Quote Of The Year

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


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

Thursday, July 31, 2008

Three Interesting Reports on Parts of Health IT

It seems the last week or two has been a big one for new reports.

First we have a review of Health Informatics in the UK NHS.

NHS Informatics Review says trusts need 'interim' systems

10 Jul 2008

NHS trusts are to get support, and in some cases may get national funding, to select and install “interim” systems as a result of the NHS Informatics Review.

The change in emphasis comes in response to delays of four years or more in the strategic, detailed electronic record systems at the heart of the National Programme for IT in the NHS.

The review, which was led by the Department of Health’s interim chief information officer, Matthew Swindells, before his departure to the private sector, says that good information and good information systems are essential for the delivery of Lord Darzi’s Next Stage Review of the NHS.

It reaffirms the goal of the national programme to deliver integrated care records systems, but acknowledges the impact on trusts of lengthy delays in the delivery of strategic systems from local service providers.

It also spells out the need to use proven systems until better ones becoming available. Interim systems are expected to range from very specialised departmental systems through to hospital-wide patient administration systems.

More here:


Additional information is found here:

HealthSpace set for big expansion

15 Jul 2008

HealthSpace, the government’s secure online site for patients, is to be expanded to include shared records and GP appointment booking, according to the Health Informatics Review.

The review, published last week, outlines a much wider role for HealthSpace and says its consultation highlighted strong support for the HealthSpace initiative.

In future HealthSpace will be accessed via the NHS’s website NHS Choices and the reviews sets out the proposed features including the ability for patients to record their treatment preferences, to view their Summary Care Record and, for those with long-term conditions, to access a shared record.

The document adds: “We propose an early implementation of a shared record for patients with long-term conditions such as diabetes, which will allow a more active and participative role in their care.”

The list of features which patients could benefit from includes:

• a self-care section to enable patients to monitor their condition and load the results for GPs to view and discuss at future appointments.

• Access to Summary Care Records and the ability to store information and preference.

• Reminders on tests, appointments and screening and personalised information for those with long term conditions.

• Secure online interaction with GPs and the ability to email a request for a repeat prescription.

• The ability to see available slots and book an appointment with their GP, practice nurse or hospital.

• An accessible and secure site which will show patients who has accessed their information.

More here:


The full report (.pdf) can the downloaded from the following link.


Second we have the following from iHealthBeat.

Two Reports Highlight Importance of Health IT

by George Lauer, iHealthBeat Features Editor

Last week, in a scorecard rating the most expensive health care in the world, the Commonwealth Fund said the U.S. isn't getting its money's worth.

Last month, a respected health researcher and academician said it's getting difficult to be a competent physician in this country without technical support.

The two reports are not unrelated.

David Mechanic, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, argued in the health policy journal Milbank Quarterly last month that physicians who don't use IT might not be performing to professional standards.

Asked how his assessment related to the Commonwealth Fund scorecard last week showing that the U.S. health system is falling short in several areas, Mechanic said, "There is, of course, a link in that IT and [electronic health records] are important tools that will facilitate addressing many of the deficiencies and absurdities of health care in America."


Reaching Similar Conclusions

The Commonwealth Fund scorecard ends with a recommendation to pursue several strategies including:

  • Universal and well-designed coverage that ensures affordable access and continuity of care, with low administrative costs;
  • Incentives aligned to promote higher quality and more efficient care;
  • Care designed and organized around the patient, not providers or insurers; and
  • Widespread implementation of health IT with information exchange.

Mechanic ends his book with similar sentiment:

"At some point, we as a nation will have to decide whether we wish to design our health care system primarily to satisfy those who profit from it or to protect the health and welfare of all Americans ... anything is possible if the public begins to appreciate how little it gets for what it really pays."


Much more here:


There is an abstract for the full Milbank Quarterly article available


Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations

David Mechanic

Context: Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients’ expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients’ care can contribute to both professionalism and quality of care.

Methods: The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism.

Findings: IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients’ expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser-Permanente, and general practice in the United Kingdom have successfully overcome such challenges.

Conclusions: IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians’ practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States’ dispersed and fragmented medical care system.

I am sure many who are interested will be able to access to full article via their library services.

All in all just too much reading for one week following on the huge Quality and Safety Report from last week!


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