Tag Archives: babies

Baby’s death illustrates how health IT can introduce complexity, error to system

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Chicago Tribune reporters Judith Graham and Cynthia Dizikes explore the pitfalls of health information technology through the story of an infant boy who survived despite being born months early and weighing just 1.5 pounds, only to be killed by a sodium chloride overdose when a pharmacy tech entered information into the wrong field of his electronic medical record.


Photo by Christiana Care via Flickr

The tech’s fatal clerical error was compounded by disabled alarms on a compounding machine, incorrect labeling on an IV bag and an ignored lab test. The heart of the errors, the reporters write, seems to be that all the different systems involved don’t communicate.

Almost all medication requests at Advocate are transmitted by a doctor’s keystroke to the hospital pharmacy’s drug-dispensing system. But in this case, there was no electronic connection with the automated compounding system that prepared the IV bag for baby Burkett, a specialized device that handles low-volume, highly individualized orders.

So a technician transcribed the order by hand, and an error was introduced.

Electronic communication gaps are common at large hospitals, which typically use upward of 50 to 100 different information systems at their facilities, with different technologies used in emergency rooms, labs, pharmacies and other medical departments, said Ross Koppel, a sociologist at the University of Pennsylvania who studies health information technologies.

“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Koppel said. With each jury-rigged software solution comes the potential for new software bugs, transcription errors and other problems.

N.M. midwives deliver a model for rural health

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

We’ve been following Wisconsin State Journal reporter David Wahlberg’s series on the future of rural health in his state, particularly because Wahlberg’s willing to look pretty far afield for examples that put rural Wisconsin in perspective, and which point to possible solutions to local rural health issues. His latest story, on rural midwifery and child delivery, took him to the mountainous areas around Las Vegas, New Mexico. In a way, it seeks to answer the key dilemma raised in the Montana piece: How do you provide care in areas so remote that the population can’t support an obstetrician and delivery facilities?

ratonPhoto by adventurejournalist via Flickr

Midwives have the potential to at least answer part of that equation, especially when they are used as obstetrician extenders. New Mexico is the nation’s leader in births overseen by midwives. Midwives account for 31 percent of births in New Mexico, a number that dwarfs the 8 percent national average.

Jaymi McKay, New Mexico’s maternal health program manager, said Hispanic midwives have long been a tradition in the state and activists pushed for midwife-friendly laws decades ago.

New Mexico still faces rural maternity care challenges, as 16 of its 33 counties have no hospital that delivers babies, McKay said. But without so many midwives, “it would be a lot worse,” she said. “They fill an important niche. That happens more in New Mexico than in other places.”

In addition to its culture, the New Mexico system stands out for its midwife licensing procedures. Wahlberg goes into greater detail, but here’s the national perspective:

All states offer licenses for nurse midwives. Most private insurers and Medicaid, the state-federal health plan for the poor, pay for their care.
Just 27 states license other midwives – including Wisconsin, which started doing so in 2006. Ten states ban them. Medicaid covers their care in 10 states, not including Wisconsin, and some private insurers cover them.

Public records shed light on Texas blood samples

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Texas Tribune‘s Emily Ramshaw got her hands on almost a decade of public e-mails that help show the thoughts and intentions behind the state’s decision to store infant blood samples without parental consent. She also uncovered a previously undisclosed “transfer of hundreds of infant blood spots to an Armed Forces lab to build a national and, someday, international mitochondrial DNA (mtDNA) registry.”


Photo by valleyboy74 via Flickr

Ramshaw published PDFs of the e-mails alongside her story (E-mails, part 1 | E-mails, part 2).

Ramshaw’s report follows officials’ intricate dance around the issue of parental disclosure, as well as their reluctance to publicize the warehousing of the blood samples. Here’s her summary:

For decades, the state has screened newborns for a variety of birth defects, pricking their heels and collecting five drops of blood on a paper card. Until 2002, the cards were thrown out after a short storage period. But starting that year, the state health department began storing blood spots indefinitely, for “research into causes of selected diseases.” Four years later, DSHS began contracting with Texas A&M University’s School of Rural Public Health to warehouse the cards, which were accumulating at a rate of 800,000 a year. State health officials never notified parents of the changes; they didn’t need consent for the birth-defect screening, so they didn’t ask for it for research purposes. The agency’s rationale was that it let parents who asked opt out of the newborn blood screening and de-identified all of the samples before shipping them off.

According to Ramshaw’s sources, baby blood spots are “incredibly valuable” to researchers, and can be useful even when stripped of all identifying information. Yet public perception doesn’t line up with this scientific value in part, Ramshaw says, because scientists are unwilling to even try to explain the use of blood spots because it’s such a controversial topic.

Fortunately, Ramshaw writes, the first steps toward educating the public are now being taken. Parents are being asked for their informed consent when the blood samples are taken, and the state health agency has made a clean break with the past by destroying the earlier blood spots collected without full consent.

Series shows how preemies affect families, society

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Providence Journal has published the final installment of The Price of Miracles (table of contents), a broad print and online explanatory effort spearheaded by AHCJ board member Felice Freyer. Freyer put the package together over the course of more than a year with the help of a fellowship from the Kaiser Family Foundation.

Freyer’s work was released in six chapters, each of which contained between three and six stories, as well as online components and photography. Chapter one presents both the wide view and an instructive and emotionally intense profile of a family facing the fate of their premature son. In subsequent chapters, Freyer takes an in-depth look at another specific case, considers disparities in premature birth, profiles the medical professionals who keep premature babies alive and ends on a hopeful note, examining advances in the care of premature babies and following up on the lives of some of the children profiled earlier in the package.

Here, Freyer explains how the massive effort came together, and how she found the time to put together a long-term project amid the daily pressures of a downsizing newsroom.

Each time we published in print, the latest story would be added to the online project. An unusual aspect of the project was the way we developed the online “container” to accommodate continuing additions. It took a few tries, but we finally came up with a design that would indicate that future stories were coming while clearly displaying what was already there. We also found ways to keep viewers anchored, aware of the options, and able to navigate among the many different parts without getting lost. We had many online-only features, including videos, slideshows, interactive graphics and “audio snippets,” in which readers could click to learn more in the voice of a person in the story.

Fellow reporters might be interested to know that I never had a block of time to do this, but worked on it while still covering my beat. In these times, I didn’t think I’d be allowed to go “off staff” for months on a project. So even while I was on the Kaiser fellowship, I continued to work at the Journal, setting aside one to three days each week for preemies. After the fellowship ended, I carved out time as I could to complete each chapter. (For example, there was a three and a half month gap between chapters 5 and 6 – because I was busy covering swine flu.) This project also involved a team of highly creative Web and visuals people who continued to work with me through some our paper’s toughest times, including two rounds of layoffs.

Some women’s magazines model poor baby care

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Children’s National Medical Center researchers Dr. Rachel Moon and Brandi Joyner looked at pictures of sleeping babies in 28 magazines popular with women of childbearing age and found that, of the 391 unique images analyzed (230 of which were in advertisements), 122 showed sleeping babies and 99 showed infant sleeping environments (but not the infants themselves).

More than a third of the sleeping babies were shown in improper sleeping positions (side and prone) that violate American Academy of Pediatrics’ recommendations and increase the risk of Sudden Infant Death Syndrome. Furthermore, two-thirds of the photographs portraying sleeping environments showed loose bedding and other objects and locations that violate the safety recommendations and, the report says, increase the risk of SIDS fivefold. In general, advertisements were more likely to include guideline-violating images than their editorial counterparts.