Again, in the last week, I have come across a few reports and news items which are worth passing on. These include first:
Story posted: May 21, 2007 - 10:56 am EDT
Part one of a two-part series
Like a recurring dream about having to take a test they didn't study for, some physicians view the idea of patients with electronic personal-health records as their own personal nightmare.
Visions of patients handing over a computer disk containing years' worth of blood-pressure readings taken every four hours along with random recollections of rashes and muscle strains that physicians are required to somehow make sense of and memorize are followed by thoughts of being sued because there was a kernel of important information missed in the deluge.
"That's why folks like me are terrified of personal health records and what patients will bring to us," internist Michael Zaroukian said earlier this year during a panel discussion at the Integrating the Healthcare Enterprise Connectathon, an event that brings electronic medical-record vendors together to solve interoperability problems (and sponsored by the Healthcare Information and Management Systems Society, the Radiological Society of North America and the American College of Cardiology).
While Zaroukian, who is chief medical information officer at Michigan State University, is now backing away from the word "terrified," he still maintains "there are certainly lots of reasons to be concerned."
The reasons for concern that Zaroukian cites include: the accuracy, completeness, usefulness and volume of the records physicians receive from patients; the hours of uncompensated work it will take to slog through them; and the potential for a misdiagnosis if something important was overlooked.
This article raises a large number of the potential concerns from clinicians when a medical record is shared between a range of clinicians and the patient themselves. This discussion needs to carefully reviewed by anyone interested in electronic patient information sharing for lessons that can be learnt before commencing such projects.
Second we have:
By Christopher Lee
Washington Post Staff Writer
Tuesday, May 22, 2007; A01
Seattle pediatrician Rupin Thakkar's first inkling that the pharmaceutical industry was peering over his shoulder and into his prescription pad came in a letter from a drug representative about the generic drops Thakkar prescribes to treat infectious pinkeye.
In the letter, the salesperson wrote that Thakkar was causing his patients to miss more days of school than they would if he put them on Vigamox, a more expensive brand-name medicine made by Alcon Laboratories.
"My initial thought was 'How does she know what I'm prescribing?' " Thakkar said. "It feels intrusive. . . . I just feel strongly that medical encounters need to be private."
He is not alone. Many doctors object to drugmakers' common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities -- information marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs.
Now the issue is bubbling up in the political arena. Last year, New Hampshire became the first state to try to curtail the practice, but a federal district judge three weeks ago ruled the law unconstitutional.
This is an issue that has travelled below the radar for a good while and which needs more scrutiny. While the US and Australian approaches to collection of such data differ there are certainly similar data collection and data mining processes happening based on Australian GP prescribing records.
Third we have:
By John Reichard, CQ HealthBeat Editor
The Medicare program has the data and the computer capacity to identify individual doctors who are inefficient compared with their peers and may begin contacting them as soon as mid-2008 to goad them to become more efficient, a top federal official testified Thursday.
“It’s an ambitious goal, but I think we need to set ambitious goals if we’re moving forward in this important reform area,” said Herbert Kuhn, acting deputy administrator for the Centers for Medicare and Medicaid Services.
Kuhn testified at a hearing called by House Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., to find new ways to control the growth in the volume of office visits, tests and procedures that doctors order for Medicare beneficiaries. There’s widespread agreement that the current method for doing that — cutting payments if volume exceeds a yearly spending target — isn’t working.
This has a bit of the flavour of ‘Big Brother’ about it. Readers will be aware that Medicare Australia is already using similar techniques to identify practitioners who may benefit from ‘counselling’ regarding their approach to medical practice.
Care with the use of such information is clearly important and it seems reasonable that there be reasonable disclosure of what approaches are being adopted.
Medicare Australia provides an report of its compliance program which is found here:
There is also a site for the Professional Service Review Agency which is found here:
Fourth we have:
22 May 2007
On one level, it’s a no-brainer that whenever and wherever an NHS patient is taken ill, the clinicians caring for him or her should be able to access crucial information – especially in potentially life-threatening situations. My son, for example, is allergic to penicillin and about to go off to university. If he’s unlucky enough to be rushed to hospital semi-conscious with meningitis, I’d want the doctors involved to learn of his allergy promptly and alter their treatment plan accordingly. The Summary Care Record – a central repository of key data on all patients, derived from our NHS medical records – is designed to address precisely this situation.
But as we all know, there is a major downside to placing personal health information on a central server intended for rapid, easy access in unscheduled care situations. Despite strict data protection legislation in this country and abroad, examples of harm arising from lapses of one sort or another in so-called ‘secure’ information systems are not difficult to find. Nobody is going to refuse you a mortgage for being allergic to penicillin. But what if my son were HIV positive, or taking methadone as part of a drug rehabilitation programme that nobody outside the family knew about? These data items might prove equally crucial to him receiving life-saving treatment in an emergency, but they are private and sensitive in a way that a penicillin allergy isn’t. Potentially stigmatising conditions such as mental health problems, domestic violence, epilepsy or a past termination of pregnancy often map closely to the things a doctor needs to know about when someone gets taken ill unexpectedly.
Professor Trisha Greenhalgh OBE, University College London
The good professor has expertise in evidenced based medicine and her full comments in this opinion piece are well worth a careful review.
The odd thing is that she is working towards a Final Report, to be published in May 2008 (with some interim deliverables planned). The report is to address such issues as
- What, if anything, do stakeholders value about the Summary Care Record?
- What exactly are their hopes and fears?
- And, in what circumstances, the Summary Care Record is a ‘good thing’.
The odd thing about all this is that one would have thought these questions would have been sorted out well before this. I wonder what this review presages?
Lastly we have
By Neil Versel
May 22, 2007 | DALLAS — After a couple of years of flying under the radar, a data standard known as the Continuity of Care Record (CCR) is starting to prove its worth to healthcare providers as an easy-to-use interoperability tool. And a modified version of the ubiquitous PDF is poised to do the same.
“It could be that the CCR is the only business model that works for a RHIO,” suggested St. Charles, Ill., family physician Stasia Kahn at the 23rd annual Towards the Electronic Patient Record (TEPR) meeting here this week.
Kahn talked about how she and other physicians in the Chicago area are building the foundation for a regional health information organization with the help of the CCR — an XML data set of essential information for when patients move between care settings — and encouraged other practitioners to adopt the standard. “There’s a lot of providers still waiting, and my message to you is there’s no reason to wait any longer,” said Kahn, who called the CCR the only real way to send secure, electronic clinical data from provider to provider right now.
But that may soon change, as a health-specific version of the Portable Document Format, known as PDF-H, is on its way, thanks to a collaboration between PDF inventor Adobe Systems and computer chip-maker Intel, with support from several medical specialty societies.
“Raise your hand if you can open a PDF document on your computer,” instructed Steven Waldren, director of the Center for Health Information Technology of the American Academy of Family Physicians. After pretty much everyone in the room complied, Waldren said, “That’s the use case.”
This is just a fascinating development and – given the scale of the sponsors – it will be interesting indeed to see what, if anything comes from it. The full article provides more details and is, again, worth a read.
See also for more details:
Story posted: May 23, 2007 - 11:25 am EDT
Other interesting URLs include:
by Kevin Kelley
Summary: Replacing paper with eletronic medical records could help hospitals define the next generation of SOA applications for the health care industry.
Date: 22 May 2007 - 10:47
May 25, 2007
All in all quite a bumper week!
As a reward for the reader who makes it to the bottom of the blog who can confirm or deny the following scuttlebutt?
Who else has heard?
1. Major changes in the leadership of NEHTA are in the wings.
2. There is a somewhat covert group in Minister Abbott’s office trying to work out just what to do with e-health before the election (NOT AHIC).
3. That at some point in the next little while we will get to know who is actually on the Australian Health Information Council and what they are really doing.
All tips welcome – if you are game!
More next week.