Useful Health IT Links from the Last Week

In the last week I have come across a few reports and news items which are worth passing on. These include:

First is the site established by HealthCareIT News to cover activities in the National Health Information Network (NHIN) Arena.

The site can be found at:

http://www.nhinwatch.com/index.cms

The site has an impressive range of coverage on the whole area and a lot of current news and resources. Among the areas covered are

• Federal Initiatives
• Privacy and Security
• The Business Case
• NHIN Architecture
• RHIOs
• Voice and Data Networks
• Events

The site requires one time registration for access to a wide range of resources and interesting news including an RSS Feed.

The site describes itself as follows:

“About NHINWatch.com

Brought to you by the editors of Healthcare IT News, NHINWatch.com is the most comprehensive Web site covering the creation of a Nationwide Health Information Network in the United States.

During his tenure as the first National Health Information Technology Coordinator, David J. Brailer, MD, made the development of a NHIN the centerpiece of his plans to bring American healthcare into the 21st century. Based on feedback received from the industry, Dr. Brailer described the network as an Internet-based data exchange that would allow medical providers to share health data to improve care.

But in 2006, Dr. Brailer resigned from his post with many decision about the NHIN yet to be made. Will it require a national database of patient records? Will every patient need a national identifier, or will a federated system of identity management based on existing demographic data and record locator services suffice? How will privacy be protected?

Every day, the editorial team from the industry's leading and most trusted news source, Healthcare IT News, scours the wires for the latest developments. If there's a story on the NHIN, you'll find it here.

To stay abreast of NHIN developments, please take a moment to register. As a registered user, you'll be able to browse the growing collection of news, resources and events here at NHINWatch.com. You can also subscribe to NHINWatch.com newsletters to have the latest news delivered directly to your inbox, and configure the NHINWatch.com site to present stories that best match your topical interests.”

The second item is a really good news story from e-Health Insider.

http://www.e-health-insider.com/news/item.cfm?ID=2590

PACS roll-out milestone hit in London and the South

03 Apr 2007

All NHS hospital trusts across London and the South of England have now received systems to enable them to capture and store digital diagnostic images as part of the health service IT modernisation programme.

NHS Connecting for Health, the agency responsible for NHS IT, yesterday confirmed to E-Health insider that 56 digital picture archiving and communications systems (PACS) have now been installed in the past two years, covering all hospital trusts in the capital and South of England.

Prior to the NHS IT programme 18 trusts in the two regions had already put in PACS systems, taking the total number of installations to 74.

…..

The full article can be read at the site. This is really good news and the reactions of the users of these system reported by e-Health Insider offer considerable hope for other aspects of the Connecting for Health Program in the UK.

The third item is a tale of unintended consequences.

http://www.washingtonpost.com/wp-dyn/content/article/2007/04/04/AR2007040401935.html

“CAD Mammograms Often Find Harmless Spots

By JEFF DONN

The Associated Press

Wednesday, April 4, 2007; 10:56 PM

BOSTON -- A good mammogram reader may do just as well at spotting cancers without expensive new computer systems often used for a second opinion, a new study suggests. Computerized mammography, now used for about a third of the nation's mammograms, too often finds harmless spots that lead to false scares, researchers found. That conflicts with earlier studies showing benefit from the systems.”
…..

It seems clear that while the technology to analyse mammograms is more sensitive than the simple careful visual inspection of the mammogram it also results in many more women needing invasive biopsies and so on – meaning much more worry and anxiety for many women and little, if any benefit. As the article puts it, summarising the New England Journal of Medicine report:

“The researchers in this five-year study _ backed by the federal government and the American Cancer Society _ analyzed mammograms from medical centers in Washington state, Colorado and New Hampshire. Seven of 43 centers used CAD. The mammograms came from 222,135 women and included 2,351 with a cancer diagnosis within a year of their tests.

The researchers found that with computerized mammography, a third more women were called back for suspicious findings and 20 percent more got biopsies than with ordinary mammograms. That might be a good thing, if enough cancers turned up to justify the minor surgeries and anxiety surrounding them.

Yet the computerized method showed no clear capability to turn up more cancer cases than unaided readings: Four cancers were found for every 1,000 mammograms, whatever screening method was used. That means that CAD would give 156 more unneeded callbacks and 14 more biopsies for every additional cancer it finds. And though these extra cancers tend to be early ones that are easier to treat, many would never be threatening anyway.”
…..

The lesson here is that adoption of any technology without understanding the full impact it has on patient outcomes is always risky and that trials of technology need to assess the full impact on patient care – not just an improved number of cases located.

The last report this week is of very considerable concern:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070406/FREE/70405006/1029/FREE

“Quality chasm still exists: study

By: Joseph Conn / HITS staff writer

Story posted: April 6, 2007 - 6:00 am EDT

The more things change, well, you know the rest, even without reading the Fourth Annual Patient Safety in American Hospitals Study released this week by hospital report-card compiler HealthGrades.

"I think the bottom line is the quality chasm still exists between the top and bottom hospitals on the 13 quality indicators we compare," said Samantha Collier, the physician senior vice president of medical affairs and chief medical officer of the Golden, Colo.-based research company. "I think there is a significant gap, almost a 40% lower incident rate of these types of errors that we measured in the best performing hospitals to the lowest performing."

…..

The observation of a 40% difference in error rates makes it absolutely clear some hospitals are not trying hard enough. The impact of this being addressed:

“If all hospitals performed at the level of the top 15% in the study, which HealthGrades deems to be "Distinguished Hospitals for Patient Safety," there would have been 206,286 fewer patient safety incidents to Medicare patients, 34,393 fewer deaths and an estimated $1.74 billion would have been saved, according to Collier.”

…..

It would be good if statistics of the sort produced by HealthGrades were available in Australia so the debate on how to fix our hospitals could begin.

The full report can be read here:

http://www.healthgrades.com/media/dms/pdf/PatientSafetyInAmericanHospitalsStudy2007.pdf

A sobering read, as is the very good summary article I have quoted from.

David.