Saturday, February 16, 2013

Weekly Overseas Health IT Links - 16th February, 2013.

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.

New Watson-based tool sends docs to the cloud for cancer treatment

February 8, 2013 | By Dan Bowman
IBM and New York-based Memorial Sloan-Kettering Cancer Center have taken the next step in their partnership to improve cancer care using Watson technology.
The entities, along with Indianapolis-based insurer WellPoint, today introduced a new product--Interactive Care Insights for Oncology--that will enable clinicians to provide personalized treatments to patients based on individual medical information and updated treatment guidelines and research.
Providers using the product will have remote access to a Watson-based advisor via the cloud, according to an announcement. The product is the result of an agreement reached last year between IBM and Memorial Sloan-Kettering in which the two partnered to develop a clinical decision support tool for individualized cancer treatments.
Friday, February 08, 2013

Final HIPAA Rules a Major Step Forward, but There's More Work To Be Done

On Jan. 25, HHS published the long-awaited, final HIPAA privacy and security regulations implementing most of the changes mandated by Congress in the HITECH Act. Congress intended for the HIPAA changes to help build public trust in the increased digitization of health data triggered by the HITECH electronic health record incentives. Do the new rules get the job done? In what key ways is patient privacy enhanced by the new rules?
More Objective Standard for Breach Notification
In HITECH, Congress established a right for individuals to be notified of breaches of their identifiable health information. Earlier rules to implement this provision required notification to patients only if the breach would cause a "significant risk of harm" to the data subjects. Although harm was defined to include financial and "other" harm (such as harm to dignity or reputation), we were concerned that this standard gave breaching entities the power to make subjective judgments about whether the type of data involved in the breach would cause "harm" to data subjects. Under the new standard, entities experiencing a breach must notify the data subjects unless they determine, through an objective analysis, that there is a low probability that identifiable data were compromised in the breach. Factors to be considered include whether identifiable information was actually viewed or acquired by someone not authorized to see it and the extent to which the risk of misuse of the data was mitigated. 

5 ways supply management matters

By Benjamin Harris, New Media Producer, Healthcare IT News
Created 02/06/2013
Keeping shelves stocked and enough supplies in their place is one of the most important aspects of managing any hospital department efficiently and safely. Supply management is the pipeline from whence all instruments of care flow, and if it causes more problems than it solves, a department runs a risk of wasting money or, worse, negatively affecting patient care. 
Keeping shelves stocked and enough supplies in their place is one of the most important aspects of managing any hospital department efficiently and safely. Supply management is the pipeline from whence all instruments of care flow, and if it causes more problems than it solves, a department runs a risk of wasting money or, worse, worsening patient care. 

It’s big, but is it clever?

Robert Francis’ final report into the Mid Staffordshire scandal is huge, but will its impact be in proportion to its size, asks Lyn Whitfield.
6 February 2013
Journalists wanting to attend the press conference at which Robert Francis QC was due to deliver his final report on the scandal at Mid Staffordshire NHS Foundation Trust had to register in advance.
That’s not particularly unusual. However, the reason given, that the inquiry would only have enough reports for the reporters that it was expecting, was.
All became clear when the report was distributed; in a box containing three volumes and an executive summary that runs, in itself, to 100 pages.
In total, the final report on the Mid Staffordshire NHS Foundation Trust Public Inquiry contains more than 1,700 pages and 290 discussion points and recommendations. It’s not a thing to print lightly.

Data transfer issues for HIT systems a major safety concern

February 7, 2013 | By Dan Bowman
Data transfer between health IT systems often is inadequate from a patient-safety perspective, according to a new analysis of HIT-related safety events by the ECRI Institute Patient Safety Organization.
In its report, for which 171 health IT events were examined at 36 facilities between April and June of last year, the Plymouth Meeting, Pa., nonprofit organization identified five potential problem areas for such events. In addition to inadequate data transfer, researchers said that other notable health IT related problems included systems not functioning as intended; poor system configurations; inaccurate data entry in patient records; and data entry in the wrong patient records.

Why HIE hinges on terminology standards

By Viet Nguyen, MD, Chief medical information officer for Systems Made Simple
Data “integration” has been a buzzword for years, but only now are healthcare organizations realizing what it truly means to integrate — both within and outside their own four walls. To achieve collaboration across the entire continuum of care, a significant shift in data standardization and integration must occur. Joint efforts between the Department of Veterans Affairs (VA) and the Department of Defense (DoD) are a start, and promise to spur momentum toward communication with private health systems as well. The ultimate goal is nothing less than the creation of a longitudinal patient record that helps lower costs, enhance care and improve day-to-day efficiencies.
The eHealth Exchange is one example of a national collaboration aimed at expanding the interoperable exchange of information. Formerly known as the Nationwide Health Information Network Exchange (or NwHIN), eHealth Exchange illustrates the fact that adoption of data and terminology standards is the linchpin for health information sharing.

DoD, VA to accelerate EHR integration

By Tom Sullivan, Editor, Government Health IT
Created 02/06/2013
Whereas the Defense and Veterans Affairs (VA) departments are working toward a joint iEHR that would, come 2017, wrap all patient data into a single record accessible to clinicians in both departments, U.S. Defense Secretary Leon Panetta and VA’s Secretary Eric Shinseki pushed their staffs to accelerate data exchange and interoperability where they can now, rather than waiting.
“What the Secretaries challenged us to do was find some high-value quick wins that would provide real value across the organizations ... and utilize those most critical data areas in a standard format,” said Roger Baker, VA chief information officer. “By early 2014 we will be able to we will be able to exchange the most important medical information on every one of our patients between our organizations.”

VA, Defense ditch plans for common EHR

Posted: February 6, 2013 - 2:30 pm ET
(Correction: An earlier version of this story mistakenly attributed a quote from Defense Secretary Leon Panetta to VA Secretary Eric Shinseki. The current version is correct.)
The long march to interoperability between the electronic health-records systems of the Veterans Affairs Department and the Department of Defense passed yet another milestone Tuesday as the secretaries of both announced they were scrapping a 5-year-old plan to achieve exchange capabilities by creating a single, common EHR for both healthcare systems.
“Rather than building a single integrated system from scratch, we will focus our immediate efforts on integrating VA and DOD health data as quickly as possible, by focusing on interoperability and using existing solutions,” Defense Secretary Leon Panetta said in a statement at a news conference (PDF) with VA Secretary Eric Shinseki. “This approach is affordable, it's achievable, and if we refocus our efforts, we believe we can achieve the key goal of a seamless system for health records between VA and DOD on a greatly accelerated schedule. We're now directing our departments to do just that.”

Cerner 2012 bookings at $3.14B

By Bernie Monegain, Editor
Created 02/06/2013
Cerner, which along with Epic seems to have a lock on EHR sales across the country, reported bookings in the fourth quarter of 2012 at $1.02 billion, an all-time high and an increase of 13 percent compared to fourth quarter 2011 bookings of $899 million. Full year 2012 bookings were a record $3.14 billion, up 15 percent compared to 2011 bookings of $2.72 billion.
Cerner reported numbers that beat consensus estimates handily, Piper Jaffray analysts Sean Wieland and Mohan A. Naidu, wrote in a Feb. 6 brief.

AHA on HIT Safety Plan: We Need the Patient ID System Fixed

FEB 5, 2013 5:35pm ET
The American Hospital Association likes much of the health information technology safety plan that the Office of the National Coordinator for HIT released for public comment in December. But the patient identifier issue was glossed over in the plan and must be given more focus, the AHA says in a comment letter to ONC.
“The issue of how to match patients with their medical records needs to be solved as we accelerate information exchange on regional and national levels,” according to the AHA. “The inability to match patients across silos raises safety concerns about mismatches--incorrectly matching patients, or missing a match that should have been made.

CHIME presses ONC on patient safety

By Bernie Monegain, Editor
Created 02/06/2013
The College of Healthcare Information Management Executives (CHIME) is urging the federal government to ensure that patients are matched correctly to their health information.
CHIME said it agreed with ONC that, “the accurate and efficient matching of patients to their health information is critical to ensuring patient safety,” and it urged a more focused effort to address patient data matching, saying that, “despite years of development, no clear strategy has emerged to accurately and consistently match patient data.”
CHIME, which represents 1,400 healthcare IT executives, submitted the comments Feb. 4 to the Office of the National Coordinator for Health Information Technology (ONC) in response to ONC’s Patient Safety Action & Surveillance Plan.

Riddell steps down

4 February 2013  
Sean Riddell is stepping down as chief executive of EMIS Group.
The company’s chief administrative officer, Chris Spencer, will become interim chief executive on 21 March when Riddell retires.
Riddell has been with EMIS for 23 years and is retiring to focus on family commitments.

Health IT, feedback can raise quality of care

February 6, 2013 | By Susan D. Hall
Providing feedback loops, as recommended by the Institute of Medicine, was a core recommendation in the pre-rulemaking report of the Measure Applications Partnership (MAP).
The public-private partnership, convened by the National Quality Forum to make recommendations to the U.S. Department of Health & Human Services, called feedback the best way to determine whether measurement is being used in the way it was intended.
"Ideally, the exchange of information through feedback loops is systematic, standardized, real-time, two-way, occurs among all levels of the system, and takes best advantage of information technology," the report states.

VA, DoD nix plan for new joint EHR

February 6, 2013 | By Dan Bowman
Budget and time constraints are forcing the federal government to deep-six plans for a brand new joint electronic health record system for troops and military veterans.
At a press conference Tuesday, Defense Secretary Leon Panetta and Veterans Affairs Secretary Eric Shinseki said that rather than build a new system to replace the Veterans Health Information Systems and Technology Architecture (VistA), the Departments of Defense and Veterans Affairs will focus on integrating their current systems via "existing solutions."

Telehealth reduced readmissions, hospital days: report

Posted: February 5, 2013 - 3:00 pm ET
When done right, telehealth programs work.
That's the bottom line from a 10-page report, “Scaling Telehealth Programs: Lessons from Early Adopters,” by the Commonwealth Fund. It focuses on three pioneers of home health monitoring technologies and programs: the Veterans Affairs Department, Boston-based Partners HealthCare and Centura Health, Englewood, Colo.
The authors concluded, based on the experiences of these early adopters, that home monitoring programs can improve care and patient experiences, reduce hospitalizations and cut costs. Followers wanting to emulate the success of these early adopters should focus more on the people than the technology.

Primary care faces hurdles on shared decisionmaking: study

Posted: February 4, 2013 - 4:15 pm ET
An eight-site demonstration project has revealed some of the biggest challenges facing primary-care practices seeking to implement shared decisionmaking, according to a study in the February issue of Health Affairs.
Launched in July 2009 and led by the Boston-based Informed Medical Decisions Foundation, the demonstration project supported and followed early adopters as they planned and put in place a number of decision aids to better engage patients in their care.

Busy docs, inadequate IT systems hinder shared decision-making

February 7, 2013 | By Susan D. Hall
Implementing shared decision-making isn't as easy as it sounds, according to a study by the RAND Corp. and Informed Medical Decisions Foundation.
In an article published in Health Affairs, the authors follow a demonstration of shared decision-making at eight primary care sites that was funded and coordinated by the foundation.
From the project's first 18 months, the authors said the biggest barriers were time-pressed physicians, lack of training about shared decision-making and inadequate IT systems.

Guest Blog: Six Healthcare IT Predictions for 2013

February 4, 2013
Meaningful use, healthcare reform, and pressures to improve performance will drive major trends in 2013
Meaningful use of electronic health records (EHRs), health reform and ongoing pressure to improve clinical and financial performance will drive six trends that we expect will impact providers in 2013
1. Value-based purchasing (VBP) and the formation of accountable care organizations (ACOs) will accelerate. A recent report stated that the U.S. spent $2.7 trillion on healthcare in 2011, up 3.9 percent from 2010. With federal and private health insurers seeking to reduce costs by shifting from fee-for-service to shared savings, bundled payments, and other risk-sharing reimbursement models, providers will increasingly look to the formation of ACOs. These models will address VBP challenges, coordinate care, and better manage the impact of health costs incurred from the estimated 78 million baby boomers that began turning 65 on January 1, 2011, at a rate of one every 10 seconds (3 to 4 million per year). 

5 ways to succeed at BYOD

By Benjamin Harris, New Media Producer, Healthcare IT News
Created 02/04/2013
To say that mobile devices are firmly ensconced in the medical landscape is an understatement at best. Still, the conversation rages on about the proper place for smartphones, tablets and laptops. One element to this discussion is the role of BYOD. This sounds like something that should be on a party invitation, but it stands for "Bring Your Own Device," and it is a practice common in many industries where employees use their personal mobile devices in the workplace. BYOD can be cost-effective and time-saving in many settings, but the security and stability required by medical applications pose many tough questions for any healthcare organization pondering this option. Brent Lang, president and COO of Vocera, suggests some touchstones of a smart BYOD policy.
1. Have a strategy. The best way to meet the many trials of BYOD head on, Lang says, is to define what the boundaries of policy will be, and what issues they may encounter. Because mobile devices are a reality, and because they will be used, Lang says that hospitals need to "create a strategy around multiple devices, don't just take a passive role around that." Lang notes that in addition to the way that communications technology has changed over time, so have the layout and ways that hospitals operate. "Clearly, mobility is a huge movement within the healthcare environment," Lang says, pointing out that hospitals are moving away from the "classic hub and spoke" design, and that hospitals stand to lose money and efficiency by not adapting to the newer ways that personnel move and operate.

ONC details plan to engage patients

By Anthony Brino, Associate Editor, Healthcare Payer News and Government Health IT
Created 02/05/2013
As a new generation of seniors enters Medicare and millions of lower-income Americans gain Medicaid or private insurance for the first time in 2014, federal officials at the Office of the National Coordinator for Health IT are trying to help align the patient engagement movement with consumer e-health.
“The full potential of consumer e-health is far from realized and may not even yet be fully understood,” Office of Consumer eHealth director Lygeia Ricciardi and other ONC officials write in February’s Health Affairs. As patient e-health is in its nascent stage, Ricciardi and colleagues say that the current trajectories of both health IT and mobile technologies “have created ideal conditions” for the growth of patient health information technologies.
Mobile health apps have proliferated, online patient portals are growing more common and the ONC is incentivizing personal health information tools in meaningful use Stage 2 requirements. At the same time, they write, one “major obstacle to greater use of health information in electronic form appears to be lack of access, not lack of interest.”

A Business Case for Clinical Use of Big Data Analytics

FEB 4, 2013 2:48pm ET
The hype around the use of Big Data analytics would lead many to believe that we should be able to understand all things about anything, within any business, as deep or as shallow as we want to go. The reality is that most health care organizations are far away from the use of any high-end analytics systems to provide the insights that clinicians, physicians, and administrators should have available to them. 
The core issue is cost. Despite the fact that much of the technology that organizations can leverage for Big Data and Big Data analytics is open source, the amount of time and money it will take implement these systems is far beyond the budgets of most providers. 

Automated follow-up helps spot adverse drug reactions

February 5, 2013 | By Susan D. Hall
A new study from Ottawa Hospital in Canada using an automated phone system reiterates that follow-up with patients can improve medication adherence--and flag adverse reactions.
Researchers used a system called ISTOP-ADE that called patients three days after they received a prescription, and again after 17 days, according to the research, published at JAMA Internal Medicine. The authors said patients must be given more opportunities to ask questions about their medications.

HealthPartners of Minnesota: Online clinics can reduce costs, improve outcomes and experience

February 5, 2013 | By Ashley Gold
Online healthcare delivery is yielding financial and clinical benefits--signaling a need for regulatory reform that allows for expansion and innovation in the field, according to a study in Health Affairs.
HealthPartners of Minnesota's online clinic, Virtuwell, has reduced costs by an average of $88 per episode compared with traditional care, has improved clinical effectiveness and has a 98 percent "would recommend" rating from customers, according to the authors.

AMIA's 14 Usability Principles for EMR Design

Written by Anuja Vaidya  | February 01, 2013
The American Medical Informatics Association Task Force on Usability has laid out 14 usability principles for the design of electronic medical records as part of its report on enhancing patient safety by improving usability of EHR systems in the Journal of the American Medical Informatics Association.

HIT Innovations Spring from Strategy, Design, and Need

Scott Mace, for HealthLeaders Media , February 5, 2013

Innovation doesn't always come from a brand new invention or idea. Usually, it comes from  making improvements to something that already exists.
Now Lyle Berkowitz MD, associate chief medical officer of innovation at Northwestern Memorial Hospital, has co-edited an entire book, Innovation with Information Technologies in Healthcare, that riffs on the topic.
Subtitled "The Healing Edge," the book contains a surfeit of stories supporting the idea that innovation isn't the sole province of the wizards at Apple or Google. Rather it  can emerge from the good ideas and brainstorms of designers working in close concert with healthcare providers.

EHRs boost federal health center work

By Anthony Brino, Associate Editor, Healthcare Payer News and Government Health IT
Created 02/04/2013
Health IT adoption at Federally Qualified Health Centers (FQHCs) has yielded significant quality of care improvements, a new study has found, even as the health centers are still coming up to speed with meaningful use.
A study in the journal BMC Health Services Research examined 776 FQHCs using data from the Commonwealth Fund’s 2009 National Survey of Federally Qualified Health Centers, measuring the extent of electronic health record and health information exchange use and associated quality of care across several functions.
Columbia University public health policy professor Jemima Frimpong, along with researchers from the University of Alabama and Southern Illinois University, examined the centers by their level of health IT adoption and measured receipt of discharge summaries, frequency of patient reminders for preventive care and timely appointment for specialty care, finding an overall positive association between health IT use and quality of care.

Adverse Drug Reactions ID'd by Phone

Cheryl Clark, for HealthLeaders Media , February 5, 2013

An automated phone calling system that asks patients about the prescriptions their doctors ordered, with follow-up calls from pharmacists, can mitigate adverse drug events (ADEs) and prescription non-compliance that might otherwise go unnoticed.
"Most patients do ask [about their medications if they have questions] when given the opportunity," says Alan Foster, MD, general internist and Scientific Director of Performance Measurement at the Ottawa Hospital in Canada. But that's an opportunity they don't easily get, he says.
"We need to increase opportunities to ask questions—hence our intervention."
The results of his experiment with the phone system is published in the current issue of JAMA Internal Medicine.

Docs avoid drug errors with mobile apps

By Eric Wicklund, Editor, mHIMSS
Created 02/04/2013
Consumers aren't the only ones using mobile apps to improve their health. Their doctors are using them, too.
A recent study conducted by Epocrates indicates physicians are accessing drug information at the point of care, often through a mobile medical app, to make sure the drugs they're prescribing aren't harming their patients. That, says the San Mateo, Calif.-based developer of online reference tools, amounts to more than 27 million potentially dangerous drug interactions avoided each year.
Consumers aren't the only ones using mobile apps to improve their health. Their doctors are using them, too.

Statewide telehealth efforts gaining momentum

February 4, 2013 | By Dan Bowman
If recent headlines are any indication, telehealth is becoming more of a priority for several states throughout the nation of late. In Mississippi, for instance, state legislators approved a bill last week that would allow insurance companies to reimburse physicians who consult with rural doctors using telemedicine, The Commercial Appeal reported.
State Rep. Charles Busby, a Republican, told the newspaper that the cost for installing telemedicine equipment for facilities in the state is down to roughly $12,000 per facility, from a high of $40,000. According to the newspaper, rural providers who have used telehealth to work with specialists to date often have not been paid for such efforts.

Mass General EHR study probes antidepressant arrhythmia risks

By Anthony Brino, Associate Editor
In a novel use of electronic health record data, researchers affiliated with Massachusetts General Hospital have found evidence supporting recent Food and Drug Administration (FDA) warnings of the arrhythmia risks associated with the common antidepressant medication citalopram, which is sold under the brand name Celexa.
The study, published in the journal BMJ, analyzed the use of citalopram and other antidepressant medications in 38,000 patients, compared to biomarker signs of increased risk for ventricular arrhythmia, an abnormal heart rhythm that can be life threatening.
Monday, February 04, 2013

Voluntary Adverse Event Reporting Part of ONC's Draft Patient Safety Plan

In response to the Institute of Medicine's 2011 report -- titled, "Health IT and Patient Safety: Building Safer Systems for Better Care" -- on how the government and the private sector can maximize the safety of health IT-assisted care, the Office of the National Coordinator for Health IT released a draft Health IT Patient Safety Action and Surveillance Plan on Dec. 21, 2012. 
Two of the plan's key goals are to:
  • Make it easier for clinicians to report adverse events and risks related to use of health IT tools (e.g., treatment errors due to incomplete or inaccurate data in an electronic health record, or due to unclear information display); and
  • Enable the aggregation and analysis of the adverse event and risk information that clinicians report in an effort to prevent future health IT-related errors. 


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