Saturday, November 30, 2013

Weekly Overseas Health IT Links - 30th November, 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.

An Image problem?

NOV 1, 2013
Health insurance exchanges have been a godsend for many providers and payers that have had enormous difficulties figuring out how to push and pull data within the larger health care community. The exchanges have solved clinical and business needs at relatively low-cost entry points, a win-win situation for facilities that allowed HIEs to do much of the technological lifting and handle the day-to-day maintenance of information and connectivity.
But information exchanges one and all are on a relentless hunt for new revenue streams.
Many HIEs that have received state and federal seed dollars are seeing those funding sources dry up this year, at the same time they face increased competition from large health systems and other big players building their own exchanges that are butting up against other efforts.

EHR cost data for docs? Big money saver

Posted on Nov 22, 2013
By Erin McCann, Associate Editor
Out of control healthcare spending in the U.S. is no secret. Annually, healthcare expenditures currently stand at a whopping $2.7 trillion, a number that has industry leaders rushing to take new cost-cutting measures.
One of those measures involves displaying the costs of laboratory tests in an electronic health record so docs can see a real-time price comparison of what they’re ordering. And, from a financial savings perspective, it’s working. 
According to a new Atrius Health study published in the Journal of General Internal Medicine, docs who regularly viewed lab test cost data in the EHR both decreased their ordering rates for certain tests and saved up to $107 per 1,000 visits per month. Lab test utilization also decreased by up to 5.6 lab orders per 1,000 visits per month. 

Why nurses must be involved in developing new health IT

November 22, 2013 | By Ashley Gold
Nurses are an essential part of the medical system and patient care--so why shouldn't they be more involved in developing new healthcare IT?
This question is explored in an article in Nursing Times, along with discussion on how attitudes toward nurses differ in the U.K. and the U.S., and how nurses can use technology to improve practice.

Seniors Increasingly Go Online for Health Information

NOV 21, 2013 3:48pm ET
A small survey of 200 senior citizens in the United States finds many respondents using the Internet to get health information and wanting more.
Accenture conducted the survey in July 2013, which is a subset of a larger survey of more than 9,000 adults of various ages across nine nations on the electronic capabilities of medical providers. Results of the U.S. senior population shows 56 percent of surveyed Medicare consumers visited their health plan Web site at least once during the previous two months, with 67 percent saying online access to their medical information is somewhat or very important to them.

No evidence that messaging portals reduce costs, improve outcomes, review of studies shows

21 November, 2013
A key to the patient-centered medical home model is enhanced patient-physician communication—often through using a secure-messaging portal connected to an electronic health record. But according to a systematic review of 46 studies published over 22 years, there is insufficient evidence that portals improve outcomes or lower costs.
In the Veterans Affairs Department-funded review, researchers from VA and academic medical centers in Los Angeles and Indianapolis did find that portal use was associated with improved outcomes for patients with chronic diseases such as diabetes, hypertension and depression, but these improvements were also linked to portals used in case management. The researchers were unable to discern whether the portals themselves made a difference.

SnapSurvey: Most CIOs Pressured To Forge Ahead With Flawed Projects

11/20/2013 By Kate Gamble
SnapSurvey Says Leaders Often Ignore Red Flags
For weeks, the error-ridden launch of has dominated the headlines, but to CIOs, there’s nothing newsworthy about the idea of forging ahead with project that isn’t ready. And in fact, most have been in a similar situation. According to the November Snap Survey, 71 percent of CIOs have been associated with an initiative that stumbled out of the gate, and a whopping 86 percent have felt pressured to forge ahead with a project that was fraught with errors.
Times like these require CIOs to “stand up and lead,” which means gathering all the facts, making the tough decisions, and standing their ground, one respondent noted.
“I was able to negotiate changes in scope so that date could be met,” said another. “I would have resigned if not. It is better to leave with conviction than to hope it will work and fail.”

Don’t Let EHR Vendors Own Your Data

NOV 20, 2013 3:58pm ET
In a recent blog posting, John Moore and Rob Tholemeier of Chilmark Research ask the question: “Who’s Data is it Anyway?” Your electronic health records data is not the property of your vendor and there are things you can do about it, they contend. Here’s the blog:
“A common and somewhat unique aspect to EHR vendor contracts is that the EHR vendor lays claim to the data entered into their system. Rob and I, who co-authored this post, have worked in many industries as analysts. Nowhere, in our collective experience, have we seen such a thing. Manufacturers, retailers, financial institutions, etc. would never think of relinquishing their data to their enterprise software vendor of choice.

Data security still a risky business

Posted on Nov 21, 2013
By Mike Miliard, Managing Editor
A new poll from the Ponemon Institute has found that security preparedness is still sorely lacking across healthcare – a fact that could leave unsuspecting organizations "blindsided" by breaches.
The survey, conducted in partnership with Tripwire, asked 1,320 IT security professionals in healthcare and beyond about their privacy protections.
It found that, even as HIPAA fines have grown in size and frequency – including whopping sanctions against Affinity Health Plan ($1.2 million) and WellPoint ($1.7 million) this year – healthcare still lags far behind other industries when it comes to conducting risk assessments and implementing security controls.

'Tremendous interest' in genome project

20 November 2013   Rebecca Todd
Health care IT suppliers have shown “tremendous interest” in a government project to sequence 100,000 genomes and link these with electronic patient records.
The project involves the DNA codes of up to 100,000 patients being matched to their EPRs over the next five years to create anonymised datasets of the genome sequences and the clinical data.
The government has set up a new company, Genomics England, to manage the project contracts for specialist UK companies, hospitals and universities to deliver the necessary services.

Genomics pose 'daunting' test for EHRs

Posted on Nov 22, 2013
By Neil Versel, Contributing Writer
Think parsing the growing amount of information in electronic health records is tough now? Just wait until genomic data starts showing up in EHRs.
"The number of individual genetic tests is daunting," Peter Tarczy-Hornoch, MD, chair of the University of Washington's Department of Biomedical Informatics and Medical Education, said this week at the American Medical Informatics Association's annual symposium. Each needs "structure and storage."
A fully sequenced and analyzed genome contains about a terabyte of information, Tarczy-Hornoch explained during a well-attended session on integrating genomic data into the EHR, creating unprecedented storage and interoperability issues.

Evena Medical Delivers Smart Glasses Solution to Detect Patient Veins for Precise IV Placement

Evena Medical, a privately-held company operating out of Silicon Valley, focuses on delivering high-definition imaging technologies that target accurate and precise intravenous access. Evena's first successful product - the Evena OwlT, which visually identifies a patient's veins utilizing near-infrared (NIR) visualization - launched in early 2013 and is now available worldwide.
As highly useful as the technology has been, early this morning, in partnership with Epson, Evena announced the next evolution (or revolution depending on your "point of view") of the technology - its new Eyes-On Glasses system, a breakthrough and truly wearable design that brings an entirely new vision (in both senses of the word) to vascular access. It is indeed, we believe, a very cool and exciting next step in medical technology utilizing wearable tech – and, by this, we mean technology that is ready to deploy.

What activities need to come after an EHR implementation?

Author Name Jerrilyn Cowper   |   Date November 19, 2013   |  
Do you long for the day when all of your hard work is put into use, the long awaited go-live is over and your workload will finally slow down? If you have never been through the full lifecycle of an implementation, you may not realize that going live is only the beginning. In fact, many times post go-live work is more than the implementation effort.
What lies beyond implementation? This article is not meant to cause you to throw your hands in the air and run screaming. Instead, it takes aim at preparing you for what comes next.

U.S. EHR Market to Hit $6B by 2015

Written by Helen Gregg (Twitter | Google+)  | November 20, 2013
The U.S. electronic health record market is expected to be worth $6 billion by 2015, according to a Markets and Markets report.
Forecasters expect the market to grow from $2.2 billion in 2009 to just more than $6 billion in 2015 at an estimated compound annual growth rate of 18.1 percent.

Three Big Ways EHRs May be Challenged in Stage 3

NOV 19, 2013 3:19pm ET
The HIT Policy Committee is recommending electronic health records systems under Stage 3 of the meaningful use program have comprehensive capabilities to query disparate EHR systems for patient records, and to electronically respond to such queries from other EHRs.
And that may not be the toughest task ahead. The committee envisions patients having data portability to take their electronic health record with them when they switch providers, and providers having data migration that enables them to switch EHRs while having coded data in the old system consumed by the new system so clinical decision support will still work.
The policy committee is comprised of industry stakeholders who advise the Office of the National Coordinator for Health Information Technology and other federal agencies on health information technology matters--and ONC accepts the large majority of its recommendations.

GAO wants updated consumer privacy framework

November 20, 2013 | By Susan D. Hall
The Government Accountability Office, in a new report, has called on Congress to consider strengthening the consumer privacy framework to take changes in technology into account, as well as the market for consumer information.
"The current statutory framework for consumer privacy does not fully address new technologies--such as the tracking of online behavior or mobile devices--and the vastly increased marketplace for personal information, including the proliferation of information sharing among third parties," the report states.

Pentagon’s Electronic Health Record Not Ready for Initial Use Until 2017

By Bob Brewin November 19, 2013
The Defense Department will not start deploying its modernized electronic health record until 2017, nine years after President Obama called on the Pentagon and the Veterans Affairs Department to develop a joint EHR.
The joint effort was abandoned in February when estimated costs spiraled to $28 billion. The Defense EHR is expected to cost between $4 billion and $5 billion over five years, based on industry estimates.
The Navy will run the Defense EHR procurement with a single award to a systems integrator that will provide commercial EHR software, according to presentations at an Oct. 31 industry day run by the Space and Naval Warfare Systems Command-Systems Center Atlantic. The Pentagon on Sept. 13 named Christopher Miller, former executive director of the SPAWAR Systems Center Atlantic, to serve as program executive officer of the new Defense Healthcare Management Systems Modernization -- or DHMSM -- project to develop the EHR.

The Golden Age of Health Informatics?

Despite unsolved problems, healthcare IT has made great strides.
So much attention is paid to the problems in the trenches that it is easy to forget just how far we've come in the past few years. It was only 2008 when the oft-cited DesRoches NEJM survey showed that 4 percent of physicians had a clinically active electronic medical records system (my term for what they called fully functional EMRs). The following year, even an old-timer like me was surprised when a companion survey showed only 1.5 percent of hospitals had such a system.
At the same time, we've been stuck since the 1950s in the fee-for-service paradigm with seemingly no way to extricate ourselves, even though it is clear to most that we need to base healthcare reimbursement on the same criteria that apply to other businesses: quality and efficiency. And yet here we are. Now EMRs are giving way to electronic health records (EHRs), a new generation of systems promising care coordination across practices, patient engagement, and other capabilities in keeping with a new era of outcomes-based reimbursement.

7 insights from a congressional hearing on

By Diana Manos, Senior Editor
Witnesses at a recent congressional hearing said management was key in’s delays, over and above procurement problems. “They did this to themselves,” said Karen Evans, former administrator for electronic government and information technology at the U.S. Office of Management and Budget.
“I’m not calling this a failure," said Richard Spires, former chief information officer of the U.S. Department of Homeland Security, speaking of the new federal website,, intended to register and help millions of Americans to purchase affordable health insurance."it’s troubled, and we need to get it fixed,” Spires said at the Nov. 13  House Committee on Oversight and Government Reform congressional hearing. “We need the CIOs to be strengthened in this government from the standpoint of their empowerment.”

ONC to help fight Rx drug abuse

Posted on Nov 19, 2013
By Mike Miliard, Managing Editor
In an effort to combat the prescription drug abuse epidemic, the Office of the National Coordinator has launched a new interoperability initiative to better link drug monitoring programs with health IT systems.
In a blog post, Jennifer Frazier, ONC's behavioral health subject matter expert, says the new Standards & Interoperability Framework Initiative seeks to solve problems related to the lack of common technical standards and vocabularies that could help prescription drug monitoring programs "share computable information" with health IT systems.
The PDMP & Health IT Integration framework "will bring together the PDMP and heath IT communities to establish a standardized approach to retrieve data stored in the PDMPs and deliver it to EHRs and HIEs," Frazier writes.

Dropbox in healthcare: A love-hate thing

Posted on Nov 19, 2013
By Mike Miliard, Managing Editor
Torie Jones, former chief privacy officer at University of Pennsylvania Health System, had an ironclad rule in place for her staff: "No PHI in the cloud until you have a BAA in place."
For most cloud-based vendors, those who are used to the specific demands of working in healthcare, getting that business associate agreement in place wouldn't be much of a problem.
But when it comes to using the the popular file hosting service Dropbox, that all-important contract isn't something that's readily forthcoming.

iSoft users flock to Emis

18 November 2013   Rebecca Todd
Three quarters of GPs that were using iSoft systems when CSC announced it was pulling support for the products have switched to Emis Web.
Around a quarter have chosen to move to TPP and small numbers have picked INPS and Microtest systems.
EHI revealed in September last year that CSC had decided to withdraw its iSoft products from the NHS primary care market.
Based on information held by the Health and Social Care Information Centre, 409 practices were still using iSoft systems at this time.

Surge in SCR uptake

19 November 2013   Rebecca Todd
Uptake of Summary Care Records amongst secondary care clinicians has been greater in the past nine months, than in the previous five years.
The steep increase in use of the records in secondary care was revealed by NHS England’s director of strategic systems and technology Beverley Bryant at EHI Live in Birmingham this month.
Bryant also said the SCR will be renamed as the Partial GP Record.
SCRs provide emergency clinicians involved in a patient's care with a cored dataset pulled from GP records covering a patient’s allergies, medications and adverse reactions.

NEHI offers best practices for tele-ICU's second phase

November 19, 2013 | By Susan D. Hall
Tele-ICU appears to be entering a second phase marked by more diversity in practices and more experimentation. In response, the New England Healthcare Institute (NEHI) has issued best practices for making tele-ICU more scalable and accessible to more hospitals and more beds.
As of late 2012, there were 54 civilian and government tele-ICU monitoring centers in the U.S., it says, though MaineHealth in August announced that high costs had forced the Portland-based health system and its nine participating hospitals to drop the program.

UNC Health Care leverages big data to boost bottom lines

November 19, 2013 | By Ashley Gold
It's always to refreshing to see big data not just being thrown around as a buzzword, but truly being used to save lives and improve bottom lines. That's the case at the University of North Carolina Health Care (UNCHC), a large non-profit healthcare provider in Chapel Hill, N.C., where one doctor is touting data and analytics as "increasingly at the heart of" how his hospitals run.
Growth and consolidation in the UNCHC system saw a massive increase in the amount of data each facility was holding--and about 80 percent of it was unstructured, said Carlton Moore, M.D., associate professor of medicine at UNCHC, in an article in Business Cloud News. Data, he said, now is being used to improve the quality of care and reporting.

AHIMA offers tips for maintaining integrity in data mapping

November 19, 2013 | By Susan D. Hall
Mapping one data set to another--such as SNOMED CT to ICD-10--is almost always a resource-intensive project requiring hands-on review and considerable knowledge about the source and target, according to a new report on how to maintain data integrity during the process. A lot can go wrong, the American Health Information Management Association (AHIMA) notes in its paper.
For example, SNOMED CT is a comprehensive clinical terminology that contains content for both human and veterinary medicine, and it's vital for maps to use the correct reference set to exclude non-human terms.

Robots let doctors 'beam' into remote hospitals

CARMICHAEL, Calif. (AP) — The doctor isn't in, but he can still see you now.
Remote presence robots are allowing physicians to "beam" themselves into hospitals to diagnose patients and offer medical advice during emergencies.
A growing number of hospitals in California and other states are using telepresence robots to expand access to medical specialists, especially in rural areas where there's a shortage of doctors.
These mobile video-conferencing machines move on wheels and typically stand about 5 feet, with a large screen that projects a doctor's face. They feature cameras, microphones and speakers that allow physicians and patients to see and talk to each other.

Why e-Scheduling May be Healthcare's Most Valuable App

Scott Mace, for HealthLeaders Media , November 19, 2013

Cheap, ubiquitous teleconferencing technology can turn any visit to a primary care provider into a patient-centered care team huddle, cutting weeks off the referral run-around and reigning in costs. But it only works if the right team of providers, specialists, and the patient are available at an agreed-upon time.

Every one of us carries in our pocket or bag one of the untapped technological saviors of healthcare.
No, it's not Twitter. It's the calendar on your phone.
It's one of those things that generally goes unused, but not because it wouldn't be extremely useful. It's because schedule-sharing for years has had a "last mile" problem, an interoperability chasm.

KLAS Looks at Vendor Field for Population Health Management

NOV 15, 2013 3:25pm ET
With provider interest in population health management technologies soaring, along with the flood of companies jumping in, vendor research firm KLAS Enterprises has a new report on what the early playing field looks like.
The report includes results of interviews with 78 providers using at least one population health management application, with the respondents using products from a total of 23 vendors. KLAS cautions that few of the vendors have enough live client sites to produce a formal rating for their products.

HIT pioneer celebrates centennial

Posted on Nov 18, 2013
By Neil Versel, Contributing Writer
An early pioneer in medical informatics, Morris F. Collen, MD, one of seven founding partners of the Permanente Medical Group, turned 100 on Nov. 12. 
Sunday at the opening session of the American Medical Informatics Association Annual Symposium, keynote speaker "e-Patient" Dave DeBronkart, noted that friends, former students, protégés and admirers of Collen tweeted last week during Collen's centennial birthday party in San Francisco using the hashtag #collen100. DeBronkart then remarked that the first hashtag appeared in 2006 -- when Collen was merely 93 years old. 

Study: Can the EHR Be a Readmissions Tool?

Written by Akanksha Jayanthi | November 15, 2013
Electronic health record-based prediction models may help identify patients who are at risk for readmission within 30 days of discharge, according to a study published in the Journal of Hospital Medicine.

Intermountain to track, publish every cost

November 18, 2013 | By Susan D. Hall
In another demonstration of its data-driven approach to reducing costs, Intermountain Healthcare is building an ambitious new data system to track the cost of every procedure, piece of equipment and supply its 22 hospitals and 185 clinics use.
The idea is to have data available so physicians and patients can discuss costs and outcomes before making treatment decisions, according to a Wall Street Journal article.

Interoperability: A critical mess

November 18, 2013 | By Gienna Shaw
I recently moderated a panel discussion on one of the most intractable problems in healthcare today: the ability--or lack thereof--to seamlessly share data across organizations, systems, platforms, devices and more. The live and online event on interoperability was hosted by West Health, a research organization that focuses on technologies to reduce healthcare costs.
Interoperability is an issue that the health IT community has been talking about for so many years--and yet solutions are tantalizingly out of reach. This despite the fact that there are enormous incentives to get it done.  
The discussion kicked off with an arresting image--a photo of a patient in an intensive care unit room chock full of medical devices and a menagerie of carts and monitors. A jumble of wires completed the vision. You could barely see the patient and the clinician in the middle of it all. Different medical devices and systems look different, of course, but what struck me was that each monitor display also had a different look and feel.

What Do Kaiser and a Presidential Campaign Have in Common? Belief in the Power of Data.

by Kate Ackerman, iHealthBeat Editor in Chief Monday, November 18, 2013
NEW YORK -- The chair of the country's largest not-for-profit health plan and hospital and the mastermind behind President Obama's 2012 re-election campaign have had vastly different career experiences, but they both believe electronic data has the power to transform the U.S. health care system.
George Halvorson, chair of Kaiser Permanente, and Jim Messina -- national director for Organizing for Action, campaign manager for Obama's 2012 re-election campaign and Obama's former deputy chief of staff -- delivered separate keynote speeches at the New York eHealth Collaborative's Digital Health Conference in New York City last week.
Halvorson discussed how health IT and the availability of real-time data has helped Kaiser to dramatically improve care quality and reduce costs, while Messina spoke about the success of using data analytics in the 2012 presidential election and how lessons learned through that campaign could be used to help solve today's health care challenges.

Health-Care Apps That Doctors Use

Programs range from diagnostics to hand-washing trackers.

Jeanne Whalen
Nov. 17, 2013 4:07 p.m. ET
Cardiologist Eric Topol says he knew medicine had reached a turning point when patients started emailing him the results of do-it-yourself electrocardiograms.
With the help of a smartphone, a software application and a portable device that reads a person's heart rhythm, anyone can get an instant EKG reading on their phone screen.
"I am getting emails from people saying, 'I'm in atrial fibrillation—what do I do?' " Dr. Topol says, referring to a type of irregular heartbeat. "Whoa! The first time I saw that in the subject line of an email, I said, the world has really changed."
Mobile apps for smartphones and tablets are changing the way doctors and patients approach health care. Many are designed for the doctors themselves, ranging from handy databases about drugs and diseases to sophisticated monitors that read a person's blood pressure, glucose levels or asthma symptoms. Others are for the patients—at their doctor's recommendation—to gather diagnostic data, for example, or simply to help coordinate care, giving patients an easy way to keep track of their conditions and treatments.

WoHIT 2014 showcases continuity of care

Posted on Nov 06, 2013
By Dillan Yogendra
Covering two days, April 3rd and 4th next year, the Interoperability Showcase will aim to challenge industry solution providers to assemble a connected network of healthcare systems that carry patient data through the confines of the hospital to the community and to the patient's home. In addition, industry solution providers will be demonstrating the unique features that make systems usable for healthcare providers and patients.
The benefits of interoperability will be explored – from the patient visit to the GP, to diagnosis in departments such as the laboratory, digital pathology, radiology, to intervention such as cardiology and radiation therapy. Following on, patient care devices (bedside monitoring), pharmacy, patient care coordination and quality, research and public health (QRPH), and secondary use of information for overall healthcare improvement will also be reviewed. Monitoring the recovery of the patient in the home setting will ultimately be discussed.

The Biggest Mistake Doctors Make

Misdiagnoses are harmful and costly. But they're often preventable.

By  Laura Landro
Updated Nov. 17, 2013 7:56 p.m. ET
A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child's fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis.
Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes—and more likely to harm patients—but they're also the leading cause of malpractice claims, accounting for 35% of nearly $39 billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to Johns Hopkins.
The good news is that diagnostic errors are more likely to be preventable than other medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis.


1 comment:

Terry Hannan said...

What McCann is writing about here is NOT new. I cite two significant references by Tierney on this. (1-4)

EHR cost data for docs? Big money saver

Posted on Nov 22, 2013 By Erin McCann, Associate Editor

1. Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA : the journal of the American Medical Association. 1993;269(3):379-83. Epub 1993/01/20.

2. Tierney WM, Fitzgerald JF, Miller ME, James MK, McDonald CJ. Predicting inpatient costs with admitting clinical data. Medical care. 1995;33(1):1-14. Epub 1995/01/01.

3. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. The New England journal of medicine. 1990;322(21):1499-504. Epub 1990/05/24.

4. Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Annals of internal medicine. 1987;107(4):569-74. Epub 1987/10/01