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 20, 2012
Weekly Overseas Health IT Links - 20th October, 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.
A large coalition of providers, software vendors, health information exchanges, states and public agencies has launched a program to develop test standards to certify electronic health record and HIE products that use a standardized method for exchanging health information.
The goal is plug-and-play HIE, with initial benefits expected to be seen within nine to 12 months. The initiative will expand work done by the Nationwide Health Information Network Exchange, a program within the Office of the National Coordinator for HIT that brought together stakeholders to test a common set of specifications for information exchange.
From the Medicare/Medicaid EHR incentive program to ACOs and HIEs, information exchange is the centerpiece of nearly every initiative designed to bend the health care quality and cost curves. The ability to access real-time clinical data wherever a patient encounter takes place drives these improvements by informing care decisions, avoiding preventable adverse events, eliminating diagnostic and therapeutic duplications and shortening lengths of stay.
Ensuring the integrity of the data upon which this transformation depends is paramount to success, both at the individual hospital level and health care system-wide. But as more systems are interfaced, significantly higher volumes of data are flowing into patient records and other clinical, administrative and financial systems. An error at any point along the way--an incorrect birth date, transposed digit in a Social Security number, missed middle initial or misspelled name --quickly snowballs as the information feeds from one system to the next.
A small study conducted at a suburban Central Texas hospital suggests that using an electronic medication checklist at admission can reduce medication errors for elderly patients taking multiple drugs.
The researchers, from Texas State University-San Marcos published their work at Perspectives in Health Information Management. The study involved eight nurses taking medication histories from 64 patients, ages 65 or older, all of whom were taking at least five medications. The patients were hospitalized for at least a week, and three days before discharge were interviewed about medications they were given. They then were divided into two groups: one interviewed first using paper records, then again using the electronic record; and the second group interviewed in the opposite order.
A presidential commission studying privacy issues related to more readily available DNA sequencing recommends integrating whole genome sequence data into health records for research purposes.
In a report issued Thursday, the Presidential Commission for the Study of Bioethical Issues said that electronically exchanging DNA sequencing data through standardized EHRs and infrastructure would provide more data to researchers for genome-wide analysis that can advance clinical care.
Edward Koschka, CIO of Indianapolis-based Community Health Network, said that the biggest barrier was following up on and enforcing adopted policies. "The medical staff executive committee needs to make CPOE a priority," Koschka told HHN. "The efforts at The Indiana Heart Hospital have been diffused, as not all specialists coming into the hospital use CPOE routinely in other hospitals, so there is not a consistent workflow across the five network hospitals."
The Centers for Medicare & Medicaid Services failed to meet federal notification requirements when its Medicare patient database was breached, or offer much help to beneficiaries whose protected health information was compromised, an audit by the Department of Health & Human Services' Inspector General found.
CMS had 14 breaches of protected health information (PHI) between Sept. 23, 2009, and Dec. 31, 2011, affecting 13,775 Medicare beneficiaries, according to the HHS Office of the Inspector General (OIG). The beneficiaries were notified, but CMS failed to meet several notification requirements detailed in the American Recovery and Reinvestment Act, OIG found.
In 2006, the piece notes, then Michigan Governor Jennifer Granholm adopted a plan to encourage the growth of "sub-state" HIEs, of which there are now six in Michigan. It was expected that these exchanges would have interconnected through a statewide HIE by this year. Instead, the two largest HIEs are each trying to win enough market share to become statewide exchanges themselves.
The mammoth project formerly known as NwHIN-Exchange created enough buzz throughout the year, in certain circles at least, that the news might be taken as almost anticlimactic. In terms of demonstrable progress that the healthcare industry is advancing information interoperability while furthering the business case for exchange, however, the fact that ONC delivered eHealth Exchange is anything but.
Today, 28 partners share health information across eHealth Exchange, a mix of private and public organizations that includes CMS, DoD, SSA and VA as well as industry heavyweights Kaiser Permanente, Marshfield Clinic, MedVirginia. And Idaho Health Data Exchange, in late September, became the newest member.
Women whose healthcare providers use electronic health records are more likely to receive preventive care, according to a study published this week in the Journal of the American Medical Informatics Association. What's more, more sophisticated use of such tools also led to an increase in preventive care.
EHealth Insider’s second survey of acute sector IT suggests that trusts and their IT services are grimly getting to grips with the NHS reform and financial agendas. Lyn Whitfield reports.
9 October 2012
After two years of anxious speculation about the scale of the financial challenge facing the NHS and the impact of the Lansley reforms, trusts are starting to get a handle on the policy and business challenges ahead of them.
That, at least, is the impression given by eHealth Insider’s second annual survey of IT directors and others working in and with acute sector IT.
Last year’s survey found large numbers of respondents expecting their trusts to have to make very large savings of 20% or even 30% of their income – and to shed very large numbers of staff in response.
BT Health has pinned its future NHS strategy on developing a portfolio of secure health cloud-based services based on a new health cloud built over the past nine months.
The first to be launched is a pay-as-you-go medical transcription service able to handle patient identifiable data (PID), already said to have three early NHS customers. The medical transcription service is being delivered in conjunction with 3M Healthcare.
This will be followed by pay-as-you-go services for medical imaging, both services will be launched in the next few months.
The technology revolution has “barely touched” patient experience in the NHS, health secretary Jeremy Hunt told the Conservative Party conference in Birmingham yesterday.
The new health secretary used his first major speech since replacing Andrew Lansley in the cabinet reshuffle last month to highlight the important role of technology in improving patient experience of healthcare.
“The final challenge I want to mention today is the technology revolution, something that in terms of patient experience has barely touched the NHS,” he told attendees.
The HIT Policy and Standards Committees are seeking public comment on best practices for verifying patient identities--confirming they are who they say they are--in electronic communications.
That issue is particularly pertinent as requirements in Stage 2 of the electronic health records meaningful use program require more than 5 percent of patients to view, download or transmit their health information, and to conduct secure messaging with physicians.
Practices shopping for an electronic health record system or seeking to improve an existing system should have a central clearinghouse of reviews, feedback and tips from other users, says an Institute of Medicine discussion paper.
The paper, published in September, is intended to foster discussion of a recommendation the IOM made in an earlier report that examined ways EHRs can be improved. The institute recommended that the Dept. of Health and Human Services’ Office of the National Coordinator for Health Information Technology work with public and private sectors to make comparative EHR user experiences publicly available.
Health-related tweets are up 51 percent in 2012, Melissa Barnes, Twitter's head of agency and brand advocacy, told attendees at the Health 2.0 conference in San Francisco this week. And while the company wants to encourage healthcare marketers' use of the microblogging service, she offered some caveats as well, reportsGigaOM.
For instance, Twitter can't support pharmaceutical advertising and it can't give legal advice, she said, so marketers must determine their own effective strategies.
In an article published this month in Health Affairs on the reasons why scientific evidence often has little effect on clinical practice, technology played a role--though not necessarily in a good way.
The authors, from the Rand Corp., examined six studies on comparative effectiveness research and its effects on practice. Among the problems cited were limited use of clinical decision support tools that could provide better alignment.
A coalition of 15 states, 37 technology vendors and 34 health information exchanges is coming together to enable the exchange of health data for more than half of the U.S. population. The public-private partnership, which is led by both the EHR/HIE Interoperability Workgroup and Healtheway, created a testing program that will be able to determine a system's capability to exchange data with several other systems. The Certification Commission for Health Information Technology has been tasked with conducting the testing.
Ten years ago, Juergen Fritsch, chief scientist at Franklin, Tenn.-based M*Modal, was a postgraduate student at Carnegie Mellon, working on research for the government. “We were focused on a project eavesdropping calls," says Fritsch. "What emotional state [people] were in, and so on. We learned a lot about how people talk about things."
Since then, Fritsch and his colleagues have taken what they learned and developed this into natural language understanding (NLU) technology for healthcare. In a nutshell, NLU refers to a computerized system that can turn spoken and typed words in to structured data.
SEATTLE – A new survey finds that patients' expectations for healthcare providers have evolved. A majority expect their doctors to communicate with them proactively - even when they're well - via texts, emails and proactive smartphone alerts.
Sponsored by Seattle-based communications firm Varolii, the survey polled 1,001 adults across the U.S.
Its findings may come as a surprise to some busy physicians. Nearly 80 percent of respondents say it's their doctor's job to keep them healthy - not just to treat them when they're sick. And they wish there was more communication when they're feeling OK: 70 percent of respondents say their doc has never checked on them when they weren’t sick in order to help them stay healthy.
Health information management professionals play an integral role in determining whether their organizations embrace big data and use it effectively, according to an article in the October issue of the Journal of the American Health Information Management Association.
HIM pros, according to the authors, should urge key stakeholders to seize on data analysis as a strategic asset that that can improve care, create efficiencies and cut costs for providers, researchers and management.
SAN FRANCISCO — Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level.
As a third-year resident in internal medicine, Dr. Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain swelling, seizures or even death.
Dr. Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was “like a shot of adrenaline,” he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his iPhone.
ST. PAUL, MN – The Citizens' Council for Health Freedom (CCHF) has added its voice to those of four Republican lawmakers who recently called for a temporary halt to meaningful use incentives until the program is revamped.
But, unlike the lawmakers, CCHF wants federal involvement in EHRs eliminated altogether, according to Twila Brase, president of the CCHF.
CCHF, a non-profit organization based in St. Paul, Minn., does not want electronic health records pushed forward by a federal program at all, but rather supports the market leading the way. “[The] HITECH [Act] could go away as far as we’re concerned,” Brase told Healthcare IT News.
NEW YORK – The findings of a new study underscore the positive correlation between high quality care in physician practices and the use of electronic health records (EHRs). Experts say the study is one of the first to examine and subsequently validate the clinical value of EHRs.
Officials say the study, published in the October issue of The Journal of General Internal Medicine, demonstrates that the significant investment in EHRs by both the federal government – which has already invested some $29 billion in meaningful use incentives – and physicians who use them will result in better care.
Researchers in The Netherlands are claiming success with a computer system that applies natural language processing to biomedical text to link relevant concepts to sources that contain further information, a process needed to help computers extract useful information from free text.
In their paper, published this week in the Journal of the American Medical Informatics Association, the researchers compared the effects of NLP on two biomedical concept normalization systems--MetaMap and Peregrine--which were used on the Arizona Disease Corpus.
With an eye on the mountains of health data that federal and state health agencies are collecting, Northrop Grumman is developing a customizable platform to tie the data sources together and, ultimately, analyze it for the betterment of public and population health.
Known as iHAP, short for Integrated Health Analytics Platform, this early-stage solution is “a way to encapsulate the concepts of large-scale structured and unstructured data, provide the analytical tools, then be able to visualize it so we can provide tailored views,” said Morgan Crafts, director of technology in the civil systems division of Health IT at Northrop Grumman Information Systems.
According to a new study from the Hudson Valley Initiative, a Fishkill, N.Y.-based healthcare reform effort from three providers: Taconic IPA, Taconic Health Information Network and Community, and MedAllies, the use of EHRs in an physician office leads to better quality care. The study, "Electronic Health Records and Ambulatory Quality of Care," found that physicians using EHRs scored significantly higher on quality of care for four screening measures for diabetes, breast cancer, Chlamydia, and colorectal cancer.
Scott Mace, for HealthLeaders Media , October 9, 2012
As the November election approaches, money isn't flowing only into the political campaigns. Last week, healthcare seemed to be swimming in money in motion, all of it having to do with investing in technology initiatives.
The Health 2.0 conference, which began yesterday, has doubled in size in the past two years, after growth had slowed for a few years. The halls of the San Francisco Hilton are thronged by a fast-talking crowd. Deals are being made in corridors and every third person you meet seems to be a doctor with a dream and some startup capital talking to an investor looking to get in the game.
The bad news for many healthcare systems is that a lot of this money doesn't presume the continuation of the current hospital-oriented care system as we know it. Calculating the new Medicare penalties for 30-day readmissions are even the subject of a startup's website (whose URL I won't give here because the first thing the site asks for is an email address). But some hospitals will be desperate enough to take the bait, just to see how bad the news is.
In 2010, patient advocate and social media rock-star e-Patient Dave (Dave de Bronkart) walked over to me at a medical conference and handed me a small pin. It was blue and white with a downward pointing arrow. He smiled his mischievous Dave grin and said, "You are going to want one of these. Blue Button is a big deal."
So for the last two years, I have worn this symbol on my jacket and painted it into many paintings. Some folks have asked me why I use this image, "Isn't Blue Button just some idea from the Department of Veterans Affairs and the Markle Foundation?" I respond, "That is where it started." At this point more than one million patients have used Blue Button to access their data. VA, CMS, the Department of Veterans Affairs and the Federal Employee Health Benefits Program all have adopted the initiative.
Are you among the 47 percent of older Americans who have not yet entered the digital age? If so, you're likely to be missing out on a lot of e-health opportunities available to help you live well despite chronic ailments and encroaching physical limitations.
Americans over 65, whose health stands to benefit the most from modern digital technology, are the least able and least likely to use it. As of April, according to the Pew Research Center's Internet and American Life Project, 53 percent of Americans 65 and older were using the Internet or e-mail, but after age 75, use dropped off significantly, to 34 percent. By contrast, nearly 90 percent of younger adults are digitally connected.
Jacqueline Fellows, for HealthLeaders Media , October 8, 2012
As electronic medical records systems make their way into healthcare's regular workflow, two recent, but separate surveys show that physicians may be buying into the value of joining health information exchanges.
Perhaps what is significant about this survey is not what it shows, but what it doesn't. The barriers to using and exchanging health information electronically are no longer rooted in maintaining the status quo. The fear of change that often accompanies shifts from manual systems to digital processes seems nearly gone.
WASHINGTON – Additional standards that meet with broad industry agreement and consistent implementation are critical to spur the exchange of health information and value-based care, according to a new report conducted by the Bipartisan Policy Center (BPC).
The study's findings include clinician perspectives on barriers preventing them from exchanging health information with other providers, with some 71 percent of clinicians citing the lack of interoperability and HIE infrastructure as the biggest challenge.
The report also highlights the “fragmented nature” of healthcare delivery today, with BPC officials pointing to Medicare patients – who currently see seven different physicians, on average, across four different group practices. This fragmentation can significantly decrease the quality of a patient’s care, the report suggests, as it can lead to duplications, misdiagnoses and overtreatment.
A recent Markets and Markets report forecasts cloud computing in healthcare to grow at a compound annual growth rate of 20.5 percent from 2012 to 2017. Although cloud computing offers significant advantages to healthcare organizations and other stakeholders, security of patient information, interoperability and compliance with government regulations are some of the factors that are slowing down the market, according to the report.
Yet, these factors are also driving many healthcare providers to the cloud, particularly physician practices and community hospitals, says Jamie Coffin, vice president and general manager, Dell Healthcare & Life Services.
“They don’t have the IT expertise to run these things,” Coffin says. “With the new security and privacy regulations around things like HIPAA compliance and new things like you have to encrypt every drive and the things they’re having to deal with now are astronomical for a physician practice to have to deal with it.”
ROCHESTER, MN – A new mobile health application developed by mental health professionals has set its sights on the estimated 40 million people in the U.S. currently living with anxiety.
Officials say the Anxiety Coach app was created as a self-help tool to help people reduce a variety of fears and worries, ranging from extreme shyness to obsessions and compulsions.
“The reason we created [the app] is because anxiety disorders are one of the most, if not the most common mental health problem faced by both kids and adults, and only approximately 30 percent of people receive treatment," says Stephen Whiteside, director of the Pediatric Anxiety Disorders Program at Mayo Clinic, psychiatrist and co-developer of the application, to Healthcare IT News. “And even though that’s a small number, even a smaller number receive the most effective treatment, which is exposure-based cognitive behavior therapy.”
Physicians often feel that computerized physician order entry systems with computerized decision support are basically crying wolf by issuing too many unimportant adverse drug event alerts, causing many to defeat the purpose by overriding the alert function, a new study reports.
In the study published online this week in BMC Medical Informatics and Decision Making, researchers theorized that alert overload could be minimized if drug safety alerts were tailored to specific clinical situations. They set out to see what type of context physicians would need to prioritize drug safety alerts.
More than 230 physicians surveyed at four European hospitals identified four factors that could be used to filter out low-priority alerts, selected from a potential list of 20.