Quote Of The Year

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

Wednesday, March 18, 2009

International News Extras For the Week (16/03/2009).

First we have:

Kaiser Permanente Identifies Key Elements in Successful Health Care Information Technology Implementation

Posted : Tue, 10 Mar 2009 12:10:33 GMT

Author : Kaiser Permanente

OAKLAND, Calif., March 10 CA-Kaiser-Permanente

New Data Shows a Comprehensive Technology Infrastructure Improves Efficiency, Patient Engagement and Satisfaction; Highlights Adoption Trends

OAKLAND, Calif., March 10 /PRNewswire/ -- Two Kaiser Permanente studies published today in Health Affairs show that a comprehensive electronic health record can increase consumer convenience and satisfaction and provider efficiency while maintaining clinical quality and that connecting patients directly with their care providers and giving online access to important medical information was critical in adoption of online tools.

The papers were published just two weeks after President Barack Obama signed into law a $789 billion stimulus package that includes $19 billion earmarked for health care IT. The two studies could help answer questions about how best to maximize that investment to improve the U.S. health care system.

The first paper, The Kaiser Permanente Electronic Health Record, Transforming and Streamlining Modalities of Care, examined the impact of KP HealthConnect(TM), Kaiser Permanente's comprehensive health information system, on ambulatory care patient contacts, including outpatient, urgent care, emergency department visits, scheduled telephone visits and secure patient-physician e-mail messaging. The study was based on Kaiser Permanente's 225,000 members in Hawaii and found that between the implementation of KP HealthConnect in 2004 and 2007, office visits per member decreased 26.2 percent, total scheduled telephone visits per member increased nearly 900 percent. Secure e-mail, which began in late 2005, increased nearly six-fold by 2007.

In addition to the convenience of fewer office visits and the benefits of faster resolution of health issues, e-mail messaging and scheduled telephone visits saved consumers the often overlooked out-of-pocket expenses for travel, parking, and time lost that would otherwise be spent at work or other pursuits.

"Technology is transforming the way we deliver health care at Kaiser Permanente," said study co-author Louise Liang, MD, recently retired senior vice president, quality and clinical systems support, Kaiser Permanente. "We must become more efficient and sensitive to the needs of the individual patient to improve our health care system. Our experience can inform other efforts to harness the power of health care IT."

A second paper, If You Build It Will They Come? The Kaiser Permanente Model of Online Health Care, examined the rate at which consumers are adopting online health services, which services they are using, and the key factors that contribute to consumer acceptance of online health tools. With the world's most widely used personal health record, Kaiser Permanente's experience indicates that members find the greatest use in a Web site that facilitates e-connectivity with their health care team, allows them to view key components of their medical records, conduct clinical transactions online, and provides them with information so that they can make knowledgeable decisions about their health.

Other key findings in If You Build It Will They Come? include:

In 2007, there were nearly 33 million total visits to My Health Manager at kp.org and an average of 90,315 visits per day - a three-fold increase from 2004.

Consistently ranked among the site's top six visited features between 2004 and 2007 were prescription refill, online appointment transactions, facility directory and health encyclopedia visits.

The most visited feature on the Web site in 2007 was viewing lab test results, which became widely available to members in 2006.

In 2007, 300,000 secure e-mail messages on average were sent to providers each month, an increase of 152 percent from 2006. Since the completion of the study, the popularity of e-mail soared, with an average of 500,000 e-mails sent from members to providers each month.

By 2007, 62 percent of members registered on kp.org accessed the site two or more times in a six-month period - up from 27.7 percent two years earlier.

Member registration data showed that consumers of all ages are using online health tools. Recent data shows that approximately 31.5 percent of Kaiser Permanente's 8.6 million members are accessing the secure features on My Health Manager.

More here:

http://www.earthtimes.org/articles/show/kaiser-permanente-identifies-key-elements,743580.shtml

There could be no more powerful reminder of the capabilities Health IT can deliver than the outcomes described here. This stuff works when done right! Pity the clowns who govern this country can’t quite see it. Their stupidity or stubbornness (not sure which) is just gobsmacking

Second we have:

Wal-Mart Plans to Market Digital Health Records System

By STEVE LOHR

Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine.

Wal-Mart’s move comes as the Obama administration is trying to jumpstart the adoption of digital medical records with $19 billion of incentives in the stimulus package.

The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.

“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director of health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”

The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, the continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.

Much more here:

http://www.nytimes.com/2009/03/11/business/11record.html?_r=2&emc=eta1

Just repeated here for those who have been hiding under a rock for the last few weeks (GFC and all that). A heap of commentary has followed this!

This is some good analysis:

http://www.informationweek.com/blog/main/archives/2009/03/behind_walmarts.html

Behind Wal-Mart's E-Health Records Plans

Third we have:

Operating efficiently

Tough economy could help bring more healthcare information technology to the OR

By Joseph Conn

Posted: March 9, 2009 - 5:59 am EDT

Hospital operating rooms could see an uptick in adoption of health information technology under the twin prods of a faltering economy and IT funding courtesy of the economic stimulus package.

The American Recovery and Reinvestment Act of 2009 will provide an estimated $19.2 billion to boost health IT adoption, including reimbursement for purchasing hospital IT systems. But for hospitals, as well as most healthcare providers, the bulk of the federal IT money will come after the systems are installed.

Under a Medicare reimbursement program—which is expected to be the largest of the IT incentive initiatives—hospitals will receive a “base” amount of $2 million each, with additional funding available based on a complex formula with variables for the timing of the purchase, number of patient days, Medicare patient mix and total charges.

HIMSS Analytics, the data arm of the Healthcare Information and Management Systems Society, divides the OR market into four categories of IT systems: scheduling, pre-operative, post-operative and—the most complex—intraoperative, or in-surgery, which includes clinical support and documentation, coding, charge capture and anesthesia. (HIMSS Analytics refers to intraoperative IT systems as peri-operative.)

More here:

http://www.modernhealthcare.com/article/20090309/REG/903069993

This is a useful discussion of Health IT in the operating theatre.

There is also a nice report of a clever idea here (in a closely related area)

http://www.news-medical.net/?id=46621

Electronic medical records improve operating room scheduling

Fourth we have:

What will the stimulus do to Microsoft's HealthVault?

The stimulus package signed into law last month allocates billions of dollars to the goal of creating electronic health records for every American by 2014.

That, in turn, could increase the relevancy of Microsoft's HealthVault, an online platform where anyone can store their health records.

David Cerino, the general manager of the consumer health solutions group at Microsoft, said details about how the government effort will work are vague. (Microsoft has urged congressional officials to focus on medical "data liquidity – making it easy for the data to move around and do some good for us all.")

But Cerino said that once consumers have easy access to their digital records, they will want to take control of them and work with them.

"(Electronic) data itself doesn't mean a whole lot," Cerino said in an interview.

That's where HealthVault comes in, he said.

HealthVault allows users to easily share their health data with doctors or family members. Some of the 50 applications built on HealthVault can also take a user's digital medical records and interpret them. (Digital medical records can come from a variety of sources: Some health organizations, including Aetna and Kaiser Permanente, have linked up with HealthVault to make it easy to transfer medical records onto the platform. A service called YourHealth can also take paper medical records and upload them on the site. And selected devices, like pedometers and blood pressure monitors, can upload data directly.)

More here:

http://blog.seattlepi.nwsource.com/microsoft/archives/163343.asp

Interesting analysis of the potential impact of PHRs and where they may fit.

More discussion here:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090309/REG/303099974/1029/FREE

Microsoft unsure of stimulus law’s impact on its PHR

Fifth we have:

Doctors override most e-Rx safety alerts

E-prescribing systems' clinical decision support is "grossly inadequate," says a new study. But there are ways to stop low-severity alerts.

By Kevin B. O'Reilly, AMNews staff. Posted March 9, 2009.

If an electronic prescribing system pops up a medication safety alert but no doctor heeds it, does it ever sound the alarm?

That question appears more salient than ever, as research continues to show that the clinical decision support systems intended to protect patients from medication errors prove in some ways to be more of a hindrance than a help to doctors.

The latest example is a study of the electronic prescribing records of nearly 2,900 community physicians and other prescribers in Massachusetts, New Jersey and Pennsylvania. Nearly 230,000 times these doctors were warned about potential drug interactions, and 90% of the time they decided to proceed as if the alert had never appeared.

"The systems and the computers that are supposed to make [physicians'] lives better are actually torturing them," said Saul N. Weingart, MD, PhD, co-author of the study, which was published in the Feb. 9 Archives of Internal Medicine.

The results, Dr. Weingart said, do not show that physicians are recklessly ignoring warnings. Rather, too many of the electronic alerts are irrelevant to the clinical circumstances doctors face and the patients they treat.

More here:

http://www.ama-assn.org/amednews/2009/03/09/prsa0309.htm

eHealth events as indicator of eHealth activity

Objective

To draw a rough general picture of eHealth activity and ehealth trends in the period 2005 to 2009 using major events as indicator.

Method

We selected 6 major eHealth conferences as an *indicator* for the level and type of activity related to ehealth worldwide:

  • International Conference & Exhibition for ICT solutions in the healthcare sector - Telehealth at Cebit
  • International eHealth, Telemedicine and Health ICT Forum. For Education, Networking and Business - Medatel
  • American Telemedicine Association - ATA
  • Healthcare Information and Management Systems Society - HIMSS
  • World of Health IT Conference & Exhibition - WoHIT
  • International Society for Telemedicine and eHealth - IsfTH

Analysis & Conclusion

Assuming that the number of eHealth Conferences is a good indicator of eHealth activity worldwide, we can say that eHealth activity has increased gradually and considerably since 2005, the year of the passage of the eHealth Resolution by the World Health Assembly.

More here:

http://www.who.int/goe/ehir/trends/en/index.html

The details are interesting. There is little doubt interest is very much on the rise!

Seventh we have:

Twitter, blogs and other Web 2.0 tools revolutionize government business

If you cut through all the hype about Web 2.0 tools, you’ll find government managers and elected officials who use the technology to communicate, share information and network. Web 2.0 technologies for social networking and online collaboration let people connect quickly and with a larger audience than was ever available before.

If they’re looking for information about an obscure contract vehicle, they can post a message on a messaging service such as Twitter and see if someone can help them learn about it. Or if they run across a particularly useful piece of information on a community-created Web page, they can give it a high rating so others can find it easily in the future.

Here is a sampling of how Web 2.0 has changed the way some government managers take care of business.

Life before Web 2.0

When Jeffrey Levy needed an answer to a work-related question or an opinion about a project, he would reach out for help by e-mail or phone to a network of people that was limited to his co-workers at the Environmental Protection Agency and some peers from professional organizations.

Levy, director of Web communications at the agency, might send a group e-mail message to people he knew, but this approach was not ideal. People who did not have the time or expertise to help would receive the messages. And people outside of Levy’s ring of colleagues would never know he was looking for help.

Using Web 2.0

By using Twitter, Levy has a ready-made online network of people who share his professional interests, but who are not all government employees. Twitter lets users post short messages as long as 140 characters in length — called tweets — that other interested users can receive and comment on.

For example, Levy was trying to decide if a $1,500 Web 2.0 conference was worth the money to attend. With so much free information available from webinars and on blogs, Levy wasn’t sure he could justify going to the conference.

“So I threw out a question to my Twitter followers asking if they thought there was any value in this very expensive conference,” Levy said. His followers quickly responded that the conference was probably not worth the investment.

He also uses Twitter as a way to filter information. Levy chooses the people he follows, so he only tracks people talking about topics he’s most interested in.

Much more here:

http://fcw.com/articles/2009/03/09/web-2.0-in-action.aspx

This is a good summary of the impact Web 2.0 is having – worth a browse.

Eighth we have:

Vision 3 first GPSoC level 4 system

09 Mar 2009

INPS has announced that its Vision clinical system has become the first GP system to achieve GP Systems of Choice accreditation for its hosted services.

NHS Connecting for Health has granted Vision 3 level 4 compliance under GPSoC, which means the system has met its standards for hosted services.

Primary care trusts can also claim GPSoC funding for Vision practices using the hosting service.

The system is the first to be accredited for hosting under GPSoC, more than 18 months after eight suppliers were awarded contracts to take part in the initiative.

INPS said it had designed and built a dual data centre solution, the Vision Managed Service, to meet CfH’s hosting standards. The company said the service had been live since September 2008 and it had now reached the final milestone of its contract to deliver the service.

More than 300 GP practices are already hosted on the Vision Managed Service and INPS said a further 300 practices are scheduled to migrate to the service by the third quarter of 2009.

Full article here:

http://www.ehiprimarycare.com/news/4637/vision_3_first_gpsoc_level_4_system

This is an interesting article. I had not appreciated the number of practices in the UK that were using hosted services. I imagine part of this is due to the slightly typically larger size of practices in the UK.

Ninth we have:

The future of Scotland's health

Hi-Tech Scotland reporter | Tuesday March 10, 2009

Patients in Scotland will be able to be treated more quickly and closer to home through a raft of hi-tech health projects courtesy of funding from international IT services company Atos Origin and its partners.

eHealth investment totalling £1.6 million, including £564,000 funding from NHSScotland’s major IT partner - the Atos Origin Alliance – was announced at the first annual Scottish Telehealth and Telecare conference by Health Secretary Nicola Sturgeon.

Speaking at the conference, Ms Sturgeon unveiled details of projects extending the use of electronic technology in the NHS, including: Touch screens in the homes of hundreds of patients with chronic conditions in Lothian, allowing them to be monitored from home; Online scanning allowing patients in Orkney to be diagnosed remotely, avoiding lengthy trips to hospital; New software in Glasgow transmitting patients’ records directly to consulting rooms.

Ms Sturgeon said: “Telehealthcare technologies and eHealth have huge potential to benefit patients, by harnessing all that technology can offer to make care quicker, safer and closer to home. It also allows more efficient working and better support for our health and care staff.

Much more here:

http://hi-techscotland.com/article/09-03-10__the-future-of-scotlands-health

Interesting to see how Scotland is pushing forward building on the pretty good basic systems they already have in place.

Tenth we have:

Stimulus Money + EHR + Medical Home = Reform

Kathryn Mackenzie, for HealthLeaders Media, March 10, 2009

There are five areas the United States has to concentrate on in order to improve healthcare: coverage for all, payment incentive reform and realignment, wellness initiatives, quality improvement, and health information technology. That is what American Hospital Association President Richard Umbdenstock told key stakeholders last week during President Obama's White House healthcare summit.

If those are indeed areas we should be focusing on for healthcare reform, why aren't we hearing more talk about the patient centered medical home model? The very idea of the PCMH is founded upon reducing chronic diseases and improving quality care through preventive medicine and wellness initiatives, according to guidelines put forth by the National Committee for Quality Assurance.

The concept also represents a way of realigning financial incentives with healthcare delivery goals to provide coordinated, integrated, ongoing care, says Salvatore Volpe, MD, who runs a PCMH practice in Staten Island, NY.

Two things facilitate that integration and continuity of care: the primary care physician and health information technology, says Volpe. Primary care physicians, understandably, balk at spending the extra (uncompensated) time on attempting to arrange for follow-up care for each patient. But under the PCMH model, physicians are paid for services such as care management and care coordination, which are not reimbursed under the current fee-for-service system.

"The current system penalizes you for using HIT. If I spend the additional time to use my EHR to look up what's needed for my patient in terms of preventative, I'm being penalized because I'm spending additional time I could be spending seeing another patient," says Volpe. "We have to be reimbursed for that extra service and time. The only place I'm seeing that done is with the patient centered medical home," he says.

More here:

http://www.healthleadersmedia.com/content/229487/topic/WS_HLM2_TEC/Stimulus-Money-EHR-Medical-Home-Reform.html

A good perspective – also pointing to a direction Australia could usefully push harder towards with some modifications based on how the Australian system works. I believe evolution of the ‘medical home’ concept has a good deal to offer here!

Eleventh for the week we have:

Few hospitals reach HIMSS Stage 7 EHR ranking

By Joseph Conn / HITS staff writer

Posted: March 10, 2009 - 5:59 am EDT

Thirteen hospitals have been named by HIMSS Analytics as tops in the nation in that organization’s latest ratings of hospital information technology systems adoption.

All 13 hospitals named as the first ever to achieve the highest rating of Stage 7 on the HIMSS Analytics EMR Adoption Model came from two hospital systems, Oakland, Calif.-based Kaiser Permanente, which had 12 hospitals on the list, and NorthShore University HealthSystem, Evanston, Ill., which had three of its four campuses honored. All 13 have products from Epic Systems Corp., Verona., Wis., at the core of their clinical healthcare IT systems.

Last month, HIMSS Analytics announced that 42 hospitals had reached Stage 6 of its model. The model was developed in 2004 as a way for the industry to measure the penetration of electronic health-record systems in hospitals. The scale runs from zero to 7. HIMSS Analytics is the data analysis arm of the Chicago-based Healthcare Information and Management Systems Society

More here:

http://www.modernhealthcare.com/article/20090310/REG/303109991

Certainly this shows there is room for improvement in hospital system deployments!

Twelfth we have:

Obama calls healthcare IT 'low hanging fruit' on health reform

March 06, 2009 | Diana Manos, Senior Editor

WASHINGTON –

President Barack Obama called healthcare IT the "low hanging fruit" on healthcare reform and an area in which Republicans and Democrats could find common ground.

His comments came during Thursday's healthcare reform summit at the White House, which brought together a bipartisan mix of Congressional leaders and other stakeholders to launch the president's healthcare reform plans.

Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee – and someone expected to play a key role in healthcare reform legislation – endorsed healthcare IT as a way to cut costs and align provider incentives.

"Healthcare reform is a no-brainer," he said. "The American public wants it."

Rep. Henry Waxman (D-Calif.) chairman of the influential House Committee on Energy and Commerce, said there would be trade-offs in working out healthcare reform, but "doing nothing is not an alternative."

More here:

http://www.healthcareitnews.com/news/obama-calls-healthcare-it-low-hanging-fruit-health-reform

Certainly a sensible approach!

Thirteenth we have:

RC WinScribe Digital Dictation Speeds Up Life-Saving Diagnoses in East Kent

SRC have delivered a digital dictation with integration speech recognition solution to East Kent Hospitals. Reporting turnaround times have been cut from a week to often the same day. The Trust has reported an accuracy rate for all speech recognition work in excess of 99% across a variety of accents.

London, UK (PRWEB) March 11, 2009 -- Cancer patients in East Kent are now being diagnosed twice as quickly, thanks to a digital dictation solution provided by SRC (www.src.co.uk) and implemented at East Kent Hospitals University NHS Foundation Trust.

Where Pathologists once had to write the often complex results of their tests by hand for a secretary to input into a computer system, SRC's voice recognition solution now allows them to dictate into the system in real time while they are actually performing the tests, which means GPs and Consultants receive life-saving results much more quickly.

Histology reporting turnaround times have been cut from a week to often the same day.

More here:

http://www.prweb.com/releases/2009/03/prweb2217874.htm

Seems like voice recognition is really making a difference here!

Fourteenth we have:

Google Health now made for sharing

10 Mar 2009

Google Health has unveiled a new feature of its online personal health record that allows users to share their medical details with doctors, carers or family members.

The new features allow a user to elect to share either a summary, or selected details, of their record with chosen individuals. The sharing feature can subsequently be amended at any time by a user.

Google said it added the feature in response to users' concerns that caregivers and family members might not know the latest details about their health situation, particularly in an emergency situation.

More here:

http://www.ehealtheurope.net/news/4641/google_health_now_made_for_sharing

Sounds to me Google is now essentially a plug in replacement for the NEHTA IEHR!

Third last we have:

NHS boss puts programme tender on table

12 Mar 2009

NHS chief executive David Nicholson told MPs on Wednesday that the Department of Health is going to tender for alternatives to the iSoft Lornezo and Cerner Millennium care record systems.

Nicholson said that the tender was being carried out as insurance because the National Programme for IT in the NHS is now at a “critical phase”. He said both the iSoft and Cerner products needed to come good in the next few months.

Speaking at a Health Committee hearing into the Operating Framework for 2009-10, he remained cautiously optimistic about this happening. But he said: “It’s helpful to us, I think, to have reserves if one of them fails.”

E-Health Insider understands that NHS Connecting for Health will say that Nicholson was only referring to the South of England, where Fujitsu left as local service provider a year ago.

More here:

http://www.e-health-insider.com/news/4652/nhs_boss_puts_programme_tender_on_table

I wonder who might have a go in responding to this?

Second last for the week we have:

AMA to White House: Don't Dictate Care

John Commins, for HealthLeaders Media, March 9, 2009

President Obama is calling for flexibility and compromise from stakeholders in the healthcare reform debate, but the nation's largest physicians' organization warns that any attempts by the federal government to use evidence-based medicine to dictate how physicians provide individualized care would be a deal breaker.

In an interview with HealthLeaders Media, American Medical Association President Nancy Nielsen, MD, says she's already made that clear in her two summit meetings with the president in the last two weeks.

"Government control of the doctor-patient relationship is a no deal," Nielsen says. "Although there is no question that we need to be sure that the best science and evidence is used when we deal with a patient, it isn't that easy. People who think that 'we just put out a guideline and if you don't follow it, we will smack you down,' well, it isn't that simple because patients aren't that simple. What we have to get to is the concept that what needs to be done is what is appropriate for that patient."

The "smack you down" people that Nielsen is referring to would include White House Budget Director Peter Orszag, who has emerged as a leading figure in the Obama administration's drive to reform healthcare—in part because Kansas Gov. Kathleen Sebelius has yet to be confirmed as HHS secretary. The Obama administration included $1.1 billion in last month's $787 billion stimulus program to launch "comparative effectiveness" research, and Orszag has said that evidence-based medicine could be used as a financial incentive to guide physicians toward cost-effective care.

"We have a set of financial incentives that encourage more care rather than better care," Orszag told a Robert Wood Johnson forum last year. "In order to change that we need to do a lot more testing of specifically head-to-head comparisons of what works and what doesn't and we need to pay for what works and not so much for what doesn't."

More here:

http://www.healthleadersmedia.com/content/229394/topic/WS_HLM2_HR/AMA-to-White-House-Dont-Dictate-Care.html

I always love seeing the medical profession demanding the right to ‘stuff up’ by not following evidence. Sure there are exceptions – and professional skill is important – but not following clear evidence about what works and what doesn’t in a particular clinical situation is just arrogance!

Last for this week we have:

HHS Seeks Candidates for HIT Standards and Policy Committee

Mike Klein

March 11, 2009

Madison - The US Department of Health and Human Services is seeking nominations for individuals to make recommendations to the National Coordinator for Health Information Technology on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information for purposes of health information technology adoption.

There is an urgency that these nominations be submitted for appointments to either the HIT Standards Committee or the HIT Policy Committee, no later than March 16, 2009, to ensure adequate opportunity for review and consideration of nominees prior to appointment of members.

The American Recovery and Reinvestment Act of 2009 amends the Public Health Service Act. The new section 3003 of the PHSA establishes the HIT Standards Committee to make The HIT Standards Committee members are to be appointed by the Secretary of the Department of Health and Human Services with the National Coordinator taking a leading role.

Very much more here:

http://wistechnology.com/articles/5674/

Clearly the US is moving very fast to get the various standards monitoring and development systems in place to make the Health IT thrust a reality! We seem to lack the same sense of urgency in OZ!

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

David.

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