Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, May 05, 2012

Weekly Overseas Health IT Links - 5th May, 2012.

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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Mostashari: 'Keep our eyes on the prize'

By Diana Manos, Senior Editor
Created 04/26/2012
WASHINGTON – The changes taking place in U.S. healthcare as a result of rapid healthcare IT adoption leave the nation's health IT chief  Farzad Mostashari optimistic - especially about improving quality, he told the audience at a meeting of the National Quality Forum Thursday, as he urged: "Keep our eyes on the prize."
Known for rousing speeches, this one was no different as he advocated, cajoled and urged the audience to put the patient at the center.
Quality is the cornerstone of what needs to be done, Mostashari emphasized. "When Congress wrote HITECH Act, they didn’t micromanage what meaningful use would mean. But they did say, three things needed to be included, and one of them was quality measures."
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How Predictive Modeling Cuts Hospital Readmissions

Karen Minich-Pourshadi, for HealthLeaders Media , April 27, 2012

This article appears in the April 2012 issue of HealthLeaders magazine.
With the looming threat of reimbursement losses for preventable 30-day readmissions, healthcare organizations nationwide are analyzing care transitions in an effort to achieve better outcomes and keep patients from returning to their facilities unnecessarily. While transition programs show promise in helping hospitals reduce their readmission rates, predictive models are also being used successfully in tandem with these programs. Three early adopters of these models are achieving positive results thanks to tactics and technology that identify at-risk patients from the outset of care and influence treatment approaches and the level of transitional care needed.
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The Effect of Health Information Technology on Quality in U.S. Hospitals

HCFO
April 2012
Mistakes in the clinical setting are responsible for an estimated $17 billion of direct costs annually to the health care system.Proponents of health information technology (HIT) believe tools like electronic health records (EHRs) and computerized physician order entry (CPOE) could help reduce these errors and related costs by improving communication between providers and encouraging the implementation of standard guidelines and decision-support tools.
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Saskatchewan Takes a Step Closer to Full Integration of the Provincial Electronic Health Record

Better Care, Better Health, Better Value
April 27, 2012 (Regina, SK) - Saskatchewan residents will soon have access to faster lab results. Today, the province introduced the Saskatchewan Lab Results Repository that will help improve patient care.
“Helping patients get access to health care services as quickly as possible is a priority,” said Minister of Health, Don McMorris. “This service puts results in providers’ hands faster than traditional ways of receiving lab results.”
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ICD-10 Chills and Thrills

APR 27, 2012 10:56am ET
Last December, I prepared a cover story for our print magazine, “Here Comes Trouble,” that laid out the top ten fear factors facing the industry in the transition to ICD-10. After recently attending a leadership conference on ICD-10 sponsored by The Advisory Board Company, I could easily add another 10—or more—fear factors to the list. On the hospital side of the industry, the massive diagnosis and procedural coding system represents a change whose breadth is unprecedented. And as speakers at the summit pointed out, the new coding system—which is at the heart of hospital billing—has major financial implications. The financial risk resides not only in the cost of the transition, but in the eventual impact on service line reimbursement based on the way the government calculates its DRG groupings.
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Meaningful Use Stage 1 confusion doesn't bode well for Stage 2

By mdhirsch
Created Apr 26 2012 - 9:31am
As the clock ticks down toward the May 7 deadline for commenting on the proposed Stage 2 Meaningful Use rules, reports that express concern about the program seem to be rising.
The latest warning cry, this time from consulting giant KMPG, reveals that many hospitals and health systems--arguably the more sophisticated providers eligible for the incentive program--don't even understand the requirements for Stage 1 of Meaningful Use [1], let alone believe that they'll successfully attest to them. But evidently these results are not surprising, and mirror reports elsewhere, Mike Beaty, Principal at KPMG and Health IT Enablement Leader tells FierceEMR.
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Hospitals doubt their ability to meet Meaningful Use requirements

By mdhirsch
Created Apr 26 2012 - 9:14am
A large number of hospitals and health systems are concerned about their capability to meet Stage 1 of Meaningful Use, according to a new poll [1] released by KPMG, a U.S. tax, consulting and advisory services firm.
The survey, conducted during a recent webcast and released April 24, revealed that while almost three-fourths of hospitals surveyed (71 percent) reported that they were more than 50 percent of the way to completing adoption of  their electronic health records, many of them worried about meeting the requirements. Less than half (48 percent) were confident in their level of readiness to meet Stage 1 of Meaningful Use. More than one-third (39 percent) were only somewhat confident in their ability to meet Stage 1; 3 percent admitted that they weren't at all ready to meet the requirements.
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IBM targets big data with acquisition, new research

By Mike Miliard, Managing Editor
Created 04/26/2012
ARMONK, NY – IBM has made news on the big data front twice this week, first with Wednesday's acquisition of Pittsburgh-based Vivisimo, and today with an announcement from SUNY Buffalo about multiple sclerosis research.
Vivisimo develops federated discovery and navigation software meant to enable organizations to access and analyze big data enterprise-wide. With some 2.5 quintillion bytes of data created every day, IBM says the deal – terms of which were not disclosed – will help accelerate its analytics initiatives, helping organizations such as healthcare providers, government agencies and telecommunications companies navigate and analyze the full variety, velocity and volume of structured and unstructured data.
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8 common questions about HL7

By Michelle McNickle, Web Content Producer
Created 04/25/2012
As recent talks have Health Level Seven International (HL7) moving beyond IT professionals, the standards process is setting the stage to make a significant impact on usability and workflow. And as more communities are embracing HL7, learning the basic ins-and-outs of the standards process is more important than ever. 
Rob Brull, product manager at Corepoint Health, answers eight common questions about HL7. 
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Many hospital CIOs skeptical of HIE efforts

By danb
Created Apr 26 2012 - 1:08pm
While a majority of hospital CIOs responding to a recent survey [1] conducted by healthsystemCIO.com say they are participating in regional health or system-to-system information exchange efforts, not all of the respondents have faith in such efforts. In fact, some see such HIEs as a "Band-Aid approach" until interoperability enables more seamless information sharing between providers, according to a healthsystemCIO.com post [2].
Overall, 58 percent of the 174 respondents say their organizations are currently participating in regional or system-to-system HIE efforts. And 80 percent said integration with outside providers is a top three priority. Close to 21 percent, though, say they are "skeptical" of HIE sustainability, while another 21 percent say that while they are hopeful, they need to see more results before passing judgment.
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Health IT empowers seniors, creates e-patients

By sjackson
Created Apr 26 2012 - 1:34pm
Technology holds several important keys for improving the lives of seniors, according to a study [1] published in the journal Preventing Chronic Disease this week. The report explores the emergence of seniors as "e-patients [2]" and the potential of technology to empower them and improve their health.
For example, the authors point out, video-enabled telehealth services provide a critical service for aging adults--the ability to receive care at home, without having to travel. It particularly will be valuable for seniors who are located in hard-to-reach areas, and for whom traveling to health clinics is a major obstacle to obtaining care.
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Mobile App Helps Physicians Communicate "On the Go"

Written by Kathleen Roney | April 24, 2012
A new mobile application, DocBookMD, allows physicians to send and receive secure HIPAA-compliant patient information from a smartphone.
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Report: Web-Based EMRs Increasingly Appealing to Physicians

April 25, 2012
According to a new report from New York-based market research publisher Kalorama Information, the fastest growing segment in the EMR market is web-based solutions, sold over the internet, mainly to private, office-based physicians. Overall, sales of EMRs to physicians grew at an estimated 22 percent from 2010 to 2011, higher than the growth of EMR sales to hospital systems.
The report, EMR 2012: The Market for Electronic Medical Records, which found increasing physician acceptance and sales results of EMRs, including for specialist firms such as eClinicalWorks, E-MD, NextGen, and Practice Fusion.
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Docs willing, but not ready, to collect MU incentives in 2011

By Diana Manos, Senior Editor
Created 04/25/2012
WASHINGTON – There was a readiness gap between what physicians thought they could do and what they were eligible to do to collect meaningful use incentives last year, a new study finds.
According to the report, which appears in the May issue of Health Affairs, 91 percent of physicians nationwide said they were eligible for federal EHR incentives in 2011, but only ten percent intended to apply for the program, falling on the low side of what the federal government had anticipated.
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Will Cerner, Epic, And Allscripts Continue To Dominate Health IT?

Click here to find out more!Zina Moukheiber, Contributor
4/26/2012 @ 9:59AM
When reporting on Epic Systems, I asked several hospital chief information officers, as well as Claudia Williams, a director at the Office of the National Coordinator for Health IT, whether Cerner, Epic Systems, and Allscripts will continue to dominate the market for electronic health records. Their answer was a quick no. “No one vendor can dominate, it is an evolving marketplace,” says Williams. “It’s clear to me that these EHRs we are rolling out today are version 1.0. In the next five years, we’ll see someone leapfrog to bring us to the next generation that mimics the workflow of doctors and nurses,” says Pamela McNutt, chief information officer at Dallas-based Methodist Health System, which uses Meditech’s EHR.
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IT seen as critical to population health

By Bernie Monegain, Editor
Created 04/24/2012
NEW YORK – Managing population health requires new skill sets, new infrastructures and automation, according to new research from the Institute for Health Technology Transformation (iHT2).
The findings are from the Automating Population Health Research Project, which seeks to educate the healthcare industry on how best to apply technology in meeting the challenges of population health management.
“Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare” was prepared in consultation with a broad range of industry experts, iHT2 officials say.
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KPMG's top 5 hurdles to meaningful use

By Mike Miliard, Contributing Editor
Most hospitals and health systems report being well along in completing electronic health record implementation, but many still have doubts about their ability to meet new EHR standards, according to a new poll from KPMG.
Forty-eight percent of hospital and health system business leaders who participated in the survey said they were confident in their organization’s level of readiness to meet Stage 1 meaningful use requirements, say KPMG officials. Thirty-nine percent said they were somewhat confident, 3 percent said they were not confident at all, and 10 percent didn’t know what their level of readiness was.
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Why Stage 2 MU transactions need more than SMTP

By Dr. John Loonsk
Health IT is at a critical juncture with the technical NPRM for Stage 2 of Meaningful Use (MU). There have always been questions about whether enough standards, implementation guidance, and policies would be expressed ahead of the huge HITECH EHR investment in order to leverage an interoperable health IT infrastructure for health reform needs. But now, in addition to the tiered schedule for meeting MU requirements, the deadlines for Stages 2 and 3 have been further extended. As a result, Stage 2 standards and certification requirements will be the only technical requirements some EHRs are held to as late as 2019.
Numerous CMS programs will tweak the related quality measures in an ongoing fashion, but MU is the only place with any focus on the technical tools to actually help manage the quality of care. And while many Stage 2 commenters will focus on those voluminous quality measures, threshold changes, and MU timing complexities, there are core technical building blocks that may be more important for the success of health IT than any of the measure specifics.
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Veritas to Pay $1.25 Billion for Thomson Reuters HIT

APR 23, 2012 4:36pm ET
Thomson Reuters will sell its health care business line to an affiliate of Veritas Capital for $1.25 billion in cash.
The business includes provider clinical decision support in Micromedex, clinical benchmarking and regulatory reporting, data analytics including the MarketScan research databases, payer fraud and abuse management and cost control applications, and the Medical Episode Grouper methodology to enable government agencies to evaluate provider performance.
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Cumbria steps up record sharing

23 April 2012   Rebecca Todd
GPs and community services in Cumbria are streaming live into a shared patient record that can be viewed in some out-of-hours providers via Healthcare Gateway's medical interoperability gateway.
NHS Cumbria hosted an interoperability day last week to showcase its work on sharing patient information between services.
NHS Cumbria chief clinical information officer Dr William Lumb said the area’s population was ageing and suffering from more long term conditions.
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U.S. telemedicine efforts lacking

By mdhirsch
Created Apr 24 2012 - 12:28pm
Patient outcomes would improve--and at a much lower cost--if only the United States would embrace telemedicine, says Vijay Govindarajan, Professor of International Business at the Tuck School of Business at Dartmouth College.
Govindarajan, writing in a recent Harvard Business Review blog post [1], points to a recent study of telemedicine at Lazarus Hospital in India that adopted telemedicine to treat patients with end stage renal disease (ESRD). For their rural patients, the hospital opted to use peritoneal dialysis (PD), which is performed in patients' homes, rather than the more expensive hemodialysis (HD), which is provided at the hospital and which requires the patients to travel for treatment.
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Evidence of decision support benefits lacking, researchers say

By gshaw
Created Apr 24 2012 - 10:25am
Healthcare technology continues to come under fire for failing to deliver results--whether lower costs, increased efficiency, better clinical outcomes. This time researchers are turning their critical eye to clinical decision support.
Despite increasing emphasis on the role of clinical decision-support systems for improving care and reducing costs, evidence to support widespread use is lacking, they conclude in a systematic review of 148 randomized, controlled trials. The study [1] was funded by the Agency for Healthcare Research and Quality and published yesterday in the Annals of Internal Medicine.
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EMR Apps Taking Off, Starting with Refill Requests

Scott Mace, for HealthLeaders Media , April 24, 2012

Lyle Berkowitz, MD, has graced the pages of HealthLeaders Media before, but with the new twist his story is taking, healthcare technology leaders everywhere should take notice.
Berkowitz was one of the HealthLeaders 20 in 2008—"20 people who make healthcare better."
Berkowitz had recently founded the Szollosi Healthcare Innovation Program while continuing his primary care practice at Northwestern Memorial Physicians Group, the largest primary care group in the city of Chicago.
Now, in addition to these ongoing duties, add entrepreneur to his CV. In the process, he's using more technology to disrupt current healthcare best practices.
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The 4 Best Free Health and Fitness Apps of 2012

With the help of The Eatery, CardioTrainer, and other no-cost mobile coaches, you can take control of your diet and exercise routine.

By Megan Geuss Apr 23, 2012 6:00 PM

Staying in shape is a constant struggle, but a slew of apps out there can help you track your fitness.
If you’ve always regarded counting calories as too challenging, try a new app called The Eatery (available on iOS only), which lets you snap pictures of your food and rate the general healthfulness of the meal. You can post images, and ask friends who use The Eatery to comment on them. From your self-reported information, The Eatery gives you insight into where the traps are in your eating habits, and how healthy your diet was for the past week. Looking for a more-specific diet tracker? Calorific for iOS and Android gives you a food library to record your calories, and assigns foods a red, yellow, or green light depending on whether they’re likely to help or harm your health.
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Federal privacy work group wants EHRs to verify patient ID

Posted: April 24, 2012 - 1:45 pm ET
To be certified for use in the federal electronic health-record incentive payment programs, EHRs should have to demonstrate that they can authenticate the identity of patients looking to view or download their medical records or have their records transmitted to someone else, according to a federal privacy work group.
The Privacy and Security Tiger Team of the federally chartered Health IT Policy Committee met Monday to go over a four-page draft of comments on a pair of proposed rules issued in February by the CMS and the Office of the National Coordinator for Health Information Technology. The proposed rules govern Stage 2 of the Medicare and Medicaid EHR incentive payment programs created under the American Recovery and Reinvestment Act of 2009. The Stage 2 rules are expected to come into use in 2014.
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Physicians In Nonprimary Care And Small Practices And Those Age 55 And Older Lag In Adopting Electronic Health Record Systems

By Sandra L. Decker, Eric W. Jamoom, and Jane E. Sisk
Decker and Jamoom are with the Centers for Disease Control and Prevention's National Center for Health Statistics; Sisk is a scholar-in-residence at the Institute of Medicine.
To analyze the rate of adoption of EHR systems from 2002 to 2011 among office-based physicians, the authors used data from the annual National Ambulatory Medical Care Survey. Overall, there was a 38 percentage point increase in EHR adoption among office-based physicians, and by 2011 more than half of physicians had EHR systems, tripling the percentage of physicians with EHRs over the decade.
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Small, Nonteaching, And Rural Hospitals Continue To Be Slow In Adopting Electronic Health Record Systems

By Catherine M. DesRoches, Chantal Worzala, Maulik S. Joshi, Peter Kravolec, and Ashish K. Jha
DesRoches is at Mathematica Policy Research; Worzala, Joshi, and Kralovec are with the American Hospital Association; and Jha is affiliated with the Harvard School of Public Health and Harvard Medical School.
In the first nationally representative survey of hospital EHR system adoption since the federal incentive program began, the authors examined the rate of EHR adoption among US hospitals, using data from the American Hospital Association annual survey of health information technology. Overall, they found that the percentage of hospitals with at least a basic EHR system increased from 15.1 percent in 2010 to 26.6 percent in 2011. Also, they found that 18.4 percent of US hospitals had achieved what is a reasonable proxy for meaningful use, a large jump from just 4.1 percent in 2010.
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Most Physicians Were Eligible For Federal Incentives In 2011, But Few Had EHR Systems That Met Meaningful-Use Criteria

By Chun-Ju Hsiao, Sandra L. Decker, Esther Hing, and Jane E. Sisk
Hsiao, Decker, and Hing are with the Centers for Disease Control and Prevention's National Center for Health Statistics; Sisk is a scholar-in-residence at the Institute of Medicine.
This study is one of the first to look at physicians' eligibility and intentions to apply for federal incentives as well as capabilities of physicians' EHRs to support meaningful use. The authors used data from the 2011 Electronic Medical Records Supplement to the National Ambulatory Medical Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics and sponsored by the Office of the National Coordinator for Health Information Technology.
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As More Docs Use Digital Records, So Will Consumers

HITECH Act is prompting widespread adoption of e-health records, but there's more to "Meaningful Use" than what's in the government's programs.
By Marianne Kolbasuk McGee,  InformationWeek
April 24, 2012
With billions of dollars of HITECH Act incentives are being waved in front of healthcare providers for the meaningful use of health IT, you shouldn't be surprised to learn that the percentage of healthcare providers using digital records has doubled over the last two years. Undoubtedly, that's impressive progress, considering that e-health record technology has been around for decades, and adoption was in single-digit percentages until very recently. But digging below the surface, there are a couple key things to keep in perspective.
For starters, it's a good thing the HITECH Act's financial incentives are tied to a laundry list of objectives and measures that healthcare providers need to accomplish through the meaningful use of health IT, and aren't just being paid for the broad adoption of EHRs. AdTech Ad
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Loss of Wisdom Hits Health Care Where it Hurts

APR 20, 2012 2:39pm ET
 “Know the enemy and know yourself, and your victory will never be endangered; know the weather and know the ground, and your victory will then be complete.”
 Sun Tzu 500 B.C.
Twenty-five hundred years ago, Sun Tzu asserted that with sufficient knowledge about yourself, your opponent and the environment, your victory would be assured. In our battles against rising health care costs and medical errors, this wisdom has been lost.
As an industry, when it comes to technology we are concerned with adoption, usability, efficiency and features. We are much less concerned with knowledge generation. Unfortunately, it is the knowledge generation that will lead to a significant return on investment. Technology purchases that do not help us understand our organizations, staff, environments and patient care challenges will never demonstrate the promised gains in safety and cost reductions.
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Count the ways: Strike down of health reform would affect health IT

By Mary Mosquera, Contributing Editor
Created 04/23/2012
WASHINGTON – If the Supreme Court were to overturn the health reform law, five areas in the statute that rely heavily on health IT tools could lose funding for their implementation.
Striking the Patient Protection and Affordable Care Act (ACA) would not knock out health IT in general, but it would delay the more active involvement of the federal government in health IT when it comes to quality reporting and benchmarking.
Raising performance criteria to the federal level will spread more broadly the adoption of electronic health records and, in turn, enable health reform, said James Wieland, principal at Ober, Kaler, Grimes & Shriver in Baltimore, Md., and a member of the HIMSS legal task force. The Supreme Court is expected to rule on the constitutionality of the ACA in June.
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ICD-10 triggers computer-assisted coding adoption

By kterry
Created Apr 23 2012 - 1:23pm
Spurred by the impending transition to the ICD-10 diagnostic code set, nearly half of healthcare providers surveyed by KLAS Research [1] plan to adopt computer-assisted coding (CAC) software within the next two years. Twenty-one percent of providers already use CAC applications, according to the Orem, Utah-based research firm.
Many providers believe that CAC can help them compensate for some of the lost productivity and reimbursement that ICD-10 will bring, KLAS said in its announcement. ICD-10 will require more intensive coding work because it has five times as many codes as the current ICD-9 set.
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Impact of older technology in healthcare should not be overlooked

By kterry
Created Apr 22 2012 - 10:43am
Recently, the advocates of disruptive change in healthcare have been focusing on the possibilities of hot new social networking and gaming apps for improving health behavior. There are some indications [1] that this approach may bear fruit. But some older methods of using health IT to improve healthcare quality and efficiency have received much less attention, despite evidence of their effectiveness.
Studies have shown the value of computer kiosks, for example, in several care settings. In urgent care centers [2] and emergency departments [3], kiosks have been used to eliminate the need for women with uncomplicated urinary tract infections to see a physician; other EDs have used kiosks to teach patients [4] about appropriate use of antibiotics for upper respiratory infections; free [5] and rural [6] health clinics have employed them to educate patients about chronic disease self-care and health behavior change; and in the U.K., kiosks in the waiting rooms of general practitioners [7] have improved outcomes and saved the practices time and money.
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EHR incentive payments tally $4.5B to date

By Mary Mosquera, Contributing Editor
Created 04/20/2012
WASHINGTON – The Medicare and Medicaid electronic health record program has paid $4.5 billion to 76,612 physicians and hospitals in incentive payments through March 2012.
Of that amount, the Centers for Medicare and Medicaid Services paid out $339.9 million for Medicare eligible providers, according to its latest data
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Physicians Like Digital Tech, But Adoption Is Slow

Many doctors say they want technology tools for medical education and training. But actions speak louder than words.
By Anthony Vecchione,  InformationWeek
April 20, 2012
Many doctors say they want to spend more time engaging in online activities. But that doesn't reflect their actions in the real world. According to a survey that measured physicians' digital behavior, 84% of doctors would prefer to attend events such as continuing medical education (CME) training online. But only 6.4% say that they actually participate in virtual events very often, and only 18.5% participate in them often.
The Joint Survey of Physician Digital Behavior, conducted by San Francisco-based ON24 and Boston-based MedData Group, queried 971 physicians about their online behavior and use of technology such as the iPad. Among the major findings: 75.5% of the respondents realized that virtual events and webcasts are increasing in number, while 91% asserted that they see benefits to being able to attend more conferences, meetings, and CME events virtually. In addition, 35% of the respondents said that embracing virtual events leads to better overall patient care. AdTech Ad
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Why Harvard's Health Record Bank could be a turning point

By William Yasnoff, MD, PhD, President, Health Record Banking Alliance
In a major new development in the world of health IT, the Data Privacy Lab in the Institute of Quantitative Social Science at Harvard University will soon unveil a health record bank (HRB) that allows anyone to own and manage a complete, secure, digital copy of their health records and wellness information with a free account. This is the first time that a prominent academic institution is hosting an HRB for use by the general public and communities nationwide.
The service, called MyDataCan, is a secure and trustworthy technical infrastructure for receiving, storing and facilitating consumer-controlled access to personal information, including medical data. Its design is extensible to cover various forms of personal data, customizable through third-party applications, and benefits from a multimillion-dollar investment by Harvard.
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Computerized Therapy Equal to Usual Care for Depressed Teens
Computerized cognitive behavior therapy program promising for teens with depressive symptoms
FRIDAY, April 20 (HealthDay News) -- For adolescents presenting with depressive symptoms, use of a computerized cognitive behavior therapy intervention (SPARX; Smart, Positive, Active, Realistic, X-factor thoughts) is a potential alternative to usual care, according to a study published online April 19 in BMJ.
Sally N. Merry, M.B.Ch.B., from the University of Auckland in New Zealand, and colleagues conducted a multicenter randomized controlled trial involving 187 adolescents, aged 12 to 19, seeking help for depressive symptoms. Participants were allocated to SPARX (94 adolescents), which comprised seven modules delivered over a period of four to seven weeks, or usual care (93 adolescents), comprising in-person counseling delivered by trained counselors and clinical psychologists.
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Monday, April 23, 2012

Health Gaming and the Power of Social

Americans love to play video games. In 2010, the gaming industry generated more than $25 billion in revenue on digital games, which includes software and content sold for home-based consoles, portable gaming, and digital and social games, according to market research company the NPD Group. In the same year, 72% of American households reported playing computer or video games.
As the gaming industry has grown, so, too, has an interest in harnessing the power of play to help consumers improve their health. Finding entertaining ways of getting people to eat a healthier diet, exercise more or keep track of and treat chronic illness is becoming big business.
"It's clearly a growing market," said Bill Ferguson -- editor-in-chief of the Games for Health Journal: Research, Development, and Clinical Applications, a new peer-reviewed journal dedicated to game technology that improves physical and mental health and well-being.
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Enjoy!
David.

Friday, May 04, 2012

An Interesting And Already Working Alternative To The NEHRS And Cheaper Too.

This very interesting article and report appeared from the UK a little while ago.
Here is the news report.

Cumbria steps up record sharing

23 April 2012   Rebecca Todd
GPs and community services in Cumbria are streaming live into a shared patient record that can be viewed in some out-of-hours providers via Healthcare Gateway's medical interoperability gateway.
NHS Cumbria hosted an interoperability day last week to showcase its work on sharing patient information between services.
NHS Cumbria chief clinical information officer Dr William Lumb said the area’s population was ageing and suffering from more long term conditions.
He said paper processes could support the old way of doing things, but could not support the modernised NHS structure and methods for delivering healthcare.
In 2008, he embarked on an IT project in Cumbria with a number of aims. These included migrating services to EMIS Web and developing an interoperability network involving community services, acute trusts and out-of-hours services.
Dr Lumb argued that as 85% of healthcare is provided by GP or community services, it made sense to start there when moving to an electronic patient record system.
Two thirds of GPs in Cumbria have an EMIS system and one third of those have upgraded to EMIS Web.
Three quarters of community services in Cumbria are also live with EMIS Web Community and all are now streaming information to a shared record via EMIS Connect.
This record can be accessed via a button on the clinician’s normal screen view with the patient’s consent.
Those organisations not on EMIS can view a shared record via the MIG. This pulls data from EMIS and INPS practices and creates a read only view of the patient record.
Lots more here:
Associated we have a more detailed article.

Breaking down borders

NHS Cumbria has forged ahead with an ambitious interoperability project. EHI Primary Care reporter Rebecca Todd went to a conference at the Rheged Centre in Penrith to hear about progress.
23 April 2012

NHS Cumbria has a vision of an interoperable healthcare system – in which all the clinicians involved in the care of a patient can see their relevant health data.
Leading the project to make the vision a reality is NHS Cumbria’s chief clinical information officer, Dr William Lumb.
He believes that while paper processes could sustain old ways of doing things, a digital record is needed to support the move towards a modernised NHS structure and new ways of delivering healthcare.
His “grand plan” for IT services in Cumbria started to take shape in 2008. The aim of the project was to migrate services to EMIS systems and have the majority of organisations streaming information via EMIS Web.
It also set out plans to invest in a community of interest network; develop a hosted GP system; and develop an interoperability network involving community services, acute trusts and out of hours services.
Two thirds of the area’s 91 GP practices are now streaming via their EMIS systems, while the remaining INPS practices stream via Healthcare Gateway’s medical interoperability gateway, which provides a view of the patient record to other organisations such as out-of-hours providers.
The system only provides a clinical view, so people can not alter the shared record and certain information, such as sexual health, is automatically blocked.
At a recent conference to outline progress, Dr Lumb said there were just a few practices that had not signed up to share their data.
“You can’t take a group of GPs in a single line together, so work with the one third who wants to work with you, get things going, and then work towards critical mass,” he advised an audience member who said GPs in his area were against the idea of data sharing.
Write records with care
One GP who was on board from the outset, and who now leads the project in Carlisle, is Dr Alan Edwards. “I can’t see how we can deliver on the agenda of the NHS without this information sharing; that’s what we told our primary care trust and that’s how get got a project manager’s time and my time,” he explained.
Much more here:
Both these articles are well worth read to see the level of thought that has gone into getting to where this area now is.
What it also shows is that there are some really interesting ways of ‘skinning the (important) information sharing cat’ that really can make a difference and be implemented with the support of both clinicians and patients.
Given all this has been underway since 2008 there is no reason to assume that the NEHTA/DoHA boffins should not have been considering such approaches before rushing into the NEHRS. Just where is the strategic options document / benefits options analysis that should have been produced before all that money was committed? I wonder was it ever written and why it has not come to light.
We all know the public consultation has been desultory at best and despite the efforts of many submitters very little in the way of change actually happened.
I would argue the facts and evidence on health information sharing have been evolving rapidly and despite that none have gone the NEHRS route for a good reason. That there are better ways of reaching the same end have been obvious for a couple of years - before the kick-off of the PCEHR - and yet we just push on. Who was it who asked “When the facts change I change my view, what do you do sir?”
We are seeing better and simpler approaches working in the UK, the US and NZ at least and so far we seem to be struggling. There is still time to sort it out before all that has been done is wasted. I hope someone sees that and gives it a go.
David. 

Thursday, May 03, 2012

The Canadian Medical Journal Suggests the NEHRS (PCEHR) Is A Crock. The World Is Starting To Notice.

The following appeared a few days ago in Canada.

NEWS

April 30, 2012

Bloom fading from e-health golden wattle

It sounded like a great idea in 2010: a personally controlled electronic health record that would allow Australians to access and share medical records in a nationwide database. The system, it was argued, would support better medical decision-making, reduce errors and save time and money.
To that end, the government set aside A$467 million and targeted an ambitious launch date of July 1, 2012.
Medical groups such as the Australian Medical Association lauded the notion, asserting that a shared electronic health record would help doctors deliver better care as they’d have access to a patient’s full clinical records no matter where he was treated. Health and consumer advocates were equally effusive. The proposed system would yield improved health outcomes, reduce medical mistakes and provide confidential health records.
But as details emerge and the launch date nears, the supposed charms of a Personally Controlled e-Health Record (PCEHR) appear to be fading, much as the bloom eventually withers on Australia’s national flower.
“E-health in general is a good idea, but you need some other infrastructure and you need it to be comprehensive,” says Robert Wells, director of the Australian Primary Health Care Research Institute. “In my view, it’s a complete waste of money and I’m not sure what they hope to achieve from it.”
What has changed so dramatically in a few scant years?
As now envisioned, patient interaction with the system will be much more limited. The federal Health Department has admitted there will be privacy risks in the transfer of patient data. And a recent Senate inquiry indicated that the software, as well as the architecture that will allow patients and clinicians to join the network and share data, may not be ready on time.
“There is still some very significant development work to be done on the PCEHR functionality,” Rosemary Huxtable, deputy secretary with the Department of Health and Ageing, told parliamentarians.
Because of that lack of “functionality,” the Australian Medical Association and the Health Care Consumers’ Association have expressed consternation about the timing of the system’s rollout, while a coalition of senators is urging that the venture be delayed for 12 months.
.....
As for privacy concerns, Australian security experts are warning that insufficient security protections could leave the system open to hacking.
The health department insists clinical data will be encrypted during transmission but acknowledges that it could be compromised at the personal computer level. To combat that, the department says it will issue instructions to users as to how to protect themselves from security threats.
Others are now struggling to comprehend whether the system, as currently envisioned, will have any benefits.
.....
An ideal e-health plan would reduce costs for funders, reduce liability risks for physicians and bolster a patient’s ability to share in the management of his health records, says Klaus Veil, vice president of the Australasian College of Health Informatics.
But as currently configured, the personally controlled electronic health record that will become operational in July is not capable of “doing the job,” Veil says. “Core bits are missing. We don’t know if and when this functionality will actually be in the PCEHR.”
DOI:10.1503/cmaj.109-4180
— Tanalee Smith, Adelaide, Australia
Full article is found here:
Looks like the news is starting to turn on the NEHRS as more and more local expert decide to speak out to point out the legion of flaws they now seem to be seeing in the PCHER.
In December 2010 this blog was pointing out a major set of issues:
See here:
and here:
and even earlier we had more here:
Funny it seems to have taken so long for people to realise just what a crock this is.
Indeed see here a full 18 months earlier:
“I previously provided a Submission on the PCEHR proposal to NHHRC in May, 2009 and the views expressed in that submission remain my position despite the work undertaken by DoHA and NEHTA since.
This submission is available here:
Sadly they stubbornly pressed on and now we see the result. Next Tuesday (Budget Night) will tell us all just how stubborn they will really be!
David.

Wednesday, May 02, 2012

Is This Another Evidence Free Intervention From DoHA? It Might Not Be But More Work Is Needed To Be Sure.

The following appeared a little while ago.

Consider broad telehealth benefits

A NEW US study which showed “underwhelming” clinical outcomes from telemonitoring still adds to the knowledge base about telehealth and should not dissuade doctors from its benefits, according to Australian experts.
Professor Len Gray, director of the Centre for Online Health at the University of Queensland, said the study, published in Archives of Internal Medicine, was well designed but examined only clinical outcomes, when there were many other potential benefits of telehealth. (1)
In the trial, 205 older adults with multiple illnesses were randomly allocated to receive usual self-directed care, or daily sessions of telemonitoring for assessment of symptoms and measurement of biometrics such as weight, blood pressure, blood glucose levels, oximetry and peak flow, with the use of videoconferencing.
In the 12 months following enrolment there were no differences in rates of hospitalisation and emergency department visits between patients receiving telemonitoring and those receiving usual care.
The study authors said the results provided “further evidence of a lack of efficacy of telemonitoring on hospitalisations and ED visits”.
“Given the potential costs of telemonitoring and the lack of efficacy, it may be important for physicians and funding organizations to evaluate which patient groups might be most responsive and which implementation strategies will be most useful”, they said.
Professor Gray said telehealth came in many forms and had an array of outcomes other than clinical, such as lowering costs for patients and allowing doctors to be more efficient, which were not measured by this study.
He said that in Australia the goals of telehealth were not necessarily confined to clinical improvements but were also about providing health services to rural and remote communities and increasing efficiency for doctors.
More here:
One really has to wonder what is going on here - if we are not doing things for overall clinical benefit just what are we on about?
Clearly we need to consider just what all this means. I fear we might be a bit trapped in a definitional mess.
The Government announced a $620 Million Telehealth Initiative in June 2011.
Here is the release.
The abstract reports a rather limited type of telehealth - and certainly does not address some issues of concern in far-flung rural Australia.

A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits

Paul Y. Takahashi, MD, MPH; Jennifer L. Pecina, MD; Benjavan Upatising, MSIE, PhD; Rajeev Chaudhry, MBBS, MPH; Nilay D. Shah, PhD; Holly Van Houten, BA; Steve Cha, MS; Ivana Croghan, PhD; James M. Naessens, ScD; Gregory J. Hanson, MD
Arch Intern Med. Published online April 16, 2012. doi:10.1001/archinternmed.2012.256
Background  Efficiently caring for frail older adults will become an increasingly important part of health care reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to assess differences in hospitalizations and emergency department (ED) visits among older adults using telemonitoring vs usual care.
Methods  A randomized controlled trial was performed among adults older than 60 years at high risk for rehospitalization. Participants were randomized to telemonitoring (with daily input) or to patient-driven usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting, and videoconference. The primary outcome was a composite end point of hospitalizations and ED visits in the 12 months following enrollment. Secondary end points included hospitalizations, ED visits, and total hospital days. Intent-to-treat analysis was performed.
Results  Two hundred five participants were enrolled, with a mean age of 80.3 years. The primary outcome of hospitalizations and ED visits did not differ between the telemonitoring group (63.7%) and the usual care group (57.3%) (P = .35). No differences were observed in secondary end points, including hospitalizations, ED visits, and total hospital days. No significant group differences in hospitalizations and ED visits were found between the preenrollment period vs the postenrollment period. Mortality was higher in the telemonitoring group (14.7%) than in the usual care group (3.9%) (P = .008).
Conclusions  Among older patients, telemonitoring did not result in fewer hospitalizations or ED visits. Secondary outcomes demonstrated no significant differences between the telemonitoring group and the usual care group. The cause of greater mortality in the telemonitoring group is unknown.
Here is the link to the abstract.
But this report needs to be considered in the light of this work from the UK:

UK telehealth saves lives and money

The results are in on how the UK is doing telehealth, and the numbers are staggering. Will Turner reports.
The Challenge: One quarter of the UK population living with long term chronic illness.
The Approach: A trial of 6,000 patients involving biometric monitoring where patients take and transmit health readings through to clinicians who then monitor and advise the patient.
The Outcomes: Major reductions in mortality rates and hospital admissions.
The Lessons Learned: Upfront investment in telehealth based prevention saves public health dollars and improves patient quality of life.
The Upside for:
Clinicians: Better able to focus on work requiring their clinical expertise.
Patients: Empowered to better manage their own health and greater confidence in their access to care that keeps them out of hospital.
The Organisation: A more cost effective model of primary and secondary care that at the same time delivers better quality of care in a sustainable manner.
In Australia the term telehealth typically refers to video consultation: doctors talking to doctors, doctors talking to patients. By contrast telehealth in the UK is more about biometric monitoring: patients taking personal device readings in their own homes, transmitting them through to clinicians who then monitor and advise the patient.
Lots more here:
I suspect the last paragraph is the clue here. Defining Telehealth, Telemonitoring and so on is the only way to compare with apples with other apples and not oranges. The two trials look quite similar, but quite different to what is being funded here in OZ.
I think we need to wait for the evaluations of what is being done here and to see more studies in the telemonitoring area (given the different US and UK experiences) before clear conclusions can be drawn.
Bottom line, you have to be sure what you are talking about!
David.

Tuesday, May 01, 2012

NEHTA Looks To Be Suffering A Major Funding Cut From June 30, 2012. Duck and Cover!

We had the 2012/13 Victorian Budget announced today.
NEHTA got a mention I am told.
On the latest figures Victoria has the following proportion of the Australian Population.
Population breakdown of Australia is 5 640.9 (Victoria) of 22960.0 (Total OZ) Individuals X 1000 - This means the ratio .245 of the national population (Source ABS 29/03/2012).
See here:
Here is the mention and quote.
The Victorian Government plans to spend $16.6M over 2 years on NEHTA.
“$16.6 million over 2 years to enable the National E-Health Transition Authority (NEHTA) to the development and maintenance of national e-health foundations” - From Victorian Budget Papers today. (Source VHA Members Bulletin)
This implies an annual contribution of $8.8M.
This means a proportional total Jurisdictional Contribution of $35.918M
Add the Commonwealth 50% and we arrive at say $72M per annum.
Here are the totals for the last 2 years - Source Annual Reports:
Member provided revenue (which I believe is separate from the special funding for PCEHR delivery etc. - but how can you be sure?):
 2011 $122,392,640 (- $50M from this level.)
 2010 $95,635,311 (- $23M from this level.)
Looks like the contractors and temporary staff will be out on the streets with this level of cut.
Seems like (at say even $200,000 per head)  between 100 and 200 staff out the door.
Maybe the PR Department could become a single secretary, we could do without paid spruikers and the CEO could look at a pay cut since there will be a smaller organisation to run?
The implications for the Federal Budget and the NEHRS (PCEHR) are obvious. Slow down to stop mode will most likely be in place.
Please note: I am really sorry for the high quality and dedicated people who may be affected by the rather nasty cut if I am right. They deserved much better management to deliver much more skilfully so their future was much more secure.
David.

An Interesting Pair Of Articles On IT Project Failure. There Is Considerable Relevance To The NEHRS.

The following pair of articles appeared a little while ago. There seems to be a lot of relevance to what we have seen in the NEHRS (PCEHR) Program in what is said.

Who's accountable for IT failure?

By Michael Krigsman | April 16, 2012, 4:45am PDT
Summary: IT failures are a management crisis of serious proportions that have been largely ignored. Here’s what senior executives need to know - and do - right now.
This two-part series presents a structure for understanding why IT projects fail, in a way that goes far beyond project management alone. Part one elaborates the problem while part two discusses the need for greater accountability on the part of senior management.
It’s a sobering statistic: nearly 70 percent of IT projects fail in some important way, putting the economic impact worldwide at three billion dollars, which corresponds to 4.7 percent of global GDP. And it’s a universal problem: setbacks span the public and private sectors, occur in all industries, and often result in substantial economic and productivity losses.
Just look at these CRM failure statistics for the years 2001-2009 - the numbers tell a story of significant problems related to IT project delivery:
  • 2001 Gartner Group: 50%
  • 2002 Butler Group: 70%
  • 2002 Selling Power, CSO Forum: 69.3%
  • 2005 AMR Research: 18%
  • 2006 AMR Research: 31%
  • 2007 AMR Research: 29%
  • 2007 Economist Intelligence Unit: 56%
  • 2009 Forrester Research: 47%
In virtually every case of failure, management fails to anticipate serious problems. Even in cases where challenges are likely, IT failure is too often considered business-as-usual, with executives throwing their figurative hands in the air, in surrender to chance or bad luck.
IT failures happen when managers exercise insufficient judgment, possess too little experience, hire the wrong people, ignore warning signs and, crucially, fail to involve affected employees in a way that eases the path to success.
WHY IT PROJECTS FAIL
Although tempting to blame project managers for failure, we must point attention to senior executives for allowing the conditions for failure to exist in the first place. The underlying reasons fall into three categories:
  1. Unrealistic and mismatched expectations
  2. Conflicts of interest among customers, vendors and integrators
  3. Corporate organization structure that conspires toward failure
Lots and lots more is here:
The link to Part 2 is in the text above.
I especially like this idea presented a little further down about the ‘Devil’s Triangle’
“The Devil’s Triangle principle explains that:
Three parties participate in virtually every major software deployment: the customer, system integrator or consultant, and the software vendor. Since each of these groups has its own definition of success, conflicts of interest rather than efficient and coordinated effort afflict many projects.”
The NEHRS program has this in spades and even worse than that ‘the customer’ (i.e. the public) is the one left without essentially any voice and is being given something there has simply been no demand for in the shape it is proposed.
Point 3 also has spectacularly high relevance as we consider the utterly broken governance and leadership of the program with two distinct centres of power (DoHA and NEHTA) and the consumer essentially out of the loop.
All the issues about NEHTA being not really able to understand who the customer is and how the different stakeholder groups will see things also rings true.
Any expectation this will all turn out well seems to be extraordinarily optimistic based on this analysis.
As for who should be accountable it has to be DoHA who have taken the running and really don’t still know what they don’t know who take most of the blame and NEHTA to a lesser extent for not telling the DoHA team they were asking for a lemon. I know there are current and former NEHTA staff who have had this view for ages.
Do read the full article - they should be inscribed on tablets in every IT Department.
David.