Again there has been just a heap of stuff arrive this week.
First we have:
Electronic records would improve Americans' health
Robert Pearl
Wednesday, February 25, 2009
For much of his retirement, my father traveled back and forth between New York and Florida, joining many other so-called snowbirds who spend their winters playing golf in the Sunshine State. But five years ago, my father became ill. My father's New York physician assumed he had received the recommended pneumococcal vaccine in Florida. His Florida physician assumed he received the vaccine in New York. Sadly, because neither physician had access to my father's complete medical history, both had no way of knowing their assumptions were wrong, and my father died from a preventable pneumonia.
When I returned home from my father's funeral, I put his medical information into Kaiser Permanente's computerized health-record system, which factors gender, age and myriad medical variables and generates a regimen of recommended care. There, at No. 7 on the list, was the pneumococcal vaccine.
The American health care system is archaic, fragmented and paper-based. As a result, it's highly ineffective. The Institute of Medicine has pointed out that close to 100,000 Americans a year die from medical errors, and a Rand study found that patients receive only 55 percent of the recommended treatment for preventive care, acute disease and chronic conditions. This is unacceptable.
Much more here:
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/24/EDDK1641AH.DTL
A nice article that makes the e-health case as it should be made – the positive impact on the individual!
Second we have:
A stimulating conversation
Healthcare organizations praise the economic stimulus law, start considering ways to use the $150 billion in relief
Posted: February 23, 2009 - 5:59 am EDT
The $150 billion in planned healthcare spending contained in the giant stimulus package signed last week by President Barack Obama can’t come soon enough for some healthcare providers.
Much of the money for healthcare in the spending package to revitalize the economy over the next 10 years is likely to come sooner rather than later to states and providers in the form of increased Medicaid spending—but the long-term effects of these new benefits won’t be felt for quite some time.
And while the package has the potential to create new jobs, decrease insurance and provide hospitals and other providers with the resources to improve their infrastructure, not every provider or patient will come out of this a winner, healthcare sources indicate.
The $787 billion American Recovery and Reinvestment Act of 2009, signed in Colorado last week by President Obama, includes at least $150 billion for healthcare, with the lion’s share going toward expanding COBRA by $25 billion and Medicaid assistance to the states by $87 billion, while bulking up health information technology to the tune of $19 billion. The new law also takes steps to boost hospital pay, fund comparative effectiveness research, and support clinical preventive services and community-based prevention programs.
Much more here:
http://www.modernhealthcare.com/article/20090223/REG/902209937
Just by way of a reminder that the total additional dollars into the US health system is huge – about $150 Billion or so
Third we have:
California HIE to launch in Orange County
- By Brian Robinson
- Feb 20, 2009
Project is the first of similar health information exchanges planned for Los Angeles County, Sacramento, and other population pockets
The development of a statewide health information exchange in California will formally begin in July with the launch of an electronic medical record service that will provide critical patient information to 23 Orange County emergency departments.
The initiative is the first step in a possible expansion of similar services early next year to other populous areas such as Los Angeles County and Sacramento, and eventually to other urban and rural areas of the state.
The Orange County system will at first provide emergency physicians with medical record information on some 360,000 patients enrolled in CalOptima, which provides coverage for people on Medi-Cal, the state’s version of Medicaid, as well as Medicare and the Healthy Kids program.
Early in 2010 the system, based on the HIE platform built by the California Regional Health Information Organization (CalRHIO), is expected to also provide additional data to physicians such as medical history, laboratory data and clinical claims data.
More here:
http://govhealthit.com/articles/2009/02/20/california-hie-to-launch-in-orange-county.aspx
This is really huge news –as what is being moved towards is essentially an approach to the NEHTA IEHR for 37 million people. This should be watched very closely indeed by NEHTA and the UK NHS!
Fourth we have:
Watchdog warns of pitfalls of healthcare by e-mail
Published Date: 22 February 2009
By Kate Foster
SCOTLAND'S emergency medical hotline, NHS24, has launched a service providing patients with health advice by e-mail.
Scots with non-urgent health worries can send in their questions and nurses will respond with answers.
The move is the latest expansion for the telephone service, which provides out-of-hours medical cover for the NHS across Scotland.
John Turner, chief executive of NHS24, revealed the move was part of its plan to provide wider health services for patients.
He said hundreds of inquiries were being logged every month, on subjects including sexual health, immunisations and children's health, as well as dentistry and NHS services.
Staff can provide information on illnesses and conditions, as well as details of local pharmacies, GP and dental practices, including opening times.
The service has been set up for patients using the NHS24 website, which also has a self-help guide and support groups directory.
Turner added: "Since NHS 24 was created, our focus has been on our increasing role in supporting the wider out-of-hours services and a wider health care agenda for Scotland."
More here:
http://scotlandonsunday.scotsman.com/scotland/Watchdog-warns-of-pitfalls-of.5004377.jp
I must agree with the caveats on this. Care should be taken to rapidly screen all incoming e-mails and triage those that are inappropriate to other services.
Fifth we have:
Physicians to receive incentives for EHR use
February 20, 2009 | Chelsey Ledue, Associate Editor
CHICAGO – The American Recovery and Reinvestment Act of 2009 provides financial incentives to physicians who adopt and use Electronic Health Record (EHR) technology. However, physicians who haven't adopted certified EHR systems by 2014 will have their Medicare reimbursements reduced by up to 3 percent beginning in 2015.
The act provides $20 billion in health information technology funding, divided between $2 billion in discretionary funds and $18 billion in investments and incentives through Medicare and Medicaid, to ensure widespread adoption and use of interoperable healthcare IT systems.
"In one stroke, Congress has all but removed the biggest stumbling block to EHR adoption - cost," said James R. Morrow, MD, a physician at North Fulton Family Medicine in Alpharetta, Ga., who was named "Physician IT Leader of the Year" by the Health Information and Management Systems Society (HIMSS). "It's time for doctors to stop complaining about the cost of an EHR and take the ball and run with it toward the goal of better medicine with better records and information sharing across the healthcare team."
With the stimulus, the Centers for Medicare and Medicaid Services will pay physicians $44,000 to $64,000 over five years, beginning in 2011, for deploying and using a certified EHR. The stimulus package is expected to ignite significant job growth in the information technology sector and, according to a Congressional Budget Office review, drive up to 90 percent of U.S. physicians to EHRs in the next decade.
More here:
http://www.healthcarefinancenews.com/news/physicians-receive-incentives-ehr-use
It was always going to be money that would facilitate adoption and use. Seems it is the only incentive that really works. The trick is to link the money closely to the actual END outcomes sought. Australia did not get this quite right a few years back in my view.
Sixth we have:
EHR Vendor: We Need to Step Up
February 20, 2009
Electronic health records vendors need to take the new Health Information Technology for Economic and Clinical Health Act within the economic stimulus law seriously and start educating employees and customers now. They also need to step up and quickly enhance their products to meet the act's requirements.
That's the view of Charlie Jarvis, assistant vice president of healthcare industry services and government relations at NextGen Healthcare Information Systems Inc., Horsham, Pa. "The vendor community needs to see this law as totally evolutionary in how they will make their products and conduct their business," he adds.
NextGen in late January added a new section to its Web site to explain components of the stimulus bill and continues to update it. The vendor also conducted a Web seminar on the law's health I.T. provisions on Feb. 17, the day that President Obama signed the bill.
Physicians, who are "somewhere between confused and concerned," about the new law, need to get more involved as the process now moves to the administrative rules stage, Jarvis believes. "It is extremely important for physicians to be involved in this process," he contends. "There's still a lot of work to be done. There's still a lot of influence they can have on the final product."
More here:
http://www.healthdatamanagement.com/news/stimulus27752-1.html
It is good to see there is recognition that progressive improvement of systems will be important as this initiative is rolled out.
Seventh we have:
New Vendor Tackles Referrals
February 20, 2009
A new company, Visions@Work LLC, has introduced software to automate the patient referral process.
.....
The new software, called Preferr, enables providers to initiate, receive and manage referrals electronically.
.....
The remotely hosted software is available via a monthly subscription. More information is available at visionsatwork.org.
--Joseph Goedert
More here:
http://www.healthdatamanagement.com/news/referrals27748-1.html
I think we are surely going to see more of this sort of startup over the next year or so as the Obama funds flow!
Eighth we have:
Conference "in Limbo," Former Leader Says
February 23, 2009
The leaders of the Medical Records Institute in Boston have left the organization and will lead mHealth Initiative Inc., an organization announced in early February.
The Medical Records Institute "is in limbo," says Peter Waegemann, who was CEO of the advocacy organization that operated the TEPR Conference and now is executive director of mHealth Initiative. "There may be another TEPR, there may not be."
Claudia Tessier, who served as vice president at the Medical Records Institute, now is president of mHealth Initiative. The Medical Records Institute last year created the Center for Cell Phone Applications in Healthcare to promote the use of mobile technologies. In early February, the center was reestablished under the mHealth Initiative name as an independent, not-for-profit organization.
More here:
It seems one of the earliest into the EHR space has bailed out – just before the dream was funded and has a chance of realisation!
Ninth we have:
The healthcare of tomorrow: Siemens networks Dutch medical center
23 Feb 2009 , Munich :
Advanced information and communication technology for the hospital of the 21st century: Siemens implements modern solutions at the Orbis Medical Center in the Netherlands. The project comprises the digitalization of incoming mail, identity and access management including smartcards, the integration of bedside terminals, virtualization of workstations and the establishment of IP networks and IP telephony. The Orbis Medical Center includes the Maasland Hospital, nine clinics and care centers, a psychiatric center, a nursing service and a hospice.
Orbis Medisch en Zorgconcern developed a new concept for healthcare and care of the elderly. All work, treatment and care processes were redefined and adapted to the new concept. The concept required a new and tailored IT landscape which was integrated by Siemens IT Solutions and Services: “Thanks to the ICT architecture, we are now in a position to gear our healthcare processes even more strongly towards our patients. We can provide better healthcare and even save money at the same time,” says Cees Sterk, member of the Managing Board of Orbis medical healthcare group.
Full article here:
http://www.prdomain.com/companies/S/Siemens/newsreleases/200922468199.htm
Sounds like this would be worth a visit when next in Europe – some interesting ideas here clearly!
Tenth we have:
How To Consolidate Patchwork of Health Information Confidentiality Laws
by Dennis Melamed
Legislative mandates to generate reports and statistics almost always evoke yawns if they are noticed at all. And possibly no detail could be smaller and more obscure than the requirement in the huge economic stimulus package for HHS to report its statistics on HIPAA privacy and security enforcement as part of the multibillion-dollar plan to computerize medical records.
So why bother mentioning it?
Because these statistics could create the foundation for rationalizing our fragmented system of privacy laws and regulations and at least provide some baby teeth for enforcement.
Bear with me for a moment or two.
No discussion of electronic health information can occur without at least a cursory bow in the direction of patient rights, which is immediately followed by the lamentation that the "devil is in the details." One of these details is the lamentable failure of HHS' Office for Civil Rights to respond to the majority of HIPAA privacy and security complaints that fall out of its jurisdiction. (For the purposes of this discussion, I'll put aside the serious issues afflicting the Office of e-Health Standards and Services at CMS and the transparency of its activities.)
From the moment the HIPAA medical privacy rule went into effect in April 2003 through Dec. 31, 2008, OCR received a total of 41,107 complaints, according to the agency's statistics. Of those, only 11,587, or 28%, fell within the scope of OCR's HIPAA jurisdiction and required the agency to respond, according to OCR.
That left the remaining 72%, or 29,520 complaints. To be sure some were frivolous or filed too late.
More here:
Seems the US has the same problems with its States that we do!
Eleventh we have:
Health-Care Technology: Patient Involvement Helps
A new study shows the participation of patients in the use of electronic medical records can improve the effectiveness of the system
As President Barack Obama pushes for the use of more information technology in the health-care sector, a new study suggests that getting patients involved in the effort, along with hospitals and doctors' offices, can lead to substantial benefits. The research, conducted by Harvard Medical School and two other institutions, shows that reminding patients to take a critical cancer test is actually more effective than reminding their doctors about the same test. "When we talk about improving the health-care system, what we should do is also talk about how we can take advantage of our patients as a resource," says Thomas Sequist, one of the study's authors and an assistant professor of medicine and health-care policy at the Harvard Medical School, and Brigham & Women's Hospital.
The report comes just as the Barack Obama Adminstration is undertaking an ambitious effort to overhaul U.S. health care. The economic stimulus package Obama signed into law on Feb. 17 includes roughly $20 billion to help convert wide swaths of the industry to electronic health records. Experts have said for years that information technology could improve the productivity, efficiency, and safety of the health-care industry. But hospitals and doctors have resisted making technology investments, in part because they have had to bear most of the costs of technology while they reap few of the benefits.
The Obama approach aims to change the financial calculation for health-care providers. The government will give up to $65,000 to each doctor's office and $11 million to each hospital that shows meaningful use of digital records. (To be eligible, the health-care providers need to participate in Medicare, the government health-insurance program for the elderly. There are similar financial incentives for Medicaid participants.) In addition, the government will spend about $300 million to create regional data exchanges, making it easier to maintain comprehensive patient records as people switch between doctors’ offices, hospitals, and pharmacies.
The government will also begin penalizing health-care providers that resist the adoption of electronic records. Doctors who don't begin using the technology by 2015 will stop getting inflation adjustments for Medicare payments. The goal is to make all health-care records digital within five years. "It's a combination of a carrot and a stick," says Karen Davis, president of the Commonwealth Fund, a nonprofit research group in New York.
More here:
http://www.businessweek.com/technology/content/feb2009/tc20090223_182043.htm
This study makes an important point regarding patient involvement – worth a read of the full set of articles on the topic.
Twelfth for the week we have:
Here Comes the Stimulus Money, Now Spend It Wisely
Kathryn Mackenzie, for HealthLeaders Media, February 24, 2009
Now that the $787 billion American Recovery and Reinvestment Act has been signed into law and billions of dollars are about to be funneled into HIT, the promise of improved care through technology has become something of a mantra: If you implement an electronic medical record, you will save money and more of your patients will survive.
Seems like a fairly simple equation, and a recent study from UT Southwestern certainly bolsters that notion, concluding that hospitals that use EMRs, CPOE, and clinical decision support systems saw a 15% decrease in the odds of in-hospital deaths. But one of the study's lead researchers warns that simply acquiring and installing these systems won't be enough.
The study compared 41 urban hospitals in Texas using an instrument created by the researchers that measures physicians' interactions with information systems. The researchers examined the rates of inpatient death, complications, costs, and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same time frame in 2005 and 2006.
More here:
It is hard to argue with that as a proposition!
Second last for the week we have:
Stimulus Bill dramatically modifies HIPAA rules
February 18, 2009
Business Associates and Covered Entities Must Address New Requirements
The American Recovery and Reinvestment Act (the “Act”; also informally known as the “Stimulus Bill”) was signed into law by President Obama on February 17, 2009. The Act contains surprising modifications to HIPAA's Privacy and Security Rules. These changes will likely require every business associate agreement to be modified. The Act also, for the first time, requires business associates to comply directly with many of HIPAA's rules and subjects business associates to HIPAA’s civil and criminal penalties. The Act increases the penalties for various HIPAA violations and dramatically expands other remedial actions (such as increasing federal government audits; granting attorneys fees in some HIPAA lawsuits; and allowing a method for individuals to recover penalties under HIPAA). The changes are significant to all covered entities, but are most challenging for business associates, who now face a host of new requirements.
Much more here:
http://wistechnology.com/articles/5513/
I provide this – not as more on the Obama stimulus – but as a reminder of how complex health privacy law can become. This is something I am not sure NEHTA yet grasps!
Last for this week we have:
The search for John Doe
- By Nancy Ferris
- Jan 26, 2009
Scientists and policy-makers seek ways to maintain patient anonymity and tap the data treasure trove of personal medical records
A new era for medical privacy dawned in 1997, when a computer scientist named Latanya Sweeney showed she could identify then-Gov. William Weld of Massachusetts on a list of patients discharged from a hospital, even though the data had been stripped of identifiers such as names, addresses and Social Security numbers.
Using a publicly available list of registered voters, Sweeney zeroed in on Weld’s ZIP code in Cambridge, Mass., and matched dates of birth and genders on two lists downloaded from the Internet. Weld emerged as the only match.
Sweeney said 87 percent of Americans could be similarly identified in a dataset even if it reveals only their birth dates, genders and ZIP codes. Lawmakers took her comments into account when they crafted the Health Insurance Portability and Accountability Act’s Privacy Rule, which took effect in 2003, nearly seven years after Congress passed HIPAA.
Today, medical data is increasingly being stripped of identifying information and sold to the highest bidders. However, a growing number of mathematics and computer science experts are saying that such de-identified datasets lend themselves to re-identification with today’s advanced data-mining techniques.
Sweeney told a workgroup of the National Committee on Vital and Health Statistics in 2007 that the chances of re-identifying someone through data that complies with HIPAA’s requirements for de-identification are 0.04 percent.
Much more here:
http://govhealthit.com/articles/2009/01/26/the-search-for-john-doe.aspx?s=GHIT_240209
Read and be amazed just how hard this can be!
This is also worth a look:
http://govhealthit.com/Articles/2009/01/26/5-ways-researchers-can-get-medical-records.aspx
5 ways researchers can get medical records
- By Nancy Ferris
- Jan 26, 2009
Under the Health Insurance Portability and Accountability Act’s Privacy Rule, biomedical researchers have five ways to obtain medical records, although they say none is ideal.
There is an amazing amount happening (lots of stuff left out). Enjoy!
David.
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