John Zaleski, Ph.D., CPHIMS

An interesting article published in the May Edition of Critical Care Medicine (Gaieski et al., “Benchmarking the Incidence and Mortality of Severe Sepsis in the United States.” CCM May 2013. Volume 41. Number 5. DOI: 10.1097/CCM.0b013e31827c09f8) summarized a survey of sepsis reporting based upon ICD-9 codes established for sepsis, severe sepsis, and septic shock established in 2002-2003, and on the variability in reporting and rate of occurrence during the 6-year period from 2004-2009. Between 2002 and 2003, ICD-9 codes for sepsis, severe sepsis, and septic shock (995.91, 995.92, 785.52) were introduced.

Using ICD sepsis codes, the authors surveyed reports associated with these ICD-9 codes. What they found was that the average annual incidence of sepsis (ICD-9 Code 995.91) 231 cases of sepsis per 100,000 patients; 144 cases of severe sepsis (ICD-9 Code 995.92); and 95 cases of septic shock (ICD-9 Code 785.52) per 100,000 over this 6-year period.

Sepsis was identified as the 11th leading cause of death in US (Reference: CDC, 2009). Severe sepsis, defined as sepsis associated with new organ dysfunction, hypoperfusion or hypotension, has was estimated to cost U.S. healthcare system $24.3B in 2007.

Various studies considered:

Angus et al: 750,000 cases (300 / 100,000 population) and in-hospital mortality rate of 28.6% in 1995.

Martin et al.: 256,000 cases in 2000 (81 / 100,000).

Dombrovskiy et al.: 391,000 cases (134 / 100,000) with an in-hospital mortaility rate of 37.7% in 2003.

Wang et al.: 571,000 annual emergency department (ED) cases nationally between 2001 and 2003.

Gaieski et al. estimated that, for all sepsis codes, an annual increase in was observed and the rate of this increaase varied by ICD-9 code: 22.3% for sepsis, 25.3% for severe sepsis, 18.2% for septic shock.

My mother died 20 years ago from a very virulent form of inflammatory breast cancer. From the time of diagnosis until her passing was approximately 18 months.

She was 54.

The recent reports about Angelina Jolie and her brave decision to undergo a double mastectomy helps shed some light and attention on breast cancer and on her knowledge that she had inherited the harmful form of the BRCA1 or BRCA2 mutation.

In the recent mHealth article “Mobility: Key to overcoming barriers to clinical transformation and ACOs“, Matt Patterson asserts that mobile health information technology (mobile health IT) interoperability and data access barriers need to be broken down to achieve the seemingly elusive transformation of care. I agree completely. Two of the key headlines within this article grabbed my attention:

“Bring data to physicians instead of forcing physicians to go to the data.”

Give the physician the data wherever he/she is, and provide this in a manner that makes it simple to interact. This does not mean simply taking the desktop and miniaturizing it for a smart phone. This means a transformation of the experience to support whatever form factor is available for use by the physician that is clear, simple, easy to use and does not cause frustration or impediment. Too often, the “mobile” solutions are nothing more than a miniaturization of the desktop. This miniaturization without proper architecture or adherence to workflow or the peculiarities of the experience can result in frustration and disuse.

“Let physicians close the transaction from wherever they are.”

Allow the complete workflow to be accomplished from wherever the physician is located in whatever form factor is available for use. Closing the loop and providing the capability to turn any geographic location into a working location from and with which orders, vitals, results, notes, images can be viewed, created, analyzed, and interacted is the key to flexibility. To achieve this, interoperability and access to data are essential within the mHealth space.