Friday, November 26, 2010

Weekly Overseas Health IT Links - 26 November, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. 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.


Wireless health care


The convergence of mobile telephony and health care is under way

Nov 11th 2010 | WASHINGTON, DC | From The Economist print edition

BILL GATES seems to relish being the skunk at the garden party. The former boss of Microsoft, now a global-health philanthropist, was invited to address a big “m-health” conference in Washington, DC, this week. Some 2,400 proponents of delivering health services over wireless telecoms, from the private and public sectors, gathered to celebrate the dozens of pilot projects under way around the world.

Mr Gates, however, warned the participants not to celebrate too soon. Just because an m-health pilot scheme appears to work in some remote locale, he insisted, don’t “fool yourself” into thinking it really works unless it can be replicated at scale. Rafael Anta of the Inter-American Development Bank was even more cautious: “We know little about impact and nothing about business models.”

Happily, evidence of m-health’s usefulness is at last starting to trickle in. A study this week in the Lancet, a medical journal, shows that something as simple as sending text messages to remind Kenyan patients to take their HIV drugs properly improved adherence to the therapy by 12%. WellDoc, an American firm, found in a recent trial that an m-health scheme that relies on behavioural psychology to give diabetics advice on managing their ailment has more effect than putting them on the leading diabetes drug.


Verizon Offers Free Security Credentials To Healthcare Professionals

The credentials meet Level 3 authentication requirements and allow healthcare providers to receive digitized health data from other clinicians securely.

By Marianne Kolbasuk McGee, InformationWeek

Nov. 17, 2010


Verizon Business is offering 2.3 million licensed healthcare professionals in the U.S. free medical identity credentials to make it easier for clinicians to securely share patient information via Verizon’s own Medical Data Exchange and other e-health platforms.

The credentials can allow healthcare providers to securely receive digitized health data from other clinicians via private inboxes accessed from a new Verizon Medical Data Exchange physician web portal.

Verizon’s multi-factored identity credentials meet Level 3 authentication requirements of the National Institute of Standards and Technology, said Steven Archer, head of Verizon Business Innovation Incubator Group. The security offering allows healthcare providers to comply with provisions of the HITECH Act that require "strong identity" credentials for accessing and sharing patient data starting in mid-2011.


Standard Debate

The need for standards to underpin interoperability was one of the big themes of eHealth Insider Live 2010. Daloni Carlisle reports.

Back in the day, the mantra was “education, education, education”. At eHealth Insider Live 2010, it might have been “standards, standards, standards”.

From an IT perspective, the government’s pledge to free the NHS from bureaucracy and devolve power to the frontline can only be achieved with the underpinning of universally accepted standards.

It is standards, most of those attending the two-day conference and exhibition in Birmingham agreed, that underpin interoperability.

And it is interoperability that underpins the ‘connect all’ rather than ‘replace all’ philosophy for IT systems that was launched 18 months ago, but which has been taken up by the new administration.

It is also interoperability that will enable the flow of information that the NHS will need to deliver the efficiency, productivity and innovation required of it. And, indeed, the new information driven services for patients outlined in the current consultation on an ‘information revolution.’


OIC: Alarming Rates of Preventable Adverse Events

HDM Breaking News, November 16, 2010

A startling number of adverse events affect Medicare beneficiaries in hospitals, according to a study from the Department of Health and Human Services' Office of Inspector General. Based on a random sample of 780 beneficiaries discharged during October 2008, the OIG estimates:

* 13.5 percent of beneficiaries experienced adverse events during their hospital stay--prorated to 134,000 beneficiaries experiencing at least one adverse event during that single month;

* Another 13.5 percent experienced other events not labeled as "adverse" that resulted in temporary harm. Many cases were minor, but others were classified as "temporary" only because the patients were in the hospital for a lengthy period for other reasons, which allowed the hospital enough time to address the "temporary harm" before discharge;


GAO: EHRs promote better care

By Christine LaFave Grace

Posted: November 17, 2010 - 12:00 pm ET

The use of electronic health records supports efforts to improve patient care within integrated healthcare delivery systems, according to a report from the Government Accountability Office.

The GAO report details the strategies that 15 public and private integrated delivery systems serving medically underserved populations have employed to provide better-coordinated and higher-quality care. In interviews with GAO researchers, officials from the surveyed ID systems said that EHRs serve to boost care quality by improving communication among physicians, staff members and patients and by increasing the availability of clinical information and patient population data.


GAO: EHRs improve care coordination, quality at large health systems

November 18, 2010 — 2:13pm ET | By Neil Versel

EHRs can, in fact, improve the quality of care, at least at large, integrated delivery systems, says a new report from the Government Accountability Office. But even major provider organizations continue to struggle to share EHR data outside of their own networks.

The GAO report, required by the Health Care Safety Net Act of 2008, says that EHRs support care coordination, disease management, computerized physician order entry, e-prescribing and adherence with care protocols at many of the 15 public and private delivery networks the federal agency studied. Operating a health plan and employing physicians also can help bolster care quality, the GAO says.


Healthcare sector among top adopters of iPad

November 15, 2010 | Molly Merrill, Associate Editor

REDWOOD CITY, CA – The healthcare sector is among the top three industries seeing the heaviest adoption of the iPad for business use, according to data from Good Technology, a Redwood City-based provider of multiplatform enterprise mobility.

The data comes from an analysis of Good Technology's user base, which includes more than 4,000 enterprise customers, whose iPad deployments range from one to more than 1,000 iPads.

"We took a close look at our customers who have deployed iPad devices so far," said John Herrema, senior vice president of corporate strategy at Good Technology. "We found that the financial services sector dominated, accounting for 36 percent of Good's iPad activations to date. The technology sector came in second at 11 percent, followed closely by healthcare at 10 percent. We believe these industries are embracing the iPad because its unique design makes it easier to perform time-sensitive, mission-critical tasks."


Sunday, November 14, 2010 3:22 AM EST

Health apps: the next big thing in smartphone wave

By IB Times Staff Reporter

Five hundred million of a total of 1.4 billion smartphone users will be using mobile health applications in 2015, a report said.

The report from Berlin-based research2guidance found that both healthcare providers and consumers are embracing smartphones as a means for improving healthcare.

"Our findings indicate that the long-expected mobile revolution in healthcare is set to happen," Ralf-Gordon Jahns of research2guidance said.


First NHS trust goes live with Alert

18 Nov 2010

Blackpool, Fylde and Wyre Hospitals NHS Foundation has become the first NHS trust to go live with an electronic patient record system from Alert Life Sciences, E-health Insider can exclusively reveal.

The trust signed a deal with Portuguese company, Alert last November and went live with its Emergency Department Information System across it A&E department on Tuesday.

The system is being used by 200 core staff that work in the department as well as 250 who need to access the information as part of their job. The system is said to provide a fully integrated clinical record, including the use of orders and results, eprescribing and clinical documentation functionality.


Blumenthal: Specialists may claim exceptions to certain MU measures

November 18, 2010 — 4:17pm ET | By Neil Versel

Remember the uproar from some specialty societies and makers of specialty EMRs over their perception that the CMS rules for "meaningful use" of health IT unfairly favored primary-care physicians? Now, no less a figure than national health IT coordinator Dr. David Blumenthal is offering some tips on how specialists can comply.

According to American Medical News, Blumenthal told last month's meeting of the American Academy of Ophthalmology that specialists can claim an "exception" to each rule that doesn't apply to their specialty and still get credit for meeting that specific objective. He was backed up by Dr. Derek Robinson, medical director for HHS Region V, covering Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.


Broken-glass perils

I was talking with Catherine O'Neill recently about a federal rule called 42 CFR Part 2.

O'Neill is senior vice president and HIV/AIDs project director for the Legal Action Center, a not-for-profit law and policy organization based in New York with an office in Washington.

She is good at her job—so good that when I asked an official with HHS' Substance Abuse and Mental Health Services Administration about whether the unique consent requirements of 42 CFR Part 2 would mesh with a proposed health information network, he recommended I give O'Neill a call.

The 42 CFR Part 2 rule is intended to give drug- and alcohol-abuse patients and their caregivers some protection from law enforcement officers nosing around in medical records—the thought being that if drug users want to kick their habits, they should be encouraged to seek confidential treatment.


Designed for Efficiency, New Computer Software at Health Dept. Misfires


In July, the San Francisco Department of Public Health started using an $11.2 million electronic medical records system, Avatar, that was designed to streamline billing and improve care for tens of thousands of clients. Thus far, however, it has brought administrative chaos to the mental health and substance abuse services in the city.

Documents obtained by The Bay Citizen under a California Public Records Act request show that shortly after installing Avatar, providers struggled to use the new software, causing health officials to lose track of millions of dollars of services.

Officials are scrambling to fill in the missing data to meet deadlines to qualify for reimbursement from the state.

The department has a $310 million budget for mental health and substance abuse, and San Francisco General Hospital, city-run clinics, community organizations and private therapists provide the services. Medi-Cal reimburses the department for some of those costs.


AMIA issues new recommendations for health IT vendors, customers

Written by Editorial Staff

November 10, 2010

The American Medical Informatics Association (AMIA) has adopted recommendations for new practices targeting the reduction or elimination of tensions that mar relationships between health IT vendors and their customers, specifically with regard to indemnity and error management of health IT systems.

The recommendations, which resulted from deliberations by an AMIA board-appointed task force, seek to imbue the health IT vendor-customer relationship with transparency, veracity and accountability through collaborative education focused on the installation, configuration and use of health IT systems in combination with enterprise-wide ethics education to support patient safety, according to the Bethesda, Md.-based AMIA.


Heart patients not helped by phone monitoring as much as hoped

Heart failure patients who called daily to report their weight and symptoms were just as likely to be readmitted to a hospital or suffer another heart attack or die as those who received conventional care, a six-month trial shows.

By Thomas H. Maugh II, Los Angeles Times

November 17, 2010

It was a good, commonsense idea that simply didn't work out.

Researchers thought that having heart failure patients who were freshly released from the hospital call their doctors' offices daily to report their weight and symptoms might catch relapses earlier, allowing physicians to intervene quickly and save lives.

Unfortunately, that's not what happened. Patients who called in regularly were just as likely to be readmitted to the hospital or to suffer a heart attack or die as were those who received normal care, according to a six-month clinical trial of 1,653 patients by Yale University.

"We had a lot of faith and hope that providing increased information could improve outcomes," said Dr. Sarwat I. Chaudhry of Yale, who led the study reported at a Chicago meeting of the American Heart Assn. and online in the New England Journal of Medicine. "Obviously that wasn't enough."


Guerra On Healthcare: Don't Underestimate CPOE Challenge

Government program rushes implementation and may compromise patient safety, but are CIOs empowered to buck the system?

By Anthony Guerra, InformationWeek

Nov. 16, 2010


We all know that a cornerstone of the government's Meaningful Use program is CPOE. Requiring that only 10 percent of in-patient orders are entered electronically (for Stage 1) would seem to indicate policy makers realize just how difficult implementation is. However, speaking to CIOs who've given it a shot but were quickly rebuffed by livid physicians tells me that even 10 percent is unattainable if the approach is not right.

Usually "the wrong way" means too fast, and too fast means cutting corners. Those corners often involve engaging both the users and vendor at a deeper level than may seem necessary at first blush. I recently interviewed one of those rare -- but likely growing in numbers -- CIOs who is also an MD.


e-Health Intelligence Report

November 16, 2010

Scientific Articles

:: Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles

PLoS Med 2010;7(11)

We argue that the assumptions, methods, and study designs of experimental science, whilst useful in many contexts, may be ill-suited to the particular challenges of evaluating eHealth programs, especially in politicised situations where goals and success criteria are contested. We offer an alternative set of guiding principles for eHealth evaluation based on traditions that view evaluation as social practice rather than as scientific testing, and illustrate these with the example of England's controversial Summary Care Record program.

:: Open mHealth Architecture: An Engine for Health Care Innovation

Science 2010;330(6005):759-760

Mobile communication devices, in conjunction with Internet and social media, present opportunities to enhance disease prevention and management by extending health interventions beyond the reach of traditional care—an approach referred to as mHealth. However, mHealth is emerging as a patchwork of incompatible applications ("apps") serving narrow, albeit valuable, needs, and thus could benefit from more coordinated development.


A wealth of data … for vendors

With the proposed new health IT glitch-reporting system, developers will know immediately when a complaint has been lodged against their EHR, and vendors may even know the name of the person who filed the complaint. But the physicians, clinics or hospitals saddled with a buggy or hard-to-use system won't know if there have been multiple complaints filed against their vendor.

The EHR Safety Event Reporting System was announced Nov. 15 at the National Press Club in Washington.

David Blumenthal, the head of the Office of the National Coordinator for Health Information Technology at HHS, added federal heft and credibility to the project by being on hand at the launch party, calling the effort "a great example of the private sector providing leadership in a very important area."


HIMSS: Not 10% can meet meaningful use

By Joseph Conn

Posted: November 16, 2010 - 11:45 am ET

Fewer than 1 in 10 hospitals is prepared to meet most of the meaningful-use requirements to qualify for federal subsidy payments for electronic health-record systems under the American Recovery and Reinvestment Act, according to a survey by HIMSS Analytics, the market analysis arm of the Chicago-based Healthcare Information and Management Systems Society.

This data point was drawn from an ongoing survey by HIMSS Analytics that included 687 hospitals. The questioning was begun before the final rule on meaningful use was released in July, fixing the number of core and so-called "menu" requirements at 14 and 10 respectively.


5 Must-Haves for CMIO Success

Gienna Shaw, for HealthLeaders Media , November 16, 2010

Thinking of adding a chief medical information officer to your IT staff? You can't just pluck anyone from the doctor's lounge and consider the job filled. Here are five key attributes that should be part of the job description for any CMIO.

1. Must have leadership, communication skills

It might seem a little obvious, but CMIOs can't effectively champion electronic health record systems if their peers won't listen to them. "This physician has to be more than just a clinician, they have to be a leader," says Edward Marx, CIO at the 13-hospital Texas Health Resources in Arlington, TX. "That's what helps make an excellent CMIO."

Jon Morris, CMIO at WellStar Health System in Marietta, GA, agrees that the CMIO must be more than a spokesperson. "Don't misunderstand: I'm out there selling a lot of the time, but I also act as an interpreter [and] facilitate engagement of other providers."

Morris' communication skills and the fact that he has the respect of his peers is what makes it work, says Ron Strachan, senior vice president and CIO at WellStar. "Physicians need to be involved and they need to be involved from working with a peer, a respected peer, because I or any other CIO that's not a physician can stand up and essentially preach all day long about values of their involvement in various projects and process change, but I'll never have the credibility with the physicians at large when compared to one of their peers. There's no replacement for that," Strachan says.


Hospitals are bad for your health

November 16, 2010 — 11:45am ET | By Sandra Yin

Add this to the list of reasons a hospital might not be the best place for patients to seek care. Hospitals kill an estimated 180,000 patients a year due to adverse events, according to a report released Monday by the Department of Health and Human Services' Office of Inspector General.

The OIG report offers the first statistically valid national incidence rate for adverse events among hospitalized patients who are Medicare beneficiaries, officials said.


Welsh telehealth pilots save £2.2m

15 Nov 2010

Three demonstrator projects in Wales testing new ways of managing chronic conditions including use of predictive risk software and telehealth have reported NHS savings of at least £2.2 million in the last year.

The Chronic Conditions Management demonstrator sites in Carmarthenshire, Cardiff and Gwynedd have published a report on the second year of their three year project showing improving patient care, reduced emergency admissions and NHS savings.

All three sites are also using the Welsh predictive risk tool PRISM to identify high risk patients, improved joined up working and inform priorities for community based services.


With innovation, the concept is the easy part

- By Edward Meagher

- Monday, November 15, 2010

I couldn’t escape a sense of déjà vu at a recent industry conference. Jonah Czerwinski, director of VA’s internal innovation initiative (VAi2), delivered a glowing report. VA Secretary Eric Shinseki challenged VA’s more than 300,000 employees to provide “actionable ideas” that would increase access, lower costs, improve performance, or raise the quality of the services and benefits provided to our nation’s 25 million veterans. More than 50,000 VA employees responded with over 10,000 submissions.

Czerwinski praised this awesome display of care and commitment on the part of VA employees, and he described how the VAi2 program would manage this wealth of ideas. They would be evaluated, then selected ideas would proceed to piloting, and those proven most beneficial would be implemented.


A computer's advice to cut medical costs

Star Tribune (Minneapolis

MINNEAPOLIS — Do you really need an MRI for that aching back or sore shoulder? How about a CT scan?

For the last three years, thousands of doctors have been using a computer program to help answer those questions. They plug in information about an individual patient, and a computer using national guidelines tells them if a CT or MRI is a good choice — or if there's something better.

That simple step has helped save an estimated $28 million a year by eliminating thousands of unnecessary tests, according to the Institute for Clinical Systems Improvement, a health research group in Bloomington, Minn.

Starting next year, ICSI will make it available, free of charge, to doctors throughout Minnesota, in what some say could be a national model for curbing health costs.

"Doctors aren't infallible ... sometimes, they choose the wrong thing," said Cally Vinz, a vice president at ICSI, which sponsored the project with some of Minnesota's largest health plans and medical clinics.


Doctors: Web ratings flawed

Critics say Web scores based on few reviews are unfair, unreliable

By Julie Deardorff, Tribune reporter

November 15, 2010

Web-savvy consumers use online rating services to review restaurants, rant about hairdressers, praise carpenters and even assess their college professors. So why shouldn't patients rate their doctors?

While more than 30 different online services now grade doctors, assessing a doctor's skills has turned out to be much more complicated and controversial than ranking hotels or restaurants. Critics say that most sites have too few reviews per doctor to offer statistically significant information, and the medical establishment has vocally questioned the concept.

But the trend gets another chance at growth this month, with one of the best-known restaurant guidebooks, Zagat, joining the field of medical reviews in Illinois in a limited way.


Report Gives Brief, Clear MU Explanation

HDM Breaking News, November 15, 2010

A new report from consultancy Computer Sciences Corp. gives a brief, clear layout of the requirements and implications of the electronic health records meaningful use incentive program.

"The purpose of this paper is to take a closer look at the relationship between certification and meaningful use under the temporary certification program, and to outline what products need to be certified--and how they need to be used," according to the Falls Church, Va.-based company.


Privacy desires ignored

For psychiatrist Deborah Peel, maybe patient privacy and patient consent aren't identical twins, but they're sure close relatives.

Not surprisingly, a recent Zogby International poll commissioned by Peel's not-for-profit Patient Privacy Rights Foundation, Austin, Texas, focuses on patient consent and its relationship to privacy—a unity the federal government has chosen to either ignore or deny.

The 2,000 adult poll respondents reached by Zogby via the Internet put great store in their right to privacy. They cling to the quaint notion that they should be asked before their electronic health records are sent skittering off to unknown users for unknown purposes.


Mobile phones become tools of health promotion

By Steven Overly

Monday, November 15, 2010; 9

When District-based Voxiva released a free text message service in February sending prenatal health advice to expectant mothers, the technology firm hoped it would be a successful example of mobile health in the United States.

Nine months later, they say it has delivered.

The company and the other minds behind "text4baby" said at last week's mHealth Summit that more than 100,000 mothers-to-be have used the service. Johnson & Johnson also made a multimillion-dollar pledge over several years to help grow the program.


Coalition will collect data on EHR problems

By Joseph Conn

Posted: November 15, 2010 - 11:30 am ET

A coalition of medical societies and medical liability insurance carriers has announced the creation of a Web-based reporting system for physicians and other healthcare organizations to provide a centralized national repository of problems with electronic health-record system software.

According to a news release, in addition to collecting information, the Web service, called EHRevent, will "create reports that medical societies, professional liability carriers and government agencies such as the U.S. Food and Drug Administration will use to help educate providers on the potential challenges that EHR systems may bring."


NIH committed to advancing mHealth research, directors say

November 10, 2010 | Diana Manos, Senior Editor

WASHINGTON – Leaders at the National Institutes of Health and its nonprofit Foundation for the National Institutes of Health (FNIH) said they would stand behind the advancement of research for the use of mobile phones for healthcare.

At a national conference on mobile health, the mHealth Summit, held Nov. 8-10 in Washington, D.C., NIH Director Francis Collins, MD, called mHealth "a growing opportunity."

Collins, noted for his prior work in leading the Human Genome Project said, "it's time to take advantage of the marriage of mobile technology and research. That's why, in 2010, NIH will issue 150 grants for mHealth research. The research will include the use of mobile phones, telehealth and GPS.

Some studies already underway include one at Arizona State University using a wearable, real-time chemical sensor system to assess personal exposure to hydrocarbons. Another at UCLA involves the use of a microscope that doesn't need a lens to transmit data in resource-limited locations. A computer can interpret the images from the phone for infectious disease.


Laptop thefts top cause of health data breaches

By Mary Mosquera

Friday, November 12, 2010

Laptop theft is the most prevalent cause of the breach of health information affecting more than 500 people, according to the Health & Human Services Department, which last year began tracking data breaches by public and private healthcare organizations.

The fact that laptops are so easily stolen underscores the importance of physical security in the protection of health information, according to Adam Greene, senior health IT and privacy specialist in HHS’ Office for Civil Rights, which enforces the privacy and security rules under the Health Insurance Portability and Accountability Act (HIPAA).

Of the 189 records of data breaches affecting more than 500 individuals in the first year, 52 percent were from theft. About 20 percent were from unauthorized access and disclosure of protected information, while 16 percent were from loss, he said Nov. 10 at the mHealth Summit conference.


AMIA 2010: 'Five to 10 years away' always seems five to 10 years away

November 15, 2010 — 3:25pm ET | By Neil Versel

Health IT always seems to be five to 10 years away from radically transforming what passes for a healthcare system in this country. If you recall, Dr. David Brailer's national health IT strategy was based on President George W. Bush's 2004 goal of delivering interoperable EMRs to most Americans by 2014. President Barack Obama, upon taking office in 2009, reiterated the 2014 target date, but raised the goal to all Americans.

I'll have more tomorrow in FierceMobileHealthcare about some lofty prognostications from last week's mHealth Summit. Today, though, I'd like to draw your attention to some comments made Sunday by Dr. Don Detmer, immediate past president and CEO of the American Medical Informatics Association.


e-health entering era of ‘normality' says industry leader

e-health is now very much on the political agenda, recognised as a key enabler for delivering better healthcare and choice for patients. In this article Dr Harald Deutsch, Vice President CSC Healthcare EMEA, explains why he believes we are entering an era of the “normalisation” of e-health and how the convergence of technology standards will be a key driver for success. He also explores how healthcare – and e-health – could be a winner from the financial crisis.

Time after time, we hear from industry when something new comes along – like cloud computing, for example – that it’s a “new era” for health, that it’s a breakthrough, that it’s something revolutionary. Then, on the other hand, there are some groups that are saying that there is an e-health speculative bubble in Europe which is going to burst.

Normalisation of e-health

I would say that neither of these positions is correct. What we are currently observing is “normalisation” of e-health. By that I mean that e-health is becoming recognised as the way we do things – and as a means of doing them better – in the day-to-day decisions taken by politicians and managers of Healthcare IT.




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