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, March 16, 2013
Weekly Overseas Health IT Links - 16th March, 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.
The jokes were sparse as a somber former President Bill Clinton took on the ills of the health care system during his HIMSS13 keynote speech, and urged his information technology audience to accelerate their work to support improvements.
The politics and social impact of the health reform law have yet to be fully determined, Clinton noted, because that depends on how fully the law is implemented and many contentious issues have not yet been resolved. The politics of reform continue to resonate deep, he reminded. Health care reform politically killed supporting congressional candidates in 2010, then the politics changed and reform politically killed candidates opposed to the law in 2012.
The Office of the National Coordinator for Health Information Technology anticipates releasing a final health information technology safety plan by early summer, officials announced on March 5 at HIMSS13 in New Orleans.
ONC released a draft plan in December and accepted public comment until February 4. The draft followed an Institute of Medicine report that ONC commissioned that highlighted the need for better understanding of the HIT impacts on safety, as well as shared responsibilities among all stakeholders to improve safety, Jodi Daniel, director of the ONC office of policy and planning, said during an educational session.
The day after President Bill Clinton told the HIMSS13 audience that the healthcare system was broken, but could be fixed, ONC chief Farzad Mostashari, MD, offered a personal example of that broken system: his Mom. Mostashari launched his own keynote on Thursday morning by describing what his mother endured when she was admitted to the hospital for routine knee surgery.
"Healthcare is broken not just when it comes to costs of healthcare," he said. "Healthcare is broken as a system, as a lack of systems."
Health IT Standards Leader Reveals Details of Move ?to Make Standards and Other Selected IP Freely Available
Health Level Seven International (HL7), announced a plan to make much of its intellectual property (IP) freely available under licensing terms, which it says will ensure that all stakeholders have equal access to its HIT standards. The policy is effective as of April 1, 2013 and includes all currently published standards, implementation guides and other select IP as determined on a case-by-case basis.
“By making our standards freely available, we hope to accelerate the evolution of healthcare information exchange at the very basic levels, and ultimately to impact wellness and healthcare delivery on a global scale” said Charles Jaffe, M.D., Ph.D. and CEO of HL7.
NEW ORLEANS -- National Coordinator for Health IT Farzad Mostashari may have had one of the busiest schedules at the Healthcare Information and Management Systems Society's annual conference this year. It's not unusual for federal health officials to stop by HIMSS and other big conferences for just mere hours on the day of their big speech, but Mostashari made a week of it.
He helped kick off the conference on Monday with an Office of the National Coordinator for Health IT Town Hall, sat in the front row for acting CMS Administrator Marilyn Tavenner's speech, held a press conference with reporters and was seen roaming the mile-long exhibit hall and observing the Interoperability Showcase in action, not to mention stopping by HIStalkaplooza at Rock 'n' Bowl.
On Thursday -- the final day of HIMSS13 -- Mostashari took the stage to deliver his keynote, and he had a lot to say after spending nearly a week at the Earnest N. Morial Convention Center in New Orleans.
One benefit of Kaiser Permanente spending an estimated $6 billion for an integrated electronic health records (EHR) system to serve 9 million people across eight regions from coast to coast is it that has amassed a vast repository of clinical data. That storehouse also contains information from a patient portal, ancillary systems, smart medical devices and even home-based patient monitoring systems.
All those terabytes of electronic data now are helping to fuel a massive analytics operation, part of an overall organizational goal of improving care and reining in costs. "It's all about the data and information, not the electronic health record," Carol Cain, senior director of clinical information services for the Kaiser Permanente Care Management Institute, said this week at the Healthcare Information and Management Systems Society (HIMSS) annual conference in New Orleans.
IBM's Watson—the same machine that beat Ken Jennings at Jeopardy—is now churning through case histories at Memorial Sloan-Kettering, learning to make diagnoses and treatment recommendations. This is one in a series of developments suggesting that technology may be about to disrupt health care in the same way it has disrupted so many other industries. Are doctors necessary? Just how far might the automation of medicine go?
By Jonathan Cohn
Harley lukov didn’t need a miracle. He just needed the right diagnosis. Lukov, a 62-year-old from central New Jersey, had stopped smoking 10 years earlier—fulfilling a promise he’d made to his daughter, after she gave birth to his first grandchild. But decades of cigarettes had taken their toll. Lukov had adenocarcinoma, a common cancer of the lung, and it had spread to his liver. The oncologist ordered a biopsy, testing a surgically removed sample of the tumor to search for particular “driver” mutations. A driver mutation is a specific genetic defect that causes cells to reproduce uncontrollably, interfering with bodily functions and devouring organs. Think of an on/off switch stuck in the “on” direction. With lung cancer, doctors typically test for mutations called EGFR and ALK, in part because those two respond well to specially targeted treatments. But the tests are a long shot: although EGFR and ALK are the two driver mutations doctors typically see with lung cancer, even they are relatively uncommon. When Lukov’s cancer tested negative for both, the oncologist prepared to start a standard chemotherapy regimen—even though it meant the side effects would be worse and the prospects of success slimmer than might be expected using a targeted agent.
Home monitoring can help lower blood pressure, according to a study by researchers from Kaiser Permanente Colorado in Denver published online this week in Circulation: Cardiovascular Quality and Outcomes.
The home monitoring, which was pharmacist-led and enabled by Heart360, the American Heart Association's web-based tool for tracking heart health, was tested in 10 Kaiser clinics. Nearly 350 patients with blood pressure above the recommended levels participated, and although there were no "statistically significant differences in baseline characteristics" between the tested groups, the home monitoring group, at six months, was significantly closer to reaching their BP goal than a usual care group.
The Department of Health and Human Services has issued a request for information as it considers policy moves to further accelerate interoperability and health information exchange beyond initiatives previously launched under the Office of the National Coordinator for Health Information Technology.
Comments due by April 21. Adoption of basic electronic health records systems has steadily risen under the meaningful use program. An estimated 40 percent of physicians were using the software in 2012, and HHS expects that to top 50 percent during 2013. Now, the goal is to accelerate health information exchange.
Adoption of basic electronic health record systems in acute-care hospitals has more than tripled since 2009, as roughly 44.4 percent of hospitals had a basic EHR system in 2012 compared with 12.2 percent in 2009, according to new reports from the federal government.
The Office of the National Coordinator for Health Information Technology released two briefs on the status of EHRs among acute-care hospitals in the United States. The first brief (pdf) covered overall hospital adoption of EHR systems, while the second brief (pdf) covered how hospitals were meeting meaningful use objectives.
Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.
Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.
The study, which was reported in the Journal of the American Medical Informatics Association on Wednesday, is based on data-mining techniques similar to those employed by services like Google Flu Trends, which has been used to give early warning of the prevalence of the sickness to the public.
NEW ORLEANS -- The heavy hitters in the federal health care world were out in full force at the Healthcare Information and Management Systems Society's annual conference on Wednesday. Despite this week's news about federal budget cuts under the sequester, federal officials made it clear that their support for health IT is unwavering. In fact, they're ready to step it up a notch.
During a speech at HIMSS13, acting CMS Administrator Marilynn Tavenner said, "I am truly committed to health IT as a platform and strategy" to transform health care delivery.
She added that the health care system cannot lower costs and improve quality "if we don't have an electronic ability to understand what's going on."
Scott Mace, for HealthLeaders Media , March 6, 2013
This article appears in the January/February 2013 issue of HealthLeaders magazine.
Like a surging tide, the next wave of technology has landed in hospitals, changing the nature of healthcare delivery. Tablet computers are overturning concepts of how clinicians will use technology, raising work-life balance issues, and having a beneficial impact on hospital IT budgets.
Tablet computers have gone from relative obscurity to something approximating the appearance of stethoscopes: Nearly every doctor has one. What's different with this generation of technology is that demand is coming from clinicians rather than being rolled out by IT departments.
"Certainly the iOS devices from Apple are very popular among physicians," says Ferdinand Velasco, MD, chief health information officer at Texas Health Resources, an Arlington-based system that includes 25 hospitals, more than 21,100 employees, 5,500 physicians with staff privileges, and 3,800 licensed hospital beds.
The CMS launched the eHealth initiative this week as a central repository for information on the federal government's digital record-keeping and electronic prescribing initiatives.
The page provides a central location to search the CMS site for details of the major digital health initiatives, including the $22 billion electronic health-record incentive program, the hospital inpatient quality reporting system and the e-prescription incentive program.
“CMS is committed to helping healthcare providers deliver better patient care by simplifying the use of electronic standards and encouraging the adoption of health information technology,” Robert Tagalicod, director of the Office of E-Health Standards and Services at CMS, wrote on the eHealth blog.
Sequestration, set to begin April 1, will prove to be a painful blow to the Meaningful Use Medicare incentive program, National Coordinator for Health IT Farzad Mostashari said Wednesday, speaking to members of the press at the Healthcare Information and Management Systems Society's annual meeting in New Orleans. Medicare reimbursements are set to be reduced by 2 percent, a total that, according to Mostashari, will take roughly $3 million away from ONC's budget.
Privacy and security realities hit David Collins hard.
Looking forward to cracking 1,000 Twitter followers at HIMSS13, the senior director of mHIMSS had 967 – until, that is, his account was compromised.
“I got hacked and I can’t get back in,” Collins said during the Preparing for an OCR Audit session here at HIMSS13. “I have to open a new account so I’m starting to take this personally.”
Collins’ own experience highlighted the lack of privacy and security policies and technologies in the new world of applications, healthcare and otherwise. An even bigger barrier, and one particular to health apps, Collins added, is a general lack of funding for investing in mHealth technologies.
The Certification Commission for Health Information Technology will pilot test a certification program for health information exchanges.
CCHIT is a veteran certifier of electronic health records software that meet certain best practice measures; it also is one of a handful of federally-deemed companies that certify EHRs for supporting meaningful use criteria.
Most U.S. doctors believe patients should be able to update their electronic health records, but only 31 percent say patients should have access to their full health record, according to a new poll by Accenture.
While the survey results were largely consistent across 3,700 doctors surveyed by Accenture in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the United States--U.S. physicians were the most open to patients updating their own records.
The U.S. physicians said patients should be able to add into their records demographic information (95 percent), family medical history (88 percent), medications (86 percent) and allergies (85 percent). And 81 percent said patients should be able to add some clinical updates, such as new symptoms and self-measured metrics, including blood pressure and glucose levels. Forty-seven percent, however, believe patients should not be able to update their lab test results.
NEW ORLEANS -- The Healthcare Information and Management Systems Society's annual conference kicked off in New Orleans on Monday with a bang, as a high-school marching band treated attendees to some early-morning music.
Soon after the impromptu concert, New Orleans Mayor Mitch Landrieu (D) took the stage to welcome HIMSS13 attendees back to New Orleans; the city served as host to the 2007 HIMSS conference, just 20 months after Hurricane Katrina had a devastating effect on the city.
Landrieu highlighted the progress and recovery New Orleans has made over the last few years, but he also acknowledged that New Orleans and other cities across the U.S. face challenges related to health care. He urged conference attendees to "find a way through technology to bend the cost curve" in health care.
Chelsea Rice, for HealthLeaders Media , March 5, 2013
Electronic health records systems are the latest source of information overload.
Nearly one-third of physicians miss electronic notifications of test results in electronic health record systems, according to a research letter published this week in JAMA.
Of the 2,590 primary care providers surveyed in the Department of Veterans Affairs by the researchers, 86.9% perceived the quantity of EHR alerts to be excessive, and 69.6% said they received more alerts than they could effectively manage. More than half (55%) of surveyed physicians said current EHR systems made it possible to miss the alerts.
"What stood out was information overload and the easier the systems were to use, you tended to miss [fewer] test results." said Hardeep Singh, MD, MPH, the study's lead author, from the Houston VA Health Services Research and Development Center of Excellence.
By David Pittman, Washington Correspondent, MedPage Today
Published: March 04, 2013
The average physician lost nearly $44,000 over 5 years implementing an electronic health record system, a large pilot study found, but the technology itself was just part of the reason.
Just 27% of practices achieved a positive 5-year return on investment -- a number that would rise to 41% with the addition of federal incentives to use EHRs, the study in the March issue of Health Affairs stated.
But the vast majority of practices lost money because they failed to make operational changes to realize the benefits of EHRs such as ditching paper medical records after adoption, Julia Adler-Milstein, PhD, of the University of Michigan in Ann Arbor, and colleagues wrote.
John Commins, for HealthLeaders Media , March 5, 2013
Adopting electronic health records appears to be a money-losing proposition for most physicians, especially specialists and those in smaller physician groups.
The average physician would lose $43,743 over five years after adopting EHRs and only 27% of physicians would profit through the transition away from paper records without federal financial aid. And even when the $44,000 in meaningful use incentives are added to the pot, only 41% of physicians would be in the black, according to the study published this month in Health Affairs.
The study examined data gleaned from 49 community practices of varying sizes and specialties that were part of the Massachusetts eHealth Collaborative, an EHR pilot project. Meaningful use incentives were not in place for the period examined by the study. However, the study authors added the value of the meaningful use incentives on top of their initial projections.
Big news was made at HIMSS13 on Monday when, in an unprecedented collaboration, some health IT heavy-hitters joined forces in an effort to push the needle on interoperability.
In announcing the launch of the CommonWell Health Alliance, executives from Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth touted what they say is a first-of-its-kind organization: a collaboration of rival vendors, uniting to enable care integration and data liquidity.
At a press conference Monday morning, McKesson chairman and CEO John Hammergren said the independent, not-for-profit organization represents an "industry-led approach" to one of the thorniest problems in health IT.
When it comes to your organization successfully adopting electronic health records, it's not just a matter of "going live" with the technology, says Don Harrison, co-leader of the Sunday workshop titled "Solving the Healthcare IT Adoption Dilemma," at the 2013 HIMSS Annual Conference & Exhibition.
"Installation does not equal implementation," says Harrison, founder and CEO of Implementation Management Associates, Inc. Many organizations want to purchase the best technology, but fail to take into account the most important factor for success–human behavior.
If an organization wants to get an exponential return on investment, at the fastest speed possible, they need to shift their thinking from focusing only on time and budget to focusing on human behavior and how to reinforce it, Harrison says. This will involve breaking away from annual, semi-annual or even quarterly reviews linked to financial rewards. Behavioral standards need to be set up, measured, and managers need to reinforce the desired behavior regularly.
With its 36 hospitals all at top-rung Stage 7 on the HIMSS EHR adoption scale, Kaiser Permanente knows a thing or two about electronic records. And while having visionaries at the top who champion I.T. is an important part of the program, listening to clinicians in the trenches—particularly nurses—is critical to growth and user acceptance, said Ann O’Brien, R.N., national director clinical informatics, at Kaiser. Speaking before several hundred nurses at the HIMSS Nursing I.T. Symposium in New Orleans on Sunday, March 3, O’Brien noted how in the day to day operation of a hospital, nurses function as a type of “information integrator,” meaning they must pull information from a variety of sources, some digital, some human, in the formulation and delivery of the care plan.
Aside from having nurses in high-level I.T. management roles, Kaiser has taken steps to assure nurse feedback about the way its EHR functions. Nurses were surveyed about their most pressing needs, and the majority said they wanted to quickly access Kaiser’s EHR as they made their rounds. “Nurses would log on 80 to 100 times a day,” O’Brien says.
Health clinics in poorer communities less likely to offer services such as electronic communication
March 1, 2013
FRIDAY, March 1 (HealthDay News) -- Many low-income patients want to communicate electronically with their doctors but can't because the clinics they use generally do not offer such services, a new study finds.
An increasing number of health care systems provide online services to patients in order to manage care outside of office visits, and this includes enabling patients to communicate electronically with health care providers.
But this is not available to many poorer patients, according to the study from researchers at the University of California, San Francisco.
Electronic prescribing software vendor DrFirst, which integrates with many inpatient and ambulatory clinical information systems, reports strong growth in e-prescribing of controlled substances during 2012 after the federal government approved the practice.
Because information technology (IT) has so quickly transformed people's daily lives, we tend to forget how much things have changed from the not-so-distant past. Today, millions of people around the world regularly shop online; download entire movies, books, and other media onto wireless devices; bank at ATMs wherever they choose; and self-book entire trips and check themselves in at airports electronically.
But there is one sector of our lives where adoption of information technology has lagged conspicuously: health care.
Some parts of the world are doing better than others in this respect. Researchers from the Commonwealth Fund recently reported that some high-income countries, including the United Kingdom, Australia, and New Zealand, have made great strides in encouraging the use of electronic medical records (EMR) among primary-care physicians. Indeed, in those countries, the practice is now nearly universal. Yet some other high-income countries, such as the United States and Canada, are not keeping up. EMR usage in America, the home of Apple and Google, stands at only 69%.