Saturday, December 18, 2010

Weekly Overseas Health IT Links - 18 December, 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.


CPOEs Can Decrease Mortality Rates, Research Shows

Cynthia Johnson, for HealthLeaders Media , December 9, 2010

By now, many healthcare organizations are on the road to implementing electronic medical record (EMR) and computerized physician order entry (CPOE) systems that we optimistically hope will cut costs, improve quality, and reduce medical errors—as well as comply with federal and state regulations. Although some organizations are further along on this journey than others, we all could use a little encouragement that we're travelling in the right direction.

A recent study released by researchers at Lucile Packard Children's Hospital (LPCH) and Stanford University may be just the signpost we've been waiting to see.

For the first time, researchers have shown that a significant decrease in hospital-wide ­mortality rates can be associated with implementing a CPOE system that enables physicians and other medical staff to order medications, tests, and other treatments electronically. If configured properly, the systems can also provide decision support at the point of care.


Telemonitoring in Patients with Heart Failure

Sarwat I. Chaudhry, M.D., Jennifer A. Mattera, M.P.H., Jeptha P. Curtis, M.D., John A. Spertus, M.D., M.P.H., Jeph Herrin, Ph.D., Zhenqiu Lin, Ph.D., Christopher O. Phillips, M.D., M.P.H., Beth V. Hodshon, M.P.H., J.D., R.N., Lawton S. Cooper, M.D., M.P.H., and Harlan M. Krumholz, M.D.

N Engl J Med 2010; 363:2301-2309December 9, 2010


Small studies suggest that telemonitoring may improve heart-failure outcomes, but its effect in a large trial has not been established.


We randomly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was reviewed by the patients' clinicians. The primary end point was readmission for any reason or death from any cause within 180 days after enrollment. Secondary end points included hospitalization for heart failure, number of days in the hospital, and number of hospitalizations.


The median age of the patients was 61 years; 42.0% were female, and 39.0% were black. The telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point, which occurred in 52.3% and 51.5% of patients, respectively (difference, 0.8 percentage points; 95% confidence interval [CI], −4.0 to 5.6; P=0.75 by the chi-square test). Readmission for any reason occurred in 49.3% of patients in the telemonitoring group and 47.4% of patients in the usual-care group (difference, 1.9 percentage points; 95% CI, −3.0 to 6.7; P=0.45 by the chi-square test). Death occurred in 11.1% of the telemonitoring group and 11.4% of the usual care group (difference, −0.2 percentage points; 95% CI, −3.3 to 2.8; P=0.88 by the chi-square test). There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components. No adverse events were reported.


Among patients recently hospitalized for heart failure, telemonitoring did not improve outcomes. The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption. (Funded by the National Heart, Lung, and Blood Institute; number, NCT00303212.)


European Pharmacists Call For Pharmacist Access To Electronic Patient Records

08 Dec 2010

The Pharmaceuctical Group of the European Union (PGEU) the association representing Community Pharmacists, calls for pharmacists to be granted access to electronic patient records in a statement on E Health released today.

The statement points out that E Health represents a major opportunity to improve patient safety and make health services in Europe more cost effective and efficient.

Appropriate deployment of both e-prescribing systems and electronic health records, as well as other ICT tools such as decision support systems, can significantly contribute to the minimisation of harm to patients who have to take multiple medications.


The iPad goes to the OR

December 07, 2010 | Molly Merrill, Associate Editor

DURHAM, NC – Surgeons at Georgetown University are exploring the benefits of using an iPad in the operating room, according to an article published in the Journal Surgical Radiology. One surgeon says the technology's most obvious advantage in the OR is providing a "convenient way to easily access previous patient imaging."

The article, "The iPad in the Hospital and Operating Room," was written by Felasfa M. Wodajo, MD, senior editor, and assistant professor, orthopedic surgery, at both VCU School of Medicine, Inova Campus
and Georgetown University Hospital.


November 23, 2010

Privacy Groups Fault Online Health Sites for Sharing User Data With Marketers


QualityHealth is a popular health Web site with more than 20 million registered users that offers online medical information and e-mail newsletters on a variety of topics, including diabetes, allergies, asthma and arthritis.

But according to a complaint filed Tuesday with the Federal Trade Commission, site visitors who provide personal details about themselves might not be aware that QualityHealth collects information about people’s medical conditions, preferred medicines and treatment plans and uses it to profile its users for prescription drug marketing.

Rob Rebak, the chief executive of QualityHealth, a company also known as Marketing Technology Solutions of Delaware, did not return a request for comment.


Health IT problems make top tech hazards list

By Joseph Conn

Posted: December 8, 2010 - 11:00 am ET

Health information technology problems ranked fifth on a list of the Top 10 Technology Hazards for 2011, according a report released by ECRI Institute, Plymouth Meeting, Pa.

Data loss, system incompatibilities and other health IT complications made the annual list of the not-for-profit patient safety organization, which reflects not a count of the most common or severe incidents, but ECRI staffers' judgment “about which risks should receive priority now," according to a news release about the report. Those opinions are based on ECRI's review of recent recalls and other actions, literature reviews, reports to ECRI's own medical device problem reporting database and those of other organizations, "and our experience in investigating and consulting on device-related incidents," according to the release.


ECRI Predicts 2011's Top Health Technology Hazards

HDM Breaking News, December 7, 2010

ECRI Institute, a Plymouth Meeting, Pa.-based research firm and patient safety organization, has issued its list of the Top 10 Health Technology Hazards for 2011, with information technologies playing a prominent role.

Listed as No. 5 is "Data loss, system incompatibilities and other health I.T. complications." The convergence of medical technology such as monitors and ventilators into electronic health records brings many benefits to care, according to ECRI. But ineffective convergence can lead to data being lost or associated with the wrong patient.


CCHIT to Begin Testing Hospital-Developed EHR Technology

‘EACH’ program intended to help hospitals close gaps in their mix of certified and uncertified EHR technologies.

By David Raths The Certification Commission for Health Information Technology (CCHIT) is preparing to launch its certification program for hospitals with self-developed electronic health record technology.

During a Dec. 1 webinar, Alisa Ray, CCHIT’s executive director, announced that the organization would begin pilot testing in December with three hospitals: New York University Hospital, Care Partners in Boston and Edward Hospital in Naperville, Ill. The official launch of the program will be Jan. 10.


Majority of Children's Hospitals Not Set Up for Electronic Health Records

Nancy Fowler Larson

December 6, 2010 — Most pediatric hospitals lack even the minimum setup needed to keep good electronic health records (EHRs), citing cost as the chief deterrent, according to a study published in the December issue of the Archives of Pediatric & Adolescent Medicine.

EHRs are growing in importance as chronic conditions such as asthma, obesity, and behavioral disorders emerge as the primary reasons for children's hospitalizations. Easily obtainable knowledge about patients' prior treatment is advantageous in managing these conditions, but such data are in short supply.


Data standards for healthcare supply chain gain ground

December 06, 2010 | Bernie Monegain, Editor

WASHINGTON – Healthcare organizations are moving closer to the adoption of global supply chain standards, according to an independent survey of healthcare providers, group purchasing organizations, device manufacturers, wholesalers and distributors.

The Health Industry Group Purchasing Association's (HIGPA) Committee on eHealth Standards announced the results of the survey on Dec. 3.


Basingstoke rolls out IBM portal

09 Dec 2010

Basingstoke and North Hampshire NHS Foundation Trust is rolling out a clinical portal based on IBM’s Websphere platform.

The portal will allow users to view historical patient information, access the trust’s JAC e-prescribing system, place requests for pathology and radiology through its Sunquest ICE system, and create correspondence for GPs.

IBM has been working with the trust on the portal and on getting its systems ready for go-live. This has included upgrading the trust's core network, virtualising its servers in a move from 120 non-IBM to 10 IBM servers, and deploying a wireless network.


Confidence in meaningful-use readiness plunges: CHIME

By Joseph Conn

Posted: December 8, 2010 - 5:00 pm ET

The percentage of chief information officers who are confident that their organizations will qualify by April 2011 for federal incentive payments for the purchase of electronic health-record systems plunged to 15%, down by nearly one-half from 28% of responding CIOs in a similar survey released in August, according to the College of Healthcare Information Management Executives.

Oct. 1 was the start date for hospitals under the Medicare portion of the program under the American Recovery and Reinvestment Act of 2009. Hospitals have to string together 90 consecutive days of meeting federal meaningful-use criteria within the 2011 federal fiscal year to qualify for reimbursement payments on their EHR investments.


ONC looks to evaluate health IT training

By Joseph Conn

Posted: December 9, 2010 - 11:45 am ET

The Office of the National Coordinator for Health Information Technology at HHS is seeking public comment on a proposed survey of the efficacy of its own health IT workforce development program.

In April, the ONC awarded $112 million in grants under the American Recovery and Reinvestment Act of 2009 to dozens of universities and community colleges for various IT workforce training and advanced-education programs ranging from six-month certificates through post-graduate degrees.


Friday, December 10, 2010

Home Health Technology Could Ease Strain on Health Care System

WASHINGTON, D.C. -- On New Year's Day, the oldest of the country's 77 million baby boomers will turn 65. Those baby boomers will become eligible for Medicare, if they are not already, and, increasingly, they will be putting more strain on the U.S. health care system.

Medical advances have led to improved survivability of many diseases and longer life spans. In 2000, the proportion of U.S. residents ages 65 and older was 12%, or 35 million. By 2020, the percentage of the U.S. population ages 65 and older is expected to increase to 17%, or 50 million Americans.


NIST partners with ONC, AHRQ to provide EHR usability guidance

Written by Editorial Staff

December 9, 2010

The National Institute of Standards and Technology (NIST) has partnered with the Office of the National Coordinator for Health IT (ONC) and the Agency for Healthcare Research and Quality (AHRQ) to publish new reports to guide software developers in improving EHR usability.

Usability has been a topic of considerable interest in the health IT community; one of the new reports provides NIST guidance about processes of user-centered design (UCD) for EHR application developers.

UCD serves to engineer improved usability and human performance into a system or device, according to the report. UCD models have the following principles:

  • Understand user needs, workflows and work environments;
  • Engage users early and often;
  • Set user performance objectives;
  • Design the user interface from known human behavior principles and familiar user interface models;
  • Conduct usability tests to measure how well the interface meets user needs; and
  • Adapt the design and iteratively test with users until performance objectives are met.


Most docs using at least partial EHR: CDC

By Maureen McKinney

Posted: December 10, 2010 - 11:45 am ET

Adoption of health information technology is growing among office-based physicians, according to preliminary results of a survey released by the Centers for Disease Control and Prevention.

More than half of physicians reported using at least a partial electronic health-record system in their practices, according to 2010 estimates from the National Ambulatory Medical Care Survey, conducted by the CDC’s National Center for Health Statistics. That figure is up slightly from 48.3% of physicians in 2009.


KP Follows Data To Better Hip, Knee Replacements

By developing registries and tapping e-medical record data, Kaiser Permanente is improving outcomes for hip and knee implant patients.

By Marianne Kolbasuk McGee, InformationWeek

Dec. 8, 2010


At Kaiser Permanente, a recently released study about hip and knee replacement devices highlights how best practices can be developed (and discovered) and patient safety bolstered in large part through the gathering and analyzing of data in patient’s electronic medical records.

With 600,000 knee and hip replacements performed annually in the U.S. -- and with those numbers expected to grow as Baby Boomers age -- KP’s study advocates the development of a national registry to track procedures and patient outcomes in those surgeries.


Aetna to Buy HIE Vendor Medicity

HDM Breaking News, December 7, 2010

Insurer Aetna Inc. has agreed to acquire health information exchange platform vendor Medicity Inc. for approximately $500 million. The acquisition is expected to close in early January.

Salt Lake City-based Medicity has considerable market share among emerging state HIEs, and regional and proprietary HIEs. In total, the company says it serves more than 760 hospitals, 125,000 physician users and 250,000 end users.


Blumenthal, EHRs: Change for the Better?

Gienna Shaw, for HealthLeaders Media , December 7, 2010

Each year the editors at HealthLeaders magazine choose 20 people who are making healthcare better. One of my nominees this year was David Blumenthal, MD, the national coordinator for health information technology. I called him "kind of a rock star" among healthcare tech types—I wonder how this buttoned-down doc will react to that characterization. And I wonder, too, how the healthcare industry in general will react to the idea that we think he is one of the 20 people who are playing a crucial role in the betterment of healthcare.

I'm guessing that opinions either way would be not so much a referendum on Blumenthal personally but on electronic health records systems in general.


Direct Project completes first models of simple NHIN

By Mary Mosquera

Tuesday, November 30, 2010

The first version of the software that will allow simple information exchange between providers, a crucial enabler for the first stage of meaningful use of electronic health records, was announced by the Office of the National Coordinator for Health IT.

The open source reference model of the standards and services that enable connectivity, which will be available as both Java and .Net formats, will be deployed first in a series of pilots to test it for real-world use, according to Arien Malec, coordinator of the Direct Project, the new name for the old NHIN Direct, a project of the ONC.

The Direct Project is a streamlined version of the more robust nationwide health information network standards set (NHIN), and will offer physicians and small practices the ability to conduct basic health record exchanges. For example, a primary care physician who is referring a patient to a specialist can use the Direct Project to send a clinical summary of that patient to the specialist, and to receive a summary of the consultation.


EMR Implementation: How Do You Stack Up Against Your Peers?

Philip Betbeze, for HealthLeaders Media , December 2, 2010

I think by now, we're past the point of arguing whether introducing complex technology into the healthcare continuum is a good idea. Whether to help caregivers make the right decisions more quickly, to better integrate clinical and financial systems to cut down on waste, government mandates, or a host of other good reasons to automate many parts of the healthcare process, hospitals and health systems are investing as never before in technological innovation.

Besides, even if you're stubborn enough to think it's not a good idea, or, at least, that it's unproven and too expensive, you know the feds are also behind the push. And when a customer that pays the freight for up to 50% and more of your patient flow says "jump," most of you who haven't seen the need for an EMR are now asking, "how high?"


Orion Health updates HIE

Written by Editorial Staff

December 2, 2010

Orion Health has added a modular suite of components to its health information exchange (HIE) tools, allowing healthcare organizations to customize their exchanges.


Health-record providers take aim at privacy concerns

By Joseph Conn

Posted: December 6, 2010 - 12:00 pm ET

The main federal privacy law covering electronic patient records that are held by healthcare providers may be perceived as more stringent than the laws and rules regulating personal health-record systems, but the privacy practices of some PHR providers are far more patient-controlled and thus, protective, according to panelists at a recent daylong public hearing on PHR privacy and security.

"When we look at this whole privacy debate, we're looking at it the wrong way," said panelist Colin Evans, the former director of digital health policy and standards for computer chipmaker Intel Corp. and now CEO of Dossia, a PHR provider launched in 2006 by Intel, Wal-Mart Stores and several other major U.S. employers. Evans was one of 21 panelists at the Dec. 3 event in Washington, which was sponsored by the Office of the National Coordinator for Health Information Technology at HHS.


PHR Exec: Providers, Payers Block Patient Data Access

HDM Breaking News, December 6, 2010

Too often, providers and payers use privacy and security issues as excuses to not permit patients access to their own information, the leader of a personal health records software vendor told federal officials on Dec. 3.

The Office of the National Coordinator for Health Information Technology and the Federal Trade Commission held a public roundtable on Dec. 3 to hash out PHR issues. They got an earful from Colin Evans, president and CEO at Dossia, a Cambridge, Mass.-based PHR vendor targeting large employers.

The real barrier to consumer access of their health information via PHRs is not privacy and security issues but the unwillingness of providers and payers holding the information to give consumers control over information, Evans said.


ONC: $16M program will fund HIE breakthroughs

Written by Editorial Staff

December 3, 2010

The Department of Health and Human Services' (HHS) Office of the National Coordinator (ONC) for Health IT has allotted more than $16 million to fund the Health Information Exchange (HIE) Challenge Program, which encourages breakthroughs for nationwide HIE.

The program focuses on five challenge areas identified as key needs since federal and state governments began implementation of the HITECH Act, according to the HHS.

Awards will fund the development of technology and approaches that will be developed in pilot sites and then shared, reused and leveraged by other states and communities to increase nationwide interoperability.

The five themes are:

  1. Achieving health goals through HIE;
  2. Improving long-term and post-acute care transitions;
  3. Giving patients access to their own health information;
  4. Developing tools and approaches to search for and share granular patient data (such as specific lab results for a given time period); and
  5. Fostering strategies for population-level analysis.


Renamed Direct Project to demonstrate email-like secure messaging

December 6, 2010 — 2:09pm ET | By Neil Versel

NHIN Direct, we hardly knew thee.

The health information exchange protocol to help small physician practices participate in the Nationwide Health Information Network and achieve a key "meaningful use" measure--often referred to as the "trust fabric" of HIE--has a new name: the Direct Project.

More importantly, the rebranded Direct Project has completed its open-source enabling software and is launching a series of pilots to demonstrate the effectiveness of secure messaging of sensitive healthcare data over the Internet. This set of standards-based technical tools and services will allow providers and other healthcare entities to "push" electronic messages to known, trusted recipients much like email, except that these healthcare messages will be encrypted to HIPAA standards.


HHS agenda looks to IT for self-management, patient engagement

December 6, 2010 — 4:14pm ET | By Neil Versel

HHS' newest 10-year health goals for the country, Healthy People 2020, focus on prevention, shared decisionmaking between patients and providers, personalized self-management of health conditions and, yes, "meaningful use" of health IT. The department is issuing a related challenge, called myHealthyPeople, to application developers to create apps for healthcare professionals who track state- and community-level health data.

The initiative's overarching goals include attaining high quality, longer lives free of preventable disease, disability, injury, and premature death; and eliminating health disparities and improving the health of all groups. "This milestone in disease prevention and health promotion creates an opportunity to leverage information technology to make Healthy People come alive for all Americans in their communities and workplaces," HHS Chief Technology Officer Todd Park says in a press release.


Few hospitals closing the loop on med administration

December 6, 2010 — 2:49pm ET | By Neil Versel

"Closing the loop" on medication management has long been discussed as a worthy health IT goal, but just 5 percent of U.S. hospitals have been able to get there, Health Data Management reports. That figure comes from a recent HIMSS Analytics report on EMR adoption.

There are many reasons why closed-loop medication management is so elusive. "When you look at medication management across the continuum of care and all the processes involved, they're complex and have multiple points of failure," Mark Siska, assistant director of informatics and technology for pharmacy services at the Mayo Clinic, tells HDM. "There are a number of opportunities for distraction and miscommunication, so automating medication management and connecting everything is very challenging."


Sunday, December 05, 2010

Professors at Harvard and Nottingham Medical School (UK): Are we repeating the UK's clinical IT failures in the US?

In the opinion piece "Don't Repeat the UK's Electronic Health Records Failure" (Huffington Post, Dec. 5, 2010), Dr. Stephen B. Soumerai, Professor of Population Medicine at Harvard Medical School and Dr. Anthony Avery, Professor of Primary Care at the University of Nottingham Medical School, UK share familiar themes on health IT.

These themes will be especially familiar to HC Renewal readers and to my students and other readers of my Medical Informatics teaching website.


Robot ER staff could speed triage

December 7, 2010 — 2:41pm ET | By Sandra Yin

If a group of computer engineers gets their way, we will no longer hear stories of patients dying in the ER after excruciatingly long waits. A solution for overburdened triage staff and long emergency room wait times appears to be in sight.

If you're willing to wait five years, robots could help speed the ER triage process, according to Mitch Wilkes, associate director of the Center for Intelligent Systems and associate professor of electrical and computer engineering at Vanderbilt University. He is the lead author of a paper presented yesterday at the Humanoids 2010 conference held in Nashville.

The paper describes an ER that would feature electronic kiosks (like those at the airport) at the registration desk and smart chairs. A mobile robot or two might monitor patients in the waiting room.




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