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, August 25, 2012
Weekly Overseas Health IT Links - 25th August, 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.
MINNEAPOLIS – A new Wolters Kluwer Health Survey of 1,000 U.S. consumers revealed that nearly one third of Americans (30 percent) have experienced a medical mistake either firsthand or from a third-party. A majority (68 percent) believe that as the medical field continues to adopt new technologies, medical errors will decrease.
Seventy-three percent of respondents expressed concern about medical errors, with nearly half (45 percent) characterizing their distress as significant (“very”). Anxieties fluctuated based on age and sex, with older consumers aged 35-54 expressing more apprehension than younger contributors (76 percent vs. 66 percent), and women out-worrying men by eight percentage points (76 percent vs. 68 percent). No matter how it’s sliced, very few people are dismissing lapses made by physicians, medical personnel or other healthcare providers.
It is time to stop thinking of dashboards as a “nice to have” and instead view the technology as a way to provide everyone in the company with a common version of the truth. Long-gone are the clunky spreadsheets and simple, static graphs; data visualization has evolved into a dynamic discipline that is opening up new doors for the exploration and analysis of complex data sets for a wide range of businesses.
Knowledge is Power
Collection of information is required for every industry. For example, the number of patients seeing a doctor each day or how quickly a waste management company’s employees are picking up refuse are measures that can be tracked to determine how a business is running. Without this intelligence, it is impossible to know what is working, where weaknesses exist and what processes may need to change to ensure the health of the organization.
Electronic health records are designed to improve access to patient health information and, in turn, quality of care. Researchers from the University of Florida, however, have discovered a correlation between primary care doctors who use EHRs and decreased depression treatment for patients who also suffered from multiple chronic conditions.
Cloud-based clinical information systems are becoming increasingly attractive for clinicians, hospital administrations and CIOs. In radiology in particular, cloud-based RIS/PACS solutions can streamline processes and facilitate cooperative care scenarios within regions or even across borders without compromising privacy. A remaining challenge is to address the popular misconception that cloud-based healthcare IT is about transferring patient data to Google, Amazon, Apple and the like. The reality is that RIS/PACS vendors engage in highly protected private clouds to guarantee the highest security levels.
Healthcare systems in industrialized nations have been under pressure for several years now. No wonder that IT solutions that help to increase care efficiency are high on the agenda of many hospitals. But the IT revolution in healthcare is not only about technology; it is also about business models. Software as a service (SaaS) and infrastructure as a service (IaaS) have been marketed as potentially attractive alternatives to buying large-scale information systems like RIS, PACS or indeed HIS. Under the “cloud” label, the concept has gained considerable momentum in recent years.
My group purchased our Electronic Health Records system (EHR) about 5 years ago. We had 4 clinical practice locations (soon to be 5 ½) with 1 administration office. None of these sites are close to each other. A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments. In other words, we wanted to know how our patients were doing in all of our offices, which treatments were working and which were not, and then use this information to refine and practice the best medicine we could. This was the promise of EHR.
An inmate at a California correctional facility nearly received a lethal dose of heart medication last week at the prompting of a newly implemented electronic health record system. The system--from EHR vendor Epic--reportedly has caused multiple additional headaches for nurses since going live July 1, sparking a record number of complaints and a call for the system to "go away until it's fixed," the Contra Costa Timesreported.
Contra Costa County officials had visions of seamless connectivity for the exchange of health records between the county's correctional facilities and Contra Costa Regional Medical Center, according to the newspaper. Instead, the $45 million system has been nothing but trouble, claim the nurses charged with its use. Jerry Fillingim, a labor representative for the nurses, told the Times that Epic was treating the county as its "guinea pig."
The rising tide of electronic health records (EHRs) in hospitals is lifting many other boats, ranging from clinical analytics apps to private health information exchanges. Another beneficiary is medical device integration (MDI) software, which connects medical device data output to EHRs.
According to a new Capsite survey, 44% of the nearly 300 responding hospitals said they had purchased an MDI application in recent years. The majority of those purchases were made in 2011 and 2012.
Information Management, a sister publication of Health Data Management, recently interviewed Philip Fasano, CIO and executive vice president at Kaiser Permanente:
Uncertainty has become the norm with health care information management, but few entities have handled and risen to the challenge like health plan and health care provider Kaiser Permanente. The not-for-profit carries an operating revenue of approximately $42 billion yearly and serves more than 8.8 million members. CIO and EVP Philip Fasano joined Kaiser Permanente in 2007 and has lead a team of 6,000 IT employees through a handful of sweeping implementations in the last few years, including the establishment of HealthConnect, the largest civilian electronic health record repository. Fasano recently discussed some of the high-level approaches he said need to be in order before any IT implementation goes out for a bid, and what, if anything, health agencies can do to plan for requirements and pools of new patients from federal health care reform.
The Surgeons of Lake County, a group practice in Libertyville, Ill., recently announced a breach of protected information following an extortion attempt.
The practice discovered on June 25 that a hacker had taken control of a server hosting corporate email and electronic health records. A message on the server said its contents had been encrypted and demanded an undisclosed financial payment from the practice for a password to turn off the encryption. The practice turned off the server and it was not been turn back on, and notified authorities.
"High-quality data requires a very clear understanding of the meaning, context, and intent of the data – unambiguous and, ideally, standardized computable definitions of data that can form the basis for future safe decision making," accordin to AHIMA HIE practice council members who contributed to the white paper: Linda Bailey-Woods, Teresa M. Hall, Aviva Halpert, Steven Kotyk, Shirley Neal Letha Stewart and Susan O. Torzewski.
Move over, retrospective data analysis--the future is in real-time and predictive analytics, says a new market report from Frost & Sullivan. The trend is also toward web-based systems that aggregate disparate data across diverse care settings.
The more "holistic" approach to data mining includes clinical data from electronic health records combined with financial and administrative information to provide a more well-rounded view of the quality and efficiency of patient care--and then using that information to make strategic decisions, according to a Frost & Sullivan announcement.
There are now over 13,000 health, fitness, and medical apps available. In a previous post I discussed ’Five creative and necessary ways of getting medical apps adopted.’ Specifically they were incorporating medical apps in informatics, utilization in schools for health education, government initiatives regarding digital technologies, medical apps in EHR clinical decision support tools, and patient portals. These however do not necessarily lead to adoption of these apps. Some of these are years away. But the industry is rapidly maturing and here are some ways in which it has or heading towards.
GLOUCESTER, UK – About one third of Americans are willing to receive some of their healthcare from robots, and 98 percent said they would receive robot care if it meant lower co-pays and health insurance costs.
A survey by www.CouponCodes4u.com of 1,723 Americans, aged 18-30, found 34 percent said that they would opt for care from a remote presence virtual and independent telemedicine assistant robot (RP-VITA), if given the choice, while 5 percent of respondents claimed to be “indifferent.”
Those surveyed were asked how regularly they visited their doctor: 52 percent said they saw a doctor regularly; 37 percent said they saw their doctor ‘every now and again;’ and one in 10, 11 percent of respondents said they visited their doctor, “hardly ever or not at all.”
A new deal between Department of Health and CSC for the North, Midlands and East is looking increasingly likely, with a number of trusts poised to sign-up to take CSC's Lorenzo system.
At least one trust, Walsall Healthcare NHS Foundation Trust, has already committed to take the electronic patient system through the NPfIT contract. Others appear to be on the verge of committing, should a new national deal be signed.
The current ‘standstill’ agreement between CSC and the DH is due to end on 31 August.
Online programs geared toward weight management are helpful for patients who have little to no contact with physicians, but aren't as effective as face-to-face visits, according to new research.
The study was a retrospective look at 18 different studies--14 weight loss studies with more than 2,500 participants and four more on weight maintenance that included more than 1,600 participants. After the six-month mark in both sets of studies, weight loss and regain results proved more positive for those receiving computer-based interventions when compared with those receiving minimal interventions (pamphlets, for instance).
John Redfield is testing a prosthesis that he can adjust using an app on his smartphone, instead of a wrench at a doctor's office.
For amputees like John Redfield, shopping for a new pair of shoes used to be a major hassle. Walking up or down an incline was as awkward as wearing ski boots. And going shoeless required performing a constant balancing act.
Adjustable prostheses and other high-tech devices may benefit patients who have a tendency to ignore or delay care but there are some risks. Sarah Needleman reports on digits. Photo: Mathew Healey.
The adoption of electronic medical records was likely to provide savings for urban hospitals after three years of their use, while rural hospitals faced increased costs for at least six years, a study found.
Hospitals' proximity to information technology companies and their experience with health IT upgrades were among the biggest determinants of whether the addition of EMRs would lower or increase costs, according to an analysis for the National Bureau of Economic Research.
The researchers examined records for hospitals that adopted EMRs from 1996-2009 and found hospitals in “IT-intensive markets” experienced a 3.4% decrease in costs three years after adopting a basic EMR and a 2.2% cost decrease three years after adopting an advanced EMR. However, hospitals in areas with the least amount of IT firms had up to a 4% increase in costs even six years after adoption of EMRs.
NATIONAL HARBOR, Md. -- At the eHealth Initiative's National Forum on Data and Analytics in Healthcare last week, stakeholders discussed the importance of data and analytics in implementing health reform, as well as the challenges associated with it.
Jennifer Covich Bordenick, CEO of the eHealth Initiative, said, "Our survey, CIOs and members kept telling us that they are concerned about analytics. They don't feel they have the tools necessary to meet the demands of accountable care and meaningful use." She noted that "93% of the CIOs believe it is very important, but 72% don't feel their organizations have what they need to meet the analytical needs."
By convening experts in health data and analytics, the forum aimed to highlight organizations that are leading the way and facilitate conversations around the need for improvement, she said.
For insurance companies, moving to a new policy administration or claims processing system is usually a major forklift operation that requires a huge investment of time, money and human resources--no matter how smooth the eventual cutover may be. Such is the nature of the IT beast, which has reached a scale of enormous complexity and inter-dependency between systems.
However, in recent years, there has been momentum for doing things a little easier--of breaking down IT task and migrations into more manageable “chunks”--to be done iteratively, in concert with the business. IT, with its big systems, big networks and now big data, is an ideal candidate for this strategy. The big question, of course, is: is it realistic? Yes, says Brad Power, writing in Harvard Business Review, advocating chunking as the best way to manage ever-expanding and ever-complex IT projects.
While the Direct protocol is coming to increasing use for submission of data from providers to public health, a more sophisticated technology – web services – is becoming popular as well.
Even though Stage 1 Meaningful Use (MU) only requires uni-directional interfaces to public health, some programs (especially Immunization Information Systems, or IIS) anticipate that bi-directional interoperability will soon be the norm (and may be incorporated into Stage 3 MU). Using web-services, XML-based system-to-system transactions can be constructed relatively easily.
But public health systems have historically interacted directly with provider systems. What role can and should an HIE have in these interactions?
As a fan of the relational database, and the inventor of the relational model, the late Ted (Edgar F.) Codd, I have drafted a brief set of rules that I believe an HIE must comply with to be completely effective.
These rules are not for any particular type of exchange. Whether you implement stone carvers with chisels, paper and fax, peer-to-peer electronic exchange, federated repository, or a centralized repository; HIE quite simply must support these tenets to be effective.
When Dr. Codd introduced his rules for relational database management systems in 1985, it was in response to the market starting to introduce products that they said were RDBMS but actually were not. So in order to protect the relational model, which he introduced in 1970, Codd threw down the gauntlet, defining what a real RDBMS should be. And his rules stuck.
Federal officials say a $415 million information technology program approved six years ago to build broadband networks among rural healthcare providers is successful in reducing costs and enhancing healthcare quality.
The FCC created its Rural Health Care Pilot Program in 2006 to provide an infrastructure for letting rural healthcare providers build networks connecting them to their urban counterparts. The initiative includes programs at 50 sites across 38 states. In many rural and underserved areas, the program brought broadband connectivity to those regions. The findings from the pilot program will be useful as the FCC develops a permanent program, the agency said in a 98-page report released Monday (PDF). As of January, $368 million of the $415 million available has been requested.
Researchers studying electronic health records say not enough medical schools give students permission to access EHRs.
Based on their results, the Alliance for Clinical Education concludes that medical students need more training. They found that 64% of medical-school programs allow students access, and about two-thirds of those students are allowed to write notes within the record. The results were reported in two studies that appeared in last month's edition of “Teaching and Learning in Medicine.”
Scott Mace, for HealthLeaders Media , August 14, 2012
The question isn't should you use cloud computing. The question is how.
First tip: Don't go all in without some sort of disaster recovery plan. Disasters do happen in the cloud. Earlier this month, dozens of hospitals temporarily lost access to patient records due to a cloud outage.
They should have asked the tougher questions earlier of their cloud service providers. In this case, it was Cerner Corporation, which attributed the outage to human error. The outage affected Adventist Health, which reverted to using paper-based records during the five-hour interruption in service.
Having just written a story about the cloud for HealthLeaders magazine, I was startled by just how many hospitals appear to have entrusted their EHRs to someone else's data center. Dell Healthcare recently told me it hosts more than 500 hospitals' EHRs in its cloud. Many Cerner customers run their own data centers, but an increasing number do not, leaving the hosting to Cerner.
IEEE Humanitarian Technology Challenge helps build pilot system in India
By KATHY PRETZ 13 August 2012
India’s health-care system is in dire straights, perhaps worst of all in the country’s countless “informal settlements,” or slums. Health centers are the cornerstone of health care in India’s rural areas, where most of the country’s 1.2 billion people reside. For the most part, modern technology is little known in the centers, with each covering a population of 100 000 spread over about 100 villages.
That is where the IEEE Humanitarian Technology Challenge hopes to make its mark. In a pilot program, it has introduced a central database in two clinics, fed by information from RFID tracking cards that identify each patient and handheld devices through which a patient’s medical history and ailments are filed and accessed. It’s a giant step up, for the clinics often have limited patient records or sometimes none at all. Those that do keep records might use paper notebooks, but there is no filing system. And notebooks can be misplaced, memories fade, and mistakes happen.
Allscripts has been trumpeting its “open architecture” philosophy for some time now, and Health Data Management recently talked with CEO Glen Tullman and Cliff Meltzer, executive vice president of solutions development, about what that really means.
“Open architecture is almost a philosophy,” Tullman says. The company, he notes, is not so arrogant as to believe it will figure out every aspect of the integration puzzle, but will work with other major players to interoperate with their systems, he adds. If an organization has a great financial system and is buying a clinical system from Allscripts, “We don’t say ‘rip it out,’ we’ll work with it,” he adds. “Being open is a state of mind.”
CHICAGO – A burgeoning number of electronic health record systems are now being integrated with telehealth technology, purporting to make healthcare easily accessible to patients from virtually any location.
Allscripts announced Wednesday it would jump on the integration bandwagon, as the company unveiled plans for a new telehealth solution, that officials say would expand access to care and enable providers to save time and money.
The solution will integrate the American Well Online Care telehealth platform into the Allscripts Electronic Health Records (EHR) platform.
A new scientific study validates the workability of a digital medical-imaging sharing system controlled by patients, not providers.
The study looked at an open-source prototype of the Patient Controlled Access-key REgistry (PCARE), according to an abstract published online Aug. 11 by the Journal of the American Medical Informatics Association.
The authors note that the current image-sharing method of patients hand-carrying CDs puts a burden on patients, while digital sharing networks coordinated by medical organizations challenge patient privacy. The PCARE prototype includes a central patient portal allowing patients to manage the access keys.
Hospital operations, including patients' personal and health records, are becoming more digital by the day. As that landscape shifts online, an emphasis on keeping such information safe grows increasingly important.
Being reactionary, however, isn't enough in today's world. Just ask Phoenix Cardiac Surgery, a five-physician practice which earlier this year was fined $100,000 U.S. Department of Health & Human Services' Office for Civil Rights after a calendar of patient appointments was posted online.
HIPAA violations are an expensive proposition both for hospitals and patients--the former can face fines up to $1.5 million from OCR in addition to reputational hits, while the latter can face loss of identity, ruined credit and more.
WASHINGTON – The Office of the National Coordinator for Health IT wants to automate for all patients the Blue Button feature that is currently available to veterans, military service members and Medicare beneficiaries to obtain their health information.
The Blue Button enables patients to view and download their information in simple text format. ONC is working with the Veterans Affairs Department, which first established Blue Button two years ago for its personal health record, MyHealtheVet, according to Lygeia Ricciardi, acting director of ONC’s Office of Consumer eHealth.
But first, standards and technical descriptions for the tool must be identified. So ONC’s Standards & Interoperability Framework will kick off this project Aug. 15 with a webinar to get participants involved in a wiki community.
Dr. Stephen Covey recently passed away. The self-help and management guru was 79 years old. It has been years since I saw him present his "Seven Habits of Highly Effective People," but I clearly recall his charisma, sincerity and wisdom. Over the intervening years, I occasionally have reread and benefited from his simple but profound insights. The best advice, I have found, is simple: If all of us did the simple things we already know, it would change the world. My Advisory Board Company colleagues -- former CIOs themselves -- and I have attempted to relate Covey's seven habits to the work life of health care CIOs. CIOs have difficult, complicated and stressful jobs. Who could benefit more from a little simplicity?
We are going to list each of the seven habits, as Covey defined them, and then identify ways that CIOs can apply these habits, based on input from leaders in the field.
Habit 1: Be Proactive -- Take initiative in life by realizing that your decisions are the primary determining factor for effectiveness in your life.
Right or wrong, a CIO in most hospitals today has to earn his or her place at the executive table. A passive CIO is headed for trouble, quickly -- few organizations will define your role strategically or arrange effective IT governance for you -- you must continually take the initiative and take responsibility for your results. A CIO who only does what his or her users ask is not going to earn that seat at the table. Assess your organization from the CEO's perspective: look at what makes the organization work, do your own SWOT -- strengths, weaknesses, opportunities, threats -- analysis and determine how you, as a leader, can help. Use this information to avoid becoming just an "order taker" by initiating brainstorming and "what-if" exercises with your users. Ingrain proactive service into your department -- make it a priority to identify problems before the users do and encourage staff to suggest uses of technology to their users instead of waiting for requests and fending them off.