relief is attributed to a drug’s pharmacological effect and how much to placebo effect, and demonstrates that a positive message and a powerful medication are both important for effective clinical care.
Senior authors Rami Burstein, PhD, Director of Pain Research in the Department of Anesthesia and Critical Care at BIDMC, and Ted Kaptchuk, Director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at BIDMC and Harvard Medical School, took advantage of the recurring nature of migraine headaches to compare the effects of drug treatments and placebos in seven separate migraine attacks in each of 66 individuals.
Their findings uncovered several key points:
- The benefits of the migraine drug Maxalt (rizatriptan) increased when patients were told they were receiving an effective drug for the treatment of acute migraine;
- When the identities of Maxalt tablets and placebo pills were switched, patients reported similar reductions in pain from placebo pills labeled as Maxalt as from Maxalt tablets labeled as placebo; and
- Study subjects reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all.
“One of the many implications of our findings is that when doctors set patients’ expectations high, the Maxalt [or, potentially, other migraine drugs] become more effective,” says Burstein, the John Hedley-Whyte Professor of Anaesthesia at Harvard Medical School (HMS). “Increased effectiveness means shorter migraine attacks and shorter migraine attacks mean that less medication is needed,” he adds.
“This study untangled and reassembled the clinical effects of placebo and medication in a unique manner,” adds Kaptchuk, a Professor of Medicine at HMS. “Very few, if any, experiments have compared the effectiveness of medication under different degrees of information in a naturally recurring disease. Our discovery showing that subjects’ reports of pain were nearly identical when they were told that an active drug was a placebo as when they were told that a placebo was an active drug demonstrates that the placebo effect is an unacknowledged partner for powerful medications.”
The investigators studied over 450 attacks in 66 patients with migraines, throbbing headaches commonly accompanied by nausea, vomiting and sensitivity to light and sound. After an initial “no treatment” episode in which patients documented their headache pain and accompanying symptoms 30 minutes after headache onset and again two hours later (2.5 hours after onset), the participants were provided with six envelopes containing pills to be taken for each of their next six migraine attacks.
Of the six treatments, two were made with positive expectations (envelopes labeled “Maxalt”); two were made with negative expectations (envelopes labeled “placebo”); and two were made with neutral expectations (envelopes labeled “Maxalt or placebo”). In each of the three situations — positive, negative or neutral — one of the two envelopes contained a Maxalt tablet while the other contained a placebo, no matter what the label actually indicated. The patients then documented their pain experiences in the same manner as they had initially in the no-treatment session.
The results consistently showed that giving the pills accompanied by positive information incrementally boosted the efficacy of both the active migraine medication and the inert placebo.
“When patients received Maxalt labeled as placebo, they were being treated by the medication — but without any positive expectation,” notes Burstein. “This was an attempt to isolate the pharmaceutical effect of Maxalt from any placebo effect.” Conversely, the inert placebo labeled as Maxalt was an attempt to isolate the impact of the placebo effect from pharmaceutical effect.
Adds Kaptchuk, “Even though Maxalt was superior to the placebo in terms of alleviating pain, we found that under each of the three messages, the placebo effect accounted for at least 50 percent of the subjects’ overall pain relief. When, for example, Maxalt was labeled ‘Maxalt,’ the subjects’ reports of pain relief more than doubled compared to when Maxalt was labeled ‘placebo.’ This tells us that the effectiveness of a good pharmaceutical may be doubled by enhancing the placebo effect.”
Furthermore, the authors were surprised to find that even when subjects were given a placebo that was labeled as “placebo,” they reported pain relief, compared with no treatment.
“Contrary to conventional wisdom that patients respond to a placebo because they think they’re getting an active drug, our findings reinforce the idea that open label placebo treatment may have a therapeutic benefit,” say the authors, adding that while further research will be needed to explore how these findings could be applied to clinical care, the findings suggest that in the future placebos may provide a therapeutic boost to drug treatments.
BIDMC Welcomes a New Member to Our Family, BID-Plymouth
Jordan Hospital formally became Beth Israel Deaconess Hospital-Plymouth, part of the Beth Israel Deaconess Medical Center family of hospitals, on January 1, 2014. BID-Plymouth begins the new year with strengthened intensive care, neonatology and interventional cardiology services and short-term plans to expand programs in primary care, cancer and stroke care for the South Shore and Cape Cod.
This alliance will provide significant benefits to patients in the Jordan Hospital service area, offering access to world-class academic medical care in Plymouth and surrounding communities. Independent market research shows that patients and potential patients already place a high value on both Jordan Hospital and BIDMC, and feel that both can provide high quality health care.
“Today our hospital entered its 114th year of service to the community by becoming part of the Beth Israel Deaconess Medical Center family of hospitals,” says BID-Plymouth President and CEO Peter Holden. “Although our name has changed, our mission has not: To improve the health and well-being of our patients and community by providing a full continuum of health care services with excellence.”
“We are proud to welcome Beth Israel Deaconess Hospital-Plymouth to our family,” says BIDMC President and CEO Kevin Tabb, MD. “Our formal alliance strengthens our community network, and is fundamental to our long-standing philosophy to provide care in the right place at the right time.”
As part of the new relationship, local Atrius Health patients needing emergency care — or hospitalization for common inpatient medical problems — will have access to BID-Plymouth, where they will benefit from an integrated system of care, including easy access, up-to-date electronic connectivity with the care team and the hospital, and a coordination of treatment that will insure a quality health care experience.
The alliance also includes greater collaboration with the Harvard Medical Faculty Physicians at BIDMC, the practice that includes the medical center’s primary care and specialist physicians.
Transitions have been underway since the Massachusetts Public Health Council approved the relationship in October. Alan Lisbon, MD, associate chief of BIDMC’s Department of Anesthesia, Critical Care and Pain Medicine, has been serving as BID-Plymouth’s Critical Care Center’s Medical Director, with plans to add four additional BIDMC intensive care specialists in the coming months.
BIDMC neonatologist Barbara Shephard, MD, has been the medical director of the Continuing Care Nursery at The BirthPlace. She has been joined by associate director Maggie Everett, MD, and a team of eight additional neonatologists from BIDMC, caring around-the-clock, seven days a week, for babies who need a little extra care and encouragement as they start out in life.
Later this spring, three BIDMC interventional cardiologists will join the team already in place in the BID-Plymouth cardiac catheterization lab, helping to provide both diagnostic and on-site interventional catheterization. In addition, three BIDMC thoracic surgeons will help to expand that program.
Coming in mid-January will be BIDMC TeleNet: Stroke, providing 24-7 access to the BIDMC’s stroke team through two-way video. Within 15 minutes of a patient’s arrival, a Plymouth-based physician will be able to get an assessment of a potential stroke from Boston-based experts. Patients needing advanced care will be quickly transported into Boston and returned home as soon as practical to receive local care.
BID-Plymouth will further expand the scope of its outstanding cancer services with BIDMC oncologists and surgeons collaborating with medical and radiation oncology teams to develop clinical pathways, the tools used by BIDMC’s multi-disciplinary cancer team to provide guide-evidenced-based patient care. The relationship will also expand an already robust menu of clinical trials on site in Plymouth and in Boston.
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Posted January 2014