Quote Of The Year

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

Friday, February 27, 2009

International News Extras For the Week (27/02/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Diagnosis by 'telemedicine' can save stroke victims

By Kim Painter, USA TODAY

Phoenix neurologist Bart Demaerschalk was enjoying Thanksgiving dessert at home when he got a message: A woman in an emergency room 200 miles away in Kingman had developed slurred speech and drooping facial muscles during her own holiday dinner.

Within minutes, Demaerschalk was looking at the patient, asking her questions, going over her brain scan and confirming a diagnosis: stroke.

Demaerschalk is no superhero. He made that 200-mile leap with the help of a two-way video and audio link set up just for such consultations.

And it mattered. As a result of the "telestroke" consultation, he and the woman's local doctors agreed she should be treated with a clot-busting drug that could restore normal blood flow in her brain and lessen her risk of lasting disability.

"The patient made a nearly full recovery over the next 24 hours," Demaerschalk says.

Much more here:

http://www.usatoday.com/news/health/painter/2009-02-15-your-health_N.htm

This is an important issue – which as it happens was also discussed in the Health Report a week or two ago (9-2-2009):

See:

http://www.abc.net.au/rn/healthreport/stories/2009/2482992.htm

There is a live controversy about the treatment proposed for stroke victims but I know for myself when I have a stroke I want the treatment – given the specialist neurologists to a man seem to recommend it. The Health Report tells you more than you will ever need to know!

Second we have:

This is more by way of an alert of a site I recently discovered.

Oncology EHR

Promoting Quality & Safety in Oncology Electronic Health Records

Welcome to ASCO’s new electronic health record (EHR) social networking site where oncologists, their practice staff, and EHR vendors can easily connect, collaborate, and exchange information about health information technology. On this site, you have an opportunity to write blogs as well as create forums and groups specific to EHR products so that other site members can post questions about systems that they are currently using or would like to use. Take a moment to explore the capabilities of the site and be sure to invite colleagues and practice staff to join this important network.
John V. Cox, DO, MBA
Chair, ASCO EHR Workgroup

The site is found here:

http://ehr.ascoexchange.org/

More than worth a visit, especially if you are interested in Cancer care.

Third we have:

Cleveland Clinic partners with MinuteClinic, links EMRs

February 13, 2009 | Bernie Monegain, Editor

CLEVELAND – Cleveland Clinic, a pioneer in the use of healthcare information technology, has entered into a clinical collaboration with MinuteClinic, the largest provider of retail healthcare in the country.

As part of the collaboration, Cleveland Clinic and MinuteClinic will fully integrate their electronic medical records systems to streamline communication around all aspects of a patient's care.

Each Cleveland Clinic-affiliated MinuteClinic will have access, with patient consent, to a patient's Cleveland Clinic MyChart electronic medical record, which includes medical history, prescriptions, treatments and health maintenance information.

At the patient's request, MinuteClinic will share its patient information with other Cleveland Clinic-affiliated locations in northeast Ohio via the MinuteClinic EMR for MinuteClinic patients who have been treated in those locations.

MinuteClinic is a subsidiary of the CVS Caremark Corp. It has 500 clinics in 25 states.

More here:

http://www.healthcareitnews.com/news/cleveland-clinic-partners-minuteclinic-links-emrs

This is an interesting move – integrating the IT of primary and hospital care to improve information flows. It will be interesting to see how it works out and how often the integration turns out to be clinically useful.

Fourth we have:

Online Health Data in Remission
Nascent Industry Ready With Systems If Money and Standards Are Resolved

By Anita Huslin
Washington Post Staff Writer
Monday, February 16, 2009; D01

The $19 billion prescribed in Congress's economic stimulus package to bring America's health-care records into the electronic age is a welcome opportunity for information technology firms seeking to build market share in a still-young industry.

Although the federal government set a goal five years ago of creating an electronic health record for every American by 2014, the effort has lagged for several reasons. Roadblocks include concerns over lack of universal protocols for collecting data as well as rules that establish how, with whom and under what circumstances the data can be shared. Many health-care providers -- physician practices, testing facilities, hospitals and clinics -- fear liability if private information gets into the wrong hands. Embedded in all these issues is the cost, an estimated $150 billion, which has proven to be a significant barrier to that 2014 target.

Few expect the new spending to change things immediately. "The incentives for doctors and hospitals to use these tools have months of regulatory processes to go through," said David Brailer, former head of the Office of the National Coordinator for Health Information Technology (ONCHIT), created under the Bush administration to establish standards for the collection and use of electronic medical records. "I don't think doctors will go out tomorrow and buy electronic records because there is a little bit of money coming."

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/02/15/AR2009021501284.html

I think David Brailer must now be missing his old job as head of ONCHIT – now it has a few billion to spend and a very important role for the next few years. He is right also that there are a few gaps to be filled before steaming forward will be totally easy!

Fifth we have:

HHS idles as top jobs go unfilled

By Jeffrey Young

Posted: 02/12/09 05:39 PM [ET]

The leadership void at the top of the Department of Health and Human Services (HHS) is affecting more than President Obama’s health reform agenda.

Though the department is capable of fulfilling its day-to-day responsibilities as guardian of the nation’s public health, pharmaceuticals, foods, medical research and other areas, the continued lack of a secretary and of leaders at key agencies will delay the Obama administration from putting its stamp on the massive bureaucracy.

As illustrated by the Food and Drug Administration’s (FDA) active role responding to the salmonella outbreak from contaminated peanut butter, HHS does not grind to a halt without its senior leadership team in place.

But while the senior civil servants and Bush administration holdovers overseeing the department’s 67,000 employees have the know-how and experience to keep the engines at HHS running, they lack the clout to set new policy. Charles Johnson, a Bush appointee as assistant secretary for budget, is acting HHS secretary.

The administration has installed a handful of political appointees, but they also lack the clout to make big changes to departmental policy without explicit direction from the highest levels of the administration.

The White House, meanwhile, has too full an agenda to get involved in all but the biggest items of departmental business.

Lots more here:

http://thehill.com/the-executive/hhs-idles-as-top-jobs-go-unfilled-2009-02-12.html

This shows the downside of having a politicised executive level of government administration – and the issue is also feeding through to E-Health with uncertainty about who will head up ONCHIT long term. The upside of this system is, however, that the new President / PM can get on with their agenda swiftly – once the executive is in place! Six of one and half a dozen of the other I suspect!

Hospital boss slams new NHS computer system
By Reuters Health

February 13, 2009

LONDON (Reuters), Feb 13 - An NHS hospital boss criticized the new computerized medical records system on Friday, saying it has cost an extra 10 million pounds to implement and is slowing the rate at which patients are seen.

Andrew Gray, chief executive of London's Royal Free Hospital -- which is being seen as a test case for the system -- said the technology, part of a broader 12.7 billion pound IT upgrade at hospitals nationwide, is "incredibly disappointing."

The software was taking staff four times as long to book appointments for patients and soaking up money the trust would have otherwise invested in new x-ray machines.

"I think it is very disappointing that the work we had to do as a trust has caused our staff so much heartache and hard work," he told BBC radio.

Explaining the added costs he said: "About 4 million of it is additional expenditure over and above the project plan that we already have in place and 6 million is related to (patient) income losses."

Gray said the hospital had to take on 40 extra staff to handle the added workload and that initially the software kept on crashing.

The Department of Health said lessons would be learned from the Royal Free's experience.

More here:

http://www.auntminnie.com/index.asp?Sec=sup&Sub=pac&Pag=dis&ItemId=84610

It seems there are some urgent lessons to be learnt about one size fits all application implementations if the NHS Program (and similar ones here in NSW and Victoria) are to go smoothly and be as successful as might be hoped.

Seventh we have:

Eight NHS hospitals floored by datacentre hardware fault

Sources lay responsibility for fix with supplier CSC

By Leo King, Computerworld UK

Hospitals in eight NHS trusts had to resort to using pen and paper when a datacentre hardware fault cut off their access to new multi-billion pound patient systems.

The hospitals lost access to the systems for several hours on 10 February after a hardware fault hit a datacentre run by CSC, according to sources close to the problem.

The problem initially hit Ipswich Hospital in Suffolk, and then went on to affect seven other NHS trusts.The NHS declined to name the other trusts affected, but they are understood to have been in the same region.

Sources said the hospitals were unable to access the central iSoft Lorenzo patient administration system until the evening, forcing a return to pen and paper, and complicating administration tasks.

A report in the Sun newspaper also claimed sensitive patient data could have been viewed.

CSC declined to comment on the claims that there was a hardware fault, citing commercial confidentiality, but insisted no sensitive patient data was lost and "there was no impact to patient care".

The NHS told Computerworld UK there was "no evidence of risk to patients".

More here:

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=13400

The lesson here is that there is a downside to data-centre aggregation and that this must be managed carefully – with appropriate redundancy – when critical systems are involved. It is also a warning that even in 2009 such failures do happen so manual systems do have to be maintained at a reasonable state of readiness.

Eighth we have:

Worthing decides to switch off Cerner

16 Feb 2009

Worthing and Southlands Hospitals NHS Trust has agreed plans to switch off its Cener Millennium electronic records software and move back to its old Sema-Helix software.

As first reported by E-Health Insider on 26 January, the trust has been examining whether to move from its current Cerner Millennium system back to its old Sema-Helix patient administration system as part of a merger with neighbour Royal West Sussex (RWS).

The new NHS trust, to be created in April from the proposed merger of RWS and Worthing and Southlands Hospitals (WaSH), will adopt the Helix Patient Administration System to ensure the continued safe management of medical records across the three sites.

The future IT plans will still have to be ratified by the board of the newly merged trust, but had previously been described as one of several options.

More here:

http://www.e-health-insider.com/news/4575/worthing_decides_to_switch_off_cerner

This has the feel of being a bit of a mess. What I really enjoyed was the first comment on change management – or the virtual impossibility of it in some circumstances!

More blunt coverage here:

http://www.theargus.co.uk/news/4132078.__2m_NHS_computer_system_scrapped/

£2m NHS computer system in Sussex scrapped

12:00pm Tuesday 17th February 2009

Ninth we have:

Former CIO for Veterans Health Urges 'Change in Philosophy'

by George Lauer, iHealthBeat Features Editor

The new field general in the bureaucratic battleground of the claims department at the Department of Veterans Affairs got a first-hand look at the carnage last week and promised help is on the way.

Retired Gen. Eric Shinseki, the new VA secretary, told Congress he would move quickly toward an all-electronic claims system that would speed up and improve the overloaded, criticized system.

A former lieutenant in the same war welcomed the new leader and the sentiment, but he warned other strong generals with similar good intentions have tried and failed.

"What's really needed is a change in philosophy, a change in the basic concepts that guide the claims department," said Gary Christopherson, former CIO for the Veterans Health Administration and former senior adviser to the undersecretary for health.

"It's good to hear of [Shinseki's] commitment; however, it worries me that we've heard this before and yet here we are with a broken system," Christopherson said.

Full article here:

http://www.ihealthbeat.org/Features/2009/Former-CIO-for-Veterans-Health-Urges-Change-in-Philosophy.aspx

It is good to see the embrace of electronic records extends right throughout the Obama team with VA – which has a good technology record in the EHR domain – pushing forward to do more as well.

Tenth we have:

Obama Set To Sign Stimulus Package With Health IT Funds

Today in Denver, President Obama is scheduled to sign a $787 billion economic stimulus package that includes $19 billion for health IT that the House and Senate approved Friday, Healthcare IT News reports (Healthcare IT News, 2/17).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

Health IT Provisions

The legislation would:

  • Provide $2 billion to the Office of the National Coordinator for Health IT, in part to support regional health information exchanges and establish regional extension centers;
  • Require ONC to appoint a chief privacy officer;
  • Strengthen HIPAA medical privacy rules;
  • Establish health IT policy and standards committees as federal advisory committees;
  • Require insurers and health care providers that participate in Medicare and Medicaid to use health IT systems that comply with national standards;
  • Tap the National Institute of Standards and Technology to test health IT standards;
  • Restrict the sale of information included in health records;
  • Permit state attorneys general to sue individuals to enforce HIPAA medical privacy and security rules (Ferris, Government Health IT, 2/13); and
  • Require vendors of electronic health records to alert individuals and the Federal Trade Commission of data breaches (Health Data Management, 2/17).

The bill also would provide health IT funds for the Social Security Administration, Indian Health Service, community health centers, and medical schools and other organizations.

The legislation aims to make electronic health records available to all U.S. residents by 2014 but would not require individuals to use EHRs (Government Health IT, 2/13).

Forecast

The Congressional Budget Office projects that health IT provisions in the stimulus package will result in 90% of doctors and 70% of hospitals using certified EHR systems by 2019 (Health Data Management, 2/13).

More here:

http://www.ihealthbeat.org/Articles/2009/2/17/Obama-Set-To-Sign-Stimulus-Package-With-Health-IT-Funds.aspx

This is as good a wrap up of what was signed into law. Really just for the record.

Eleventh we have:

Home monitoring devices poised to create flood of data

February 17, 2009 — 2:36pm ET | By Anne Zieger

Of late, research has increasingly shown that remote monitoring devices that feed clinical data to providers can have significant benefits. For example, one recent study concluded that when clinicians monitor congestive heart failure patients remotely, they can cut re-hospitalization rates for such patients by 60 percent.

Results like these have driven providers to test a wide range of remote monitoring devices, including devices tracking patients' weight, blood pressure, oxygen and glucose levels, as well as others tracking medication compliance. This has taken place despite the fact that most health plans don't pay for such devices as of yet--and they're not cheap, either.

More here:

http://www.fiercehealthit.com/story/home-monitoring-devices-poised-create-flood-data/2009-02-17?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

More also here:

To learn more about this trend:

- read this piece in The New York Times

This is an interesting issue I had not thought of but it is for certain a real one. The growth is likely to be exponential I would guess over the next decade!

Twelfth for the week we have:

Stimulus’ HIT parts would cost taxpayers $24 billion

By Joseph Conn / HITS staff writer with Jennifer Lubell

Posted: February 17, 2009 - 5:59 am EDT

The portion of the $787 billion federal stimulus package devoted to healthcare information technology, privacy and security issues formalizes several key components of the federal government’s healthcare IT booster program started under the Bush administration while creating some new components and programs. But by far the biggest change is in funding.

According to an analysis by the Congressional Budget Office, the health IT sections will cost taxpayers $24.2 billion beginning this year and running through 2019. The bulk of that money is going to fund bonus payments through the Medicare and Medicaid programs with the balance going to grants under the Office of the National Coordinator, or ONC, at HHS, though the exact breakdown varied, depending on the source.

The bill gives congressional authorization to the ONC. The head of the office is given broader authority than under the Bush administration.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179997/1029/FREE&nocache=1

It certainly becomes clear the realists appreciate this US EHR project is a decade long and will cost a good deal more than the initial funds ($US20B or so) that was allocated!

Second last for the week we have:

ANSI requests funds to standardize clinical research

By Joseph Conn / HITS staff writer

Posted: February 17, 2009 - 5:59 am EDT

The American National Standards Institute is fundraising to support its work facilitating the uses of electronic health information to support global clinical research activities, according to a news release. Its goal is to obtain “the active engagement and financial support of the clinical research community to ensure that divergent and disparate standards do not inhibit the use of electronic health records for future research and clinical decision support,” the release stated.

HHS asked the institute last year to convene a work group to prioritize use cases for standards harmonization in the research field. HHS and the Office of the National Coordinator, the Veterans Affairs Department, the National Cancer Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have contributed to the development of the use cases.

So far, ANSI reports it has signed up 27 contributors, including providers Cleveland Clinic, MetroHealth System, Cleveland, Partners HealthCare System, Boston; universities including Case Western Reserve, Cleveland, and Duke; and information technology companies Greenway Medical Technologies, Hewlett-Packard Co. and Phoenix Data Systems; pharmaceutical data-miner Quintiles Transnational Corp.; and drugmakers and biotech companies including Abbott Laboratories, Biogen Idec, GlaxoSmithKline and Pfizer.

More here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090217/REG/302179996

This is good to see – the spin off could be valuable here in Australia I suspect once we get our EHR act together.

Last for this week we have:

Low-Tech Safety

Jay Moore, for HealthLeaders Media, February 4, 2009

Hospitals have increasingly turned to advanced technology to help keep patients safe. But some providers are discovering that there are considerable virtues in simplicity.

As the challenge of keeping patients safe has grown more complex, so have many of the solutions. From radio frequency identification to computerized medication administration to bar coding, technologically advanced initiatives designed to reduce errors and protect patients have become more prevalent as provider organizations struggle with drug-resistant infections, overworked caregivers, overcrowded facilities, and simple human imperfection.

But at Kaiser South San Francisco Medical Center, one of the most decidedly low-tech patient safety solutions has proven to be the most effective. The 120-licensed-bed California hospital has seen a significant reduction in medication errors from its medication vest program, in which nurses wear specific apparel when dispensing medications to indicate they are not to be bothered, thus reducing distractions. Despite a higher patient census, the hospital cut medication errors by 50% in January 2008 compared to January 2007, says Becky Richards, RN, adult clinical services director.

More here:

http://www.healthleadersmedia.com/content/227686/topic/WS_HLM2_MAG/LowTech-Safety.html

Just to show there are often many ways to skin a cat! Love the idea – especially now there is goog evidence it works! Anyone know if it has been adopted anywhere in OZ?

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

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