Sunday, August 30, 2015

A Senior Clinician Tries To Use The PCEHR And Discovers What A Heap Of Crock It Is!

This appeared earlier in the week:

Ian Maddocks: Record of care

Ian Maddocks
Monday, 24 August, 2015
INTEGRATION of care is a common theme in health, with expectations that information technology will play a major part to bridge gaps in offering patients continuous, seamless care.
 In 2012, the federal government launched the e-health record system, where patients could register for a personally controlled electronic health record (PCEHR). More recently, the government has announced moves to introduce an “opt out” rather than “opt in” system and will rename the PCEHR myHealth Record.
The PCEHR aims to provide continuity of care by providing full details of the patient’s health care, medical contacts and interventions. But is that enough?
Access to my own record finds it is designed to advantage health care providers rather than those receiving care.
I enrolled for a PCEHR over 12 months ago, but attempting to access it recently I found considerable difficulty working through its security codes and passwords.
A recent change of address was a difficulty. When challenged by security to insert the name of the primary school I had attended (there were three), I failed to choose the one I had nominated a year ago, so I was a source of some suspicion to the system.
Even with assistance from a patient helpline adviser, I was unable to consistently satisfy the security bars. I am a fading octogenarian, lacking all but the simplest IT skills, but we are the major users of health care these days.
Eventually able to search my file, I could find a Medicare-based listing of some of the doctors and dates I had visited, but no diagnoses or opinions; and dates of pathology tests and x-rays, but no reports. There was also a list of drugs obtained through the Pharmaceutical Benefits Scheme.
As a child, I had access to fully integrated, whole-of-life health care, from a solo GP in a Victorian country town. I had home care for pleurisy (a mustard plaster to the chest), whooping cough and measles (boiled water only for 2 days), and an appendicectomy at the local hospital (open ether anaesthetic by the doctor from the next town).
…..
When I worked in Uganda about 50 years ago, patients carried their health record with them — so the concept of a PCEHR is used in many places.
A mother would present her child in my clinic along with a bundle of small papers retrieved from deep in the front of her bosom. It contained all the child’s former consultation entries and I would add my own, to see the record disappear again into the depths.
I learned the value of a patient-held record that was never lost and always available.
…..
Emeritus Professor Ian Maddocks is an eminent palliative care specialist, recognised internationally for his work in palliative care, tropical and preventive medicine. He was Senior Australian of the Year in 2013.
The full article is here:
This article says so much about the failings of the PCEHR.
It’s hard for older people to use, it’s incomplete and largely empty and it will be years, if ever, that Professor Maddocks, or anyone else, will see any value from the system.
What amazes me is why the geniuses in NEHTA and the Department of Health can’t grasp that they have a genuine lemon on their hands and cut their losses.
Does anyone recall just who determined the PCEHR was a good idea and can we ask them to explain themselves?
David.

AusHealthIT Poll Number 285 – Results – 30th August, 2015.

Here are the results of the poll.

How Important Do You Think It Is That The CEO Of The Proposed Australian Commission for eHealth (ACeH) Be An E-Health Expert?

Critical 36% (31)

Pretty Important 17% (15)

Neutral 15% (13)

Unimportant 31% (27)

I Have No Idea 1% (1)

Total votes: 87

It seems a clear majority (53% to 31% of those who had a view) feel expertise is important. We can now see how much notice is taken of this view. Very little I fear!

Good to see such a great number of responses!

Again, many, many thanks to all those that voted!

David.

Saturday, August 29, 2015

Weekly Overseas Health IT Links -29th August, 2015.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Surveys on Physician EHR Satisfaction Show Conflicting Results

AUG 21, 2015 7:50am ET
Depending on who you talk to these days, physician satisfaction with their electronic health record systems is either dramatically increasing or decreasing. Results of two new surveys released this month point in opposite directions, fueling debate about whether widespread EHR adoption is in fact having a positive impact on doctors’ practices.
On the positive side of the ledger, a survey out this week by market research firm Black Book has identified a “shift upward in physician experience across the large practice and clinic sector, since first measuring EHR satisfaction six years ago.” In particular, the firm finds that large physician practices are more satisfied with electronic health record usability, interoperability and productivity improvements over the past few years than small practices.
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Snooping employees sacked, disciplined after HIPAA breach

Posted on Aug 21, 2015
By Erin McCann, Managing Editor
What happens when a healthcare organization's employees are found to have been inappropriately accessing patient medical records? The actions of one health system might serve as an example.
After 14 of its employees were found to have accessed a high-profile patient's medical records "without a legitimate patient care need," the nine-hospital Carilion Clinic in Roanoke, Va., is sending a clear message that this behavior will not be tolerated.
"Appropriate actions have been taken with each employee, up to and including termination," said Vicki Clevenger, vice president of internal audit & compliance, and chief compliance officer for the health system, in a prepared statement
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John Halamka: 3 areas healthcare should address in 2016

August 21, 2015 | By Katie Dvorak
It's already almost time to plan for a new year, and as 2015 heads toward its final stretch, stakeholders in the healthcare industry already are looking at what areas to focus on in 2016.
In a recent post to his Life as a Healthcare CIO blog, Beth Israel Deaconess Medical Center CIO John Halamka outlines some of the things learned this year that could shape planning at his and other facilities in 2016.
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Google Glass Comes to Doctor’s Office Near You as Upgrade Looms

August 20, 2015 — 10:00 PM AEST
 A few weeks ago, a New Zealand doctor donned Google Glass and beamed video of an aortic surgery to the U.S. offices of medical device maker Endologix Inc.
The test demonstrated the potential power of a technology that famously flopped with consumers but is quickly becoming a go-to gadget for the medical world. Google is expected to roll out a new version of Glass in the coming months, and medical device makers, hospitals and family doctors are eagerly anticipating improvements. These will probably include an adjustable eyepiece, longer-lasting battery and water-resistant properties, according to people familiar with the project.
Medical professionals see Glass -- lightweight eyewear that lets wearers livestream events, take notes, surf the Web and more -- as a way to save money and provide better care. Endologix plans to use Glass to train doctors to implant the stents and arterial grafting technology it sells.
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OpenNotes Strives for Better Physician-Patient Communication, Transparency

AUG 20, 2015 7:22am ET
From humble beginnings in 2010 to more than 5 million patients nationwide currently, the OpenNotes initiative is gaining momentum as patients are being given unprecedented online access to the notes their clinicians write after a doctor visit, increasingly making believers of once skeptical physicians.
As the effort garners support from provider organizations across the country, Beth Israel Deaconess Medical Center (BIDMC) in Boston remains at the epicenter of research activities aimed at demonstrating that the sharing of visit notes with patients can improve overall safety and quality of care by ensuring the accuracy of clinician notes, while reducing medical errors and improving medication adherence.
Providing patients with “full and early access to their data” is a prerequisite, argues Sigall Bell, M.D., assistant professor of Medicine at BIDMC and Harvard Medical School, as well as director of patient safety and quality initiatives at the Institute for Professionalism & Ethical Practice at Boston Children’s Hospital. She believes that ambulatory care, in particular, presents some unique safety challenges and that the sharing of visit notes can go a long way towards fostering good communication between patients and doctors so that follow-up appointments and referrals, diagnostic tests and procedures, and prescribed medications are clearly understood.
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Does it matter if docs don't like EHRs?

Posted on Aug 20, 2015
By Michelle Ronan Noteboom, Contributing writer
Physicians are increasingly dissatisfied with their electronic health records. According to a recent survey conducted by the AMA and AmericanEHR Partners, just 34 percent of physicians said they were satisfied or very satisfied with their EHR in 2014, compared to 62 percent in 2010.
While the statistics make for great headlines, should we be alarmed – or even care?
To summarize the findings: 42 percent of physicians thought their EHR's ability to improve efficiency was difficult to very difficult; 72 percent believed their EHR made it difficult to very difficult to decrease their workload; 54 percent reported that their EHR increased total operating costs; 43 percent claimed they hadn't overcome productivity challenges related to their EHR.
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Wachter on patient safety musts

Posted on Aug 20, 2015
By Bernie Monegain, Editor-at-Large
As much as patients have benefited from a healthcare system that has avoided blaming individual care providers for errors, Robert Wachter MD, proffers that the approach must also include accountability.
He writes in a new blog post in the journal Health Affairs that there are some practices in medicine that are a must-do, not merely a nice-to-do.
Robert Wachter, MD"We believe that the time has come to articulate criteria for 'must do' safety practices: practices that have sufficiently compelling supportive evidence that clinicians should not have the right of individual veto," he writes.
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Vendor changes increasing EHR satisfaction among larger doc practices

August 19, 2015 | By Marla Durben Hirsch
Vendor improvements to their electronic health records are increasing large practices' satisfaction with their systems, according to a new survey from Black Book Rankings.
The survey, of 1,304 large multispecialty practices, found a shift upward. For instance, in 2013, 92 percent of multispecialty groups using EHRs were very dissatisfied with their systems' ability to improve clinical workload, documentation and user functionalities. But in 2015, 71 percent of large practice clinicians said that their expectations were met or exceeded; 82 percent of support and administrative staff also reported better operational and financial performance.
Allscripts, Greenway, McKesson and athenahealth all recorded the largest increases in satisfaction in the past 12 months. Users of these systems stated that uptick was due to vendor investments in updates and releases, practice assessments and clinical workflow enhancement. Other factors included revenue cycle management and analytics value add, population health improvements and solicitation of physician feedback.
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Hospitals face readmissions head on with help from health IT [Special Report]

August 19, 2015
By Katie Dvorak
From the minute a patient is admitted to the hospital and for months after he or she leaves, providers are committed to ensuring a return visit doesn't happen--and health IT is aiding in that effort.
As penalties continue to come down and costs continue to rise, providers are using all the tools at their disposal to combat the problem, with the goal of keeping patients healthy the most important of all.
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Vendor changes increasing EHR satisfaction among larger doc practices

August 19, 2015 | By Marla Durben Hirsch
Vendor improvements to their electronic health records are increasing large practices' satisfaction with their systems, according to a new survey from Black Book Rankings.
The survey, of 1,304 large multispecialty practices, found a shift upward. For instance, in 2013, 92 percent of multispecialty groups using EHRs were very dissatisfied with their systems' ability to improve clinical workload, documentation and user functionalities. But in 2015, 71 percent of large practice clinicians said that their expectations were met or exceeded; 82 percent of support and administrative staff also reported better operational and financial performance.
Allscripts, Greenway, McKesson and athenahealth all recorded the largest increases in satisfaction in the past 12 months. Users of these systems stated that uptick was due to vendor investments in updates and releases, practice assessments and clinical workflow enhancement. Other factors included revenue cycle management and analytics value add, population health improvements and solicitation of physician feedback.
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Top 4 EHR vendors with most improved user satisfaction

Written by Akanksha Jayanthi (Twitter | Google+)  | August 19, 2015
Over the past six years, EHR satisfaction among large physician practices has risen, according to a Black Book Rankings report. From 2013 to the second quarter of 2015, physician experience satisfaction has increased 737.5 percent, from 8 percent to 67 percent.
In 2013, 92 percent of multispecialty groups using EHRs said they were "very dissatisfied" with their EHR systems' ability to improve clinical workload, documentation and user functionalities. However, in 2015, 71 percent said their expectations for vendors to optimize and improve their EHRs had been met or had been exceeded.
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HIMSS Seeks Input on Role of Government in HIT

AUG 19, 2015 7:29am ET
What comes after Meaningful Use? And, what is the appropriate role that government should play in health information technology going forward?
Those are the kinds of questions the Healthcare Information and Management Systems Society is trying to answer by collecting industry feedback through a survey that delves into government intervention.
Given that Stage 3 is likely to be the final stage of the EHR Incentive Program, HIMSS believes that now is the right time to get industry input on the proper role for government in health IT, especially in light of ongoing efforts by the Department of Health and Human Services for healthcare delivery system reform and the Precision Medicine Initiative that will rely heavily on health IT to achieve their objectives. 
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Telehealth program slashes lengths of stay, boosts outcomes

Posted on Aug 19, 2015
By Eric Wicklund, Editor, mHealthNews
A telehealth program that engages patients before and after their hip and knee replacement procedures not only made those patients feel better about the experience and their providers, but reduced length of stay and improved post-discharge responses.
VOX Telehealth, based in Princeton, New Jersey, reported those results from a study conducted at Bon Secours St. Mary's Hospital in Richmond, Virginia, where the program was compared to the hospital's traditional process and national averages.
According to VOX officials, 92 percent of patients enrolled in the telehealth platform -- which starts 30 days before surgery and continues until 60-90 days after surgery -- were discharged directly to home, compared to a national average of only 30 percent. Officials attribute that improvement to the fact that patients are more prepared for the process, so there are fewer complications or concerns that would merit a longer stay of transfer to another facility (length of stay, in fact, dropped to 1.6 days, compared to the hospital's average of two days and the national average of 3.7 days).
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Virtual reality for medical training: How it benefits hospitals

August 19, 2015 | By Katie Dvorak
While virtual reality use to train medical employees is still fairly new, some health organizations already are seeing benefits from the technology.
At Nicklaus Children's Hospital, for example, part of the Miami Children's Health System, virtual reality is being used to train employees on procedures that include cardiopulmonary resuscitation (CPR), nasal gastric tube insertion, starting an IV, wound care and more, according to a Fortune article.
In addition, virtual reality use at Miami Children's is improving retention rates, CEO Narendra Kini says in the article. The provider has seen retention hit close to 80 percent after a virtual training session, compared to 20 percent after traditional training.
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FDA's infusion pump warning sends 'powerful message' on risk management

August 19, 2015 | By Susan D. Hall
The U.S. Food and Drug Administration's warning to healthcare organizations to stop using a line of infusion pumps because of cybersecurity flaws is only one of the regulatory developments affecting medical device makers and pharmaceutical firms, attorney Anna Spencer says in an interview with HealthcareInfoSecurity.
Still, the agency sent "a very powerful message to the industry" to be more focused on risk management, says Spencer, a partner and team leader for health information policy in Sidley Austin LLP's healthcare and privacy, data security and information law practices.
At the same time, companies also must grapple with how to apply older laws to the use of new technology, she adds.
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Healthcare IT market will grow at rapid rate

By AuntMinnie.com staff writers
August 18, 2015 -- Driven by an increase in healthcare costs, the healthcare information systems market is expected to reach $53.2 billion in revenues by 2019, according to a new report by Transparency Market Research.
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Hospitals Use Paper, Electronic Methods for Summary of Care Records Exchange

AUG 18, 2015 7:49am ET
Electronically exchanging health information with outside providers is critical to ensuring access to patient records at the point of care in hospital settings. However, less than 10 percent of hospitals use only electronic means of exchanging summary of care records with outside sources.
That’s the finding of a newly released Office of the National Coordinator for Health IT analysis of 2014 data from a nationwide survey of non-federal acute care hospitals conducted by the American Hospital Association.
ONC’s data brief reveals that last year a majority of hospitals used a combination of electronic and non-electronic means to send (77 percent) and receive (67 percent) summary of care records to/from outside sources. And, a quarter (26 percent) of hospitals received summary of care records in non-electronic format only (e.g., mail, fax or eFax).
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Stage 3 meaningful use: What's next?

Posted on Aug 18, 2015
By John Andrews, Contributing Writer
Stage 3 of meaningful use is shaping up to be the most challenging and detailed level yet for healthcare providers. Among the elements that warrant attention are quality reporting, clinical decision support and security risk analysis.
But first things first: Stage 3 may not be as near final as some would hope, and there are likely to be modifications before a final rule is issued, says Pamela Chapman, implementation specialist with Austin, Texas-based e-MDs.
"We have a long way to go until Stage 3 is finalized and it is my understanding that CMS is not even looking at the public comments yet, so we don't know what we'll be looking at," she said this past month.
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How the healthcare system discourages creating low-cost solutions

August 18, 2015 | By Susan D. Hall
The U.S. leads the world in creating new drugs and healthcare tech, but the system discourages inventors from creating cost-lowering technologies in favor of ones with a healthy return on investment, according to an article at the Journal of the American Medical Association.
"In the United States, the surest way to generate a healthy return on investment is to increase health care spending, not reduce it," says the authors, from the Uniformed Services University of the Health Sciences and Yale School of Medicine.
They use as an example a low-cost, once-a-day pill to treat cardiovascular disease, with the estimated potential to reduce the incidence of myocardial infarction and stroke by more than 80 percent.
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Cerner Wins DoD Award, Changing the Interop Landscape

Scott Mace, for HealthLeaders Media , August 18, 2015

Twin shocks have upset conventional wisdom: Epic failed to nab a coveted Department of Defense contract to supply electronic health records system technology, and along with other contenders, failed to appeal the federal government's decision.

EHR vendors' big ambitions include wanting to be every provider's health information exchange intermediaries, and replacing basic state-run and private HIE functions, that is: requesting patient records, and transmitting updated records after episodes of care.
Until now, these ambitions looked lopsided depending on the market share of the EHR vendor. Epic has claimed to have more than half the U.S. population under its EHR management. Kaiser and Geisinger led the Epic wave years ago. More recently, large academic medical centers in particular have skewed toward Epic.
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Community Hospitals Look to Replace EHR Vendors

AUG 17, 2015 7:43am ET
More than half of community hospitals across the country are unhappy with the usability of their EHR systems, and nearly 20 percent of those hospitals are actively looking to replace their EHR vendors, according to a recent survey.
That’s the finding of a new survey of 277 community hospital providers from healthcare research firm peer60. At a time when community hospitals—particularly rural hospitals—are struggling with financial challenges, these healthcare organizations are also finding the implementation of EHRs to be an unsatisfying experience: 54 percent of respondents indicated that they were unhappy with the usability of their system and 53 percent said their system lacked functionality. 
According to peer60, the introduction of federal Meaningful Use guidelines “has not been particularly good for community hospitals.” While 53 percent of providers in their survey have attested for Stage 2 Meaningful Use, a sizable portion of hospitals (36 percent) said they are still in the middle of attesting and 11 percent said they have not even started.
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OpenNotes showing benefits at BIDMC

Posted on Aug 17, 2015
By Mike Miliard, Editor
Five years after being chosen as one of three pilot locations for the OpenNotes project, Beth Israel Deaconess Medical Center is seeing encouraging returns from allowing patients access to their clinical notes.
A study this month in the Joint Commission Journal on Quality and Patient Safety makes the case that such no-holds-barred patient engagement can drive real improvements in quality and safety.
"What we heard from patients and doctors fell into recognizable categories – for example, catching medication errors, better remembering next steps and improved plan adherence, enhanced error reporting, improved coordination of care for informal caregivers of vulnerable patients with many providers and appointments and reduced diagnostic delay," according the report's lead author, Sigall Bell, MD, of the division of general medicine and primary care and assistant professor of medicine at Harvard Medical School.
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DirectTrust's David Kibbe: Healthcare waking up from years of security neglect

August 17, 2015 | By Susan D. Hall
Long-term neglect has put healthcare behind the curve in terms of security, according to David Kibbe, M.D., president and CEO of DirectTrust.
"I think we're getting the message, but we could do a lot better," he says in an interview with HealthcareInfoSecurity.
The healthcare industry is feeling the pressures of two competing concepts, he says: that information needs to flow more freely to better coordinate care, and that the more "liquid" flow of data is more vulnerable to hacking.
"Healthcare as an industry has not taken seriously security in the past, to the extent that other kinds of industries have taken security and privacy, and has not bothered to put those security components into place that would protect the privacy of that information," Kibbe says. "They are trying to play catch-up now, very desperately."
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Ready or Not: Oct. 1 ICD-10 Transition Deadline Appears Here To Stay

by Joe Infantino, iHealthBeat Senior Staff Writer Monday, August 17, 2015
All signs point to ICD-10 going live in October, observers say, regardless of whether all players are ready.
After years of delays, U.S. health care organizations are set to transition from ICD-9 to ICD-10 code sets by Oct. 1. With about a month-and-a-half left before the transition deadline, several lawmakers are pushing for more flexibility for those who aren't ready, while CMS has issued a set of measures aimed at easing lingering concerns.

A Long Time Coming

In 2009, HHS published regulations setting the ICD-10 transition for 2011.
But in the following two years, reports showed:
  • A general lack of readiness;
  • Providers were concerned about costs; and
  • The transition to the 5010 operating system in preparation for ICD-10 was not progressing smoothly.
By August 2012, HHS had delayed the transition date to Oct. 1, 2014. It was delayed again in the summer of 2014, when CMS announced a final rule establishing Oct. 1, 2015, as the new deadline.
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Enjoy!
David.