Held Tight

Talking about mistakes. Not just rude selfish mistakes, that in reality it takes two. I've had those many times too. But literally, mistakes that are deep within us-"known better," but we continue to act upon them, over and over... and all can blame whomever, or the Devil, or a tough life- but in darn reality everything, every choice is still in our hands. Free will is still our control-and we can choose to follow what is in God's line... or what is in our selfish desire. 

Today, seven years ago I was sure struggling to find out who Jesus was. This was my first big hospitalization in 2003 at Mayo Hospital for my overdosing issue. It was my "answer" my "numbing pain" following my ex husband beating me October 6, 2002. I was hospitalized twice in TX for it in 2002. My neurologist, who has been with me for all my brain surgeries was guiding me, even from AZ when I was in TX back in 2002. Then I came back, and he had to deal with me face to face. But that was a gift from Jesus. As for he was actual art for the whole year of my overdosing struggles. He always saw the light in me, ready to come out and burn one day-soon. It was just taking me--my time, His time, and some help from others.

I had been searching for Jesus, dealing with ex issues, reality of what occurred, new boyfriend (husband today), raising my toddler on my own, trying to pop online pharmacy viagra to numb pain-and hold a job.... this all was not happening. I could not hold everything together and find this whole new Heather. The one I had no idea about. One that would love Jesus. Family. Life. People. Struggles to reach out to others, wellness for excitement for family.... so much to come... and more. 

But I had my first break-down June 18, 2003. My parents dropped me off up at my Mayo Hospital-my neurologist was there. My level was almost three times the level it should be, and I was not cognitive-alert. So I wasn't able to answer all the ER's questions. But my medical records are down the line of suicidal attempt, or euphoric distraction. Either way, I was the one who knew what was in the bottle-no matter what occurred to "cause" me to feel like I needed to escape or end-it was my choice, no one poured it down my throat.

I was there for two long nights. Not too much I can remember, other than my poor psychiatrist really trying to put his foot down to having me admitted to a psychiatric hospital for more long-term. And I threw a fit. Part of it was the loud, aggressive mood you get from the Phenobarbital high--dropping. Then also there was the mom in me who was roaring in an aggressive, unkind divorce-and I was not leaving my child, whom I was TRYING to raise right, with anyone who holds a fist in the air to any other human flesh. (granted, ex was in Iraq) So, we all went back and forth-and social services even stepped in-my neurologist held onto faith, and backed me up with many close appointments to see him.

My doctors did not see eye to eye-but my neurologist sure saw me hanging tight-heard my life stories, and compares to so much in personal life lived-and that is when you know God placed you somewhere exactly where He wanted you. As for I was learning more about Jesus-my Lord and Savior, and my neurologist sure supported that, but he also was this mini-training-god until I realized who was, and Who worked thru who, and why. And the beauty, when I found Christ showed even more thru every step my doc took me, thru His plans-even more, every month, every year.

It is amazing what hard times can bring. Even when they were brought on yourself-He can turn all into such beauty-His time, and teaching. We just sure have to live, learn, trust, and hold tight.... as for He held me tight the whole way-as He does you.

I thank Him for everyone who held on thru all of this. My family, my little girl, my husband-Christian .... so many-I am here. All from His glory-His plans. Our choices are just lame- all but ONE-following His whispers-His plans-Him!





In His Love,

Heather Siebens



John 14:12 "The Truth is, anyone who believes in Me will do the same works I have done, and even greater works because I am going to be with the Father."

Indiana HCAHPS Performance - Patient's Overall Rating of Hospital

The following is the most recent list of Indiana hospitals sorted by the percent of patients rating the viagra 9 or 10 on the HCAHPS question about overall care. This is derrived from the cialis compare database which was updated Dec 2009.

Percentage of patients who gave rating of 9 or 10 (high)
% Hospital
91 WOMEN'S HOSPITAL THE(NEWBURGH)
89 ST VINCENT HEART CENTER OF INDIANA LLC(INDIANAPOLIS)
87 INDIANA ORTHOPAEDIC HOSPITAL LLC(INDIANAPOLIS)
83 MONROE HOSPITAL(BLOOMINGTON)
82 INDIANA HEART HOSPITAL, THE(INDIANAPOLIS)
82 CLARIAN NORTH MEDICAL CENTER(CARMEL)
81 ST FRANCIS HOSPITAL MOORESVILLE(MOORESVILLE)
79 DUPONT HOSPITAL LLC(FORT WAYNE)
79 DEKALB MEMORIAL HOSPITAL INC(AUBURN)
78 PARKVIEW HUNTINGTON HOSPITAL(HUNTINGTON)
78 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC(FORT WAYNE)
78 ST VINCENT CARMEL HOSPITAL INC(CARMEL)
77 CLARIAN WEST MEDICAL CENTER(AVON)
77 HENDRICKS REGIONAL HEALTH(DANVILLE)
77 PARKVIEW HOSPITAL(FORT WAYNE)
77 MEMORIAL HOSPITAL AND HEALTH CARE CENTER(JASPER)
76 WITHAM HEALTH SERVICES(LEBANON)
76 TIPTON HOSPITAL(TIPTON)
76 PARKVIEW NOBLE HOSPITAL(KENDALLVILLE)
76 PARKVIEW LAGRANGE HOSPITAL(LAGRANGE)
76 SCHNECK MEDICAL CENTER(SEYMOUR)
75 PARKVIEW WHITLEY HOSPITAL(COLUMBIA CITY)
75 WABASH COUNTY HOSPITAL(WABASH)
75 GOSHEN GENERAL HOSPITAL(GOSHEN)
75 FRANCISCAN PHYSICIANS HOSPITAL LLC(MUNSTER)
75 DUNN MEMORIAL HOSPITAL(BEDFORD)
74 LUTHERAN HOSPITAL OF INDIANA(FORT WAYNE)
74 GOOD SAMARITAN HOSPITAL(VINCENNES)
74 ST VINCENT WILLIAMSPORT HOSPITAL INC(WILLIAMSPORT)
74 MARGARET MARY COMMUNITY HOSPITAL INC(BATESVILLE)
74 RIVERVIEW HOSPITAL(NOBLESVILLE)
74 ST FRANCIS HOSPITAL AND HEALTH CENTERS-INDIANAPOLI(INDIANAPOLIS)
74 CLARK MEMORIAL HOSPITAL(JEFFERSONVILLE)
73 ST MARY MEDICAL CENTER INC(HOBART)
73 MAJOR HOSPITAL(SHELBYVILLE)
73 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC(EVANSVILLE)
73 MEMORIAL HOSPITAL OF SOUTH BEND(SOUTH BEND)
73 SAINT JOHN'S HEALTH SYSTEM(ANDERSON)
72 COMMUNITY HOSPITAL(MUNSTER)
72 ST VINCENT HOSPITAL & HEALTH SERVICES(INDIANAPOLIS)
72 JAY COUNTY HOSPITAL(PORTLAND)
72 BLUFFTON REGIONAL MEDICAL CENTER(BLUFFTON)
71 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY(ANDERSON)
71 COLUMBUS REGIONAL HOSPITAL(COLUMBUS)
71 HARRISON COUNTY HOSPITAL(CORYDON)
71 FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES(NEW ALBANY)
70 BEDFORD REGIONAL MEDICAL CENTER(BEDFORD)
70 HENRY COUNTY MEMORIAL HOSPITAL(NEW CASTLE)
70 ST FRANCIS HOSPITAL AND HEALTH CENTERS(BEECH GROVE)
69 HANCOCK REGIONAL HOSPITAL(GREENFIELD)
69 ST JOSEPH HOSPITAL & HEALTH CENTER INC(KOKOMO)
69 CAMERON MEMORIAL COMMUNITY HOSPITAL INC(ANGOLA)
69 ST VINCENT FRANKFORT HOSPITAL INC(FRANKFORT)
69 ST VINCENT MERCY HOSPITAL(ELWOOD)
69 ST ANTHONY(CROWN POINT)
******69 Indiana State Average******
68 SCOTT COUNTY MEMORIAL HOSPITAL AKA SCOTT MEMORIAL(SCOTTSBURG)
68 SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH(PLYMOUTH)
68 ST CATHERINE HOSPITAL INC(EAST CHICAGO)
68 LAPORTE HOSPITAL AND HEALTH SERVICES(LA PORTE)
68 WESTVIEW HOSPITAL(INDIANAPOLIS)
68 KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES,THE(MADISON)
67 COMMUNITY HOSPITAL SOUTH(INDIANAPOLIS)
67 DECATUR COUNTY MEMORIAL HOSPITAL(GREENSBURG)
67 MARION GENERAL HOSPITAL(MARION)
67 DAVIESS COMMUNITY HOSPITAL(WASHINGTON)
66 SULLIVAN COUNTY COMMUNITY HOSPITAL(SULLIVAN)
66 ST JOSEPH HOSPITAL(FORT WAYNE)
66 REID HOSPITAL & HEALTH CARE SERVICES INC(RICHMOND)
66 DUKES MEMORIAL HOSPITAL(PERU)
66 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND(SOUTH BEND)
66 MEMORIAL HOSPITAL(LOGANSPORT)
66 DEACONESS HOSPITAL INC(EVANSVILLE)
66 JOHNSON MEMORIAL HOSPITAL(FRANKLIN)
******65 National Average******
65 HOWARD REGIONAL HEALTH SYSTEM(KOKOMO)
65 ST VINCENT JENNINGS HOSPITAL INC(NORTH VERNON)
65 GIBSON GENERAL HOSPITAL(PRINCETON)
65 CLARIAN HEALTH PARTNERS INC D/B/A METHODIST IU RIL(INDIANAPOLIS)
65 BALL MEMORIAL HOSPITAL INC(MUNCIE)
65 ST VINCENT CLAY HOSPITAL INC(BRAZIL)
64 ELKHART GENERAL HOSPITAL(ELKHART)
64 BLOOMINGTON HOSPITAL(BLOOMINGTON)
64 ST MARGARET MERCY HEALTHCARE CENTERS(DYER)
64 WILLIAM N WISHARD MEMORIAL HOSPITAL(INDIANAPOLIS)
64 UNION HOSPITAL CLINTON(CLINTON)
63 KOSCIUSKO COMMUNITY HOSPITAL(WARSAW)
63 DEARBORN COUNTY HOSPITAL(LAWRENCEBURG)
63 FAYETTE REGIONAL HEALTH SYSTEM(CONNERSVILLE)
63 PORTER, VALPARAISO HOSPITAL(VALPARAISO)
62 ST ANTHONY MEMORIAL HEALTH CENTERS(MICHIGAN CITY)
62 UNION HOSPITAL, INC(TERRE HAUTE)
61 COMMUNITY HOSPITALS OF INDIANA INC (EAST)(INDIANAPOLIS)
61 ST ELIZABETH CENTRAL(LAFAYETTE)
60 TERRE HAUTE REGIONAL HOSPITAL(TERRE HAUTE)
60 ST CLARE MEDICAL CENTER(CRAWFORDSVILLE)
59 MORGAN HOSPITAL AND MEDICAL CENTER(MARTINSVILLE)
56 ST MARGARET MERCY HEALTHCARE CENTERS(HAMMOND)
56 STARKE MEMORIAL HOSPITAL(KNOX)
55 ST MARY'S WARRICK HOSPITAL INC(BOONVILLE)
55 LAFAYETTE HOME HOSPITAL(LAFAYETTE)
54 ST VINCENT RANDOLPH HOSPITAL INC(WINCHESTER)
44 METHODIST HOSPITALS, INC(GARY)
39 SAINT CATHERINE REGIONAL HOSPITAL(CHARLESTOWN)

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That Which We Call a Rose

What’s in a name? Sometimes nothing much. Sometimes a shift in paradigm.

The Medical Record in its current format was created over a century ago by Dr. Henry Stanley Plummer at the Mayo Clinic. When in the course of human events the Medical Record began migrating from paper folders to computer files, the Institute Of Medicine naturally named the new invention Computer-based Patient Record System (CPRS). The Medical Records Institute chose the term Electronic Patient Record (EPR). Somewhere along the line the “patient” got dropped from the concept and the software used to compose and store medical records became known as Electronic Medical Record and the name EMR stuck.

As the EMR software evolved and started exhibiting rudimentary information exchange abilities and some semblance of “intelligence”, it was felt that a name change was in order. To differentiate the newer and smarter software from the original EMR, the term Electronic Health Record (EHR) was introduced and is now enthusiastically supported by the Federal Government. The term EHR is used in acts of Congress, rule makings from CMS and ONC and Presidential speeches. Since EMR has been around for quite some time, most industry veterans, as well as most doctors, are a bit confused about the new terminology. Is it EMR or is it EHR? Is it just semantics? Would an EMR by any other name smell as sweet (bitter)?

In a recent ONC blog, Peter Garrett and Joshua Seidman argue that there is a significant difference between EMR and EHR. The former is just “a digital version of the paper charts” and “not much better than a paper record”, while the latter is “designed to be accessed by all people involved in the patients care”, including patients, and generally “represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual”. This dramatic difference stems from replacing the word “Medical”, which implies disease, with the word “Health” which is “the general condition of the body”. Note that the word “Patient” is still absent. However, Health is supposedly from cradle to grave, while Medical is episodic in nature. Since, no matter what you call it, clinicians are the primary users of this software, would we say that doctors provide Medical Care or Health Care?

When we say that cost of Health Care is sky-rocketing, we don’t usually include costs for clean air, clean water, car seatbelts and gym memberships, and although we all know that an apple a day keeps the order cialis away, the cost of apples is not included in our Health Care expenditures. To be sure, Medicine, “the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease”, does include costs for direct prevention of specific diseases (immunizations) and efforts for early diagnosis of others (screenings). Historically, doctors, nurses and their less formally educated predecessors have been tending to the very sick. It is with this goal in mind that Dr. Plummer’s collaborative Medical record was created, and it is for this purpose that the American Academy of Pediatrics advocated for a Medical home for sick children, and it is Medical care for the sick which the EMR attempted to facilitate, one patient at a time. The EHR represents quite a different philosophy and places new and expanded responsibilities on the Medical profession.

The EHR is intended to serve the healthy as well as the sick, and the President’s vision is that every American should have one, whether that particular American is healthy or not. The ONC vision, shared by many innovators in the field, is that “EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care”. That broader view will presumably include lifestyle habits, diet and exercise and everything one may wish to record which pertains to one’s general health status. If and when a person becomes ill and is transformed into a patient, the various clinicians and care providers will contribute their documentation to the EHR, and since EHRs are easily shareable, all Medical care will be coordinated through the EHR and collaboration will flourish, as it should. This sounds almost exactly the same as what a Personal Health Record (PHR) is supposed to be. Is an EHR really a PHR?

No. EHRs include one feature that is not possible in a PHR: the ability to aggregate individual patients into populations. When physicians write introspectively about their work, you usually find stories about this or that particular patient, pondering whether they did too much for the 90-year-old Alzheimer’s victim, or too little for the misdiagnosed 40-year-old ovarian cancer patient. They talk about emotions, or lack thereof, about small victories and exasperatingly “non-compliant” middle aged executives who should know better. Each story has a patient with a name, physical details and most often character description. For those inclined to self-assessment, the day-in and day-out tally of these personal episodes is the decisive yardstick. When people recommend a cialis to a friend, they usually talk about “nobody could figure out what was wrong with Katie; he took one look at her and knew right away” or “you can get in today or tomorrow and she is so nice and patient ; always takes my phone calls and you know I can be a pain (giggle)” or “when Adam had that knee problem, he fixed it like magic and he did surgery on cousin Joe’s shoulder; as good as new, and I think he takes care of the Cardinals too; he is definitely the best in town”.

This unscientific, anecdotal method of both performing and assessing one’s work will be replaced by the broader view of EHR enabled population indicators and considerations. Instead of dealing with Mr. Wilson’s gout and Mrs. Wilson’s incontinence, you are now the keeper of the Health of Populations. The EHR can tell you that half of your under 40 patients are obese and doing absolutely nothing about it. You, or your team, will need to intervene because an ounce of prevention today will lead to healthier lives for this population, and lower costs for society. While managing Mrs. Wilson’s neuropathy is important (especially to Mrs. Wilson), having your population of 300 diabetics controlled within acceptable cost effective parameters will become the main focus of your practice. EHRs will provide you with the intelligence (information) to manage your numbers and with ongoing measurements to assess your performance against goals, and EHRs will continuously collect data for ground-breaking research and more effective recommendations.

EHRs, as imperfect, ineffective and downright primitive, as they are today may be our first glimpse of a future where curing or treating disease is largely a thing of the past. If populations are proactively managed and everybody gets their shots and recommended genetic therapy, or whatever they will come up with next, Medical care will be limited to trauma and exotic ailments that have not been researched just yet. While our generation will not be crossing the River into the Promised Land of perpetual Health, it is up to us to manage this transition so human dignity is preserved and collateral damage is minimized in the process of industrializing medicine, a process which starts with changing the M in EMR to the H in EHR.