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August 2, 2010
By Alice Shepherd
For The Record
Vol. 22 No. 14 P. 10
Critics wonder what good it is to invest in EHR technology if it fails to engender itself to users who feel betrayed by its lack of intuitiveness.
EHR systems promise to increase efficiency and productivity, reduce costs, provide 24/7 accessibility to medical records, and improve clinical outcomes. Each day, about 300 vendors vie for market share, adding bells and whistles to already comprehensive product suites. Yet, if EHRs are so great, why isn’t every provider singing their praises? The problem, some say, lies not with functionality but with usability.
Stuck in the Past
While EHRs provide numerous benefits, users are sometimes frustrated with the time and effort it takes to enter information. “At this time, most providers are not realizing a productivity increase if they switch from paper to electronic records because it takes much longer to enter data,” says Jiajie Zhang, PhD, the Dr. Doris L. Ross professor and associate dean of research at the University of Texas Health (UT Health) Science Center at Houston. Zhang is also the principal investigator of UT Health’s National Center for Cognitive Informatics and Decision Making in Healthcare, which received a $15 million stimulus grant to conduct research to advance the adoption and meaningful use of HIT.
“Usability is a huge barrier to EHR adoption,” adds Eric Ford, PhD, the Forsyth Medical Center professor of healthcare management at the University of North Carolina in Greensboro. “In their current format, EHRs are cognitively burdensome and labor intensive to use. While physicians find that receiving lab and radiology reports electronically is a great time-saver, having to type formerly handwritten material is slow, and making selections from drop-down menus takes too many clicks. It’s still easier and quicker to write a note than to codify a diagnosis in an EHR. Science and industry need to improve the products dramatically.”
Ford and Zhang compare the current state of EHRs with personal computing using DOS 20 years ago. “People had to remember commands, like Shift + F4, and had cardboard labels above the keyboard to remind them of the most common commands,” says Ford. “Since then, consumer products have become far more usable, but that hasn’t happened yet in healthcare.”
By Mary Mosquera
Wednesday, August 11, 2010
Healthcare providers who already use electronic health records urged a federal health IT advisory panel last week to add more goals for improving patient care coordination into the meaningful use financial incentive plan.
These include sharing information about the medications that they prescribe their patients and merging them into their electronic records as patients obtain treatment from multiple physicians.
The resulting medication reconciliation will improve coordination of care and patient safety by avoiding duplication and potential adverse drug effects, according to one of the physicians testifying at August 5 meeting of the Health IT Policy Committee’s meaningful use work group.
Department of Health and Human Services honored Text4baby messaging service, which has more than 64,000 subscribers.
By Elizabeth Montalbano, InformationWeek
Aug. 9, 2010
The Department of Health and Human Services (HHS) has granted an innovation award to a mobile application that provides health information for expecting mothers.
Text4baby, which sends weekly health information to pregnant women, is one of three recipients of the department's HHSInnovates award, according to a White House blog post by Hillary Chen, a policy analyst in the White House Office of Science and Technology Policy.
A private-public partnership driven by federal CTO Aneesh Chopra developed Text4baby, which went live in February. The application has more than 64,000 subscribers, who receive free text messages providing pregnancy-health advice every week. More than 3.5 million messages have been sent since the service went live.
Lax handling of data, storage of it, and access to databases biggest culprit
By Ericka Chickowski, Special To Dark Reading, DarkReading
Aug. 10, 2010
Healthcare data breaches have swollen in 2010: Identity Theft Resource Center reports show that compromised data stores from healthcare organizations far outstrip other verticals this year. According to figures updated last week, healthcare organizations have disclosed 119 breaches so far this year, more than three times the 39 breaches suffered by the financial services industry.
Though many of these breaches aren't necessarily caused directly by unauthorized access or hacking of healthcare databases, some experts believe that the high numbers (PDF) are due to lax handling of how data is stored and accessed within these databases. This atmosphere, along with the extreme portability of healthcare data due to consumer devices and laptops and increasing numbers of malicious insiders seeking to profit from electronic medical records (EMRs) and other patient data, has formed a poisonous combination within the industry.
August 2, 2010
Selling Physicians on the Value of Speech Recognition
By Lisa A. Eramo
For The Record
Vol. 22 No. 14 P. 14
To avoid a lackluster reception, experts recommend several steps healthcare organizations can implement to obtain staff buy-in.
At Rockingham Memorial Hospital (RMH) in Harrisonburg, Va., all the tell-tale signs to justify using speech recognition were present: a failing end-of-life legacy dictation system, increasing dictation demands, escalating costs, and overall physician dissatisfaction with transcription services. The hospital knew it needed to make the switch, but first it needed to figure out how to get physicians on board.
“Physician buy-in is critical to the success of any clinical documentation process,” says Mike Rozmus, chief information officer (CIO) and vice president of information services at RMH. In 2008, he organized a transcription task force to examine alternatives to what he says was a failing transcription model that included a combination of insourced and outsourced services.
By Jeff Rowe, Editor
"'In this world,” Ben Franklin once famously wrote to a French acquaintance, “nothing can be said to be certain, except death and taxes."
After reading two recent sets of comments from healthcare sector stakeholders, we can’t help but wonder if even a cursory exposure to the world of HIT might lead Mr. Franklin to add to his list of certainties.
The first comment comes from The Leapfrog Group, a watchdog organization which, in the wake of the new Meaningful Use rule, praised federal policymakers for a “good first step”, but then voiced disapproval for what it sees as a lack of attention to HIT safety issues.
4 Mass. hospitals investigating
Four Massachusetts community hospitals are investigating how thousands of patient health records, some containing Social Security numbers and sensitive medical diagnoses, ended up in a pile at a public dump.
The unshredded records included pathology reports with patients’ names, addresses, and results of breast, bone, and skin cancer tests, as well as the results of lab work following miscarriages.
By law, medical records and documents containing personal identifying information must be disposed of in a way that protects privacy, and leaving them at a dump is probably illegal, privacy lawyers and hospital officials said. Violators face steep fines.
A Globe photographer discovered the records July 26 when he was dumping his trash at the Georgetown Transfer Station. When he got out of his car, he said, he saw a huge pile of paper about 20 feet wide by 20 feet long. Upset that the paper wasn’t being recycled, he looked more closely.
Posted: August 12, 2010 - 11:30 am ET
Part one of a two-part series.
Health information technology in current use is incapable of providing the level of privacy protection that some patients may desire, so it is important for federal policymakers as well as healthcare providers not to oversell the limited protections that are available, according to a federal privacy and security advisory panel.
In fact, providers should consider discussing privacy limitations with patients instead.
"I think the conclusion we can draw is if we really want to maintain the patients' sense of trust, we shouldn't let them conclude that they have more protection," said Wes Rishel, a vice president in the healthcare provider research practice of Gartner, an IT market-research firm.
Rishel is a member of the privacy and security Tiger Team, a special work group of the federally chartered Health IT Policy Committee. The committee was created under the American Recovery and Reinvestment Act of 2009 to advise HHS on healthcare policy matters.
August 12, 2010 — 11:14am ET | By Neil Versel
We've often reported how EMRs represent vast, untapped sources of clinical and business intelligence. A system developed at Massachusetts General Hospital to extract EMR data for radiologists may be able to help far beyond imaging departments, according to new research published in the Journal of the American College of Radiology.
"The potential impact of advanced EMR search tools is by no means limited to radiology and in fact many departments in the hospital and outpatient clinic may benefit from these capabilities," lead author Dr. Michael Zalis, a diagnostic radiologist at Mass General, says in an American College of Radiology press release.
VA, DOD agree on single lifetime personal identifier
By Mary Mosquera
Wednesday, August 11, 2010
The Veterans Affairs and the Defense departments have agreed on a single common personal identifier, one of the keys to its efforts to build an electronic record that can be follow military service members throughout their lifetimes.
The agreement is a significant step toward making the complex Virtual Lifetime Electronic Record (VLER) project a reality because it will identify a service member whether they are seeking healthcare services or payment benefits and on active duty or retired, according to a senior VA official.
Thursday, August 12, 2010
by Protima Advani
The much-awaited final rule defining the first stage of "meaningful use" of electronic health records -- a requirement that hospitals and eligible professionals (EPs) must meet in order to qualify for the Medicare and Medicaid incentives -- is finally here. Overall, the final definition relaxed the meaningful use criteria for hospitals and physicians, expanded the eligibility requirements making more entities eligible for incentives and clarified critical details surrounding the incentive program payout schedules. Detailed below are the most salient changes to the meaningful use requirements and their implications for health care providers aiming to collect the meaningful use incentives.
August 10, 2010 | Molly Merrill, Associate Editor
CINCINNATI – Today some ambulances come equipped with telecommunciations technology that allows in-transport contact with physicians. But even the minutes between when a patient is loaded into the ambulance, or out and into a care setting, can leave room for miscommunications, according to one expert.
That is why Hamilton Schwartz, MD, led an initiative to find a technology that would allow his team access to the patient from the moment of pick-up until the patient was physically in the same room with the physician. Schwartz is a board certified emergency room pediatric practitioner, who serves as the medical director of Statline, a division of the Cincinnati Children’s Hospital Medical Center’s Emergency Department that serves as the hospital’s interface with emergency medical service providers and ambulance transport teams. After hearing about Scottsdale, Ariz., based GlobalMedia, Schwartz contacted the telemedicine company and they began a two-year collaboration.
05 Aug 2010
WellDoc, a specialist in mobile health applications, has received FDA clearance for its WellDoc DiabetesManager System aimed at patients with type 2 diabetes.
The United States Food and Drug Administration (FDA) 510(k) clearance to will enable the firm to market the WellDoc DiabetesManager System to healthcare providers and their adult diabetes patients.
WellDoc’s system offers automated clinical coaching and behavioural algorithms driven by real-time patient data. Patients and their healthcare professionals can configure specific parameters and extend their care beyond traditional office visits by using a mobile phone application and the Internet.
09 Aug 2010
The delayed French electronic health record, Dossier Medical Personnel (DM-Personnel), will be launched by the end of the year, the agency responsible for the programme has said.
The EHR will allow patients to organise their health records for consultations with their GP and other healthcare providers and give them access to medication histories and a summary of recent appointments.
The second part of the programme, the Dossier Medical Patient (DM-Patient), will be developed over the next few years to allow medical records to be shared among healthcare professionals.
Current e-health record software fails to help clinicians identify patients who need additional services, finds government report.
By Nicole Lewis, InformationWeek
Aug. 11, 2010
As doctors increasingly extract more data from the health IT they've deployed, a new study finds that software that tracks population health at physician practices is very limited.
The report, "Practice-Based Population Health: Information Technology to Support Transformation to Proactive Primary Care," is based on interviews with 18 physicians and nine clinicians and other office staff to find out if they are using technology that collects data on practice-based population health (PBPH).
Published last month by the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ), the report defines PBPH as an approach to care that uses information on a group of patients within a primary care practice or group of practices to improve the care and clinical outcomes of patients within that practice.
e-Health Intelligence Report
10 August 2010
This paper, the first in a series of WSDAN briefing papers, looks at how telehealth and telecare innovations are being used in health and social care. It considers the range of innovative approaches that have been developed, giving some practical examples. We identify some of the key challenges to the adoption of technology-based approaches to care, and suggest some strategies to overcome these challenges, so that telehealth and telecare innovations may be sustained. The ‘References’ and ‘Resources’ sections at the end of the paper provide useful links to key documentation, innovations and evidence.
- 08/09/10 04:42 PM ET
Preventable medical errors cost the country $19.5 billion in 2008 — or roughly $13,000 for each avoidable case, according to a report published Monday by the Society of Actuaries (SOA).
And that number is likely low, according to consultants at Milliman, who crunched the data.
"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, an actuary for Milliman who co-authored the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."
Gienna Shaw, for HealthLeaders Media, August 10, 2010
From a tiny eye telescope to microscopic health data on the surface of contact lenses to advances in cancer treatments, medical devices continue to get smaller and smaller. And the smallest of the small fields—nanotechnology—is expected to get bigger (so to speak) over the coming years.
The global market for nanotechnology was worth $11.6 billion in 2007 and could reach $27.0 billion by the end of 2013, according to India-based market research firm Bharatbook in a report released this month. Biomedical applications has the highest projected growth rate (56%) compared to other applications over the next 5 years.
Posted: August 10, 2010 - 11:30 am ET
In a big week for information technology deals, healthcare businesses across the country sought to capitalize on growing demand for IT that can help companies analyze and control their healthcare costs and meet the changing health needs of an aging population.
GE Healthcare and Intel Corp. last week announced they are forming a joint venture to tap what's expected to be a multibillion-dollar market for systems to support independent living and chronic-disease management programs. Meanwhile, four other healthcare industry firms formed new IT alliances. Patient-satisfaction ratings firm Press Ganey Associates, South Bend, Ind., acquired one of the nation's forerunner systems for clinical performance measures, the Maryland Hospital Association's Quality Indicator Project for undisclosed terms. And Eden Prairie, Minn.-based Ingenix, a division of UnitedHealth Group, revealed plans to acquire Executive Health Resources, Newtown Square, Pa., a company that provides software and services that help hospitals with physician medical management and necessity compliance.
Posted: August 10, 2010 - 11:45 am ET
IBM Corp. has acquired the privately held information-capture firm Datacap, Tarrytown, N.Y., as the company continues to look for inroads into the healthcare industry.
Datacap sells data-management systems that help clients create digital documents from disparate formats and manage them in centralized systems. Healthcare clients, for example, can use the systems to automate image-capture processes for medical claims, patient correspondence, enrollment forms, encounter forms, medical records, laboratory results and other records, according to a news release.
Senators Propose HITECH Incentives For Mental Health
Senators Whitehouse and Reed introduced a bill proposing to expand e-health record system use by mental health, behavioral health and substance abuse professionals and facilities.
By Marianne Kolbasuk McGee, InformationWeek
Aug. 10, 2010
A bill proposing to extend Health Information Technology for Economic and Clinical Health Act (HITECH) financial incentives for e-health record use by mental health professionals has been introduced into the U.S. Senate, complementing similar legislation introduced in the U.S. House of Representatives in April.
The Health Information Technology Extension for Behavioral Health Services Act of 2010, introduced last week in the U.S. Senate by Senators Sheldon Whitehouse (D-RI) and Jack Reed (D-RI) aims to expand use of e-health record system by mental health, behavioral health and substance abuse professionals and facilities, including licensed psychologists, clinical social workers and psychiatric hospitals.
Health-insurance companies including Humana Inc. and Aetna Inc. are stepping into the race to equip doctors with high-tech patient records.
The lure: the estimated 80% of U.S. physicians and 90% of hospitals whose records are still on paper, and the $27 billion in federal stimulus money available to help these holdouts switch. The Obama administration last month outlined how doctors can qualify for the funds starting next year. Come 2015, doctors will be penalized under Medicare if they haven't computerized their records.
Work on the Department of Health and Human Services' Nationwide Health Information Network to include issuing digital certificates, updating network directories, and providing help desk support.
By Nicole Lewis, InformationWeek
Aug. 3, 2010
The Department of Health and Human Services has awarded IT services provider Stanley a two-year, time-and-materials contract valued at $6 million to provide operation and infrastructure support for the Nationwide Health Information Network (NHIN).
The NHIN, which is being developed under the direction of the Office of the National Coordinator for Health Information Technology (ONC), will provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and other stakeholders involved in supporting healthcare.
HDM Breaking News, August 6, 2010
San Jose, Calif.-based Axolotl Corp. has introduced a streamlined, lower-cost version of its core Elysium health information exchange software.
Elysium Express is designed for hospital-to-physician and physician-to-physician connectivity, according to the San Jose, Calif.-based vendor.
Monday, August 09, 2010
Now that the health care industry has had time to fully digest the final rule on "meaningful use," federal officials are looking to the private sector to help drive health IT adoption and propel the country's health care providers to becoming meaningful users of electronic health records.
At a briefing sponsored by the Health Industry Forum at Brandies University and the journal Health Affairs on Thursday, National Coordinator for Health IT David Blumenthal told a packed room at the National Press Club in Washington, D.C., that "changing the health care system is a team sport." He said that it's now time for the private sector to "pick up the baton and run with it."
Based on the panels following Blumenthal's opening remarks, it appears the private sector is ready to do just that.
August 9, 2010 — 2:05pm ET | By Neil Versel
Two government officials who have been at the forefront of health IT implementation and quality improvement for years call last month's publication of the standards for "meaningful use" of EHRs a "starting point" on a "journey toward ubiquitous and effective use of health information technology," while also putting the rule into historical perspective.
Writing on the blog of policy journal Health Affairs, national health IT coordinator Dr. David Blumenthal and CMS Administrator Dr. Donald M. Berwick remind the healthcare community that the Office of the National Coordinator for Health Information Technology has been around for six years. They also note that it's been more than a decade since the Institute of Medicine dropped its bombshell of a report on medical errors, To Err Is Human (1999) and followed it up two years later with an equally significant tome, Crossing the Quality Chasm.
New Rochelle, NY, August 9, 2010—Without hands-on access to doctors and hospitals, oil rig workers who become sick or injured increasingly rely on telemedicine "visits" with physicians and specialists on land, a trend explored in detail in an article published in Telemedicine and e-Health, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). The article is available free online at www.liebertpub.com/tmj
Work on an oil rig can be dangerous, with cuts, sprains, fractures, and other injuries not uncommon. Ailments such as respiratory infections, asthma, and heart attack also pose a serious problem on a rig, where access to medical professionals is limited. To improve healthcare delivery, oil companies increasingly depend on technology to link a nurse or emergency medical technician working on the oil platform to emergency physicians and specialists at major medical centers through Internet or satellite connections.