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, June 30, 2012
Weekly Overseas Health IT Links - 30th June, 2012.
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.
On Twitter, 10,000 people are listening to Jen Gunter. Sexual health, shoes and "The Hunger Games" are the subjects of just a few of the 36,500 tweets crafted by the obstetrician-gynecologist at Kaiser Permanente in San Francisco.
Gunter's social-media presence also includes a blog, which she uses to write about birth control and weight loss; a professional Facebook page; another Facebook account for friends; Instagram; and Tumblr.
Gunter has plenty to say and plenty of ways to say it, but when patients she's never met ask for medical advice online, she has just one thing to say: "No."
"We are really at a tipping point here; providers and patients alike have come to realize that the modernization of healthcare is long overdue and that we all have a role in its broad adoption."
So said Jason Kunzman, project officer for the Office of the National Coordinator for Health Information Technology, as he moderated the "Beacon Communities: Leveraging Health IT to Fuel the Quality Revolution" education event at the recent HIMSS 2012 Virtual Conference and Expo.
A new federally sponsored program will test giving providers quick access to prescription histories in ambulatory and emergency departments to combat prescription drug abuse.
The Office of the National Coordinator for Health Information Technology and Office of National Drug Control Policy have launched the initiative with tests in Indiana and Ohio. The goal is to better take advantage of the information in the databases of state prescription drug monitoring programs and other sources. The Substance Abuse and Mental Health Services Administration is funding the pilots.
The Office of the National Coordinator for Health IT (ONC) is launching a pair of pilots to test the effects of expanding state programs designed to prevent abuse of prescription drugs. The pilots in Indiana and Ohio will find out how health IT can help increase the effectiveness of prescription drug monitoring programs (PDMPs).
PDMPs are statewide electronic databases that providers can use to identify and intervene with prescription drug abusers. The databases collect, monitor and analyze electronically transmitted prescribing and drug dispensing data.
One researcher explains his views of a major issue from the EHR vendor market
In a recent piece for the New England Journal of Medicine, two Boston Children’s Hospital informatics researchers, Kenneth Mandl, M.D. and Isaac Kohane, M.D., make the argument that EMR and EHR vendors are holding back innovation in the health IT industry. Many vendors, the duo insists, have failed to adopt basic Internet-era sources for their systems such as private cloud-based storage and secure communication protocols, as well as modern consumer technologies such as word processing and search engines.
Mandl and Kohane say the lack of interoperability and standards with these systems have put the industry’s innovation in a standstill. Instead of constraining physicians, they suggest that more open systems with diverse functionality would drive improvements in patient engagement, care coordination, and overall create better care quality, which in turn would reduce costs.
In a two-part interview, HCI Associate Editor Gabriel Perna recently spoke with Mandl, who is the director of the Intelligent Health Laboratory at the Boston Children's Hospital Informatics Program as well as an associate professor at Harvard Medical School, about his somewhat controversial opinion, why he says EHR vendors are afraid of interoperability, and why they shouldn’t be. Below are excerpts from the first part of that interview.
Computerworld - Electronic health records (EHR) are now being used by 110,000 healthcare providers and more than 2,400 hospitals, according to a report released today.
In all, there are about a half-million healthcare providers and just over 5,000 hospitals across the country that are eligible to receive reimbursements for EHR rollouts through the Medicare and Medicaid EHR Incentive Programs, according to the Office of the National Coordinator for Health Information Technology (ONC).
Significant efforts are underway to develop an end-to-end approach to quality reporting from EHRs, according to Health Level 7 International (HL7), which hosted a webinar on the topic earlier this week.
"Standards are a prerequisite to functionality. When it comes to quality reporting, if you can't measure it, you can't improve it. If you can't standardize it, you can't measure it," Bob Dolin, president and chief medical officer at Lantana Consulting Group, Past chair of vice chair of HL7 and co-chair of the HL7 Structured Documents Work Group, said during the online event.
Electronic health records have the potential to help providers in different settings better communicate about patients, but they won't improve patient care in a vacuum, warns the Medicare Payment Advisory Commission (MedPAC) in its latest report to Congress.
"[A] better information system by itself is unlikely to improve care unless the systems are interoperable, the providers involved establish protocols for how they will communicate key information to each other, and processes are in place to augment the information provided in the electronic medical record so that all pertinent information can be shared across providers," the report says.
The federal government needs to take a step back as it seeks to establish a governance model for the emerging nationwide health information network, according to the HIMSS Electronic Health Record Association.
The 41-vendor group recently sent a comment letter to the Office of the National Coordinator in response to a request for information published in May. The RFI sought comment in five categories, including a set of conditions for trusted exchange of data, or “rules of the road.”
John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, details how his team is analyzing security risks and deciding what to do about them in a recent post on his blog "Life as a Healthcare CIO."
In a previous post, Halamka said that "mounting regulatory and compliance pressures" are keeping him up at night. Unsurprisingly, a full third of the capital requests in his FY2013 budget were for security and compliance-related projects.
As strategic initiatives across IT continue to grow, many are looking to the CIO as a leader. But according to Pamela Dixon, managing partner at SSi-Search, another prominent position is evolving to aid the CIO in the development of new projects.
"To assist in meeting these challenges, we see the chief medical information officer (CMIO) taking a seat next to the CIO in meeting Meaningful Use objectives – and possibly beyond," she said. "The CMIO's role is not new to healthcare but is rapidly gaining importance. How the role will evolve is raising some questions for the C-suite."
Electronic health records suffer from a lack of innovation that thwarts physicians' attempts to advance healthcare processes and workflow. Unlike word-processing programs, search engines, social networks, and mobile phones and apps, EHRs are stuck in the pre-Internet world where EHR vendors not only control the data, but also resist improvements to functionality while reaping huge financial rewards, concludes a commentary that appears in the June 14 issue of the New England Journal of Medicine.
Penned by Kenneth Mandl and Isaac Kohane, both professors at Harvard Medical School, "Escaping the EHR Trap – The Future of Health IT", says EHR vendors insist that the healthcare industry is so unique that data collection, the sharing of health information, and many other tasks associated with healthcare workflow require a highly specialized set of tools. This myth, the authors say, has led to EHR vendors declaring that only they can develop health IT to meet the current demands of the healthcare system--a notion with which the authors sharply disagree.
Legislation soon to be voted on in Congress and expected to pass lays the framework for federal regulation of health information technologies.
The health I.T. language is part of a final version of the Prescription Drug User Fee Amendments Act of 2012, worked out in a House-Senate conference committee. Companies pay user fees, which in turn help pay for FDA regulatory programs.
June 20, 2012 | By Susan D. Hall - Contributing Writer
Although most medical videos on YouTube are aimed at patients, physicians also use the videos to present research papers or talks from professional meetings, according to an article in American Medical News. Doctors also use the site to help with personal branding, Michael Banks, M.D., president of The Doctors Channel, told the publication.
"I can tell you 29 percent of physicians do not post their own videos on YouTube," said Banks, who was referencing a figure reported in a report published earlier this year by healthcare recruitment firm AMN Healthcare. "But the ones that do make videos are helping to establish themselves as experts in a certain area."
Statewide health information exchange grantees in nearly 30 states are using the Direct Project clinical messaging protocol, and a dozen more are slated to inaugurate Direct this summer, according to a recent Health IT Buzzblog post.
According to ONC project officer Brett Andriesen, Direct is available to all hospitals and physicians in these states, although an accompanying map indicates that the protocol still is being piloted in five of the states.
As threat risks continue to grow for mobile devices in healthcare — think thumb drives, smartphones, tablets and laptops — the pressure to mitigate these risks is being put on the providers. The folks at ID Experts believe now is the time to assess your mobile strategy and take charge of PHI.
Here are 13 tips for fighting mobile device threats, as compiled by ID Experts and others.
1. Consider USB locks. These can be for your computer, laptop or any other device that may contain PHI or sensitive information, said Christina Thielst, vice president at Tower Consulting Group. A USB lock can help prevent unauthorized data transfer — whether uploads or downloads — through USB ports and thumb drives. "The device easily plugs ports for a low-cost solution and offers an additional layer of security when encryption or other software is installed," she said. "The locks can be removed for authorized USB port use."
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have announced that more than 100,000 healthcare providers are using electronic health records that meet federal standards and have benefitted from the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.
The goal of 100,000 healthcare providers to adopt or meaningfully use EHRs by the end of 2012 was given by CMS’ acting administrator Marilyn Tavenner and National Coordinator for Health Information Technology Farzad Mostashari, M.D., Sc.M., three months ago. Tavenner proposed the 100,000 provider goal in a blog in March with Dr. Mostashari that declared 2012 the “Year of Meaningful Use.”
A new advisory body is being created to look at expanding the Summary Care Record to include non-GP information such as hospital data.
The Department of Health told eHealth Insider that it is recruiting a chair for a new group, the Summary Care Record Content and Advisory Board, which will look at including information from non-GP settings.
The creation of an advisory board was recommended in The Ministerial Review of the Summary Care Record, which reported in October 2010.
Many of the national projects developed by the National Programme for IT in the NHS relied on the buy-in and support of GPs. Rebecca Todd investigates their fate and their future.
19 June 2012
“Basically they haven’t achieved what they wanted to do and that’s great.” That is how Dr Paul Cundy sums up the impact of the National Programme for IT in the NHS on primary care.
The joint chairman of the BMA and RCGP's joint IT committee believes NPfIT has been a complete failure; but GPs are “absolutely overjoyed” about that.
“The original national programme completely ignored GPs,” he says. “That was initially because they thought they didn’t need to concentrate on GPs. But eventually that turned out to our advantage, in that we were largely left alone.”
The creation of Summary Care Records for 50m was the most high profile and contentious of the national projects set up by the National Programme for IT in the NHS. Patients were supposed to view and add to these records via the website organiser, HealthSpace. Rebecca Todd looks at the bumpy path of these data-sharing initiatives.
20 June 2012
‘Delivering 21st Century IT’ promised to build a “life-long health record service” that would give healthcare staff and patients access to “universally available, secure, accurate and up to date health records.”
The National Programme for IT in the NHS, which took forward the strategy, turned this commitment into the NHS Care Records Service.
On the one hand, it set up a national project to create a Summary Care Record – a central record of a patient’s health status that was intended to provide vital information for staff working in out-of-hours and A&E services, and for temporary residents.
On the other, it set up local service provider-led projects to deliver detailed care records systems to trusts and other healthcare organisations; with well-known results.
A new Medscape Business of Medicinearticle about whether and how physicians should communicate with patients by e-mail is instructive, although most of the issues it discusses were thoroughly hashed out years ago. Curiously, the article doesn't bring up the one new element of e-mail communications--the widespread use of mobile devices.
Among the topics the article does address is whether e-mail messaging reduces physician productivity; the lack of reimbursement for non-office-visit encounters; potential liability risks; how e-mail access to providers can grow a practice; the impact of e-mailing on the physician-patient relationship; and privacy issues.
June 19, 2012 | By Susan D. Hall - Contributing Writer
The interoperability group Integrating the Healthcare Enterprise (IHE) International has released a guide for simplifying mobile access to health documents for patients and providers.
The guide describes a simplified application programming interface, or API, to access health records through a patient portal, an electronic health record, a personal health record or a health information exchange.
It uses a REST, or representational state transfer, Web-based architectural framework and builds on metadata concepts found in earlier specifications from IHE and international standards group HL7, but simplifies them for web-enabled devices and applications.
June 19, 2012 | By Susan D. Hall - Contributing Writer
Geisinger Health System and drug maker Merck will collaborate on a web-based application to improve medication adherance and identify risk factors for chronic disease, the organizations announced this week.
First up: an interactive Web application to help doctors assess and engage patients at risk for cardiovascular disease and Type 2 diabetes.
Electronic health records are helping public health departments respond to health epidemics faster and with more efficiency, according to an article published this week in the New York Times. From identifying tainted food sources to spotting disease trends, EHRs have brought real-time statistics to fights that, as recently as 10 years ago, were bogged down by having to sort through paper records.
For example, according to the Times, in February EHRs helped Michigan health officials to link a string of E. coli incidents across a few counties back to sprouts being served at a popular sandwich chain. The health officials ultimately were able to warn the public, ending the outbreak by April.
Public health departments around the country have long scrutinized data from local hospitals for indications that diseases like influenza, tuberculosis, AIDS, syphilis and asthma might be on the rise, and to monitor the health consequences of heat waves, frigid weather or other natural phenomena. In the years since 9/11, this scrutiny has come to include signs of possible bioterrorism.
When medical records were maintained mainly on paper, it could take weeks to find out that an infection was becoming more common or that tainted greens had appeared on grocery shelves. But the growing prevalence of electronic medical records has had an unexpected benefit: By combing through the data now received almost continuously from hospitals and other medical facilities, some health departments are spotting and combating outbreaks with unprecedented speed.
Scott Mace, for HealthLeaders Media , June 19, 2012
One of the biggest technology trends hitting healthcare this year, mobile computing, poses one of the biggest security threats to healthcare that will last for many years to come.
Just last week, my first magazine feature story for HealthLeadersexplored the surge in Bring-Your-Own-Device behavior in healthcare. As I researched the story, I became aware of efforts to improve mobile security being led by the Healthcare Information and Management Systems Society.
James Brady, PhD, is chair of HIMSS's mobile security workgroup. Brady's day job is chief information security officer and director of technical services at Hawaii Health Systems Corporation in Honolulu. HHSC operates 1,275 licensed beds across five islands in the state of Hawaii, so Brady certainly has a vested interest in getting mobile security right.
SAN DIEGO – Voice recognition software has provided the means to lower transciption costs, speeding efficiency and populating data for achieving meaningful use, according to Richard Gwinn, MD, director of urgent care at Sharp Rees-Stealy Medical Group in San Diego.
Rees-Stealy Medical Group has 19 locations,400 physicians,1,700 staff members and is one of the largest, most comprehensive medical groups in San Diego County. The group offers primary and specialty care, laboratory, physical therapy, radiology, pharmacy and urgent care.
Although information technology certainly has the ability to change patient behaviors, a lot of untapped potential remains, according to researchers published last week in the Journal of Medical Internet Research. Such capabilities and risks, they concluded, "are not being fully explored." What's more, they said, interactions between different technology components have not been analyzed sufficiently.
The researchers combed through 41 relevant studies, examining the extent to which various technologies--such as wearable sensors and mobile phone apps--helped patients to stay fit and track calories. Overall, they determined the effect of technology on actual behavior to be mostly positive but said that more work should explicitly focus on the functions of active technologies, such as interactive education and self-monitoring.
Many physicians are dissatisfied with electronic health record systems, according to a recent survey of members of the professional networking site Sermo. Forty-four percent of respondents said EHRs are not designed with physicians in mind; 15 percent said they believe EHRs lower the quality of care; and 73 percent said EHRs are a distraction from the physician-patient relationship. Less than a third of respondents had a favorable opinion of EHRs, down from 39 percent in 2011.
That's a big drop. One possible explanation is that, because of the Meaningful Use incentive program, many physicians who don't like the technology are adopting it to obtain the government funds while they can. But the other findings suggest that EHRs are not well designed for physician workflow and that many doctors feel they're being forced to spend more time on the computer, leaving less time for interaction with patients.
The Red Cross launched a first aid app for iOS and Android, which is the first in a series of preparedness apps the organization will roll out this year.
The app is primarily a resource for emergency situations. You can look up what to do if someone around you is bleeding, for example, and follow a list of steps to determine how best to manage the situation.
Thanks to a $45,000 contribution from the American Society of Healthcare Risk Management (ASHRM), the Public Interest Committee of the American Health Lawyers Association (AHLA) will conduct a research project that will address the new types of Serious Safety events and related malpractice liability that can result from the implementation of electronic health records (EHRs).
AHLA's year-long research project, reportedly the first of its kind, will produce tools that healthcare providers can use to minimize EHR-related medical errors, including a checklist that will help identify such errors and best practices guidelines to help minimize the occurrence of EHR-related errors in the first place. In addition, the researchers will craft a list of "dashboard indicators" for use by governing bodies in their quality oversight.