Saturday, September 24, 2011

Weekly Overseas Health IT Links - 24 September, 2011.

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.

After 9/11: Health IT lessons that followed

September 12, 2011 | Dr. John Loonsk
With the 10th anniversary of 9/11, there have been many personal and political remembrances of the events that scarred families and jarred the country that day. Health IT had its own significant events a decade ago, but they began about a week after 9/11 when letters with Anthrax in them were mailed. What followed was a series of emergency health events some of which, like the largely unsuccessful Smallpox vaccination program, can be traced to 9/11, the wars that followed, and fears of bioterrorism. Other events turned out to be largely unconnected emergencies like Anthrax, SARS, and Katrina but still showed additional emergency preparedness and response health IT requirements.
All of these events demonstrated the need for a broadly interconnected health system that includes many different health-related organizations exchanging critical and processable information. Each event helped make the case for a national health IT network infrastructure that can electronically exchange such information among computer systems from different jurisdictions, health departments, other government agencies, labs, pharmaceutical companies and others - in addition to just provider Electronic Health Records (EHRs).

Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way

New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps


Today, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance.

PHRs: What's a realistic expectation?

September 15, 2011 | Jeff Rowe, HITECH Watch
The problem with health IT policymakers and stakeholders is that they are dedicated to the idea that effective, widespread use of IT can lead to a healthier population.
Now that we have your attention, allow us to explain. Or, more specifically, allow us to use that radical contention to highlight the questions we have about Personal Health Records(PHRs).
Here’s a piece that provides a good look at the headache PHRs give policymakers and providers alike.

HHS Consumer Health IT Summit power-charged for progress

September 13, 2011 | Diana Manos, Senior Editor
WASHINGTON – Sept. 12 was a big day for healthcare IT. Federal officials hosted a consumer health IT summit, jam-packed with new initiatives to advance HIT. The event was charged with a wave of energy toward grass roots change, specifically supporting patient-centered care.
The summit, held at the Department of Health and Human Services in Washington, D.C. was part of the Sixth National Health IT Week, a collaborative event hosted by the Health Information and Management Systems Society.

Blue Button: Driving a Patient-Centered Revolution in Health Care

Posted: 9/13/11 06:05 PM ET
A lot can happen in a year.
Last October, I wrote about a promising new offering for people looking to take control of their own health and health care decisions. Known as "blue button," this simple (but rather revolutionary) technology offers individuals the ability to download their own health information with just the click of a mouse. They can then use and share this information however they may choose -- with doctors, care providers, or even third-party applications designed to help them track and make sense of their own personal data.
Born out of a collaborative working group convened by the Markle Foundation, the blue button was beta-tested and then implemented by the Department of Veterans Affairs, the Department of Defense, and the Centers for Medicare & Medicaid Services (CMS). The immediate demand from their patients and beneficiaries was inspiring.

Is The Cloud Safe For Health Apps?

Some healthcare providers are still hesitant to put patient data and clinical apps in the cloud. Here's how they cope with their angst.
By Marianne Kolbasuk McGee,  InformationWeek
September 13, 2011
Healthcare organizations are slowly turning to the cloud to run applications. That's especially true for smaller healthcare providers who don't have the IT staff or resources to roll out and support new in-house applications, let alone the hardware, networking, or other IT infrastructure that goes along with it.
Yet, while some healthcare providers are beginning to sign up for SaaS subscriptions for business- and administrative-related applications, they're holding back, still refusing to move clinical software and patient data.
Summary and Comment

Computerized Decision Support System for Fluid Management Lowers Mortality in Burn Patients

Use of the system reduced crystalloid volume and increased urine output.
Fluid management significantly lowers mortality in patients with severe burns, but formulas are complicated and overresuscitation is common. Researchers developed and evaluated a computerized decision support system (CDSS) for fluid management in patients in a burn intensive care unit (BICU) who had >20% total body surface area burns. Researchers compared outcomes in 32 patients who were treated with the aid of the CDSS and 38 historical controls. The CDSS was linked to the electronic medical record and was automatically executed on bedside computers.
Mortality was significantly lower in the CDSS group (29% vs. 44%).
Salinas J et al. Computerized decision support system improves fluid resuscitation following severe burns: An original study. Crit Care Med 2011 Sep; 39:2031.
Medline abstract (Free)
Thursday, September 15, 2011

From No Doctor to E-Doctors in Rural India

A telemedicine company brings $1 virtual checkups to poor countries.
By Emily Singer
There aren't too many doctors in the village of Hari Ke Kalan, in the Punjab region of northern India. But for $1, residents who bicycle to a new health clinic can get an appointment with a physician appearing on a large-screen television and beamed in over broadband Internet.
The clinic, built by a startup called Healthpoint Services, is one of a network of eight "e-health points" that the for-profit company has built in India as part of a growing effort by entrepreneurs to capitalize on the rapid expansion of cellular and broadband access in the poorest parts of the world. With successes such as text-message-based mobile payments taking off in some countries, many experts see medicine as the next major application of technology in poor nations.

Model PHR Privacy Notice Available for Vendors

HDM Breaking News, September 14, 2011
The Office of the National Coordinator for Health Information Technology has released a model privacy notice for vendors of personal health records.

Telemonitoring Saves Money When Combined With Traditional Care

Despite the significant benefits reported in this Health Affairs study, the Centers for Medicare and Medicaid Services questions whether the benefits are real.
By Ken Terry,  InformationWeek
September 12, 2011
Combining telehealth and care management tools significantly reduces the costs of treating Medicare patients with chronic diseases, even after factoring in program costs, according to a new study published in Health Affairs. While the study focused on the use of the Health Buddy, a decade-old technology that must be used at home, it has implications for the use of the newer mobile applications for telemonitoring. Equally important, it signals the lag between studies of telehealth and its application in the field, according to a noted expert.
The researchers, who included Laurence C. Baker of Stanford University, analyzed data collected in the course of the Centers for Medicare and Medicaid Services' (CMS) Care Management for High-Cost Beneficiaries Demonstration. The Health Buddy program was one of six interventions that this demonstration investigated, focusing on patients with diabetes, chronic obstructive pulmonary disease, or congestive heart failure.

HIMSS announces Davies winners, aligns criteria with EMR model

September 13, 2011 | Molly Merrill, Associate Editor
CHICAGO – The 2011 HIMSS Davies Award Winners were announced Tuesday during a conference that was part of National Health Information Technology Week. Officials have also changed the criteria for next year's awards, aligning them with the HIMSS Analytics EMR adoption model.
Officials said the six winners deliver quality and consistent care to the patients and populations they serve with information technology – specifically the electronic health record.
Wednesday, September 14, 2011

Your Heartbeat on an iPhone

An innovator delivers a cheap, instant, and mobile way to monitor heart problems.
By Antonio Regalado
At around 11 a.m. last December 30, from his office in Oklahoma City, an inventor named David Albert uploaded a webcam video in which he demonstrated how to obtain an electrocardiogram with an iPhone.
Opening his shirt and white lab coat, he placed the phone against his chest. "Now you will see a very clean ECG," Albert explained, as a heart rhythm pulsed across the screen. "I am detecting and storing, wirelessly transmitting, and storing locally in real time. It's being analyzed, beats are being identified."
By noon, the video had 10,000 views. Three days later, it had 100,000. Bloggers and online commenters were insisting the iPhone ECG was a fraud. That was enough to impress Albert's 12-year-old son. "Dad, you've made it. You have YouTube haters!"

America's Next Top HIE Model...

Greg Freeman, for HealthLeaders Media , September 13, 2011

There are three different models for health information exchanges, with each varying according to how the patient’s data is stored and accessed by participants. Randy McCleese, FHIMSS, CHCIO, vice president of information systems and CIO at St. Claire Regional Medical Center, Morehead, KY, offers this summary of the three types in use across the country.

Invited or not, tablets are coming to your workplace

By Bob Violino
Created 2011-09-12 08:30
Health IT professionals don't need an analyst report to know that tablet computing devices are catching on – a morning rush-hour train ride suffices just fine to prove that point.
The likes of Deloitte, Gartner, IDC, Forrester and others, however, have compiled them just in case. Their projections agree: Tablets and smartphones together will outsell PCs, possibly as soon as this year.
Federal, state and local health IT shops may or may not be ready to support the new devices. No matter, those tablet-toting commuters, part of a growing BYO (Bring Your Own) movement, will be carrying their devices along just the same.
But will the mobility-related advantages offered by tablets become a bane to your IT efforts or a boon? That depends on how you handle them.

New Rule: Individuals Can Get Test Results from Labs

HDM Breaking News, September 13, 2011
The Department of Health and Human Services has issued a proposed rule enabling patients to electronically access their laboratory test result reports directly from labs.
The rule, available here on Sept. 13 and being published Sept. 14 in the Federal Register with a 60-day comment period, affects labs that are covered entities under HIPAA. The rule amends the Clinical Laboratory Improvement Amendments of 1988 that exempted labs from provisions that give patients the right to access their protected health information.
The rule specifies that "upon a patient's request, the laboratory may provide access to completed test reports that, using the laboratory's authentication process, can be identified as belonging to that patient," the proposed rule states.
By Joseph Conn

On lab results, it's "Show me—first"

The CMS this week published what it described as a proposed rule that I'm calling the "Me First" Lab Rule.
Today, patients can obtain their laboratory test results from their healthcare providers under guarantees in the Heath Insurance Portability and Accountability Act of 1996. In a few more years, the CMS' own electronic health-record incentive programs should spur widespread provider adoption of interoperable EHRs, and that should speed up patient access to lab results considerably. By then, the torrent of an estimated 6.1 billion test results per year will pour automatically into those provider EHRs. From there, lab results should flow automatically to patients by way of personal health record systems "tethered" to providers' EHRs.
The CMS' proposed rule, however, reinterprets both the flow-controlling Clinical Laboratory Improvement Amendments of 1988 and the HIPAA privacy rule in a way that pre-empts many state lab-access laws and procedures. It changes who gets to see test results first, the physician or the patient.

Clinical Decision Support and Malpractice Risk

Published in: The Journal of the American Medical Association, v. 306, no. 1, Commentary, July 2011, pp. 90-91
Clinical decision support (CDS) refers to electronic technology used to enhance clinical decision making. An important feature of CDS in computerized physician order entry (CPOE) involves automated warnings issued whenever potential drug interactions or other contraindications arise. In practice, many CDS systems have often been overinclusive in the warnings they generate, such that physician "alert fatigue" may undermine the utility the systems offer. One paradoxical result of overly abundant warnings may be to exacerbate malpractice risk for physicians who either ignore or turn off CDS alerts.

Wales outlines IT achievements

9 September 2011   Fiona Barr
Wales’ emergency summary record now covers almost 50% of GP practices and will cover all patients by the end of the year, the NHS Wales Informatics Service has announced in its first achievements report.
The report provides updates on ten information services that the Welsh IT service has been working on since it was set up in April 2010, following a merger of five Welsh’ informatics organisations including Informing Healthcare and the Primary Care Informatics Programme.
The IHR project aims to provide out-of-hours clinicians with access to summary information from the patient record held in the GP systems used in Wales.

Aetna Web Tool Lets Members Get Electronic Medical Records

By Carol Eisenberg - Sep 12, 2011
Aetna Inc. (AET), the third-largest U.S. health insurer, said 9 million customers can more easily download electronic versions of health records from a company website as part of a government push to promote online data.
The insurer expects by next year to give its members the ability to send personal health records directly to doctors and other providers across a secure system, said Brian Kelly, head of informatics and strategic alignment for the Hartford, Connecticut-based company.

Scotland goes for patient-access to electronic health records

The Scottish Government has unveiled a new electronic strategy for its health service. Under the proposals, patients will become more involved in their own healthcare and services and have direct access to their electronic records.

Launching the initiative, health minister Nicola Sturgeon said she wanted the latest e-health technology used across frontline services. She cited the example of a pioneering electronic record for renal patients. "The electronic renal patient record has allowed consultants to share health information freely with patients and improve the care that patients receive."

Scottish govt recasts e-health strategy

13 September 2011   Shanna Crispin
The Scottish Government has published an e-health strategy for the next six years that focuses on five new strategic health aims.
The strategy mandates all health boards to use information and technology to maximise efficiency and savings; enable people to communicate with NHS Scotland; contribute to care integration; improve the availability of information; and improve the safety of people taking medicines.
Speaking at the opening of the Health Informatics Scotland conference in Edinburgh, acting director general of health and chief executive of NHS Scotland, Derek Feeley, said the government expected all health boards to prove they were delivering on the aims by the end of 2014.

Capital Punishment

Gary Baldwin
Health Data Management Magazine, 09/01/2011
When it comes to financing health care operations, Juan Ruiz knows the importance of getting the best deal. He's the director of finance at St. Patrick's Home, a 264-bed skilled nursing home in the Bronx. The home is mid-way through an EHR implementation, from HealthMedx. The project represents nearly a $250,000 outlay, software, hardware and network infrastructure included.
And that's just one financial ball Ruiz has to juggle. Two years ago, the home replaced its boiler system, which came to $500,000. And looking ahead, the 20-year-old facility will need to upgrade its laundry facilities, install a new generator, renovate its bathrooms, and replace about 100 of its beds.
The beds alone represent a $120,000-plus hit to the checkbook. "We have to project our costs three to four years down the road," says Ruiz. He takes a conservative approach to financing, setting aside money each year to fund depreciation of assets-despite the fact that the state eased such requirements a few years ago in light of the economic downturn. "It is extremely expensive running a nursing home."

ONC launches twin pilots for metadata standards

September 8, 2011 — 4:06pm ET | By Ken Terry
Following an advance notice of rulemaking on metadata standards to support health information exchange, the Office of the National Coordinator for Health IT (ONC) has announced two pilot programs to test the recommendations on these standards.
The first project, called the Query Health Initiative, will test standards for querying widely distributed databases such as those of electronic health records and community records originating in the course of patient care. The other program, the Data Segmentation Initiative, will assess standards designed to let patients block the release of sensitive healthcare information.

Government cracks down on misleading medical apps

September 9, 2011 — 9:57am ET | By Sara Jackson
In its first enforcement action in the mobile health market, the Federal Trade Commission has forced two app companies to stop making health claims for their smartphone apps.
The two apps, AcnePwner and AcneApp, claimed that they emitted light from a smartphone screen to kill bacteria that causes skin blemishes. In total, the apps have been downloaded nearly 15,000 times, FTC officials say.

Cash-strapped health IT vendors a danger for hospitals

September 12, 2011 — 11:59am ET | By Marla Durben Hirsch - Contributing Editor
Financial issues for a software company could result in medical procedures going unscheduled and needy patients going without beds at a hospital across the pond, providing a cautionary tale for U.S. hospitals about the importance of vendor selection.
Late last month, IMS Computers Ltd., in bankruptcy proceedings in Ireland, discovered that it can't stay in business without an influx of investor capital, according to an article published in the Irish Examiner. The company, which manages 10 million patient records throughout Ireland and the UK, also owns software that controls both the operating schedules and the bed allocation processes at several hospitals.

Private sector influence not lacking in government's health IT push

September 11, 2011 — 3:55pm ET | By Ken Terry
While there has been plenty of grumbling about the Meaningful Use criteria for government electronic health record incentives, the Administration listened to a variety of private voices in designing those requirements. And, although the Health IT Advisory Committee arguably overestimated the industry's readiness to use EHRs in quality improvement, a New England Journal of Medicine study suggests that Meaningful Use is pushing doctors and hospitals in the right direction. That study shows that patients of physicians who used EHRs received more recommended care and had better outcomes than did the patients of doctors who relied on paper records.
Overall, the Administration--and the Office of the National Coordinator for Health IT (ONC), in particular--have bent over backward to work with the private sector. Last week, for example, ONC announced it was testing metadata standards to move the technology of health information exchange forward. ONC has enlisted the help of experts from healthcare organizations and vendors, and is housing the initiative on the wiki for its Standards & Interoperability Framework.

HHS: More than 5.4M patients affected by data breaches in 2010

Written by Editorial Staff   
September 8, 2011
In U.S. Department of Health and Human Services’ annual report to Congress, Secretary Kathleen Sebelius reported that between Jan. 1, 2010, and Dec. 31, 2010, breaches involving 500 or more individuals were less than 1 percent of the breaches reported, but accounted for more than 99 percent of the more than 5.4 million individuals who were affected.
As part of the Health IT for Economic and Clinical Health (HITECH) Act, the HHS secretary is required to annually report to Congress on the number and nature of data breaches, and actions taken to respond to the breaches.

More Patients Collect Prescriptions In Integrated Healthcare Systems

Healthcare systems that link pharmacy data with electronic health records see better compliance with patients picking up their medications, reports Kaiser Permanente study.
By Nicole Lewis,  InformationWeek
September 09, 2011
If you are a diabetic, have high cholesterol, or high blood pressure and you receive medical care at an integrated healthcare system that has electronic health records (EHRs) linked to its own pharmacy, then you are more likely to collect your new prescriptions than people who receive care in a non-integrated system, a Kaiser Permanente study shows.
The study, Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders, examined pharmacy dispensing records of 12,061 men and women who were members of Kaiser Permanente Colorado in 2007 and 2008. It found that only 7% did not get their new prescriptions for blood pressure medication filled, 11% failed to pick up new prescriptions for diabetes medication, and 13% failed to collect new prescriptions for cholesterol-reducing medication. The study was published on the Journal of General Internal Medicine's website.

Patient med adherence climbs with EHR links to pharmacy

September 15, 2011 — 9:58am ET | By Marla Durben Hirsch - Contributing Editor
Patients whose electronic health records are integrated with pharmacies are more likely to fill their prescriptions, according to a recent Kaiser Permanente study.
The study, published online in the Journal of Internal Medicine, reported that when patients receive care in an integrated healthcare system whose EHRs are connected to the dispensing pharmacy they are more likely to collect the medications they need for their newly-diagnosed chronic conditions.
In the study of 12,041 people in Kaiser Permanente Colorado with newly ordered medications for diabetes, blood pressure and cholesterol, most patients followed through and picked up their medications; only 7 percent of patients prescribed blood pressure medication, 11 percent of those prescribed diabetic medications, and 13 percent prescribed cholesterol-reducing medications did not have their prescriptions filled.

Study: CPOE Requirements in MU Stages 2 and 3 May Cut Mortality

HDM Breaking News, September 15, 2011
A new study published in Health Affairs suggests that Stage 1 meaningful use criteria for use of computerized physician order entry systems is probably too low to significantly lower mortality rates among heart patients, but higher levels of mandated use in Stages 2 and 3 "is more consistently associated with lower mortality."
Stage 1 of meaningful use requires electronic orders for at least 30 percent of eligible patients. The Stage 2 measure likely will be 60 percent with Stage 3 at 80 percent.
Researchers at RAND Corp. studied data from the American Hospital Association Annual Survey database, comparing medication orders written electronically with manual orders. "We relied on self-reported ranges--for example, 26 to 50 percent of patients--of the use of electronic medication ordering and did not have direct measures against which to validate these reports," according to the study. "It was not possible to match our data exactly to the thresholds prescribed in the meaningful use regulations because our data used ranges instead of, for example, a threshold of 30 percent of patients. Therefore, we were not able to simulate the impact of the uptake of electronic medication ordering at the exact thresholds prescribed in the meaningful use regulations. However, our data did provide thresholds that approximate those of the regulations, and we believe that the results of our simulation will be informative to policy makers."

New Patient Access Rights Will Challenge HIM Departments

HDM Breaking News, September 10, 2011
The HITECH Act gives consumers the right to access their electronic health records in an electronic format. But many security experts believe that under final rules, giving patients the records on a CD or thumb drive won't meet the intent of the law, says Lou Ann Wiedemann, director of professional practice resources at the American Health Information Management Association in Chicago.
She believes 'electronic' will mean access to a particular patient's records in a provider's EHR via a Web portal or a cloud computing application, "and not an electronic version of your EHR," Wiedemann says. "The industry is hoping CD or a thumb drive will be okay, but everyone is waiting on the final rule before they start to plan how to do this."
Monday, September 12, 2011

UC-San Francisco Medical Center Catches Up on EHRs

by Mari Edlin, iHealthBeat Contributing Reporter
The University of California-San Francisco Medical Center might be a late bloomer, but it's making up for lost time.
The hospital's first go at an electronic health record system in 2005 started the ball rolling toward a comprehensive system but stopped short of developing an ambulatory component.
In 2010, UCSF moved away from its custom-built General Electric EHR, which kept information only on patients who were admitted to the hospital, to a new vendor -- Epic Systems -- to link providers and patient records among its more than 100 clinics, emergency department and hospital.
  • SEPTEMBER 12, 2011

WellPoint's New Hire. What Is Watson?


Watson, the "Jeopardy!"-playing computer system, is getting a job.
WellPoint Inc. and International Business Machines Corp. are set to announce a deal on Monday for the health insurer to use the Watson technology, the first time the high-profile project will result in a commercial application.
WellPoint said it plans to use Watson's data-crunching to help suggest treatment options and diagnoses to doctors. It is part of a far broader push in the health industry to incorporate computerized guidance into care, as doctors and hospitals adopt electronic medical records and other digital tools that can record, track and check their work.


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