Saturday, July 06, 2013

Weekly Overseas Health IT Links - 6th 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.

What is Snowden's impact on health IT?

Posted on Jun 28, 2013
By Diana Manos, Senior Editor
Whether Americans see Edward Snowden as a hero or a traitor, the ongoing story of his deliberate leak of classified defense information has caused some to sit up and take stock of all matters related to information technology, data and privacy.
Recent reports from the Huffington Post have Snowden saying he deliberately got a job at federal contractor Booz Allen Hamilton to hack information on the National Security Agency, data he intended to leak over what he claims is a matter of principle and defense of American rights.
A June 27 story in The New York Times reported that President Barack Obama was trying to play down the highly controversial and publicized incident. "This is something that routinely is dealt with," Obama was quoted as saying. "This is not exceptional from a legal perspective. I'm not going to have one case suddenly being elevated to the point where I have to do wheeling and dealing and trading."

ONC to Congress: HIEs are Progressing

JUN 27, 2013 3:43pm ET
In its new annual report to Congress on the status of health information technology adoption across the nation, the Office of the National Coordinator for Health Information Technology provides an update on the reach of statewide health information exchanges funded under the economic stimulus law.
Thirty-nine states and territories had operational statewide health information exchanges offering broadly available directed exchange services--the secure sharing of information between two trusted parties--in December 2012, ONC reports. Directed exchange services were available in certain regions in four states, in pilot stage in five others and not available in eight.

Analytics help hospital cut readmissions by 25%

June 28, 2013 | By Susan D. Hall
El Camino Hospital in California reduced readmissions by 25 percent through the use of predictive analytics and videoconferencing with nursing home staff who care for the most high-risk patients, according to a newly published case study by the College of Healthcare Information Management Executives.
The 443-bed hospital based in Mountain View, Calif., identified 25 characteristics that could help predict whether readmission would be likely and grouped patients by low, medium or high risk. Those factors included the patient's age; where the patient was to be placed after discharge; five diagnoses (congestive heart failure, pneumonia, stroke, sepsis and renal failure); and whether the patient's primary care physician (PCP) was identified in the record.

Cloud could save health industry $11B, study says

By Tom Sullivan, Editor
While 90 percent of healthcare CIOs view IT innovation as critical to success, the more surprising statistic is that fewer than one-fourth consider their existing infrastructure capable of supporting such technological advancement. 
That’s according to a report from MeriTalk, published Monday, examining the potential of IT-as-a-service (ITaaS) within the healthcare realm by surveying 109 CHIME members.
The ITaaS model can be used to lower operational costs, shift from capital to operational expenditure, boost service levels and streamline application deployment, David Dimond, healthcare solutions chief strategist at EMC, which sponsored the report, explained in a statement.

EHR design must better support care coordination

June 25, 2013 | By Marla Durben Hirsch
Electronic health records could improve patient care coordination among providers if they were better designed for such functionality, according to a perspective article published in the Journal of the American Medical Informatics Association (JAMIA).
The authors, from RAND Corp., Brigham and Women's Hospital, and Harvard Medical School, said that coordinating a patient's care can involve the assembly of much disparate information and takes significant time and effort, resulting in "poor" coordination and errors. EHRs can help, they said, but not the way they're currently designed.

NI gets electronic care records

27 June 2013   Rebecca Todd
Northern Ireland has launched the country’s first electronic care record system.
Health and Social Care Northern Ireland signed a £9m, seven year contact with Orion Health in May 2012 for a portal-based ECR.
It has since been building the infrastructure ready for the full deployment of the portal which was originally planned for April.

Health IT Market to Hit $22.6B by 2017

Written by Helen Gregg | June 25, 2013
The U.S. health information technology market is expected to hit $22.6 billion by 2017, according to a report from R&R Market Research.

Hospital CIOs: Big data efforts need to mature

June 27, 2013 | By Dan Bowman
Despite predictions by some that big data could save as much as $450 billion in healthcare costs, hospital CIOs aren't exactly enamored with current tools and efforts available.
According to's latest survey of its advisory panel, 76 percent of respondents believe that vendors are overpromising when it comes to big data. One CIO said that while the automatic monitoring tools touted by vendors for financial data are "standard," similar tools on the clinical side are "all over the map." Another CIO added that they don't see the big data market maturing for a few more years.
Fifty-two percent of respondents said that while they are using big data tools for some analytics projects, they aren't doing so at a "sophisticated level." Additionally, 66 percent of respondents said that their organization did not have the manpower or skills necessary to take advantage of big data analytical tools at a high level.

Senate hearing: EHRs still falling short

Posted on Jun 27, 2013
By Erin McCann, Associate Editor
Developing an effective framework for driving healthcare quality improvements proves a multifaceted, complex endeavor, and although EHR systems can play a positive role in the task, much of the technology still misses the mark. This was just one of several concerns put before the U.S. Senate Committee on Finance Wednesday.
Policymakers heard testimonies from four industry officials, representing both the public and private sectors, on how best to move forward with healthcare quality.
One concern referenced repeatedly by both policymakers and those testifying pertained to the sheer number of quality measures Centers for Medicare & Medicaid Services uses. Committee Chairman Max Baucus, D-Mont., pointed out that CMS uses more than 1,000 different measures in its quality reporting and payment programs.  

Researchers: Health IT creates its own 'reality'

June 27, 2013 | By Susan D. Hall
Electronic records create a third "reality" in healthcare--one beyond the patient's physical reality and the clinician's understanding of the issues and treatment--and yet another way to miscommunicate, according to a new study.
What if the physician could take a magic stylus and mark errors and ambiguities for developers to address? That would be an ideal scenario, according to research published online this week in the Journal of the American Medical Informatics Association.

Survey Shows Many I.T. Pros not Knowledgeable of Security Gaps

JUN 25, 2013 3:33pm ET
A survey of nearly 800 information technology professionals across multiple industries with some responsibility for data security finds gaps in their knowledge of how secure their data is or should be on mobile devices or stored in a cloud application.
WatchDox, a vendor of mobile security products, commissioned research firm Ponemon Institute to conduct the survey. In a new report, “The Risk of Regulated Data on Mobile Devices and in the Cloud,” two-thirds of respondents agree that their organization must comply with federal and state privacy and breach laws, but only 18 percent know that these laws also cover protection of regulated data on mobile devices.

The Google Glass is in: Doctor documents surgery with the Glass

First Posted: Jun 23, 2013 07:50 PM EDT
The Google Glass might be gross to some or exciting to others, depending on who you are, and on June 20, it made history by making it to the operating room and becoming the first wearable technology to document a surgical operation.
Dr. Rafael Grossman, a general trauma, acute care and advanced laproscopic surgeon from Eastern Maine Medical Center, used the Google Glass to document a procedure called percutaneous endoscopic gastronomy where a feeding tube is inserted using an endoscope.
Grossman performed a simple surgical procedure and documented it using the high-tech Google Glass. The surgery was streamed using Google Hang-Out and fed to an iPad just a few steps from the doctor.

State laws, patient preferences pose privacy challenges for HIEs

June 26, 2013 | By Susan D. Hall
Dealing with myriad state privacy laws was just one of the concerns weighing on health information exchange executives at a hearing this week hosted by the Privacy and Security Tiger Team of the HIT Policy Committee.
The hearing, according to HealthcareInfoSecurity, focused on non-targeted queries--in which a provider asks an exchange for all records on a patient when the providers are not known. The Tiger Team in April submitted recommendations to the HIT Policy Committee, but asked for more study of non-targeted queries.
Some committee members were worried that patients who did not want sensitive information shared would opt out of health data exchange altogether. The Tiger Team is expected to submit recommendations about non-targeted queries in August.

eReferral — A New Model for Integrated Care

Alice Hm Chen, M.D., M.P.H., Elizabeth J. Murphy, M.D., D.Phil., and Hal F. Yee, Jr., M.D., Ph.D.
N Engl J Med 2013; 368:2450-2453June 27, 2013 DOI: 10.1056/NEJMp1215594
Health care reform has generated new pressures for the U.S. health care system to take better care of more patients at lower cost. Whereas these challenges are relatively new in the fee-for-service private sector, safety-net systems have perennially had to “do more with less”; innovations in this arena have generally been prompted by clinical exigencies rather than the need to gain market share or maximize revenues.1 We believe that one such innovation — eReferral — can serve as a new model for integrating primary and specialty care.
In 2005, San Francisco General Hospital (SFGH) was grappling with a challenge familiar to safety-net organizations: providing access to specialty care.2 Because of a tremendous mismatch between supply and demand for specialty services, patients were waiting 11 months for a routine clinic appointment for gastroenterology, 10 months for nephrology, and 7 months for endocrinology. If a patient needed to be seen sooner, the referring clinician had to plead with a specialist to overschedule into already overflowing clinics. Patients would sometimes wait for months only to discover that they were in the wrong subspecialty clinic or needed further diagnostic testing, which added to delays in care.

Federal IT projects take a hit

Posted on Jun 25, 2013
By Tom Sullivan, Editor, Government Health IT
Rather than the riskier leading-edge initiatives, the IT areas within federal agencies getting hit hardest by sequestration are the basics.
The backdrop: 41 percent of federal IT executives are amid budget cuts greater than 10 percent triggered by sequestration, according to a Big Data report MeriTalk published last week.
In asking 150 federal IT executives about their budgets, in fact, MeriTalk found a handful of information technology projects, entirely new or of the upgrade variety, which are threatened or at least facing dormancy.

Misleading data a crime - Hunt

21 June 2013   Rebecca Todd
It will become a criminal offence for NHS providers to supply false or misleading data about their performance, the health secretary says.
In a speech on patient safety delivered today, Jeremy Hunt also said he wanted the NHS to be the first healthcare system in the world to publish the relative likelihood of a harm-free patient experience across every hospital in the country
He said safety in the NHS was not as good as it should be as 3000 people died last year because of harm done by the health service.

CDS system grows on pediatricians

June 25, 2013 | By Susan D. Hall
Pediatrician satisfaction with a decision support system grew over time and a development team working with their feedback is refining it further, according to a study published in the Journal of the Medical Informatics Association.
Researchers from the Indiana University School of Medicines and Regenstrief Institute for Healthcare in Indianapolis sought to assess the opinions of users of the Child Health Improvement through Computer Automation system (CHICA), a decision support system linked to an electronic health record. They surveyed 70 users of the system at four busy pediatric clinics in 2011, and 64 in 2012.

3 keys to successful CPOE implementation

June 25, 2013 | By Susan D. Hall
Training, support and anxiety management all are key to the implementation of computerized physician order entry systems, according to research published this week in BMC Medical Informatics and Decision Making.
The research involved at least eight hours of observation at five community hospitals in Massachusetts, as well as interviews with hospital executives, physicians, nurses and pharmacists.
The lessons learned were distilled down into five areas: governance, preparation, support, and perceptions and consequences. Successful hospitals created a clear decision-making structure that involved those most likely to use CPOE: doctors and nurses. They realized that one-size-fits-all training wouldn't work and provided extra help for those less computer savvy, and provided highly trained "at the elbow" peer users to work with staff as the systems were rolled out. They also recognized the fear associated with change and provided strong leadership to help manage that anxiety.

Probe Uncovers Hospitals' Inability to Protect Patient Privacy

Scott Mace, for HealthLeaders Media , June 25, 2013

Researchers and a journalist were able to re-identify, without much fuss, the de-identified medical records of scores of patients, thought to have been protected by HIPAA. Here's how they did it.
Patients concerned about privacy have more than flimsy hospital gowns to worry about. Their medical data may be showing.
First, a visual aid. Click on the map and take a look at where much medical information is flowing today.
This map, constructed by some of the nation's leading privacy experts, is an apt illustration for a big problem. In theory, all the healthcare providers on this map are complying with HIPAA, the Health Insurance Portability and Accountability Act of 1996 and its subsequent amendments.
So how come, in a year-long investigation, a few researchers and a journalist were able to re-identify, without much fuss, the de-identified medical records of 85 patients treated in Washington state in 2011?

Digital Health Records’ Risks Emerge as Deaths Blamed on Systems

By Jordan Robertson - Jun 26, 2013 2:01 AM ET
When Scot Silverstein’s 84-year-old mother, Betty, starting mixing up her words, he worried she was having a stroke. So he rushed her to Abington Memorial Hospital in Pennsylvania.
After she was admitted, Silverstein, who is a doctor, looked at his mother’s electronic health records, which are designed to make medical care safer by providing more information on patients than paper files do. He saw that Sotalol, which controls rapid heartbeats, was correctly listed as one of her medications.
Days later, when her heart condition flared up, he re-examined her records and was stunned to see that the drug was no longer listed, he said. His mom later suffered clotting, hemorrhaged and required emergency brain surgery. She died in 2011. Silverstein blames her death on problems with the hospital’s electronic medical records.

Report: Ways to Make ED Information Systems Safer

JUN 24, 2013 3:52pm ET
A published paper in the Annuals of Emergency Medicine examines four clinical scenarios that that could result in use of an emergency department information system contributing to medical errors, with recommendations to make EDIS use more safe.
The scenarios cover communication failures, poor data displays, wrong order/wrong patient errors and alert fatigues. In one scenario, instance, a physician verbally asks a nurse to give a patient with a presumed kidney stone 1 mg of hydromorphone to ease discomfort, and a half-hour later the physician finds the patient difficult to arouse. The nurse tells the physician she gave three doses of 1 mg each. The physician asks the nurse how this happened. “Well, you remember you asked me to give 1 mg of hydromorphone while we spoke in the room, then you ordered another 1 mg in computerized physician order entry, with an as needed order for a third.”

Why Computer Languages are Still a Big Deal

JUN 21, 2013 3:09pm ET
There are many systems written in many languages, but with open-source languages getting all the attention in recent years, are there enough people to support them?
Flashback 10, 20 years ago in the IT world, and you saw a world divided by languages. On the larger systems, you had seasoned developers well versed in Cobol, RPG, C/C++ and Java. On the smaller, PC and Mac boxes, there were cadres of C/C++ developers as well, along with Visual Basic, C#, and Objective-C.
Since then, numerous more lightweight scripting languages have grown in popularity, including Javascript (which is not related to Java), Perl, Python, PHP and Ruby.

Deloitte, Intermountain tap big data

Posted on Jun 24, 2013
By Erin McCann, Associate Editor
Deloitte and Intermountain Healthcare are teaming up to launch a new data analytics tool for researchers and healthcare companies that extracts electronic health record data to better determine clinical treatment options for patients.
Deloitte and Intermountain unveiled Monday the OutcomesMiner tool at the Drug Information Association's 2013 conference in Boston. Officials say the analytics tool — one result of a five-year data partnership deal between Deloitte and Intermountain forged back in February — will produce data-driven insight necessary to conduct comparative effectiveness research and bring new therapies to the market more rapidly.
 Tapping into Intermountain's vast repository of patients' EHRs — spanning across its 22 hospitals — officials say the technology will facilitate a better understanding of associated outcomes for treatments, allow researchers to filter for sub-populations using phenotypic characteristics and specific medical conditions, and support advanced analysis surrounding patient and product outcomes under a double-blinded format designed to protect patients' protected health information. 

Intermountain Launches Analytics Tool for Population Health Data

Scott Mace, for HealthLeaders Media , June 27, 2013

OutcomesMiner is intended to help hospitals and clinics determine better medical treatments based on clinical data and patient characteristics.
The first fruits of the alliance between Deloitte and Intermountain Healthcare emerged this week with the launch of OutcomesMiner, an analytics tool designed to give researchers, and pharmaceutical and medical device companies data-driven insight needed to conduct comparative effectiveness research and bring new therapies to market more rapidly.

Stakeholders urge a delay in federal oversight of IT and apps

Posted on Jun 21, 2013
By Diana Manos, Senior Editor
A group of more than 100 health IT stakeholders sent a letter to the Obama Administration this week, cautioning the quick implementation of regulation for the industry.
The June 18 letter was signed by companies and organizations that include the College of Health Information Management Executives, the American College of Emergency Physicians, American College of Physician Executives, American Medical Group Association, American Medical Informatics Association, American Nurses Association. Companies including McKesson Corporation, Siemens Corporation, Greenway Medical Technologies and Microsoft were also signatories.

CHIME execs: IT-as-a-service could save $11 billion

June 24, 2013 | By Susan D. Hall
Healthcare providers could reduce costs by nine percent--$11 billion--over the next three years through the adoption of IT-as-a-service models, according to a report by the public-private partnership MeriTalk and EMC Corp.
The findings are based on a survey of 109 members of the College of Healthcare Information Management Executives (CHIME), according to an announcement.

Patient data protection: Let's get back to basics

June 24, 2013 | By Dan Bowman
Looking to keep your patient's data safe? You'd be wise to remember that human error often lies at the core of a breach, and build your efforts from there. Healthcare attorney Lee Kim shared that advice earlier this month at the Government Health IT Conference & Exhibition.
But her advice is not heeded by nearly enough healthcare industry leaders.
For example, a survey of IT professionals from roughly a dozen industries--including healthcare--published earlier this month by consulting and internal audit firm Protiviti determined that 22 percent of respondents still don't have a written information security policy in place, Healthcare IT Security reported.

Chamath Palihapitiya Wants to Rewire the Crap Out of Healthcare

Wade Roush6/12/13Follow @wroush
What does an ex-Facebook tycoon with a degree in electrical engineering know about fixing the U.S. healthcare system?
Well, Chamath Palihapitiya knows that healthcare is in need of some drastic reinvention, and that to some extent, this will involve training people to think and behave in new ways—in much the same way Facebook has trained us to think differently about how we spend time online and communicate with our friends.
He’s not afraid to ruffle a few feathers in the process. That’s a good thing, because many of the companies he’s investing in through his Silicon Valley-based venture fund, the Social+Capital Partnership, are out to fundamentally shift the balance of power in healthcare and upend the way diseases get diagnosed and treated—or ideally, prevented. “Empower the edges,” Palihapitiya says. “That is the way you build a multi-gajillion-dollar company.”

IT Can't Fix Complex Healthcare Problems

It took the U.S. healthcare system decades to dig the hole it's in. We'll need more than technological innovations to dig out.
A lot has been written about the need for better care coordination to rein in healthcare costs and lower the high readmission rates in U.S. hospitals. Tech vendors and medical researchers have been trying to parse all the variables to figure out what tactics we need to fix the system. It looks like we're moving in the right direction, but there's a long road ahead. A closer look at the data makes that clear.
In principle, more emphasis on care coordination and the IT tools designed to manage it makes sense. When each clinician across the continuum of care knows what everyone else in the system is doing, the quality of care should improve and the costs should drop. If, for instance, the surgery team about to perform a coronary bypass procedure has all the details from a primary care doctor about the patient's medications and allergies, there's less risk of interaction between the anesthetic and those meds. And if the ambulatory clinician handling the patient's recovery has details on the patient's discharge instructions, that clinician can help the patient adhere to a postoperative regimen. AdTech Ad
Such a well-coordinated approach could also cut costs by reducing needless duplicative diagnostic tests. If the electronic medical record (EMR) contains notes about a recent serum potassium, EKG or MRI test, there may be no reason for the next clinician in the chain to reorder it.


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