Saturday, July 27, 2013

Weekly Overseas Health IT Links - 27th July, 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.
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KLAS Report Gives Early Lay of the Land in Health Analytics

JUL 16, 2013 12:24am ET
A study of provider perceptions of the business intelligence vendor field finds a lot of interest in the field but also confusion among health care providers.
Vendor research firm KLAS Enterprises interviewed executives at more than 70 hospitals or delivery systems with more than 200 beds. Asked which BI vendors will stand out in health care, 41 percent of respondents were unsure. Of the 59 percent responding, IBM, SAP, Microsoft and Oracle are perceived as the leaders in enterprise BI applications, with none getting more than 12 percent of the vote, explained Joe Van De Graaff, a KLAS research director, during Health Data Management’s Healthcare Analytics Symposium in Chicago.
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A Sober Look at the Need for Analytics

JUL 18, 2013 12:27pm ET
During a presentation at Health Data Management’s Healthcare Analytics Symposium, John McDaniel, national practice leader at data storage and management vendor NetApp, laid out the sobering reasons why data analytics are coming to the health care industry and must be embraced.
Start with a “unibyte.” That’s 10 to the 24th power, the amount of data the health care industry is rapidly reaching, with the amount growing more than 40 percent annually for the next decade, he said. The data comes from clinical documentation, genomics, personal monitors and sensors, medical images, electronic health records, health information exchanges, claims, and machine-to-machine transfers, which is the fast growing data source and partly fueled by telehealth/telemedicine.
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Health IT has hot half for M&A

Posted on Jul 19, 2013
By Mike Miliard, Managing Editor
During the first six months of 2013, health information technology was the "most active market segment" of the healthcare/pharma/IT industry for mergers and acquisitions, according to investment bank Berkery Noyes.
Industry-wide, deal volume decreased 16 percent since second half 2012, but the number of deals was close to the industry's historical average for 2011 when examined on a half year basis, according to the report.
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3 reasons most EHR vendors will be out of business by 2017

July 17, 2013 | By Susan D. Hall
The crowded field of electronic health record vendors likely will be slashed to less than half by 2017, or by the implementation of Meaningful Use Stage 3--whichever comes first--according to a new Black Book Market Research report. Most vendors are likely to go out of business, merge or be acquired, according to the survey of 880 EHR consultants, analysts, managers and support team members.
The report follows up on another report released in February that called 2013 the "year of the great EHR switch" due to user dissatisfaction.
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The Value of Lifestyle Questionnaires to Get Good Data

JUL 16, 2013 2:32pm ET
Attention physicians interested in accountable care organizations and data analytics to support population health management: Do you have your patients complete a comprehensive lifestyle questionnaire?
John McDaniel, national practice leader for the provider market at data storage and management vendor NetApp completed a questionnaire and his physician learned that McDaniel consumed six two-liter bottles of diet cola a day. The body metabolizes artificial sweeteners as sugar, and the result of all that soda was that McDaniel had active diabetes. His level of triglycerides—a fat in the blood—was 475 compared with a normal reading of 150. He went cold turkey and improved his diet, the reading dropped to 150 within three months and the diabetes now is inactive, McDaniel said at Health Data Management’s Healthcare Analytics Symposium in Chicago.
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VA makes mHealth pilots priority

Posted on Jul 18, 2013
By Anthony Brino, Associate Editor, Healthcare Payer News and Government Health IT
The Department of Veterans Affairs is making strides with testing the viability and potential of mobile health technologies after launching several pilot projects. The agency's newest pilots include one for mobile scheduling and another distributing 1,000 loaner iPads to caregivers of post-9/11 veterans.
The Veteran Appointment Request Web App pilot is offering about 600 veterans the ability to request primary care and mental health care appointments using mobile devices and desktop computers. Currently limited to health services at the Washington-based VA Medical Center and the VA Palo Alto Health Care System, the pilot has the possibility of expanding in the future.
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Standards for EPRs launched

12 July 2013   Rebecca Todd
A new set of standards for the content and structure of electronic patient records has been launched at the Royal College of Physicians.
‘Standards for the clinical structure and content of patient records’ provides a set of generic standards for recording clinical information, allowing it to be easily shared with other parts of the health or social care system
The standards have been developed by healthcare professionals from multi-disciplinary backgrounds, patients, carers and health IT specialists in a programme of work led by the RCP and commissioned by Health and Social Care Information Centre.
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Tuesday, July 16, 2013

The Healthcare IT Applications of Google Glass

Last week I had the opportunity to test Google Glass.  
It's basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses.  The small prism "screen" displays video at half HD resolution.  The sound features use bone conduction, so only the wearer can hear audio output.   It has a motion sensitive accelerometer for gestural commands.    It has a microphone to support voice commands.   The right temple is a touch pad.  It has WiFi and Bluetooth.   Battery power lasts about a day per charge.
Of course, there have been parodies of the user experience but I believe that clinicians can successfully use Google Glass to improve quality, safety, and efficiency in a manner that is less bothersome to the patients than a clinician staring at a keyboard.
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Most health care records now are electronic

David Jackson, USA TODAY 9:02 p.m. EDT July 16, 2013
An ever-expanding amount of the nation's medical records — millions of prescriptions, medical reports and appointment reminders — are now computerized and part of an ambitious electronic medical records program, the Obama administration reports.
Since the start of a 2011 program in which the government helps finance new health records systems, doctors or their assistants have filled more than 190 million prescriptions electronically, according to data provided by the Centers for Medicare & Medicaid Services.
Providers have also shared more than 4.3 million health care summaries with colleagues when patients change doctors, according to the data.
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Clarification With Major Impact: A Safety Net for Meaningful Use Attestation Success

by Naomi Levinthal and Anantachai (Tony) Panjamapirom Thursday, July 18, 2013
Eligible professionals (EPs) and eligible hospitals (EHs) participating in the CMS Electronic Health Record Incentive Programs must demonstrate meaningful use based on a number of metrics or measures. At its basic level, many of these measures are ratios: denominators are a number of patients seen over a given period of time (i.e., the reporting period), and numerators are information collected about those patients included in denominators. The quotient is the provider's performance, of which a specified threshold must be met in order to receive incentive payments.   
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Leah Binder Wants Your Hospital Data

Cheryl Clark, for HealthLeaders Media , July 18, 2013

The Leapfrog Group CEO wants public reporting of nine so-called "never events" to remain public. The AHA, she says, wants to suppress it. But that's not all. Binder wants "more data—a lot more data."
Leah Binder has a very tricky job.  
As president and CEO of the Leapfrog Group, she has to be nice to hospitals because she needs more of them to voluntarily report quality data to Leapfrog, even though they may suffer the ignominy of getting a poor safety grade, or appear shabby for not having implemented electronic systems for physician orders.  
If she isn't nice to them, they might get turned off, or drop out of Leapfrog's program, and the employer groups and others she represents—who want public reports on lots of measures to show them where to spend their healthcare dollars won't be happy.
But she also has to be critical of the hospital industry, be tough, and hold her ground. And that side came out this week in her Forbes blog, which was topped with the provocative headline: "Bone-Chilling Mistakes Hospitals Make and Why They Don't Want You to Know."
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Will CDA replace HL7 version 2 messaging?

July 18, 2013 -- CDA, or Clinical Document Architecture, is the document standard defined by HL7 as part of its version 3, which is used to exchange information between healthcare providers' electronic health records (EHRs). The new requirements mandate EHR implementation as part of qualifying for federal meaningful use payments.
CDA implementations are still in their infancy, even though at the recent Integrating the Healthcare Enterprise (IHE) Connectathon, there were literally hundreds of those documents exchanged and properly "consumed." Consuming a document means that the information is presented properly and added to the appropriate record in the database. For example, a list of medications in the physician electronic medical record (EMR) is properly updated based on a discharge document from an emergency room visit.
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Survey shows uncertain future for ICD-10

Posted on Jul 17, 2013
By Diana Manos, Senior Editor
Despite the one-year delay in ICD-10 compliance, many healthcare providers still do not understand the value of the new medical diagnostic codes that will be used beginning Oct. 1, 2014, according to a new survey from eHealth Initiative.
The survey, conducted in partnership with the American Health Information Management Association, reveals a lack of communication around the benefits and value of the new ICD-10 code set, which was expanded to improve the quality of care, research and surveillance with more accurate and specific data. 
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EHRs 'transforming' care, says Tavenner

Posted on Jul 17, 2013
By Mike Miliard, Managing Editor
Providers are increasingly using electronic health records, both to manage their patients' care and to provide more information to those patients, according to new data published Wednesday by the Centers for Medicare & Medicaid Services.
Already, approximately 80 percent of eligible hospitals and more than 50 percent of eligible professionals have adopted EHRs and received meaningful use incentive payments from Medicare or Medicaid, according to CMS.
By meaningfully using EHRs, physicians and care providers have shown increased efficiencies while safeguarding privacy and improving care for millions of patients nationwide, the data show.
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IT can fill £30 billion gap - Kelsey

11 July 2013   Rebecca Todd
Technology can fill a “large part” of the £30 billion funding gap facing the health service, NHS England’s director of patients and information has claimed.
Tim Kelsey told a group of health IT business people at an NHS England entrepreneurs day last Friday that they must get involved in the government’s “call to action” on the future of the NHS, and push for more investment in technology.
He said NHS England projects a £30 billion funding gap by 2020 as NHS funding remains flat, but the health service faces rising demand and costs.
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Mostashari: Emphasize training when adopting health IT

July 17, 2013 | By Dan Bowman
To successfully implement technology--such as electronic health record systems--into healthcare processes, providers need to spend ample time ensuring employees are trained to use such tools, according to National Coordinator for Health IT Farzad Mostashari.
In a recent interview with NPR, Mostashari (pictured) talked about the importance of not only embracing technology in the healthcare industry, but doing so in a responsible manner.
"The key thing is that you can't just plop in technology," he said. "You've got to really work with the people and the processes. You've got to work with the training, and you've got to look at the workflows that you're doing and not just repeat the same processes--broken processes that you were doing before."
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Field of EHR vendors could shrink significantly by 2017

July 17, 2013 | By Susan D. Hall
The crowded field of electronic health record vendors will be slashed to less than half by 2017, or by the implementation of Meaningful Use Stage 3--whichever comes first--according to a new Black Book Market Research report.
It follows up on a report released in February that called 2013 the "year of the great EHR switch" due to user dissatisfaction. To that poll of 17,000 users in physician practices, this new study adds in the opinions of 880 EHR consultants, analysts, managers and support team members.
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EHRs slow increase in outpatient costs

July 16, 2013 | By Marla Durben Hirsch
Electronic health records can stem the short-term growth in healthcare costs, according to a new study published this week in the Annals of Internal Medicine.
The researchers, from the University of Michigan and elsewhere, studied four years of healthcare cost data of 179,000 patients in nine Massachusetts communities. Three of the communities had adopted EHRs; the other six were used as control groups.
The study found that EHRs reduced the costs of outpatient care by 3 percent, which amounted to about $5.14 in savings per patient per month, according to an announcement. Most of the savings were realized in radiology. 
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VA launches caregiver pilot with 10 new apps

By: Jonah Comstock | Jul 16, 2013
The Department of Veterans Affairs has fully launched its pilot, announced last year, in which it’s distributing 1,000 iPads to family caregivers of veterans loaded with 10 specially-created apps.
“There are three things that we’re looking at in the pilot,” said Kathleen Frisbee, Director of Web and Mobile Solutions in the Veterans Health Administration. ”The first is the impact of the iPads on caregivers’ stress and burden. We’re looking at the historical stress and burden scores we collect through our home visits on those that have the iPad versus those that don’t. The second is looking at caregiver preparedness and trying to understand the impact iPads can have on that. And finally we’re looking at the characteristics of caregivers that predict use of the iPad. It’s trying to understand the audience, what made people use it versus why they didn’t use it.”
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CareCloud Upgrades EHR Platform With Faster Charting

By Brian T. Horowitz  |  Posted 2013-07-16

CareCloud has released a new generation of its cloud-based electronic health record platform to speed up the real-time workflows for doctors and enable "rapid charting."

Electronic health record vendor CareCloud has unveiled the next generation of its Web-based CareCloud Charts software to allow doctors to speed up documentation of patient visits.
Introduced on July 16, the new version of Charts is built around what the company calls "rapid charting," which involves opening a note for a patient visit, documenting findings with just a few mouse clicks and ordering lab tests and medications. Many other EHR systems can slow down documentation by requiring multiple screens, mouse clicks and page reloads to document patient visits, according to CareCloud.
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July 15, 2013

10 Things that Every HIT Company Needs to Know to Prepare for the September 23 HIPAA Final Rule Compliance Date

By Reece Hirsch
On January 25, the Office for Civil Rights (OCR) of the Department of Health and Human Services published new regulations that dramatically extend the reach of federal healthcare privacy and security law to a vast array of companies that do business with the healthcare industry, including many HIT companies. The long-awaited final omnibus regulations (the “Final Rule”) amend the privacy, security, enforcement, and breach notification rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. The Final Rule represents the most significant development in health care privacy and security law since the original HIPAA regulations were published a decade ago.
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Cerner Builds Recession-Proof ‘Bunker’ For Health Data

By Elana Gordon and KCUR | Kaiser Health News,

This is a story about data. Lots and lots of data.
And not just any data. Extremely sensitive data.
The U.S. health system is undergoing a major technological shift right now. Some equate it to finally catching up to where the banking and airline industries have been for years: Doctors and hospitals are moving to electronic health records systems, and it’s not easyCerner, based in Kansas City, Mo., has grown into one of the nation’s biggest players in the field of health information technology.
Cerner’s main headquarters seems like a college campus, peppered with trees and walking paths, along with some Star Trek-like architecture.
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Finding the Right Consultant

JUL 1, 2013
Hiring an information technology consultant almost always comes down to one of three needs for a health care organization, according to Ted Reynolds, vice president at consultancy CTG Health Solutions. An organization needs expertise it doesn't have in-house; or somebody to drive an independent decision through the organization; or short-term labor to finish a project.
Sometimes the reason to hire a consultant is a combination of all three needs. In a large electronic health records implementation, the vendor often will teach users about one-third of what they really need to know, Reynolds says. A consultant who already helped with strategy can fill in the training blanks to shorten the learning curve, and do so with a smaller force than the vendor, he asserts. "The hardest thing to make up on a project is time."
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Commentary: Why healthcare must operationalize data breach response

By Rick Kam
Over the last decade, the scope of identity theft has widened from credit card and financial fraud to include widespread medical identity theft with potentially life-threatening consequences. 
In that time, organizations have grown in awareness and readiness to combat identity theft. According to Larry Ponemon, chairman and founder of the Ponemon Institute, recent research shows that companies are doing a better job of detecting, containing, and responding to breach incidents than they were ten years ago.
“C-level executives and boards now realize the costly consequences of material data loss and appear to be more willing to approve investments in data protection technologies and expert personnel,” Ponemon explained. “That’s a hopeful sign.”
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3 things to know about geomedicine

Posted on Jul 16, 2013
By Jeff Rowe, Contributing Writer
"Location, location, location" is a phrase that's long been associated with real estate, but in recent years it's also played a role in attempts by healthcare professionals to track disease. Now, some are putting health IT to work in adding location information – where patients have lived – into their EHRs.
"There's a huge body of health information that's been generated at high levels, particularly at the state and county levels, but it's had little effect in doctors' offices," said Bill Davenhall, senior health adviser for ESRI, a California-based provider of geographic information systems (GIS) services to a variety of industries.
If Davenhall has anything to say about it, that's going to change soon. In his eyes, the healthcare sector has done a great job of incorporating genetics and lifestyle into the factors considered when patients are treated, but "The third leg of the stool should be locational history."
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HIMSS launches Health IT Value Suite

Posted on Jul 16, 2013
By Diana Manos, Senior Editor
The Healthcare Information and Management Systems Society today announced the release of a new online collection of data – both quantitative and qualitative – designed to help care providers, lawmakers and other stakeholders research the value of health information technology.
As the health sector strives to improve health and healthcare through the optimal use of IT, measuring technology’s impact and value to patients and caregivers becomes critical. Recognizing the need for a consistent way to understand, evaluate and communicate the real-world impact of health IT, HIMSS introduced the Health IT Value Suite, which it bills as a comprehensive knowledge repository that classifies, quantifies and articulates the clinical, financial and business impact of health IT investments.
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AHA: Hospitals will be ready for ICD-10

July 16, 2013 | By Dan Bowman
Despite a multitude of reports that many providers are struggling with the transition from ICD-9 to ICD-10, the American Hospital Association and the Blue Cross Blue Shield Association recently assured Congress that its members are on track for implementation.
In letters to both House and Senate members, AHA Executive Vice President Rick Pollack and Blue Cross and Blue Shield Association Senior Vice President Alissa Fox offered support for the move to ICD-10, saying that "any delay in implementation threatens to increase cost."
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No Silver Bullet for Medication Adherence

Margaret Dick Tocknell, for HealthLeaders Media , July 3, 2013

Cost and forgetfulness play a large role in non-adherence, but even when medications are supplied at no cost, adherence hovers around only 50%. Forging personal connections with pharmacy staff can help, one insurer says.
A "spoonful of sugar helps the medicine go down," Mary Poppins, the quintessentially perky nanny,explains in song and dance to her young charges.
If only it were that simple to get patient to follow prescription orders.
A report card [PDF] released last week by the National Community Pharmacists Association places medication adherence for individuals with chronic conditions at the C+ level, with one in seven receiving a failing report card grade.
Skipping medicine doses and failing to get prescription refills are among the patient behaviors that threaten patient health, especially among individuals with chronic conditions. The NCPA report estimates that medication non-adherence adds about $290 billion to healthcare costs each year.
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Tech Tools Tackle Medication Problems

Scott Mace, for HealthLeaders Media , July 16, 2013

Medication adherence is a multifaceted challenge that's getting a shot in the arm from technology developers. Glowing pill bottle caps connected to the Internet and a digital library of pill images with detailed data on drug interactions are just the beginning.
If a picture is worth a thousand words, how much could a picture of a patient's medications be worth?
A lot.
It could be worth $290 billion in healthcare costs, and 125,000 lives a year – the cost of medication non-adherence and medication errors, according to the New England Healthcare Institute.
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EHRs Have Mixed Effect on Health Costs

Published: Jul 15, 2013
By David Pittman, Washington Correspondent, MedPage Today
Using electronic health records (EHRs) saved a little more than 3% in ambulatory health costs 18 months after adoption but didn't reduce overall inpatient costs, a large comparative study of EHR use found.
With that rate of savings, it would take 7 years to recoup the projected 5-year adoption costs for an EHR, according to the study, which was published in July 16 issue of Annals of Internal Medicine.
"Reducing health spending by the magnitude that we observed would result in substantial savings if sustained over several years," Julia Adler-Milstein, PhD, of the University of Michigan in Ann Arbor, and colleagues wrote. "Larger savings are possible if providers have incentives to deliver more efficient care."
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EHRs May Slow Growth in Ambulatory Health Care Costs
Among projected savings are significant decreases in ambulatory radiology costs
MONDAY, July 15 (HealthDay News) -- Adoption of electronic health records (EHRs) modestly slows growth in ambulatory health care costs, according to research published in the July 16 issue of the Annals of Internal Medicine.
Julia Adler-Milstein, Ph.D., from the University of Michigan in Ann Arbor, and colleagues analyzed data from a natural experiment that included 806 ambulatory clinicians across three Massachusetts communities which adopted subsidized EHRs and six matched control communities that applied but were not selected to participate in the EHR program. Commercial claims data (January 2005 to June 2009) were used to assess health care costs.
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  • January 23, 2012

Should Every Patient Have a Unique ID Number for All Medical Records?

The WSJ Debate

As the U.S. invests billions of dollars to convert from paper-based medical records to electronic ones, has the time come to offer everyone a unique health-care identification number?
Proponents say universal patient identifiers, or UPIs, deserve a serious look because they are the most efficient way to connect patients to their medical data. They say UPIs not only facilitate information sharing among doctors and guard against needless medical errors, but may also offer a safety advantage in that health records would never again need to be stored alongside financial data like Social Security numbers. UPIs, they say, would both improve care and lower costs.
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State HIEs prep for disaster recovery

Posted on Jul 15, 2013
By Mike Miliard, Managing Editor
Working to ensure the availability and portability of health records in the wake of hurricanes or tornadoes, four Gulf Coast states and six states in the East and Midwest have set up infrastructure to safeguard access to critical health information.
Health information exchange programs in Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin and West Virginia are working with the Department of Health and Human Services and the Office of the National Coordinator for Health IT to enable exchange of health information among providers caring for patients who are displaced from their homes.
All of the state HIE programs participating in the initiative currently have established at least one operational interstate connection and are working with other states including Arkansas and Mississippi, officials say.
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Study: Telehealth Safe, Cost-Effective Alternative to Follow-Up Visits for Ambulatory Surgery Patients

Written by Helen Gregg | July 12, 2013
Telehealth can safely be used as an alternative to in-person follow-up visits for patients who have undergone low-risk ambulatory surgical procedures, according to a study in JAMA: Surgery.
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Telemedicine helps hospitals double revenue

July 15, 2013 | By Dan Bowman
Hospitals that used telemedicine technology and referred patients to children's facilities saw their revenue increase significantly, according to research published this month in the journal Telemedicine and e-Health.
For the study, researchers retrospectively examined billing information for patients transferred from 16 hospitals that used telemedicine. They compared information before and after implementation of telemedicine tools from July 2003 to December 2010.
The researchers, from the University of California Davis Children's Hospital in Sacramento, found that the average number of patients transferred annually by 16 hospitals using telemedicine to children's facilities nearly doubled following deployment of such services, from 143 transfers before deployment to 285 after deployment. In that same vein, the researchers determined that average annual hospital revenue for the facilities examined jumped from $2.4 million before telemedicine deployment to $4 million afterward.
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Hospital workers fired after allegedly snooping into Kim Kardashian's medical records

July 15, 2013 | By Ashley Gold
Some hospital employees in Los Angeles may have gone too far in their quest to "Keep Up with the Kardashians" and now have to face the consequences.
Five workers and a student research assistant at Cedars-Sinai Medical Center (Calif.) have been fired over privacy breaches involving patient medical records--and there is speculation that the patient was Kardashian, who gave birth to her daughter with rapper Kanye West in a birthing suite at the hospital on June 15, the Los Angeles Times reports.
Accessing the records violates the Health Insurance Portability and Accountability Act (HIPAA), which limits what information can be accessed without a patient's permission.
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Update on Q2 Federal Health IT Activity

by Helen R. Pfister, Susan R. Ingargiola, and Erica L. Cali, Manatt Health Solutions Monday, July 15, 2013
The federal government continued to implement the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA), during the second quarter of 2013. Below is a summary of key developments and milestones achieved between April 1, 2013, and June 30, 2013.

Highlights

The second quarter of 2013 saw a number of important developments:
  • ONC Releases Governance Framework. On May 6, the Office of the National Coordinator for Health IT released a Governance Framework for Trusted Electronic Health Information Exchange, which presents ONC's guiding principles on HIE governance and provides a common conceptual foundation applicable to all types of HIE governance models. Its intended audience includes any entities that set HIE policy (e.g., state governments, public-private partnerships, HIE organizations and private companies). The Framework consists of four principle categories focusing on: organizational processes, patient trust, business management and technical standards. 
  • EHR Association Releases Voluntary EHR Developer Code of Conduct. On June 11, the Electronic Health Record Association (EHRA), a trade association of electronic EHR vendors, released a voluntary code of conduct. The code is designed to "reflect the EHRA's commitment to support safe health care delivery, recognize the value and impact that EHRs have for patients and families, foster continued innovation and operate with high integrity in the market." Companies that adopt the code will be responsible for determining their own specific application of the code's principles.
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Sutter’s New Electronic System Causes Serious Disruptions to Safe Patient Care at E. Bay Hospitals

California Nurses Association Press Release, 7/11/13
Introduction of a new electronic medical records system at Sutter corporation East Bay hospitals has produced multiple problems with safe care delivery that has put patients at risk, charged the California Nurses Association today.
Problems with technology are not unique to health care – pilots of the ill fated Asiana airline that tragically crashed at San Francisco International Airport July 6 told federal investigators that an automatic throttle failed to keep the jetliner at the proper speed for landing, the Los Angeles Times reported July 9.
In over 100 reports submitted by RNs at Alta Bates Summit Medical Center facilities in Berkeley and Oakland, nurses cited a variety of serious problems with the new system, known as Epic. The reports are in union forms RNs submit to management documenting assignments they believe to be unsafe.
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Enjoy!
David.

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