Again there has been just a heap of stuff arrive this week.
First we have:
Rewiring the VA
Decision to use outside contractors to replace key pieces of vaunted VistA IT system draws criticism from experts, original architects
By Joseph Conn
Posted: February 2, 2009 - 5:59 am EDT
Much of the attention of the healthcare industry over the past several weeks has been focused on Washington and the various proposals before Congress to boost the faltering economy, including spending billions of dollars subsidizing health information technology.
Meanwhile, another healthcare IT issue carries a lower profile but will have direct impact on the largest, integrated healthcare delivery organization in the country—the 153-hospital, 731-clinic Veterans Affairs Department healthcare system.
The question is whether the Veterans Health Information Systems and Technology Architecture, or VistA—the clinical information system that powers the VA health system—will wither or bloom in the months and years ahead. It’s an issue that has implications not only for millions of veterans but also millions of other potential users of open-source and proprietary versions of VistA, both in the private and public sectors in the U.S. and abroad.
The VA runs a vast, national healthcare enterprise. VA officials expect to treat 5.8 million patients in the current fiscal year, up 1.6% over 2008, including more than 333,000 veterans from the war in Iraq and some 40,000 from the war in Afghanistan, according to the VA’s fiscal 2009 budget request to Congress.
Though highly praised, the IT program at the VA also has come under fire.
Just last week, VA officials agreed to pay up to $20 million to settle lawsuits for damages following a 2006 data breach in which portions of the records of 26.5 million veterans were put at risk when a laptop computer was stolen during a home burglary of a VA employee. The laptop was turned in to the FBI, whose forensic analysts said no records were exposed.
Earlier in January, the Associated Press reported that a software glitch within VistA intermittently caused some data errors in patients’ records. According to the VA, there were nine incidents in which a doctor’s orders to stop the administration of intravenous drugs—most commonly the blood thinner heparin—failed to display in the system. The VA says it caught the errors with no harm occurring to patients. The problem was traced to a recent software update introduced last October, but several VA programmers interviewed for this story wondered whether the glitch was a symptom of a larger problem in how IT is being handled at the VA.
In 2007, however, the VistA system in Northern California suffered a far more serious problem, an eight-hour outage that J. Ben Davoren, a physician who is director of clinical informatics at the 132-bed San Francisco VA Medical Center, in written testimony before Congress, called “the most significant technological threat to patient safety VA has ever had.” Davoren linked the outage and other IT problems to a reorganization and centralization of IT management at the VA in the Office of Information and Technology.
Last month, retired four-star Army Gen. Eric Shinseki was confirmed as the new VA secretary in the Obama administration. On Dec. 7, 2008, in announcing Shinseki as his choice to head the department, then President-elect Barack Obama said, “We need to build a 21st century VA,” and that included “fully funding VA healthcare.”
But what does it mean to build a 21st century healthcare information technology system at the VA when its largely home-grown clinical IT system, VistA, remains light years ahead of all but the most elite IT programs in the most-wired hospitals and healthcare systems in the U.S.? Does that mean it’s possible the VA could return to the decentralized, collaborative and iterative software development process that was key to the creation and improvement of VistA?
A huge amount more here:
http://www.modernhealthcare.com/article/20090202/REG/901309967
This is a very useful review of the current state, and possible futures, for VistA – which has been a very successful EHR system and which has undoubtedly assisted in the care of millions of US veterans.
Second we have:
P2P networks rife with sensitive health care data, researcher warns
Data leaks could be significant threat to patients, providers, Dartmouth study finds
Jaikumar Vijayan
January 30, 2009 (Computerworld) Eric Johnson didn't have to break into a computer to gain access to a 1,718-page document containing Social Security numbers, dates of birth, insurance information, treatment codes and other health care data belonging to about 9,000 patients at a medical testing laboratory.
Nor did he need to ransack a health care facility to lay his hands on more than 350MB of sensitive patient data for a group of anesthesiologists or to get a spreadsheet with 82 fields of information on more than 20,000 patients belonging to a health system.
In all instances, Johnson was able to find and freely download the sensitive data from a peer-to-peer file-sharing network using some basic search terms.
Johnson, a professor of operations management at the Dartmouth College Tuck School of Business, did the searches last year as part of a study looking at the inadvertent hemorrhaging of sensitive health care data on Internet file-sharing networks.
The results of that study, which are scheduled to be published in the next few days, show that data leaks over P2P networks involving the health care sector pose a significant threat to patients, providers and payers, Johnson said.
"When you start thinking about the nature of these disclosures, it's far more worrisome" than compromises such as those involving payment card data, he said.
"Here you are leaking not just detailed personally identifiable information but also very personal medical information related to patients," Johnson said. Such data can be readily used by hospital employees, the uninsured, organized crime rings, illegal aliens and drug abusers for medical identity theft, and to fraudulently obtain costly medical services and prescription drugs, he said. And while such fraud can cost millions, there is less monitoring for such fraud in the health care industry than there is in the financial sector.
P2P networks allow Internet users to share music, video and data files with others on the network. Normally, popular P2P clients -- such as Kazaa, LimeWire, BearShare, Morpheus and FastTrack -- let users download files and share items from a particular folder. But if proper care isn't taken to control the access that these clients have on a system, it is easy to expose far more data than intended.
More here:
This is clearly an important article for all those interested in Health Information Security and Privacy – and needs to be read closely indeed.
Third we have:
Disruptive Innovation, Applied to Health Care
By JANET RAE-DUPREE
Published: January 31, 2009
THE health care system in America is on life support. It costs too much and saps economic vitality, achieves far too little return on investment and isn’t distributed equitably. As the Obama administration tries to diagnose and treat what ails the system, however, reformers shouldn’t be worried only about how to pay for it.
A laser keyboard could be used in spaces too small for a conventional one and might help prevent the spread of infection among hospital workers.
Instead, the country needs to innovate its way toward a new health care business model — one that reduces costs yet improves both quality and accessibility.
Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy.
“The business models were all created decades ago, and acute disease drove those costs at the time,” says Steve Wunker, a senior partner at the consulting firm Innosight. “Most businesses in this industry are looking at their business model as entirely immutable. They’re looking for innovative offerings that fit this frozen model.”
Advances in technology and medical research are making it possible to envision an entirely new health care system that provides more individualized care without necessarily increasing costs, some health care experts say.
For instance, genetic breakthroughs have helped reveal time and again that what we thought was one disease — Type 2 diabetes, for instance — actually represents a score or more of distinct illnesses, each of which responds best to a different type of therapy, according to medical professionals.
As researchers develop ways to define diagnoses more precisely, more effective treatments can be prescribed, says Matthew Holt, founder of the Health Care Blog and co-founder of the biannual conference Health 2.0. Ultimately, those therapies can be administered by nurse practitioners or others trained to handle routine ailments. The expensive “intuitive medicine” practiced by doctors trained to wade through a thicket of mysterious symptoms in search of an accurate diagnosis can then focus on those cases that truly require their services.
Using innovation management models previously applied to other industries, Clayton M. Christensen, a Harvard Business School professor, argues in “The Innovator’s Prescription” that the concepts behind “disruptive innovation” can reinvent health care. The term “disruptive innovation,” which he introduced in 2003, refers to an unexpected new offering that through price or quality improvements turns a market on its head.
Much more here:
http://www.nytimes.com/2009/02/01/business/01unbox.html?_r=1
This is a useful article describing the impact of technology on the quality or care for diabetics. Well worth a browse.
Fourth we have:
Hospitals Tune up Cart Strategies
Howard J. Anderson, Executive Editor
Health Data Management, February 1, 2009
Hospitals are having a tough time recruiting and retaining nurses. So they're on the lookout for ways to improve nurses' efficiency. One important step involves cutting the time nurses waste walking around in search of all the equipment and information they need.
As a result, a growing number of hospitals are using mobile carts that give nurses easy access to information systems, diagnostic equipment, bar code readers and more. Carts will have a long-term role in hospitals because they're extremely helpful to nurses, predicts Laura Jantos, principal at ECG Management Consultants, Seattle.
An emerging trend in the use of carts is the expansion of their functions, Jantos adds. "Hospitals are trying to use the carts as a nurse station," she says.
By using a cart for multiple purposes, hospitals avoid having nurses and other caregivers carry a hand-held computer and walk around to retrieve the equipment and supplies they need.
For example, to enhance the functionality of some of its mobile carts, Northside Hospital in Atlanta has mounted blood gas analyzers on them. This streamlines tasks for respiratory therapists.
Mobile carts also will play a key role as hospitals roll out electronic health records and computerized physician order entry, Jantos contends. That's because carts can help provide better access to data at the point of care. In many cases, hospitals are using a variety of brands and styles of carts to meet the needs of various departments, the consultant notes.
Heaps more here:
http://www.healthdatamanagement.com/issues/2009_61/27634-1.html?user_id=100325
This is a fascinating (and long) article on all the ways the nursing cart can be empowered to do more. Amazing the range of ideas and functions that are suggested!
Fifth we have:
The Next Wave of Health 2.0: Digital Peer Review
Kathryn Mackenzie, for HealthLeaders Media, February 3, 2009
It's time consuming, tedious, and often just plain uncomfortable for everyone involved. But, like most things in life that are unpleasant, peer review is necessary and unavoidable. So necessary that the Joint Commission has made Ongoing Professional Practice Evaluation (OPPE) part of its 2009 Standards Update. The Commission is urging hospital leaders to gather and analyze data on performance for all physicians with privileges on an ongoing basis rather than at the two year reappointment process.
The idea, of course, is that compiling data on a regular basis will allow the physician to improve performance before something dire occurs. Unfortunately, the administrative burden of conducting ongoing peer reviews has kept the majority of hospitals from increasing the frequency of their evaluations. Which is completely understandable—a doctor's time is stretched thin as it is, and each physician review requires the reviewer to spend precious hours poring over boxes of medical records, which often have to be shipped at great cost to the hospital to far flung locations throughout the country.
It was that burden, combined with a desire to streamline the peer review process that led Daniel LeGrand, MD, chief medical officer at St. Vincent Hospital in Indianapolis to try out a new Web-based software system that he'd been told would simplify and modernize the procedure. Now several months later, St. Vincent is wrapping up a pilot project to review several doctors in complex sub-specialties using a software system from Silicon Valley start-up Acesis. LeGrand says the pilot was so successful at simplifying the peer review process that the hospital will begin performing peer reviews throughout each department on an ongoing basis, as recommended by the Joint Commission.
Lots more (with links) here:
This is an interesting article that points out another role Health IT can play.
Sixth we have:
Indiana leaders urge Congress to see their data exchange as model
January 30, 2009 | Bernie Monegain, Editor
INDIANAPOLIS – Healthcare IT leaders in Indiana say they have a tested model of healthcare data exchange - and the government would get a quick return on its investment if it were replicated around the nation.
With $2 billion to $5 billion designated for health information infrastructure (the range between the House and Senate versions of the economic stimulus legislation), this could result in a $450 billion savings, they say.
"Indiana has seen first-hand how health information exchange drives better healthcare for our patients, increases efficiencies for our healthcare professionals and saves healthcare dollars," said Vincent C. Caponi, CEO of St. Vincent Health and chairman of the Indiana Health Information Exchange's board of directors.
Replicating Indiana's platform throughout the country "would have incredible positive implications on our healthcare outcomes and cost savings," he said.
More here:
http://www.healthcareitnews.com/news/indiana-leaders-urge-congress-see-their-data-exchange-model
This is certainly a model that needs to be closely evaluated for wider use in the US. To date it has achieved a wide range of impressive results and outcomes.
Seventh we have:
German hospitals adopt Lorenzo
2 February 2009
German hospital group Krankenhaus Buchholz and Winsen is to roll out a number of iSoft solutions at two of its hospitals at Buchholz and Winsen, south of Hamburg. iSoft, part of health information technology company IBA Health Group, will install a range of its management and clinical applications, including its new Collaboration Suite portal, eFA services and electronic patient record.
Our aim is to give users of our radiology, laboratory or hospital information systems the opportunity to migrate incrementally to Lorenzo
iSoft With iSoft Collaboration Suite, Krankenhaus Buchholz and Winsen will provide GPs with access to hospital patient records using a standard Web browser. The applications are based on Lorenzo technologies and provide a Microsoft .NET technology layer to underpin further developments in service oriented architecture. Furthermore, the group will act as an iSoft reference site in the region to demonstrate continuous developments in integrated care.
More here:
http://www.onwindows.com/Articles/German-hospitals-adopt-Lorenzo/3408/Default.aspx
It seems Lorenzo is gradually making some headway. This will be good news for IBA shareholders (of which I am one) and it will be interesting to see any impact on their results which are due on February, 17 2009.
Eighth we have:
VA agrees to pay $20 million to veterans in 2006 data breach
Lawsuit alleged privacy invasion
By Hope Yen, Associated Press | January 28, 2009
WASHINGTON - The Veterans Affairs Department agreed yesterday to pay $20 million to veterans for exposing them to possible identity theft in 2006 by losing their sensitive personal information.
In court filings yesterday, lawyers for the VA and the veterans said they had reached agreement to settle a class-action lawsuit filed by five veterans groups alleging invasion of privacy.
The money, which will come from the US Treasury, will be used to pay veterans who can show they suffered actual harm, such as emotional distress or expenses incurred for credit monitoring.
A US District Court judge in Washington must approve the terms of the settlement before it becomes final.
"This settlement means the VA is finally accepting full responsibility for a huge problem that continues to worry millions of veterans, retirees, service members, and families," said Joe Davis, spokesman for Veterans of Foreign Wars, which was not involved in the lawsuit.
More here:
Seems it can get expensive if you let data out wrongly in the US. Seems a very large sum but I guess many were affected.
This trend is confirmed here!
Data Breaches Are More Costly Than Ever
By Brian Krebs
WashingtonPost.com Staff Writer
Tuesday, February 3, 2009; D03
Organizations that experienced a data breach in 2008 paid an average of $6.6 million last year to rebuild their brand image and retain customers, according to a new study.
Ponemon Institute, a Tucson-based research firm, looked at 43 organizations that reported a data breach last year and found that roughly $202 was spent on each consumer record compromised. The average number of consumer records exposed in each breach was about 33,000, although the number of records affected in each incident ranged from fewer than 4,200 to more than 113,000.
Eighty-four percent of the companies surveyed had at least one data breach or loss prior to 2008, said Larry Ponemon, the institute's founder. The cost of a breach in 2007 was $6.3 million, and roughly $4.7 million in 2006.
Ninth we have:
New Group to Promote Mobile I.T.
February 2, 2009
The Center for Cell Phone Applications in Healthcare, created last year to promote the use of mobile technologies, is reestablishing itself as an independent, not-for-profit organization called mHealth Initiative Inc.
Full article here:
The website for the organisation is here:
http://www.mhealthinitiative.org/
Tenth we have:
Ontario grants Agfa Healthcare $29.6-million to develop radiology software
31 January 2009
The Government of Ontario, Canada is helping create 100 new jobs and supporting 276 existing jobs through a $29.6-million grant to Agfa HealthCare from Ontario’s Next Generation of Jobs Fund.
Agfa HealthCare is developing new software that allows radiologists to share digital images across a regional network, reducing the need to develop X-rays and physically transport them between facilities and healthcare professionals. The total project investment is nearly $200 million.
Partnering with businesses to generate investment, create jobs and support innovation is a key component of the Ontario government’s plan to support the economy.
“We’re proud to support Agfa HealthCare’s investment in their Ontario operations and helping create quality jobs for Ontario families. We are committed to continuing to build on Ontario’s strengths: a skilled and educated workforce, a culture of innovation, and a competitive business environment,” said Premier Dalton McGuinty.
More here:
http://www.mtbeurope.info/news/2009/901100.htm
This is clearly a serious investment to improve x-ray information sharing. Doubtless over the years such an effort will make a real difference to the ease and utility of clinical image sharing.
Eleventh we have:
Rochester study shows telemedicine could reduce pediatric ED visits
(AHC Newsletters Via Acquire Media NewsEdge)
Rochester study shows telemedicine could reduce pediatric ED visits
Physicians remain skeptical, saying most visits are necessary
Telemedicine has long been recognized for improving access to care as well as access to specialist expertise, particularly in rural facilities. Now, in an unpublished study just completed in Rochester, NY, the lead author says it also can offer a possible solution to overcrowding when it comes to pediatric ED patients, many of whom, he asserts, easily could be treated by a primary care physician.
The report, which has not yet been published, analyzed data from 2006 and tracked all pediatric visits to the city's largest ED, at the University of Rochester Medical Center. The researchers then studied more than 6,000 telemedicine visits during the same period. The ED visits were categorized into ailments that always could be managed by telemedicine; those that were usually treated through telemedicine; and conditions that usually could not be treated with telemedicine. Results showed that nearly 30% of ED visits fell into the first category and could always be treated with telemedicine. If those problems had all been handled through telemedicine, the research concludes, Rochester would have had at least 12,000 fewer pediatric ED visits in 2006.
Many, if not most, pediatric-age ED visits are for nonemergency problems, says Kenneth McConnochie, MD, MPH, founder of Health-e-Access, the University of Rochester Medical Center telemedicine program that uses the Internet to connect pediatricians with sick children at inner city child care centers. "There are a number of studies showing that between 25% and 75% of ED visits for kids are nonemergency visits," he notes. "If you accept that as a bad thing, it's a crazy use of resources."
EDs have to be prepared to manage the most severe illness and injury episodes, McConnochie says. "They are set up to manage that, and they do it very well," he says.
Subacute visits, he adds, take precious time away from the ED staff, McConnochie says. "The average time to treat a sore throat, ear infection, or pink eye, is about 4.5 to six hours, according to what parents told us, and sometimes as long as 16 hours," he says. "We can do it in a telemedicine site in no time."
More here:
http://www.tmcnet.com/usubmit/2009/01/31/3954271.htm
This is yet another small piece of evidence of how telemedicine can assist. The evidence just keeps piling up!
Second last for the week we have:
Jump-Starting Health IT: An Open Letter To President Obama And Congress
Editor’s Note. Below, Mark Leavitt, chair of the Certification Commission for Healthcare Information Technology, addresses an open letter on health information technology to President Obama and the new Congress. Health IT is also the topic of Health Affairs‘ upcoming March-April issue, which will be released on March 10.
President Obama and members of Congress:
Please accept my heartfelt congratulations for recognizing health information technology (IT) as one of the most promising targets for public investment at this crucial moment.
As a (formerly practicing) doctor, I’d diagnose our economy on the verge of a Code Blue, and our health care system with a more chronic but equally threatening condition. You’ve recognized how these two illnesses interrelate, with spiraling health care costs damaging business competitiveness and job losses threatening health care coverage. If I may offer a second opinion, I concur 100% with your decision to apply the chest paddles now, charged with $20 billion of investment in health IT.
Now I would like to offer this promise: I and my fellow health IT leaders are passionately committed to ensuring that this treatment not only succeeds, but delivers a substantial positive return far exceeding the amount invested. How can we be so confident? Well, even a 1% improvement in the efficiency of our $2.2 trillion health care spending would put us in positive payback territory. But we can do better than that, and here’s why.
More here:
This is a well worth while read on the current state of the US Health System and what might be done about it!
Last for this week we have:
BMA calls for exemption on data sharing
02 Feb 2009
The BMA is calling for confidential health information to be exempt from new government legislation which will allow sharing of personal data across Whitehall departments.
The controversial powers are included in the Coroners and Justice Bill which had its second reading in the House of Commons last week. The BMA claimed the data sharing powers would strip patients and doctors of any rights in relation to the control of sensitive health information.
The Bill means ministers who want to share data across departments can
issue an “information sharing order” which would be the subject of a formal consultation, a report from the Information Commissioner and would need parliamentary approval before it could be implemented.
The powers would reverse the data protection principle that information given to one government agency for one purpose should not normally be used by another for a different purpose.
The BMA told E-Health Insider and EHI Primary Care that it was “extremely concerned” by the scope of the proposals on information sharing in the Bill which is said appeared to permit an unprecedented sharing of confidential health data.
More here:
http://www.ehiprimarycare.com/news/4531/bma_calls_for_exemption_on_data_sharing
I must say I am amazed this sort of information sharing was even seen as an option. It really is not on except in the most specialised and secure environment.
There is an amazing amount happening (lots of stuff left out). Enjoy!
David.
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