Readers Write

Gary Baldwin, for HealthLeaders News , August 7, 2007

Many people commented about my recent columns describing the EMR vendor wars, green hospitals, and my trip to the ED (I'm fine now and thanks to all the well-wishers). I've excerpted some of the correspondence below. All letters are welcome. You should include your name, organization, and title. We'll print comments intended for publication as space allows. We also welcome longer essays for our IT Leaders Forum. I'm still getting mail--some of it quite passionate--about last week's "Sicko" review and will compile them for a future edition. Meanwhile, enjoy your summer! And keep those cards and letters coming (electronically of course)!!

Emergency department adventures

Just read your piece on your adventure in the ED. I especially appreciated the comments about the nursing staff, and your closing comments: "Or should I be miffed that a 1-minute tetanus shot, a 5-minute x-ray and a 5-minute suture wound up taking 8 hours? Truth is, I am coming down on the side of the half-full glass. After all, all those doctors, nurses, aides, and emergency techs were there waiting to treat whoever came through the door, even through the glass door like I did."

You characterized the essential struggle faced every day . . . trying to provide hospital services along the whole spectrum of services that might be needed or demanded. And somehow those services have to be delivered with a customer service or "patients first" focus. Keep writing about this subject!

Denise Ready, RN

Nursing Supervisor

Fairview Hospital, Cleveland

Crazy world

Sometime ago, somewhere, somebody described our crazy little world this way: "Islands of excellence, surrounded by the Department of Motor Vehicles." Great article ("My Night in Purgatory")!

Kendall R. Stanley, Sr. CPHIMS

Account Manager, Axolotl Corporation

ED system needs attention

Regarding your "night in purgatory," I am sorry for your pain and suffering. Yes, we have much to be thankful for-- that is those of us who have some level of health coverage and access to care. Nevertheless, one's comparative good fortune compared to some of those you met in the ER waiting room is no reason to avoid the obvious conclusion that the system you encountered makes no sense at all. (I am sure that will become even more apparent when a bill arrives, or is forwarded to your insurer. Please though, in a follow up column let us know the total.)

Your situation reminds me of other wait-to-service ratios that are out of whack: people stuck on airplanes, the time it takes to get a passport, or some Starbuck lines. While you had the "resources" to manage for eight hours, many others do not and the wait would be a severe hardship for them or their families. While you encountered good people, the system in which they work needs more than a couple of stitches. I enjoy your columns.

Daniel Danzig

Public Relations

Orinda, CA

Green efforts

Thank you for your recent plug for hospitals which are trying to be environmentally friendly. I believe the number of hospitals who are striving to be good environmental stewards is growing. Hospitals for a Healthy Environment is such a help, and a wonderful resource. Still, it is especially difficult for us small hospitals to have the staff who can work on environmental issues.

Some big medical facilities have dedicated staff who work on energy conservation and environmental issues---here it is staff who have the interest, hold the issues close to their hearts, and make the time to get involved. You won't find it in anyone's job description.

For example, we have had a recycling committee for over 10 years. It started as a "grassroots" effort by concerned employees. Later, it evolved into the "Medical Waste Reduction Committee." It is still formed of employees who volunteer to get involved; who care. They are your leaders in any hospital, big or small. Thank goodness for them! You can pass all the initiatives you want, but without "champions," they do not get off the ground or get practiced consistently.

To date our efforts include: Recycling plastic, cardboard, glass, paper, tin, and aluminum for over 10 years. Removing our mercury BP cuffs in 1999, and winning the H2E "Mercury Free Award" in 2005. Holding several mercury thermometer drives for the public. We are currently trialing "greener cleaners." We are doing away with the ancient practice of using disinfectant on the floors.

Currently we also do not discard medications in the general waste stream. We pay to have them safely treated and disposed of. We hold Earth Day celebrations. We try to minimize the use of disposables. Future goals include earning the "Energy Star" for energy efficiency, and becoming known as an environmental leader in the community.

We would like to hold a public Household Pharmaceutical Waste Collection Event for our town or county.Again, thank you for highlighting this issue. It can only help the movement grow! I feel it is our mission not only to treat current illnesses, but help prevent future illness. As Employee Health nurse, I see many of the issues (such as less chemical use) as a way to keep our employees healthy.

Jan Path, RN

Employee Health/Infection Control Nurse

Tomah(WI) Memorial Hospital

Too much of a good thing

This is going to be the next big issue: that of all these little EMR start-up companies competing in the marketplace, (and providing potentially great innovations) while their health records and the vendor just next door DON'T interface with any of the current records, or the next generation of EMRs either (whatever that will be).

Even the two BIG healthcare providers for the government (the Veterans Administration and the Department of Defense) can't agree on one record, and are only slowly working to be able to transfer information back and forth with any degree of accuracy and speed. As I understand it, even the data sharing conventions of different Regional Health Information Organizations (RHIOs) are different, although the Department of Health and Human Services (HHS) is attempting to set some standards for EMR products so that they comply with minimal standards for functionality, security and interoperability.

Final comment: the notes sections of some records don't print out the way doctors and nurses think about or process medical information, so that is not immediately helpful if you DO have to print out and send the record rather than electronically sending information. Bottom line: we REALLY need some serious standardization so that health records CAN be compatible and transferable.

Karl R. Kerchief, MD

Army Family Physician

San Antonio, TX (writing on behalf of himself, not the U.S. government)

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at

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