Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.
First we have:
Published 27 January 2009, doi:10.1136/bmj.b81
Cite this as: BMJ 2009;338:b81
Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings
Richard L Tannen, professor of medicine, Mark G Weiner, associate professor of medicine, Dawei Xie, assistant professor of biostatistics and epidemiology
1 University of Pennsylvania School of Medicine, 295 John Morgan Building, 36th and Hamilton Walk, Philadelphia, PA 19104, USA
Correspondence to: R L Tannen firstname.lastname@example.org
Objectives To determine whether observational studies that use an electronic medical record database can provide valid results of therapeutic effectiveness and to develop new methods to enhance validity.
Design Data from the UK general practice research database (GPRD) were used to replicate previously performed randomised controlled trials, to the extent that was feasible aside from randomisation.
Studies Six published randomised controlled trials.
Main outcome measure Cardiovascular outcomes analysed by hazard ratios calculated with standard biostatistical methods and a new analytical technique, prior event rate ratio (PERR) adjustment.
Results In nine of 17 outcome comparisons, there were no significant differences between results of randomised controlled trials and database studies analysed using standard biostatistical methods or PERR analysis. In eight comparisons, Cox adjusted hazard ratios in the database differed significantly from the results of the randomised controlled trials, suggesting unmeasured confounding. In seven of these eight, PERR adjusted hazard ratios differed significantly from Cox adjusted hazard ratios, whereas in five they didn’t differ significantly, and in three were more similar to the hazard ratio from the randomised controlled trial, yielding PERR results more similar to the randomised controlled trial than Cox (P<0.05).
Conclusions Although observational studies using databases are subject to unmeasured confounding, our new analytical technique (PERR), applied here to cardiovascular outcomes, worked well to identify and reduce the effects of such confounding. These results suggest that electronic medical record databases can be useful to investigate therapeutic effectiveness.
Access the full report is here if you have access from www.bmj.com.
Second we have:
- Jan 26, 2009
Letters from 21 health information technology leaders to the new president portray a road map for building an electronic health care system that rewards productivity, retains knowledge and supports effectiveness of care.
Reward physicians for using health IT
You enter office during a time of unprecedented growth and opportunity in the field of health care information technology. Health care is an issue that goes beyond party affiliations and affects every citizen, and as you begin your term as president, we urge you to continue building on the momentum this industry has gained in the past decade.
Investing in health IT, such as the adoption and advancement of electronic health records, will help bring about an interoperable health care system, which studies have shown can save upwards of $150 billion to $300 billion annually to numerous stakeholders, including the federal government and, thus, taxpayers.
Furthermore, EHR adoption improves the quality of care that physicians and other caregivers are able to provide. In times of disaster and crisis, properly constructed EHR networks enable health care professionals to access a patient’s medical records at a moment’s notice, whereby they can quickly and effectively administer the proper care.
The benefits of widespread EHR adoption are hard to ignore. Yet many physicians remain reluctant to use these solutions to their fullest potential. A key step in advancing the adoption of EHRs is the creation and support of legislation and regulations that provide monetary incentives to physicians who successfully deploy health IT systems at the point of care. EHR adoption furthers the ability for physicians to perform more accurate and widespread clinical research that can unlock new medicines and treatments that benefit the greater good, from treating common illnesses to curing chronic diseases.
We urge you to continue supporting legislation and regulations that advance health care information technology.
Vice President of Marketing and Government Affairs,
Greenway Medical Technologies
Other 20 letters are found here:
This is the equivalent of a small report and is well worth reading. It summarises the wisdom of a generation as to what is vital in getting Health IT adoption and use underway. Mandatory reading in my view!
Third we have:
Access to electronic health records would help cancer patients: report
TORONTO — Many Canadians with cancer have yet to benefit from advances in electronic information technology that could improve how their disease is treated and managed, the Cancer Advocacy Coalition of Canada says in its annual report card.
The Report Card on Cancer in Canada, released Tuesday, suggests there it too little use of electronic health records to link distant communities to regional cancer centres, potentially robbing patients of better health outcomes.
The coalition recommends that patients should be given access to their own electronic health records.
"If patients can access their financial records from anywhere in the world, why not their health records?" says Dr. William Hryniuk, medical oncologist and past-chair of CACC. "If they could, their disease management would greatly improve and many system changes would quickly follow."
Research shows there is little or no use of electronic health records in remote communities that need them the most, says the coalition, noting that cancer patients need continuing access to those records to ensure optimal care, especially if they live a distance from a regional cancer centre.
Yet a CACC survey of oncology clinics located more than two hours from a regional cancer centre found that most aren't using electronic health records to record vital information.
Of 11 clinics surveyed across the country, seven had access to an integrated electronic health record (EHR) system linking them to the other centre; and of these seven, only three allowed clinicians to enter data.
"The net result in these cases is that tertiary centre oncologists who originally devised the treatment plans were not able to follow whether treatment was being given or what complications were encountered," Hryniuk, lead author of the study, said in a release.
"This raises the possibility that patients in these communities may not be getting the full benefits of care in terms of efficacy, safety and efficiencies received by patients in direct proximity to regional cancer centres."
In virtually every case, managing a patient's care requires treatment delivered by a large number of health-care personnel located in different locations, he said.
The report can be found here:
The value of Health IT in regional areas is argued persuasively here and it is a useful part of the overall report.
Fourth we have:
A Shared Roadmap and Vision for Health IT
By John Halamka, Mark Leavitt & John Tooker
Today’s economic crisis has highlighted our need for breakthrough improvements in the quality, safety and efficiency of health care. The nation’s business competitiveness is threatened by growing health care costs, while at the same time our citizens risk losing access to care because of unemployment and the decreasing affordability of coverage. Meanwhile, the quality variations and safety shortfalls in our care system have been well documented.
Health IT is not a panacea for all of these challenges, but it is a critical first step toward addressing many of them. Before we can restructure payment systems to reward quality, we need reliable, near real time data on outcomes. Before we can reward teamwork and collaboration that re-integrates care, we need applications that let clinicians communicate patient information instantly and securely. And in order to reverse the growing burden of chronic diseases, we need online connections that engage individuals in their care and motivate them to make healthier lifestyle choices.
Our current, paper-based health information process wastes hundreds of billions of dollars annually. Transforming this into a streamlined twenty-first century electronic system will require many components: a conversion to interoperable electronic health records (EHRs) at healthcare facilities, the adoption of online personal health records (PHRs) for individuals, health information organizations that support and connect these systems to allow information sharing, and finally a national health information network that allows instantaneous secure access – always with appropriate consent from the individual -- wherever and whenever their records are needed.
The full Shared Vision document is found here:
Fifth we have:
Laurie Barclay, MD
February 11, 2009 — Because clinicians override most current medication safety alerts generated by electronic prescribing systems, these warnings may be insufficient to protect patient safety, according to the results of a retrospective analysis in the February 9 issue of Archives of Internal Medicine.
"Electronic prescribing clearly will improve medication safety, but its full benefit will not be realized without the development and integration of high-quality decision support systems to help clinicians better manage medication safety alerts," senior author, Saul Weingart, MD, PhD, vice president for patient safety at Dana-Farber and an internist at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, said in a news release. "We need to find a way to help clinicians to separate the proverbial wheat from the chaff. Until then, electronic prescribing systems stand to fall far short of their promise to enhance patient safety and to generate greater efficiencies and cost savings."
The investigators reviewed 233,537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. Multivariate techniques helped to determine factors associated with alert acceptance.
The original abstract and links to the full article are found here:
Clearly this issue needs to be carefully addressed by system designers ASAP.
Sixth we have:
HHS Enhances Privacy Web Site
February 11, 2009
The Department of Health and Human Services' Office for Civil Rights has revamped its health information privacy Web site.
The site has long had a variety of information about the HIPAA privacy rule. Now, it has added content on the Genetic Information Nondiscrimination Act and the privacy provisions in the rules that implemented the Patient Safety and Quality Improvement Act.
Not quite a report but a useful reference web-site for health information privacy in the US.
The site is here:
Seventh we have:
February 13, 2009
The Smart Card Alliance Healthcare Council has issued a white paper offering guidance to CFOs on the use of the technology.
The white paper, “A Healthcare CFO’s Guide to Smart Card Technology and Applications,” is designed to help financial executives weigh the potential benefits of the technology, according to the council.
To obtain the report, visit smartcardalliance.org.
Last – and not quite a report – but an excellent summary of the facts – we have:
The verdict on the value of health IT has always been divided and increased attention to the issue has done little to narrow that divide. Indeed, the entrance of a new administration committed to including health IT in its health care agenda has produced a near daily barrage of reports and commentary on the value of health IT -- with their verdicts increasingly disparate.
How should the incoming administration read this "scatter-gram" of recommendations? Should it conclude that health IT is so immature and unreliable that each study has legitimately arrived at a very different conclusion? Should President Obama modify his vision of moving all Americans to electronic health records from a horizon of five years to something considerably longer?
I think not. I believe a careful read of most studies -- including what lies between the lines -- reveals these common threads:
- Health IT is not mature, and does not yet contain all of the features that are necessary for it to serve as the infrastructure of 21st century health care (as defined by the Institute of Medicine); however, it is mature enough in most settings for use today;
- Health IT per se has a neutral effect on health care quality, safety and effectiveness and in some settings will be associated with worse results, in some will show no influence, and in some will show improvements to care;
- Adoption of health IT alone will not and cannot result in health care reform; however, meaningful health care reform is not possible without near universal adoption of advanced health IT;
- Health IT implemented in a dysfunctional and fragmented health care delivery and payment system will always show suboptimal and inconsistent results. This inconsistency always will be present until the variables of health care processes and incentives are controlled; and
- Adoption of health IT without health care delivery and payment reform is not enough and all but guarantees that the time, effort and dollars expended will disappoint the IT purchasers. It will certainly not give patients what they need and deserve -- which is a better, safer, and more value-laden health care system.
Those bullet points above are pretty spot on for both the US and OZ I believe.
Again, all these are well worth a download / browse.