Again, in the last week, I have come across a few reports and news items which are worth passing on.
First we have:
Clinical Information Technologies and Inpatient Outcomes
A Multiple Hospital Study
Ruben Amarasingham, MD, MBA; Laura Plantinga, ScM; Marie Diener-West, PhD; Darrell J. Gaskin, PhD; Neil R. Powe, MD, MPH, MBA
Arch Intern Med. 2009;169(2):108-114.
Background Despite speculation that clinical information technologies will improve clinical and financial outcomes, few studies have examined this relationship in a large number of hospitals.
Methods We conducted a cross-sectional study of urban hospitals in Texas using the Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on physician interactions with the information system. After adjustment for potential confounders, we examined whether greater automation of hospital information was associated with reduced rates of inpatient mortality, complications, costs, and length of stay for 167 233 patients older than 50 years admitted to responding hospitals between December 1, 2005, and May 30, 2006.
Results We received a sufficient number of responses from 41 of 72 hospitals (58%). For all medical conditions studied, a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations (0.85; 95% confidence interval, 0.74-0.97). Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively. For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications (0.84; 95% confidence interval, 0.79-0.90). Higher scores on test results, order entry, and decision support were associated with lower costs for all hospital admissions (–$110, –$132, and –$538, respectively; P < .05).
Conclusion Hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.
Author Affiliations: Center for Knowledge Translation and Clinical Innovation, Parkland Health & Hospital System and Department of Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Amarasingham); Departments of Epidemiology (Ms Plantinga and Dr Powe), Biostatistics (Dr Diener-West), and Health Policy and Management (Dr Powe), Bloomberg School of Public Health, and Department of Medicine (Dr Powe) and Welch Center for Prevention, Epidemiology, and Clinical Research (Ms Plantinga and Dr Powe), The Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of African American Studies, University of Maryland, College Park (Dr Gaskin).
The conclusion says it all. Hospital computing can make a real difference!
January 22, 2009
Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.
Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.
Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.
First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.
Let’s be clear, the stimulus package’s main role is to stop the patient from bleeding out and will probably need to be joined by a bank restructuring the likes of which we’ve never seen. Health care is a sideshow, but $20 billion is still $20 billion, and given that the current health IT market is only between $20 and $30 billion annually, it’s a huge potential increase for the industry.
Much more here:
This post, and the blog itself, is very interesting. It shows what happens when suddenly there is some money on the table to do something. How things should be done suddenly become more controversial. It would be good if e-Health in Australia could have a similar problem!
Third we have:
Friday, 23 January 2009
‘Cloud computing’ may be the new buzzword in storing e-health records, but how secure is it? Elizabeth McIntosh takes a look.
IMAGINE as a patient you tell your private health insurance company you don’t smoke and you only drink occasionally.
In fact, you say your gym membership is up to date and you spend loads of time pumping iron.
A week or two later your insurers call to say your policy has been cancelled, offering a simple explanation: they believe you are a big, fat liar.
How did this happen?
The answer is by piecing together a jigsaw about you and your spending habits. Did you really think the supermarket rewards card was just for petrol points and wouldn’t show purchases of cigarettes and beer; and surely you know if you don’t pay memberships, lists of debtors are passed between businesses and collection agencies?
While this scenario isn’t reality yet, give it time.
Data mining – the process of sorting through data to pick out relevant information – is big business, and it’s only going to get bigger as more people rely on the digital world.
Do a quick inventory.
How many loyalty cards do you have? How many subscriptions to newsletters, newspapers and magazines – both hard copy and electronic – do you receive? Do you pay bills online? Have you ever put sensitive information in an email? Do you have your health information stored electronically in Microsoft’s Health Vault or Google Health? Own a credit card or have a phone number?
Our phenomenal reliance on the digital form has happened almost by stealth. Even now the federal government is mulling over plans for individual electronic health records for every Australian.
Imagine you’re away from home, fall ill and see a doctor. Your electronic health record can be accessed from anywhere, so drug reactions, allergies and past procedures can be checked. Doctors can prescribe, update and send you on your way. Back home, your regular GP can see all of this on your file when you next visit.
Some of this is reality – some isn’t too far away. The National E-Health Transition Authority (NEHTA) is working on an electronic health record to be rolled out by 2010, and some states and divisions of general practice are already working on regionalised e-records.
It’s still unknown exactly what information will be contained in a national personalised e-record and how and who will access those details, but the recent endorsement of a national e-health strategy should mean a common framework is established.
But with any new technology come questions – the main ones being, is my personal information secure once it’s digitised, and where will it be stored?
Unlike hard-copy records, digitised information doesn’t have to be stored in a fixed place or on one computer.
Much more here (for subscribers):
This is a long article that makes some useful points. However I am not convinced anyone in Australia is planning to place electronic health records ‘in the cloud’. I am sure much more dedicated computing environments will be used to provide the ‘cloud –like’ access.
Fourth we have:
Kathryn Eccles - Friday, 30 January 2009
DIVISIONS are appealing for a $13 million funding injection to secure the future success of e-health in general practice.
In its 2009-10 Budget submission, the AGPN said the funding was crucial to the implementation of the national e-health strategy and the rollout of current work programs in information management, secure messaging, data governance and quality assurance.
“We want to focus on building essential infrastructure and capacity for the divisions network to be able to deliver future health priorities for Australians,” said AGPN chair David Butt. “The government needs to understand that we must be funded to do that.”
A focal part of the strategy was 60 division-based e-health officers, who would work with individual practices to boost their e-health capacity.
The full submission is available here:
While I am not sure the budget will be very flush this year (indeed I hear it will be ‘awful’) this is a good idea.
Fifth we have:
Rust Report – 30 January, 2009
After checking out merger and acquisition possibilities for a year Australian health systems developer Pro Medicus has acquired Visage Imaging, a US company that specialises in digital imaging and advanced 3D visualisation technology. The deal will be funded from Pro Medicus' cash reserves.
Visage Imaging was a subsidiary of Mercury Computer Systems and has developed a Web-based digital imaging system which it combines with a thinclient distribution technology that allows 3D images to be accessed on almost any PC without the need for enormous amounts of computer and network memory, said David Chambers, CEO of Pro Medicus.
"This is the next wave in medical imaging technology," Chambers said. He noted that a number of specialist areas have been enhanced by advanced visualisation, including cardiology where it provides 3D reconstruction of coronary arteries from highdefinition
CT images. Previously the only way to assess this was via angiography, an invasiveprocedure that requires hospitalisation.
It is good to see a small Australian Health IT making the effort to grow and acquire new technology in these difficult times. (Usual disclaimer – I have a few ProMedicus shares)
Sixth we have:
27 Jan 2009
Sydney – Tuesday, 27 January 2009 – IBA Health Group Limited (ASX: IBA) , today announced an agreement with leading Australian private hospital provider Healthscope Limited valued at$4.2 million over three years.
The agreement to implement its iSOFT’s software at 38 Healthscope hospitals is in addition to a $14 million agreement in December 2007 for software licences and support services over seven years. The initial agreement included pilot implementations of iSOFT’s web-based patient administration solution at two hospitals. Following the success of these pilots, implementation will start shortly at Healthscope’s remaining hospitals, including Knox Private Hospital in Victoria, Allamanda Private Hospital in Queensland and Mount Hospital in Western Australia.
The implementation services covered under the latest agreement include project management, software installation, system configuration, training, and migrating medical records and data from a range of legacy systems.
Dougall McBurnie, Healthscope’s Group Chief Information Officer said: “Given the marked improvements in feature and function from iSOFT’s web-based patient administration solution experienced at the two pilot installations, we have elected to roll-out the solution to all of our hospitals, thus standardising our data sets, configurations and business processes.”
This is good news for IBA and also shows a sensible approach on the part of the second largest private hospital operator to pilot their selected system – establish it suits their needs and then adopt company wide. (Usual disclaimer – I have a few shares in both the companies mentioned)
Last a slightly more technical article:
Latest related coverage
January 25, 2009 - 11:50AM
As Macintosh computers turn 25 years old with renewed vigor, Peter Friess professes a faith in Apple dating back to when founder Steve Jobs handed him one of the early machines in a German museum.
Friess, now president of The Tech Museum of Innovation in the heart of Silicon Valley, is not surprised that the world is catching on as "Macs" hit age 25 on Saturday.
Friess, 49, was in his twenties and cataloguing centuries-old watches in The Deutches Museum when he learned that Apple had built a computer.
These two articles make great nostalgic reading. It is hard to believe it is a quarter of a century since this was introduced.
More next week.