Saturday, August 24, 2013

Weekly Overseas Health IT Links - 25th August, 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.

ONC chief's 10 pithy quotes on health IT

Posted on Aug 16, 2013
By Jeff Rowe, Contributing Writer
Since the introduction of LexisNexis, it’s been an open question in the mind of many prominent policymakers whether they’ll be remembered for their substantive accomplishments, or for the number and variety of soundbites they managed to feed to the ever-hungry media.
Few would suggest that Farzad Mostashari, MD, the soon-departing director of ONC, doesn’t have more than his share of very real milestones marking his tenure. And he’s also had a knack for pitching his ideas in ways that are succinct, sticky (in that they stick in one’s memory), and often entertaining.
What follows, then, with no thought toward their level of memorable-ness, are 10 highlights from Mostashari’s time at the helm of ONC.

Varying stakeholder value assessments impact health IT adoption

August 16, 2013 | By Susan D. Hall
Innovations might be slow to spread in healthcare because of various stakeholders' differing views of their value, according to a study published this week in BMC Medical Informatics and Decision Making.
Decision makers assess an innovation's costs and benefits--including improvement in efficiency, health gains, satisfaction with the care process, and investments required--the researchers from The Netherlands noted. Different groups perceive those differently.

Physicians: EHR costs outweigh benefits

August 16, 2013 | By Ashley Gold
Electronic health record provider athenahealth's recently published Physician Sentiment Index report finds that although most physicians believe EHRs can improve outcomes, more than half also say that the cost of such tools outweighs their benefit.
The Watertown, Mass.-based vendor polled 1,200 physicians: 70 percent specialists, 47 percent independent practitioners and 30 percent primary-care doctors.
While most respondents said they liked EHRs (38 percent reported a "somewhat favorable" opinion, while 31 percent had a "very favorable" opinion), 51 percent of respondents said the financial benefits of EHRs do not outweigh the cost. The report points out that independent physicians are more likely to feel this way than employed physicians.

Rothman Index uses EHR to identify health risks, unplanned readmissions

  • August 15, 2013
Researchers evaluated the Rothman Index, a calculator that uses information from electronic health records to identify health risks, and concluded it can be successfully used to predict the likelihood of unplanned hospital readmissions, according to recent research published in Medical Care.
 “We know the Rothman Index is associated with readmissions, but we do not know if it can be used to improve decision making at the bedside in terms of when patients are discharged,” Elizabeth H. Bradley, PhD, from the Yale School of Public Health in New Haven, Conn., stated in a press release. “We also don’t know if physicians would benefit from using it as part of determining what kinds of added supports at home and in the community might be arranged at discharge. Answering these questions will determine if the Rothman Index can be used prospectively by clinicians to reduce readmissions and adverse events post-hospitalization.”

What can predictive analytics do for healthcare reform?

Author Name Kyle Murphy, PhD   |   Date August 13, 2013  
The shift from pay-for-service to pay-for-performance in healthcare means that healthcare organizations and providers must approach care delivery in a different way, moving from diagnostic care to preventive medicine. Part of the challenge of adopting a forward-looking approach is having the right tools, namely health IT systems with the ability to predict what’s next.
“Analytics traditionally stops at the present time, and we’re now applying this to the future so that you can add predictive analytics,” says Simon Arkell, CEO of Predixion Software, a developer of predictive analytics solutions for healthcare. “Although they sound the same, they’re different ways of approaching problems. It’s great to have a dashboard with insight on what’s happening or has happened, but unless you’re projecting what’s going to happen and then recommending the right steps to take advantage of that new knowledge, then you’re leaving money on the table.”
One area of healthcare already showing promise involves avoiding unnecessary or preventable readmissions. “The readmission problem is a big one and that’s one of the areas we focus on. It’s a very expensive problem,” observes Arkell.

Hospital IT execs: Why med reconciliation via EHR is a challenge

August 15, 2013 | By Marla Durben Hirsch
With heavy pressure to reduce readmissions and improve patient outcomes, hospitals increasingly are relying on the medication reconciliation technology in their electronic health record systems to administer the right medication to the right patient at the right time, and to coordinate new drugs with those that a patient may already be taking.
"Electronic health records help enhance the accuracy of the process by providing tools to accurately capture the patient's previous medication history, better manage the process of ordering new medications or discontinuing previous ones, and generate instructions for the patients," Ferdinand Velasco, M.D. (right), chief medical information officer of Texas Health Resources, a 25-hospital health system in the Dallas/Fort Worth area, told FierceEMR.
But the use of the technology is still evolving, and the process is proving to be a challenge.
FierceEMR spoke exclusively with several hospital IT executives regarding their efforts to use EHRs to conduct medication reconciliation.

EHRs, tech help docs avert misdiagnosis

Posted on Aug 15, 2013
By Paul Cerrato, Contributing Writer
The statistics are disturbing: between 10 percent and 15 percent of medical diagnoses are incorrect and those diagnostic errors have a high price tag. To combat potential patient harm and reduce the costs from misdiagnosis, hospitals and medical practices are turning to clinical decision support tools.
A recent analysis published in BMJ Quality and Safety examined malpractice claims over 25 years, identifying more than 100,000 cases that involved diagnostic error, with an average price of $386,849 per claim. An earlier study published in the same journal estimated that diagnostic errors account for 40,000 to 80,000 hospital deaths yearly in the U.S.
Healthcare experts and vendors are trying to address this national problem in a variety of ways.  The widespread adoption of EHRs will likely help reduce the deaths and injuries that can result from misdiagnosis because many are now equipped with clinical decision support (CDS) software to help physicians pinpoint the correct diagnosis.

Federal study shows IT improves outcomes

Posted on Aug 15, 2013
By Diana Manos, Senior Editor
A new report issued Thursday by the Agency for Healthcare Research and Quality has found that certain health IT products, including those that provide decision support, clinical workflow support and care coordination can lead to better healthcare outcomes. 
"Findings and Lessons from the Improving Quality Through Clinician Use of Health IT Grant Initiative" documents the findings of more than 20 research projects that investigated how health IT applications can assist providers in providing evidence-based care. Multiple studies showed positive impacts on process and intermediate outcomes.
The report highlights key findings and lessons from the experiences of 24 projects awarded in 2007 under AHRQ. According to AHRQ officials, the initiative was designed to investigate approaches for using health IT to support clinicians in making patient care decisions and coordinating care with a focus on effectively incorporating evidence-based information at the point of care. It's part of AHRQ’s Ambulatory Safety and Quality program, which was designed to improve the safety and quality of ambulatory healthcare in the U.S.

FDA releases final guidance on wireless medical devices

August 15, 2013 | By Greg Slabodkin
The U.S. Food and Drug Administration has published final guidance to assist industry and FDA staff in identifying and appropriately addressing specific considerations related to the incorporation and integration of radio frequency (RF) wireless technology in medical devices.
"With the increasing use of RF wireless medical devices, continuing innovation and advancements in wireless technology, and an increasingly crowded RF environment, RF wireless technology considerations should be taken into account to help provide for the safe and effective use of these medical devices," states the FDA document. "This guidance highlights and discusses RF wireless technology considerations that can have an effect on the safe and effective use of medical devices."

Scots deploy Key Information Summary

15 August 2013   Rebecca Todd
More than 60% of Scottish GP practices are live with the new Key Information Summary for patients with complex care needs.
Nearly 20,000 KIS records have already been created and the full roll-out is expected to be complete in three weeks.
KIS programme manager Jonathan Cameron said all the country’s Emis practices are live with the new service and around one third of INPS practices.
The KIS is an extension of Scotland’s Emergency Care Summary.

47% Of Doctors Use Smartphone, Tablet And PC

More clinicians than ever are "digital omnivores," using smartphones, tablets, and computers for clinical work, survey says.
Clinicians are rapidly increasing their use of mobile devices at work, according to a new report from Epocrates, a vendor of mobile reference materials that is owned by EHR vendor Athenahealth.
Of the 1,063 physicians and mid-level practitioners who responded to Epocrates' survey, 86% of the clinicians now use smartphones in their professional activities, up from 78% in 2012. In addition, 53% use tablets at work, compared to 34% last year. All of the respondents use desktop/laptop computers. And nearly half fall into a new category that Epocrates dubs "digital omnivores," who use all three platforms, or "screens." The percentage of digital omnivores has increased to 47% from 28% in 2012, and the report predicts that this group will shoot up to 82% of the total next year, largely because of the skyrocketing use of tablets among clinicians.
Tablet adoption already accounts for the bulk of the increase in mobile device use. Nearly two years ago, 80% of physicians reported using mobile devices at work -- but back then, most of them were using only smartphones. Last year, Manhattan Research found that 62% of doctors were using tablets for professional purposes. The lower number in the Epocrates survey may be related to differences in study samples.

Data Capture: Devil in the Details Confronting All Meaningful Users in 2014

by Robin Raiford and Anantachai (Tony) Panjamapirom Thursday, August 15, 2013
To meet many of the meaningful use requirements, providers must capture, store and share clinical data mostly in a specified electronic, structured and coded format. Having undergone a major ramp-up data capture in Stage 1, providers will continue to experience the increased pressure and intensity in both quantity and quality of required data elements. Providers should view this mandate, as an opportunity to transform their data collection process and develop plans to sustain providers' agility needed to successfully demonstrate meaningful use as the future stages will only bring additional data elements and more complex requirements.

4 ways IT can keep medications straight

Posted on Aug 14, 2013
By Jeff Rowe, Contributing Writer
On one level, taking a pill is one of the simplest forms of healthcare, and it's safe to say that across the country people pop pills by the millions every day.
At the same time, medication errors are responsible for the deaths of tens of thousands of patients annually, and the odds are many other patients end up taking the wrong medicine with more minor consequences.
It was an error of that sort which led to the creation of MedSnap, a Birmingham, Ala.-based company that is focused on using IT to improve medication safety. According to MedSnap's co-founder and CEO, Patrick Hymel, MD, about two-and-a-half years ago his grandfather was taking the wrong medicine to treat his prostate cancer – and it was six weeks before the error was discovered.

Royal Berks spends £16m on consultants

1 August 2013   Rebecca Todd
Royal Berkshire Hospital
Royal Berkshire NHS Foundation Trust has spent £16.6m on external consultants working on its Cerner Millennium implementation.
A Freedom of Information Act request made by BBC Berkshire asked how much the trust has spent on external consultants to help manage the electronic patient record project.
The response was a staggering £16.6m spent employing 213 external consultants since the inception of the programme.

Google Glass: Promising but risky for providers

August 14, 2013 | By Ashley Gold
While Google Glass in the eyes of some healthcare professionals holds promise as an innovative and effective tool in the operating room, to others, its privacy disaster potential looms large.
An article in the Wall Street Journal highlights the experience of cardiothoracic surgeon Pierre Theodore, M.D. with Google Glass. Theodore found he could alternate between looking down at his patient and glancing at the patient's medical imagery on the lens--similar to how a driver can look at the road and the rearview mirror.
"I had thought it was going to be a gimmick, but after that I became a zealot," Theodore, who works at University of California, San Francisco Medical Center, told WSJ. Last week at Rock Health's Health Innovation Summit in San Francisco, Theodore told participants that doctors aren't slow to adopt Glass because they're stubborn, but rather, because they're already inundated with technology--monitors, wires, screens, etc.--according to WSJ.

Algorithm could sort out the most pressing individual health recommendations

August 14, 2013 | By Susan D. Hall
Primary care physicians soon may be able to use a mathematical algorithm to help them quickly prioritize their recommendations for individual patients.
The U.S. Preventive Services Task Force has issued recommendations for 60 distinct clinical services, but physicians tend to focus on the ones that take the least time. Those aren't necessarily the most important ones for improving a patient's health, according to an article at
In a study published at the Annals of Internal Medicine, researchers used the algorithm, connected to EHRs, to sort out the recommendations most closely tied to life expectancy based on a particular patient's condition.

6 steps to health information superiority

By Jeffrey Edgell, Chief technologist at DHA Group
IT enterprises must respond rapidly to queries and be in a position to take action based on data and information that are accurate, understandable and timely. This demand extends to all areas of professional and personal use including the health environment.
Consider the instance of the acute patient in need of treatment outside of her provider network whose medical history is contained in numerous disparate systems. Think, too, of the consumer simply trying to make a decision on buying a healthcare product online and making comparisons. In both examples, the end user requires actionable, comprehensible, correct and current information. A failure in any area may ultimately result in poor decision making, possibly with life-or-death ramifications.
Users must have the capability to request data from any system that houses needed information — even if stored in formats that the host system never anticipated — and receive them in a manner that integrates properly with that host system. Historically, a user in either scenario described above would be challenged to determine where the required data were stored and how to access, translate and integrate them with other data being collected.
But as Albert Einstein so aptly put it, in today’s world one must “know where to find information and how to use it – that’s the secret of success.”

Kaiser Permanente Automates Quality Reporting To Joint Commission

Converting nearly half of core measures to e-measures saves time, but there are limits to what EHRs can do, cautions study.
Researchers at Kaiser Permanente have shown that it's possible to automate partially or fully the collection of data from an EHR for public quality reporting. They've also proved that this automation saves money, compared to manual data abstraction. However, their paper in the Journal of the American Medical Informatics Association (JAMIA) cautions that their experience "illustrates the gap between the current and desired states of automated quality reporting."
In 2010, Kaiser Permanente's care reporting staff began to retool the Joint Commission core measures for automated quality reporting. The purpose of this program was to make reporting by Kaiser's 37 hospitals more efficient and more reliable, said Terhilda Garrido, Kaiser's VP for health IT transformation and analytics, and the paper's lead author, in an interview with InformationWeek Healthcare.
Kaiser had previously developed e-measures from scratch for quality improvement purposes but had never before tried to adapt existing quality measures to the EHR. The first batch of metrics it automated were 21 measures from six of the 13 core measure sets, including those for acute myocardial infarction, ED patient flow, immunizations, the surgical care improvement project (SCIP), pneumonia and VTE prophylaxis.

Hospital HIE grows more on some branches than others

By Anthony Brino, Associate Editor
Although more than half of hospitals were sharing information with providers outside of their organizational affiliations as of 2012, only some were exchanging clinical care summaries and medication lists, according to a study by researchers at the Office of the National Coordinator.
Hospitals’ health information exchange, either through EMR interoperability and health information organizations, has increased 41 percent since 2008, and sharing of all types of clinical information increased between 39 percent and 55 percent, the ONC’s director of economic analysis and modeling, Michael Furukawa, and colleagues reported in Health Affairs.
More than half of hospitals were exchanging radiology and laboratory reports, too, Furukawa and colleagues found. But only only about one-third of the hospitals were exchanging clinical care summaries and medication lists, the study found — a slow adoption of information that’s prioritized in health reform care coordination policies.

Hospitals: Big data use is a 'significant challenge'

August 13, 2013 | By Dan Bowman
While most hospitals and healthcare organization representatives responding to a recent survey from the eHealth Initiative and the College of Health Information Management Executives see big data as important to their strategic plans, far fewer believe their facilities are implementing it appropriately.
Of 102 respondents, close to 80 percent said that use of big data and predictive analytics was important; 84 percent, however, called the actual application of such tools "a significant challenge." What's more, only 45 percent called their organization's big data strategy "flexible and scalable."
The results are similar to those of a survey conducted in June by in which 52 percent of responding hospital CIOs said that while they were using big data tools for some analytics projects, they weren't doing so at a "sophisticated level." Sixty-six percent cited lack of manpower or skills as primary reasons for not taking advantage of big data analytical tools at a higher level.

Telemedicine Consultations Improve Pediatric Care in Rural ERs, Study Finds

August 12, 2013
The quality of care for pediatric patients in rural emergency rooms—where pediatricians and pediatric specialists are scarce—improved significantly when delivered via telemedicine consultations, according to a study by researchers at the 129-bed UC Davis Children’s Hospital.
The use of technology to link far-distant practitioners has been steadily increasing in American medicine, particularly as a tool to provide rural and underserved communities with access to specialty physicians. More recently, telemedicine has been used for consultations to emergency rooms, and is particularly recommended for use in the area of stroke care.
The study, which was published in the journal Critical Care Medicine, also found that rural emergency room physicians are more likely to adjust their pediatric patients’ diagnoses and course of treatment after a live, interactive videoconference with a specialist. Parents’ satisfaction and perception of the quality of their child’s care also are significantly improved when consultations are provided using telemedicine, rather than telephone, and aid emergency room treatment, the study found.

Federally Developed CONNECT HIE Software Gets an Upgrade

AUG 12, 2013 3:01pm ET
The Federal Health Architecture, a collaboration of multiple government agencies, has released an enhanced version of the open source CONNECT software for secure health information exchange.

Independent docs not optimistic about accountable care, EHRs

Author Name Jennifer Bresnick   |   Date August 12, 2013  
Independent physicians are significantly less optimistic about the state of the healthcare industry than their employed or hospital-based peers, according to a new survey conducted by athenahealth.  With three quarters of independent doctors not even sure small practices will be able to survive the changes in store for healthcare over the next few years, trepidation over the murky path forward colored most of the findings in this year’s Physician Sentiment Index (PSI) report.
Accountable care figured largely in physicians’ minds when asked about the future of medicine, and the response to pay-for-performance medicine was mixed.  While physicians don’t necessarily blame payers for the difficulty of getting reimbursed for services, they do feel that accountable care initiatives might make the process even more burdensome.  Three-quarters of respondents said they have only “heard of” or are “somewhat familiar with” the idea of an accountable care organization (ACO), so it might be a lack of knowledge that’s holding back their enthusiasm.

Interoperability Plan Underwhelms, Mostashari Resigns: Now What?

Scott Mace, for HealthLeaders Media , August 13, 2013

In seven weeks, providers are supposed to be implementing stage 2 of Meaningful Use. The government's interoperability plans are lacking. And a key Washington player says he's leaving the scene. It's starting to look like a calamity.
As if the turbulence of July 2013 on healthcare IT wasn't bad enough, last week things got arguably worse.
First, Farzad Mostashari, director of the Office of the National Coordinator (ONC) for Health IT at the Department of Health and Human Services, announced he is resigning, staying on just long enough for a replacement to be found.

Feds dropped the ball on interoperability acceleration

August 8, 2013 | By Marla Durben Hirsch
I eagerly awaited the announcement from the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services this week about how they would respond to their Request for Information on accelerating health information exchange and interoperability.
But I was rather disappointed when they unveiled ... not much of anything on Wednesday morning.
Sure, they announced some principles and strategies. They proposed a complex care management fee conditioned on electronic summary of care record exchange. They're using incentives, such as new reimbursement models and the Meaningful Use incentive program. And they're incorporating HIE into Medicaid and other state payment policies.   

EHR analytics can identify diabetes earlier and in real time

Author Name Jennifer Bresnick   |   Date August 7, 2013   |  
EHR algorithms scanning patient records for signs of diabetes can identify sufferers more than 90% of the time, and predict the exact date of a diagnosis for the disease in 78.4% of cases, according to research published in BioMedCentral.   Using only data typically entered into an EHR, the algorithm can prevent a delayed diagnosis in 11% of patient cases, allowing physicians to prescribe treatment earlier than ever before.
Diabetes is seen as a prime example of how data analytics can improve care and reduce the costs associated with poorly controlled chronic diseases.  With the disease affecting 25.8 million people, and costing $174 billion annually, diabetes is an effective test case for the principles of the patient-centered medical home (PCMH), accountable care organizations (ACOs), and the power of predictive EHR analytics.  There is often a significant delay in the diagnosis and treatment of the condition, the researchers from the University of California San Francisco say, with a median delay between onset and treatment of 2.4 years, and 7% of cases going completely undiagnosed for a whopping seven years.

Telepsychiatry Poised To Take Off, but Obstacles Remain

by Rebecca Vesely, iHealthBeat Contributing Reporter Monday, August 12, 2013
Telepsychiatry, or e-therapy, has been around since the 1950s, but advances in secure communications technologies, combined with a national shortage of mental health professionals, are energizing the field.
The widespread adoption of tablet computers and smartphones and cheap and secure two-way video communications systems are accelerating the e-therapy field, experts say. Still, roadblocks remain, including reimbursement methods and clinician licensing and credentialing across states and health systems.
"Suddenly, you have a $1,000 setup cost instead of a $15,000 setup cost," said Avrim Fishkind, president and CEO of JSA Health Telepsychiatry in Houston and past president of the American Association of Emergency Psychiatry.

Strides made in sharing data between public, private institutions

Sharing patient records between public and private institutions will streamline care
Monday, 12 August, 2013 [Updated: 9:47AM]
Patients lugging unwieldy CT scans and X-rays to their doctor's office could soon be history.
In an eHealth Forum held earlier this month, IT and medical professionals shared the progress of their drive to set up a platform for sharing of electronic medical data between the private and public health sectors.
Doctors will be able to recognise how community diseases spread...and identify hot spots of diseases 
Stephen Lieber, ceo of a non-profit health care information group
"In 2005, medical records in the public sector were accessible to the private sector for the first time, but it was only one-way, with the private sector being able to see records in the public sector," says Dr Cheung Ngai-tseung, chief medical information officer with the Hospital Authority.


No comments: