2014 Practice Changers and Important Topics in Hospital Medicine

Larry Beresford

Disclosures

December 26, 2014

2014: The Ebola Effect on Hospital Medicine

Hospital medicine continues to play a central role in the quality, efficiency, and safety of hospital care in America, although the target is moving rapidly.

For Robert Wachter, MD, MHM, chief of hospital medicine at the University of California-San Francisco (UCSF), the transitions and turmoil that healthcare underwent in 2014 were epitomized by Ebola, a deadly infectious disease epidemic affecting West African nations. In the fall, it became a huge issue in this country, as well, when Texas Presbyterian Hospital in Dallas sent home an Ebola-infected patient from its emergency department, despite a travel history that revealed recent travel to and from West Africa.

The hospital blamed the lack of interoperability of its electronic health record (EHR) system for its mishandling of the case. The patient died of the virus in October.

"There is Ebola as the canary in the coal mine—reminding us how unprepared we are for a public health or bioterrorism emergency," Dr Wachter said. "But there's also the tendency to blame electronic health records for everything that goes wrong in healthcare."

Dr Wachter's home base, UCSF Medical Center, was designated by the federal government in early December as one of 35 Ebola treatment centers nationally, based on its ability to provide the necessary staff, training, equipment, and other resources to treat patients with the unique care requirements of Ebola virus disease. The designated hospitals were assessed onsite by teams from the Centers for Disease Control and Prevention. UCSF had been preparing for Ebola since August.

Implementation: From EHRs to the ACA

Dr Wachter remains interested in the implementation of EHRs in hospitals and all that it signifies, both positive and negative, as he wraps up his next book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, which will be published by McGraw-Hill in April 2015.

Although he identified another trend for 2014 as the year hospitals started getting serious about pulling back their financial support for their hospital medicine programs, the field continues to grow.

The number of clinicians who now identify as hospitalists is 44,000, according to the best guess and extrapolations of the Society of Hospital Medicine (SHM). The association's president, Burke Kealey, MD, of Health Partners in St. Paul, Minnesota, noted that 13,000 of them belong to SHM, and 3600 attended SHM's annual meeting in Las Vegas in March, "way bigger than anything we've seen before."

For Joseph Li, MD, section chief of Hospital Medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts, 2014 was a year when the forces of healthcare reform and the Affordable Care Act (ACA) accelerated a trend for hospital mergers and the formation of multisite hospitalist groups, with important implications for patients and the potential to standardize care delivery—if they can all get along. "We're seeing it all over the country, largely a product of the environment," he said.

The reach of hospital medicine was also seen in the naming of Vivek Murthy, MD, as the nation's new surgeon general. Dr Murthy is a hospitalist at Brigham and Women's Hospital and an instructor in medicine at Harvard Medical School in Boston, Massachusetts. SHM heralded the appointment as "historic."

"Being 'America's Doctor' requires many of the same traits required of hospitalists: leadership, sharp clinical skills, and the ability to engage with patients. And, like hospitalists in thousands of hospitals across the country," Dr Kealey said, "I am confident that Dr Murthy will become an agent of change to improve delivery of care in our country."

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