This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Saturday, October 22, 2011
Weekly Overseas Health IT Links - 22 October, 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.
About half of the first batch of federal dollars meant to encourage doctors and hospitals to switch to electronic records went to providers who were converts to the technology long before the stimulus program was announced, an iWatch News analysis suggests.
The analysis could raise questions about whether the government will be able to meet its goal of widespread adoption of health information technology. While these early numbers are hardly conclusive, they suggest that a large swath of payments intended to be an incentive for new adoption of electronic health records are merely rewarding health providers for minor adjustments to systems they have had in place for years.
The Office of the National Coordinator's plan to require use of EHR metadata in Stage 2 of the meaningful use program is premature, according to the National Committee on Vital and Health Statistics, a federal advisory body.
ONC in August issued an advanced notice of proposed rulemaking, laying out its initial thoughts about metadata and seeking public comment. Adoption of EHR metadata standards, which the President's Council of Advisors on Science and Technology has advocated, could help improve data exchange and would enable patients to segregate parts of their medical records, such as self-paid treatment for sensitive conditions.
While many providers have decided to transition from paper records to EHRs, many others have not, and cost seems to be one of the main reasons for the reluctance.
That fact in mind, this regular observer raises an interesting question: Who should be paying for EHRs?
“EHRs are by and large a complex and expensive proposition,” she points out early on, “and the HITECH incentives are not covering the average cost of purchasing and maintaining an EHR. In survey after survey, physicians consistently rank cost associated with EHRs as their top concern when considering transition from paper charts to electronic medical records. This is a bit disconcerting, since physicians have no problem buying other expensive tools and paying for human resources in their practices. How are EHRs any different?”
October 11, 2011 | Molly Merrill, Associate Editor
AUSTIN, TX – Venture capital funding and merger and acquisition activity in the healthcare IT sector saw significant growth in the third quarter of 2011, according to a report from global communications and consulting firm Mercom Capital Group.
The report shows that VC funding for healthcare IT in Q3 more than tripled, with $207 million in 17 deals compared to $66 million in six deals in the previous quarter. VC funding for the same quarter last year came to $62 million in seven deals. Fifty different investors participated in these funding rounds.
Ever wonder who’s behind the new recommendations for, say, how to treat high cholesterol or whether to screen men for prostate cancer? More specifically, do you ever wonder whether experts on the panels that develop guidelines have financial ties to pharma or device companies that might be affected?
The Institute of Medicine recommends that ideally, guideline developers shouldn’t have any financial investments in companies that stand to benefit from recommendations, nor should they (or family members) participate in marketing activities or advisory boards of those companies.
Sometimes it’s not possible to convene an entirely conflict-free panel, in which case members with financial ties to industry should be only a minority of the panel, the IOM says. Panel chairs or co-chairs should not have conflicts at all, and industry shouldn’t have a role in developing the guidelines, the group says.
One of the biggest draws of adopting electronic health records is the ability to share patient information electronically via health information exchanges (HIEs) cropping up across the country. However, there are legal considerations that providers should be aware of when joining an HIE, according to an article in the October 2011 issue of the Journal of AHIMA.
It appears our neighbors to the north are going through similar growing pains regarding electronic health record adoption by older doctors, according to a new survey. The National Physician Survey, Canada's largest survey of physicians and physicians in training, found that while residents and younger providers expect to use EHRs upon graduation, 39 percent of current physicians are using EHRs, while 37.6 percent of docs choose to only use paper.
The survey, published September 28, found that 78.6 percent of all residents have used or been exposed to EHRs as part of their medical training. What's more, 81.5 percent of family medicine residents expect to use EHRs rather than paper records when they go into practice, an increase from 75 percent in 2007 (the last time the NPS survey was conducted). More than 2,500 residents responded to the survey.
Americans love their privacy. And yet, as the ever-increasing trend of social networking illustrates, they also love to share the facts of their lives. As a result, defining privacy can be tricky in this modern age and often depends on the venue in which information is presented and the form it takes.
In today's world of electronic health records, straddling the fence between harmless information and sensitive data is no longer such an easy task, and the repercussions for the slightest transgression can be severe.
On Aug. 22, HHS issued a press release challenging software developers to create new Facebook applications to assist in emergency preparation efforts. If Facebook was a nation, its "population" would be more than double that of the United States. If online minutes for Facebook users were the functional equivalent of "dollars spent," the social network's estimated $84 trillion in annual "spending" would top the collective gross national products of all nations across the globe, even if the U.S. or European Union were counted twice.
The HIT Policy Committee has issued recommendations to ease secondary uses of electronic health records data.
In particular, use of EHR data for treatment purposes or to evaluate the safety, quality and effectiveness of prevention and treatment activities should not require patient consent, institutional review board approval or even minimal registration, according to the federal advisory body.
The committee believes the Department of Health and Human Services "could take the approach of not labeling these activities as 'research' but instead should consider them to be treatment or operations if conducted by, or on behalf of (such as by a business associate), a provider entity." Providers, however, should always use the minimum necessary amount to accomplish the task.
October 07, 2011 | Michelle McNickle, Web Content Producer
The widespread development of health information exchange is happening quickly, and with it comes worries about confidentiality, privacy and security. But its benefits far outweigh potential concerns and include improved quality of care and reduced healthcare costs.
Despite HIE’s reserved reception among hospitals and practices nationwide, many have said it will play a significant part in meaningful use stages down the road. And since there’s no time like the present to get a jump start on beneficial programs, Rob Brull, product manager at Corepoint Health, suggested six tips to make HIE implementation last.
October 06, 2011 | Molly Merrill, Associate Editor
NEW BRUNSWICK, NJ – A new study profiling how five physician practices successfully overcame their e-prescribing challenges has determined that the common thread among them was that each had carefully moved through three phrases: planning, implementation and use of the systems.
The research was led by Jesse Crosson at UMDNJ-Robert Wood Johnson Medical School and identified key techniques in the implementation and use of electronic prescribing.
Researchers at Beth Israel Deaconess Medical Center found that primary care doctors could improve preventive care for elderly patients by creating reminders in their electronic records system.
The researchers developed a tool that prompted physicians to check whether patients over age 65 had assigned a health care proxy, been screened for osteoporosis, or had received vaccines for flu and pneumonia.
The study included 54 physicians, about one-third of whom followed their usual practices with their existing records. The others were given the reminder tool; half of those were given help by an administrative assistant who contacted patients with reminders.
October 10, 2011 | Ilene Yarnoff, Lead assurance and resilience principal, Booz Allen Hamilton
The migration to electronic medical records offers patients, providers and the overall healthcare system a variety of compelling benefits and cost reductions — but we shouldn’t underestimate the challenges that stand between the idea of an e-health ecosystem and it becoming a reality.
Specifically, there’s a significant amount of work to be done around privacy, information security, compliance, and identity and payment fraud.
October 10, 2011 | Rick Kam and Christine Arevalo, director of healthcare identity management, ID Experts
or many healthcare organizations, a dreaded acronym may well be OCR—the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. With fines and enforcement of the HIPAA Privacy and Security Rules on the rise, it’s natural for collective muscles to tense in anticipation of an OCR investigation.
It’s clear that OCR is ready and willing to impose penalties for violators. And there have been several violations to date, mostly related to improper disclosure of PHI—with 14,000 reported privacy incidents, the majority due to theft and loss, according to the OCR website. Technology has complicated matters, with laptops and other portable storage devices such as USB flash drives accounting for 38 percent of reported incidents.
The act, signed Oct. 7 by Brown, loosens requirements about who can provide care using telehealth—expanding eligibility to all licensed healthcare professionals—and makes it easier to provide such care through the state's Medicaid program and under certain circumstances for patients who have private insurance. Hospital credentialing for telehealth also was made easier, according to a CTEC news release. The law drops the term "telemedicine" in favor of "telehealth."
More than 430,000 veterans have downloaded their healthcare claims information through the U.S. Veterans Affairs Department's Blue Button initiative—far exceeding initial predictions for use of the service.
The results to date for the technology, which aims to make it easy for VA patients to go online and download copies of their medical records, were reported Tuesday by Todd Park, chief technology officer at HHS, during the FedTalks 2011 conference in Washington.
Gienna Shaw, for HealthLeaders Media , October 11, 2011
Cleveland Clinic's top 10 medical innovations for 2012, released at the annual Medical Innovation Summit last week, included a mix of cool medical devices, new treatment protocols and procedures, and other healthcare technologies that, according to the organization, have significant potential for short-term clinical impact and a high probability of success.
The list includes wearable robotic devices, genetically modified mosquitoes, and medical apps for mobile devices—and one item that's not quite like the others: Harnessing big data to improve healthcare.
"Healthcare data requires advanced technologies to efficiently process it in reasonable time, so organizations can create, collect, search, and share data, while still ensuring privacy," the organization said in a release. "In this way, analytics can be applied to better hospital operations and tracking outcomes for clinical and surgical procedures. It can also be used to benchmark effectiveness-to-cost models."
by Helen R. Pfister and Susan R. Ingargiola, Manatt Health Solutions
On Sept. 12, the Office of the National Coordinator for Health IT released an updated strategic plan for implementing a nationwide health information network. The Federal Health IT Strategic Plan 2011-2015 sets forth activities to improve health care through use of health IT tools.
Below is an overview of the Strategic Plan and some of the federal government's newest initiatives, including the Query Health initiative, the electronic health record data segmentation initiative and various initiatives to drive consumer engagement in health care, such as the recent proposed regulation affording individuals direct access to laboratory results.
OAKLAND, Calif., Oct. 10, 2011 /PRNewswire/ -- Kaiser Permanente leads the nation with the most No. 1s receiving top marks in 11 out of 40 effectiveness of care measures among all reporting commercial health plans. These conclusions were based on information in the 2011 National Committee for Quality Assurance's Quality Compass® data.
Last week, I did something I have never done before: I attended the annual general meeting of one of the nearby hospital trusts. There were no fireworks. The trust is working towards foundation status and hitting its financial targets. It has about the best maternity unit in the south of England. Judging from my own visits over the last few years, it is definitely more patient-friendly than it was.
So, I was encouraged that the chief executive felt able to admit where things had gone wrong, as hospital administrators seldom do. For instance, the 18 week gap between diagnosis and treatment had slipped. She admitted that this was down to administrative error and promised to get back up to date by the end of this month. I liked her honesty.
She also apologised that some consultants took a month to write discharge summaries for their patients. I had understood that the Department of Health decreed about two years ago that discharge summaries must arrive at the patients' GPs within 48 hours of discharge. This shows that some senior doctors are still happy to flout DH instructions and the obvious well-being of their patients, despite the admonishments of a tough chief executive. I suppose I should not be surprised by this. Twas ever thus, and probably ever will be.
The Direct Project, the secure clinical messaging protocol introduced earlier this year, has advanced to the next level with the announcement that a workgroup of the Direct Project consortium has reached agreement on a key component of the "trust framework" that will be required for Direct messaging.
The Direct Project Rules of the Road workgroup has formulated a certificate policy that will govern the use of digital certificates when providers exchange messages. These will be used to authenticate the identities of senders and receivers.
Preferred Primary Care Physicians, a 32-doctor group in the Pittsburgh area, is piloting an advanced medical home model with assistance from HealthAmerica, a subsidiary of Coventry Health Care. Health IT will be a crucial component of the medical home project, in which personal physicians will coordinate patients' care across care settings.
"Our electronic health record and our robust data mining capabilities will be crucial in supporting optimal patient care, performance measurement, patient education, and communication," Gregory Erhard, executive director of Preferred Primary Care Physicians, said in a announcement.
Steve Jobs' passing last week has triggered myriad reflections on his immense contribution to the modern world. While much emphasis has been placed on Apple's recent trendsetting products--the iPod, iPhone and iPad--the signal contribution of Apple under the leadership of Jobs and Steve Wozniak was to make the personal computer practical and useful. Beyond the Apple operating system itself, the invention of the Macintosh computer--which used a mouse-based graphical user interface derived from an experimental Xerox product--radically redefined the relationship between humans and computers.
Despite all the technological advances since then, however, physicians continue to struggle with that relationship. I recall that back in the 1990s, when I began covering this space, there was considerable disagreement among experts about whether electronic medical records were ready for prime time. Clement McDonald, MD, who helped pioneer health IT at Indianapolis' Regenstrief Institute, once told me that doctors would never accept EMRs (now known as EHRs) until they could dictate their notes and have them transcribed automatically into discrete data.
One of the key elements of an HIE is the Master Patient Index (MPI), which associates records from multiple sources accurately with a single patient. Various software techniques are available to ensure accurate matching to prevent erroneous association of data from different patients (false “positive”), or failure to associate data from the same patient together (false “negative”). Deterministic tools are rules-based; probabilistic tools rely on mathematical algorithms and constructs. In either case, there is usually some manual intervention necessary to resolve ambiguous record matches where the automated algorithms cannot establish a match (or non-match) with sufficient certainty. An additional issue that HIEs face is deciding exactly who should be responsible for this activity: central HIE administrative staff, staff from participating organizations (particularly hospitals who provide larger sets of records), or both.
Health information technology has essentially become a requirement for all niches of healthcare — rural, urban, state, local, federal and everything in between — and it's evident that a strong health IT infrastructure will help providers transition into the new era of stronger quality care.
The Oregon Health Network is one example of an organization that is trying to assist local providers in health IT implementation, especially within the telehealth realm. OHN received a subsidy of more than $20 million through the Federal Communications Commission's Rural Health Care Pilot Program, and it aims to improve the disparity and quality of care for Oregon's geographically and economically diverse population through telehealth promotion. Kim Lamb, executive director of OHN, says hospitals and other providers are going to be instrumental in keeping these types of health IT infrastructures strong, and for hospitals' communities to thrive in the dawn of telehealth, there are 12 key elements providers of all types and sizes, including hospitals, must address to experience the full benefits of strong health IT.
A researcher has developed a heart monitoring smartphone app that he says is as accurate as standard medical monitors now in clinical use.
Building on the idea of using a smartphone to measure heart rate, and has added other medical monitoring facilities, Worcester Polytechnic Institute (WPI) professor Ki Chon has developed an application that can also measure heart rhythm, respiration rate and blood oxygen saturation using the phone’s built-in video camera.
"This gives a patient the ability to carry an accurate physiological monitor anywhere, without additional hardware beyond what’s already included in many consumer mobile phones," he says.
October 06, 2011 | Molly Merrill, Associate Editor
ALPHARETTA, GA – Four out of five practicing physicians use smartphones, computer tablets, various mobile devices and numerous apps in their medical practice, according to a new report from Jackson & Coker.
“Tech-savvy physicians, especially recent graduates, increasingly rely on digital and Internet-based tools to communicate with patients and improve the medical outcomes of the care they provide,” said Sandra Garrett, president of Jackson & Coker.
The report, titled “Apps, Doctors and Digital Devices,” presented the results of several recent studies that investigated the use of smartphones, mobile computing devices and a wide variety of software apps by physicians in different specialties.
The truism "Culture eats technology for lunch" surfaced during a recent InformationWeek HealthcareWebcast. Jared Quoyeser, director of healthcare marketing at Intel, one of the Webcast's sponsors, mentioned it during his presentation on mobile devices, and it reminded me of a similar maxim: "Policy changes from funeral to funeral."
The point here is no matter how useful a new healthcare technology is, whether it be a mobile device or an electronic health record (EHR), it's not going to take hold unless it fits in with the mindset of clinicians. And that mindset can sometimes be inflexible.
Medical imaging software developer Merge Healthcare has introduced free access to a cloud-based image-sharing network. The company has partnered with Dell, which already manages more than 4 billion medical images and related studies, announced Chicago-based Merge at its annual users' conference this week.
Merge said that the imaging cloud, dubbed Merge Honeycomb, will be the nation's largest network for sharing medical images. Honeycomb, which the vendor will formally launch at the Radiological Society of North America (RSNA) annual meeting in November, will be open to all healthcare organizations, regardless of whether they are Merge customers.