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Deborah Huber is Executive Director of HealthInsight Nevada. In this role, she is responsible for all the company’s governance, operations, staffing, customer and community relations, and business development. She has been instrumental in the recent organization and launching of a community-based, statewide health information exchange. Prior to assuming this role, she served as HealthInsight’s Vice President for Nevada Program and Director of the Nevada Partnership for Value-driven Health Care, an Agency for Healthcare Research and Quality (AHRQ)-designated Chartered Value Exchange. These roles required the development, management, and implementation of the HealthInsight Nevada Value agenda. The Value agenda promotes the adoption, meaningful use, and interoperability of health information technology, cost and quality transparency, payment reform, and consumer engagement in their health care.


Ms. Huber joined HealthInsight in 1998. She holds a Bachelors of Science degree in nursing from South Dakota State University and a Master’s of Science degree in Health Services Administration from the University of Kansas.

A National Epidemic; Local Experience

Pills

Katie has been my dental hygienist for the past 20 years. At my most recent "clean and check" visit, she told me about an encounter she had with the health care system.

She said that after experiencing a headache for a couple of days, she started to notice an odd crackly sound in her ear. She decided to have it checked out at the local quick care clinic. The quick care doctor told Katie she had an ear infection that would require antibiotics.

"What is your antibiotic of choice?" he asked her. "A Z-Pac, antibiotic A or antibiotic B. What do you prefer?"

Stunned, she said she just wanted what would be best to treat the infection. When she got to the pharmacy to pick up the antibiotic, the pharmacist began with an apology.

"I'm sorry," he said, "but we don't have enough hydrocodone to fill the doctor's prescription."

Now confused, Katie asked the pharmacist what he was talking about. He told her that the doctor had ordered 50 hydrocodone to treat her headache. She told the pharmacist not to worry about it, because although she mentioned to the doctor she had a headache, she had not sought treatment for it.

Lying in the dental chair with my head below her hands and a metal tool in my wide-open mouth, she asked, "Does this sound odd to you?"

Where to start?

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A Tale of Two Patients

TEST LINK FIRST

In the last two weeks, my mother and my husband had surgery. I'm happy to say that both had relatively positive experiences and outcomes. However, what was striking to me was the difference in the course of their stays.

Some background: I've been a nurse and have lived in Las Vegas for a long time. I know and work with lots of people in Nevada who:

  • Are senior executives in health care organizations
  • Are senior executives in insurance companies
  • Are skilled health care providers

Mom was having a hernia repair, a common and relatively uncomplicated procedure. And, as with most procedures, it requires coordination and communication among different disciplines and hospital departments. Despite my background and experience, I found myself:

  • Unable to get my mother answers to her questions (e.g., "Why am I getting antibiotics?")
  • Unable to get her providers the information they needed about her past medical history in a timely manner (e.g., "What were the results of the outpatient CT scan ordered by another physician?")
  • Unable to coordinate her care among providers

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Putting the “Health” Back in Health Care

Doctor with patient

You're not feeling well. You have a fever, a sore throat, an unusual pain. What do you do? You seek medical attention, of course. Why? Because when you are sick, you go to the doctor. But are there reasons to go to the doctor when you're not sick?

When my husband was 55, he went to his primary care doctor and suggested that it was probably time he got a colonoscopy (an initial one is recommended at age 50 and his mother had colon cancer), maybe an EKG or treadmill test (his dad had a massive heart attack at age 52), and maybe a shingles or pneumonia vaccination. His doctor said, "Why are you asking for all of this? I don't get paid for ordering or providing these services." In other words, "I provide sick care, not wellness/preventive care." Not only was his statement true, but in most cases, commercial insurance does not pay for services that are intended to prevent, not treat, a certain condition; so if patients want these tests, they have to pay for them themselves.

Fast forward to 2012. Medicare expanded benefits to their fee-for-service beneficiaries to include an annual wellness visit. This is a visit focused on maintaining and improving health, making a plan for preventive and screening care, and keeping the clinic up to date on all the care a patient is receiving. An annual wellness visit includes a review of all the medications a patient is taking, the names of all other doctors they are seeing and the patient's medical/family history. Among other things, the doctor conducts a screening for depression, assesses the patient's ability to perform activities of daily living, his or her risk of falling and any hearing impairment.

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Three Good Things

Change Agents - Learning and Action Network

I recently had the great pleasure of serving as the regional host for a HealthInsight-sponsored learning and action network (LAN) event, "Be the Change: Strategies for Health Care Transformation".

I have been a HealthInsight employee for nearly two decades. Part of my reasoning for continuing to work for HealthInsight for all these years is that I am still able to learn and grow, and think about new possibilities to change the health care system.

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Caregivers: Not Just Nurses and Mothers Any More

Three gnerations of family in the park

I found myself thinking about what to write for this blog post on Mother's Day, which fell in the middle of Nurses' Week this year. Both moms and nurses have a long and intertwined history of caregiving. Most nurses are women, and if asked what nurses do, it would not be surprising if the answer was, "they take care of us." We would say the same about our mothers.

For about a decade before my father died, my mother and I were his at-home caregivers. It was a labor of love. However, it wasn't until after he was gone that I truly realized how much labor it had actually been. I was exhausted and had been for years without realizing it. I jumped every time the phone rang because I was afraid something had happened to my father that might involve calling 911 or rushing to his side. Over the years, I prepared a file of all the phone numbers and information I thought I might need "when the time came." I also tried to support my mother so she still had a quality life outside of caring for dad. Did I mention I was exhausted? Even as a registered nurse for many years, I was ill-prepared for this role.

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Are You Engaged in Your Health Care?

Medications

Over the past few years there has been a great focus on "consumer engagement" in health care in the press. At face value the concept seems right, consumers need to be engaged in health care, but the idea itself creates an obvious question. "What IS consumer engagement?"

In some circles, it means the consumer (i.e. patient) is compliant with what their practitioner suggests and prescribes. In some sense, there is still a paternal view of how patients should behave within the health care system. The doctor/system knows best and if you just follow the instructions you will do well.

In other circles, consumer engagement means individuals being responsible for their own health, outside the health care system, which includes engaging in healthy behaviors and avoiding unhealthy habits, like smoking and overeating that are well known to result in negative health outcomes. It can also mean knowing how to navigate the health care system to get what you need from it, as well as searching for information on your own so that you can have an informed conversation with your health care provider.

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30 Minutes on a Thursday: a Patient’s Perspective

Doctor with Patient

In our work, we often hear the phrase "patient engagement" from a provider's point of view. Recently, I experienced the importance and significance of this phrase as a patient.

I accompanied my mother to her Thursday appointment at a local radiology center. After we filled out the routine paperwork and she changed into the typical hospital gown for the exam, we found ourselves in the CAT scan waiting room with patients and their family members. We were all strangers, but strangers in a common situation, strangers with common concerns.

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What is Quality? Do we know yet?

iStock 000017940619MediumI just celebrated my 16th year of employment with HealthInsight last week. Although too much to mention has changed from my early days here, one thing we’ve always been about is improving the quality of health care.

So when I was traveling home from Reno last week and struck up a conversation with the woman in the next seat, I was amazed that I was more than a little taken aback at the difficulty I had in answering what may, to some, seem like a simple question. “What’s the best hospital in Nevada?”

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