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Notebook: Conferences highlight gradual nature of healthcare advances


By Andis Robeznieks
Posted: October 4, 2012 - 11:30 am ET
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Three very different healthcare conferences are going on this week in Chicago, but speakers at each one had a similar message: Throughout history and even today, the healthcare industry has been slow to adopt innovations that it would eventually benefit from.

The American Health Information Management Association's 84th annual convention is going on in the east side of Chicago's McCormick Place Convention Center, while the American College of Surgeons is celebrating its centennial and holding its annual clinical congress across the street on the west side of McCormick Place. The 25th annual Healthcare Facilities Symposium and Expo is taking place along Lake Michigan at Navy Pier.

At the facilities symposium, members of the design and construction teams building Universal Health Service's new 140-bed Temecula (Calif.) Valley Hospital talked about how the project is being built in 20 months for $150 million using the integrated project delivery method. Edward Straub, DPR Construction's project executive for the hospital, said that—for the state of California—that cost and that time frame are “pretty remarkable and it's because of that process.”

As opposed to the traditional design-bid-build process—which frequently involves much redesigning and rebidding before the actual building takes place—architects, construction managers, and hospital executives work collaboratively at each step of the project to avoid having to take the same steps multiple times. The process has been around for years, but is still something of a novelty.

One speaker noted how the old design-bid-build world “just seems so foreign” now after using the integrated project delivery method, and Steven Wilson, a principal with HMC Architects, agreed. “It was really weird at first,” he said. “”But it's definitely the way to go.”

While it may take healthcare construction a few years to get with the times, history has shown it may take decades or centuries for innovations to take hold.

At the AHIMA convention, my colleague and cubicle neighbor, Joseph Conn, reported on CMS Innovation Center senior adviser Wil Yu's keynote speech that told of how it took 264 years—from 1601 to 1865—for the practice of consuming citrus products to prevent scurvy on long ocean voyages to take hold after it was discovered.

Also at the symposium, Marc Sauvé, a senior healthcare strategist with Gresham Smith & Partners in Nashville, began his talk with a slideshow that rapidly tracked healthcare from its ancient Egyptian roots in 2900 B.C., to Leonardo da Vinci dissecting corpses in 1489, to the first cases of AIDS in 1981, to the upholding of the Patient Protection and Affordable Care Act in 2012.

“Healthcare reform has been a presidential goal for nearly a century,” Sauvé said, adding that, when the Affordable Care Act was passed, “as the vice president said, it's a big (long pause) deal.”

Dr. Atul Gawande, speaking at the ACS clinical congress Tuesday, topped them all with multiple tales of resistance to innovation.

Gawande, a surgeon at Brigham and Women's Hospital in Boston and a professor of surgery at Harvard Medical School, wrote an article on the history of surgery for the New England Journal of Medicine's bicentennial. He told of how Werner Forssmann, then a 25-year-old surgical intern in Eberswalde, Germany, was convinced he could safely insert a catheter into the human heart. His professors wouldn't let him try it on patients or lab animals, so he did it on himself and took X-rays that were published in a German medical journal in 1929.

Gawande told how Forssmann was fired from his post, but his discoveries helped create the field of cardiology, and his efforts were recognized with the Nobel Prize for medicine in 1956.

Giving another example, Gawande recalled how Joseph Lister began to wash his hands and sterilize his surgical instruments in 1865 and published a report on the beneficial outcomes of these practices in the Lancet medical journal in 1867. The New England Journal of Medicine, Gawande said, responded by calling Lister's work “neither original nor beneficial.”

Even anesthesia had its critics, Gawande said, including one who called these anesthetizing products “needless luxuries.”

This prompted George Wilson, a surgeon and chemistry lecturer at the University of Edinburgh—who had his own foot amputated at the ankle without anesthesia in 1842—to respond.

Wilson wrote how he still recalled the operation “with unwelcome vividness,” the instruments being laid out, his tourniquet being twisted, and “the bloody dismembered limb lying on the floor.”

He described the operation itself as “the horror of great darkness, and the sense of desertion by God and man, bordering close on despair.”

“Could you have been a surgeon then?” Gawande asked.

It makes you wonder what other patients might have reported on if online physician reviews were available back then.

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