Again there has been just a heap of stuff arrive this week.
First we have:
Dr. David Blumenthal offered this week a first significant glimpse into how he views the policy choices ahead of him as he prepares to take over as national coordinator for health IT.
In a perspective piece published April 9 by the New England Journal of Medicine, Blumenthal said that to carry out Congress’ intentions in the recently passed health IT stimulus legislation, it will be important not to set the bar too high for providers to qualify for health IT funding.
The current certification process for health IT needs tightening, he said.
Congress provided $20 billion in health IT incentives in the American Recovery and Reinvestment Act as the means to improve the quality of health care, not as an end in itself, Blumenthal said.
“Under the pressure to show results, it will be tempting to measure…the payoff from the $787 billion stimulus package in narrow terms — for example, the numbers of computers newly deployed in doctors' offices and hospital nursing stations,” Blumenthal said.
More here:
http://govhealthit.com/articles/2009/04/10/blumenthal-signals-position-on-key-stimulus-policies.aspx?s=GHIT_140409
It is important to understand the directions ONCHIT is now pursing. Read on.
Second we have:
By CHRISTINE LARSON
RUSS CUCINA, 37, lives a double life. For two months of the year, he practices internal medicine, treating patients at the UCSF Medical Center in San Francisco. The rest of the year, he helps the hospital develop its electronic medical records and other data systems.
As a medical doctor who also has a master’s degree in biomedical informatics, Dr. Cucina has a foot in both worlds — medicine and technology — and can bridge the sometimes daunting gap between them.
“I’m the glue between the I.T. enterprise and the clinical leadership,” said Dr. Cucina, the hospital’s associate medical director of information technology. “Because I have the vocabulary of both sides, I can serve as translator between them.”
Such translators, known as “health informatics specialists,” typically have expertise in medical records and claims, clinical care and programming.
“The health I.T. people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff,” said William Hersh, chairman of the department of medical informatics and clinical epidemiology at Oregon Health and Science University.
The federal government’s economic stimulus package is dedicating $19 billion to speeding the adoption of electronic health records, so demand for health informatics specialists is skyrocketing. “My rough estimate is that we need about 70,000 health informaticians,” said Don E. Detmer, president and chief executive of the American Medical Informatics Association, a nonprofit industry group.
More here (registration required):
http://www.nytimes.com/2009/04/12/jobs/12starts.html?_r=2&hpw
It seems pretty certain that if the US needs 70,000 more we sure as heck need a few thousand extra. We are training only a handful at present – so this will be a problem! (A bit like the one the National Broadband Network will find as it tries to create the NBN – a big lack of telecoms engineers!)
Third we have:
Google service's inaccuracies may hold wide lesson
By Lisa Wangsness
Globe Staff / April 13, 2009
WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.
Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."
"I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua.
DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.
"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at Cisco Systems.
Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.
For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.
Reporting continues here:
http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/
If ever there was an example of the importance of appropriate and accurate clinical coding this is it. If we are going to trust any record – we need to be sure it is as accurate as possible. The issue is very hard in the US as the diagnostic coding system used at present (ICD-9) is essentially obsolete and is being replaced over the next few years. Of course we are a long way in OZ, as well, from having implemented what is probably needed to avoid this problem (SNOMED – CT).
Fourth we have:
NEW YORK –
NewYork-Presbyterian Hospital launched a new electronic personal health record, myNYP.org, which gives its patients free access to their medical information.
The record uses Microsoft’s HealthVault and Amalga technologies to offer patients the ability to select and store personal medical information generated during their doctor and hospital visits at NewYork-Presbyterian. The system uses a “pull model” in which patients proactively opt to copy their medical data into their own personal health record and access that information using a secure username and password with any Web-enabled device.
Hospital leaders believe the system is the first of its kind to be launched at a major medical institution and the only such system which provides security, privacy and portability to all patients.
More here:
http://wistechnology.com/articles/5893/
I have a feeling this is essentially the way of the future in some form or another.
Fifth we have:
April 14, 2009 | Bernie Monegain, Editor
CHICAGO – Critical care patients at seven of Chicago-based Resurrection Health Care's hospitals are far less likely to develop complications and have extended ICU stays since the health system implemented an advanced information technology system.
Data from more than 12,000 patients treated from 2006-2008 at 13 Resurrection ICUs, presented last week at the Health Information and Management Systems Society's annual conference, show substantial reductions in complications, mortality and length of stay. This data supports results from other hospitals nationwide that using eICU technology to link remote critical care specialists with hospital ICU teams is one solution to the nation's growing crisis in critical care.
Resurrection's eICU system, developed by Baltimore-based VISICU, uses information technology and connectivity to link ICU patients and their bedside care teams across Chicago to a remote, central command center staffed by Resurrection intensive care specialists and critical care nurses.
Intensivist physicians are in short supply. According to the Leapfrog Group, numerous studies show intensivist staffing reduces the risk of ICU mortality by up to 40 percent, but less than a third of patients nationwide have access to these specialists.
More here:
http://www.healthcareitnews.com/news/it-helps-prevent-complications-resurrection-health-hospitals
Another technology that seems to really work!
Sixth we have:
By Joseph Conn / HITS staff writer
Posted: April 14, 2009 - 11:00 am EDT
Robert Wah is no Jay Gatsby; he’s not trying to re-create the past, but he knows what it’s like not having the money to make your dreams come true.
Wah, a physician informaticist, is now chief medical officer for Computer Sciences Corp. He served as first deputy to David Brailer when Brailer was named in 2004 to head the newly created Office of the National Coordinator for Health Information Technology.
Wah made a presentation on connecting huge private- and public-sector databases of healthcare information during the recent Healthcare Information and Management Systems Society’s conference in Chicago.
When Wah moved over to the ONC, he had been associate chief medical information officer with the U.S. Navy, and it was like moving to another world. President George W. Bush’s executive order that created the ONC in April 2004 also said that there would be no additional federal money appropriated to carry out ONC’s work. Catching the drift, a Republican-controlled Congress zeroed out the ONC’s first full-year budget, forcing HHS to shift money around internally to keep the ONC afloat. “I came from DoD with a $900 million budget,” Wah recalled with a smile. “I came to David and asked him, ‘What do you have for money?’ He said, ‘$60 million.’ ”
“We were fighting for every dime,” Wah said. “We were facilitating market-based solutions. It’s a whole different environment now.”
Lots more here (registration required):
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090414/REG/304149996
This is very important as it shows how hard it is to implement an unfunded Health IT Strategy. Mr Rudd and Ms Nixon are you listening!
Seventh we have:
Monday, April 13, 2009
by Jane Sarasohn-Kahn
Billboards and banners inside the grand hall of McCormick Place set the tone for the vendor floor at the annual meeting of the Healthcare Information and Management Systems Society, version 2009 in Chicago: "The time is now," one read. Another said: "Is your strategy shovel ready?" Urgency was the undertone, from poster to corporate brochure.
And, in the polished, produced introduction to the HIMSS conference, a strong pronouncement reminiscent of the Reagan-Gorbachev Berlin Wall speech appeared on the screens insisting to thousands of attendees: "Tear down these proprietary walls."
That was the HIMSS leadership alluding to the fact that we need open standards, interoperability and connections for health information exchange, which have been provided $19 billion in funding courtesy of President Obama and the U.S. Congress. That's what's included in Title IV of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
ARRA Is the New "Ohmm" for Health IT Folk
Thus, the mantra this year at HIMSS was a low, sustained chant of "ARRA," focusing the vendor collective on health IT money earmarked in the American Recovery and Reinvestment Act -- President Obama's stimulus package. "Our work has changed in 19 billion ways," said a CIO from a venerable big hospital.
Lots more here:
http://www.ihealthbeat.org/Perspectives/2009/Connectedness-Communities-Capital-Putting-HITECH-in-Context.aspx
Love the comment that ARRA is the new “Ohmm”! Sounds very soothing and happiness making!
Eighth we have:
Choice for policy makers may be between tough patient privacy rules and speedy EMR enactment
Jaikumar Vijayan (Computerworld (US)) 15/04/2009 05:18:00
In a study that is unlikely to find favor among privacy advocates, researchers from two academic institutions warned that increased privacy protections around health data will hamper the adoption of electronic medical records systems.
The study (abstract), conducted by researchers at MIT and the University of Virginia, said adoption of EMR is often slowest in states with strong medical privacy protections.
On average, up to 30% fewer hospitals adopted EMR in states where they were forced to operate under strong privacy laws compared to hospitals in states with less stringent privacy requirements. That's because privacy protections often made it harder and more expensive for hospitals to exchange and transfer patient information, thereby reducing the value proposition of an EMR system, the study found.
"Despite EMR's effectiveness at reducing medical errors and improving baseline indicators of patient health, hospitals are deterred from adopting it by strong healthcare privacy laws," the study claimed.
The results of the research, which looked at EMR adoption in 19 states over a 10-year period, was originally presented at a Federal Trade Commission workshop in April 2008. It was publicly released only this week following its acceptance in the journal Management Science, an MIT spokesman said.
The research suggests that there's a tradeoff between achieving fast adoption of EMR and strong health-care privacy, said Catherine Tucker, an assistant professor of marketing at MIT's Sloan School of Management and one of the report's authors. In general, while medical privacy is a good thing, it doesn't always allow for quick adoption of EMR systems, Tucker said.
"What we found was that privacy laws are getting in the way of hospitals'" trying to exchange information with each other, she said. "Policy makers are going to have to choose how much EMR adoption they want and at what cost to patient privacy."
Full article here:
http://www.techworld.com.au/article/299305/privacy_rules_slow_adoption_electronic_medical_records
This is quite a surprising finding. I am sure part of it is due to the complexity of much of the privacy law at a state level in the US – which just makes people throw up their hands a say ‘it’s all too hard’!
Ninth we have:
Cultural resistance - not the least from healthcare workers - and a huge shortfall of public funds continue to be major obstacles to the widespread adoption of e-health programs in North America. Canadian and U.S.thought leaders in healthcare transformation discuss these challenges and how to overcome them.
4/13/2009 7:00:00 AM
by Jennifer Kavur
A couple of major obstacles are impeding widespread adoption of e-health programs in North America, experts say.
The first barrier is money, according to Newt Gingrich, former Speaker of the U.S. House of Representatives -- the cost of these programs, and where the funds are to be obtained.
The second, he said, is culture.
Embracing e-health technology, Gingrich noted, requires learning new things, and adopting new habits. "It's fundamentally different for workflow."
Gingrich -- founder of Center for Health Transformation -- was speaking at a recent panel discussion on e-health in Toronto.
Other panelists included Frank McKenna, former New Brunswick Premier and currently deputy chair of TD Bank Financial Group, and Peter Reuschel, founder and CEO of InterComponentWare AG (ICW).
Headquartered in Walldorf, Germany, ICW offers healthcare products designed to integrate various participants and systems in the heath care sector, including physicians, hospitals and patients. The firm actively promotes standardization in healthcare and has established the Global Standards Office.
Speakers at the Toronto event, which marked the launch of ICW in Canada, laid out the challenges, progress, and benefits of electronic health records. Those benefits, they emphasized, don't come cheap.
They cited the "resource crunch" as a major and ongoing obstacle, despite investments by both Canadian and U.S. government jurisdictions.
For instance, Ontario will be investing around $2.4 billion in healthcare over the next few years, noted Wayne Gudbranson, CEO of Branham Group, an IT consultancy based in Ottawa.
While that's "wonderful", he noted that IT spend in the healthcare sector has been far less than in other verticals -- a situation that needs to change radically or "cost and efficiencies won't be improved."
ICW's Reuschel highlighted the role of government funding. "If you really want integrated health care delivery," he said, "at least at the beginning, there's a need for public money."
In Canada, much of this funding is being channeled to Canada Health Infoway, a non-profit organization that collaborates with the provinces and territories, health care providers, and technology vendors to speed up use of electronic health records.
Infoway is to receive $500 million from the Feds to support a national electronic health record system, expected to be fully implemented across Canada by 2016.
The Canadian government has already provided $1.6 billion to support Infoway's goals, according to the organization's Web site.
Infoway's development of the e-health certification process has been welcomed by ICW. The company said it would participate in the "formal certification process" for its own products.
In the U.S., the new administration's stimulus package recently allotted US$17 billion to healthcare.
These funds have "changed the level of interest in hospitals and doctors across America in a fairly significant way," said Gingrich during a press conference at the ICW event.
Much more here (including video):
http://www.itbusiness.ca/it/client/en/home/News.asp?id=52769
Newt Gingrich has been a powerful advocate for Health IT in the US and his views are always worth a listen. Video on the site.
Tenth we have:
By Jean DerGurahian / HITS staff writer
Posted: April 13, 2009 - 10:00 am EDT
Medical students already carry a heavy academic load, but an opportunity to supplement their formal education with more patient-safety and quality topics is leading them to a new initiative offered by the Institute for Healthcare Improvement.
The IHI has created the Open School to teach what many within healthcare have considered to be the “soft” skills of medical education, concepts such as patient engagement, implementing change, dealing with errors, and fostering teams and communication. The school uses a combination of virtual and traditional learning techniques to connect students: There are podcasts, Web sites and suggestions for books and research materials. Free classes are hosted via online social networking sites, such as recorded sessions with world-renowned experts presented on a YouTube channel and a forum for posting discussions on Facebook.
The school has ignited interest in students from around the globe who are hungry for training in areas they think are lacking in their institutions, said Jill Duncan, director of the Open School. More than 9,000 healthcare professionals have signed up for the online coursework since the school was launched last fall.
In addition, some 110 student chapters—informal groups through which students may interact—have sprung up in the U.S. and overseas, in some ways taking on a life of their own as the students come up with their own ideas for furthering learning about safety and quality, Duncan said. “We’re really using students as the developers for the school,” she said.
More here (registration required):
http://www.modernhealthcare.com/article/20090413/REG/304139976
This consolidation of educational techniques and technology has to be the way of the future – in medicine and any other discipline one can think of.
Eleventh for the week we have:
By Jean DerGurahian
Posted: April 13, 2009 - 10:00 am EDT
Express Scripts signed a definitive agreement with WellPoint to acquire that company’s NextRx pharmacy benefit management subsidiaries for nearly $4.7 billion.
Under terms of the transaction, St. Louis-based Express Scripts will provide services to Indianapolis-based WellPoint through a 10-year contract. The acquisition price also includes consideration for the value of a future tax benefit for Express Scripts. The deal is expected to close in the second half of 2009 pending customary closing conditions.
More here (registration required):
http://www.modernhealthcare.com/article/20090413/REG/304139975
More consolidation – the CFG strikes again?
Twelfth we have:
By Joseph Conn
Posted: April 13, 2009 - 10:00 am EDT
Physician practices’ need for information technology and the federal government’s willingness to pay for it finally are in sync.
The Congressional Budget Office estimates that the government might pour as much as $38.3 billion into healthcare IT support through 2015 under the American Recovery and Reinvestment Act of 2009. At the same time, the respondents to the 19th annual Modern Physician/Modern Healthcare Survey of Executive Opinions on Key Information Technology Issues say they’re ready to hold out their cups.
Former President George W. Bush raised the profile of health IT to a national priority in 2004 when he created the federal Office of the National Coordinator and tasked the office and the healthcare industry with providing an electronic health record to most Americans by 2014. Bush, however, staked out the ideological position that the nation’s IT goals should be achieved largely through free-market activity and specifically ordered the ONC to “not assume or rely upon additional federal resources or spending” to accomplish adoption of interoperable health information technology.
According to the survey results, an overwhelming majority of respondents aligned more with recent congressional intent and favored the government changing the game plan by providing direct financial support for a federal IT development program.
More here (registration required):
http://modernphysician.com/article/20090413/MODERNPHYSICIAN/304129977
The survey has some interesting results which are discussed in the article.
Thirteenth we have:
Dom Nicastro, April 13, 2009
New federal HIPAA laws are here. Anxiety at hospitals is not.
That wasn’t the case in 2003, when providers scrambled for answers to comply with the new privacy and security rules of HIPAA.
Then, many even had trouble even getting the acronym right (admit it, we’ve all written "HIPPA" at one time or another).
Here we are today, six years later, and with a Congress eager to move the industry to EHRs by 2014—and even more eager to protect patients’ privacy in the process.
Now that Congress (finally) strengthened HIPAA enforcement and toughened compliance requirements through breach notification processes and accounting of disclosures on EHRs, what’s the reaction in the industry?
Well, picture this. It’s kind of like the Boston Celtics just signed Larry Bird. Not Larry Bird, the NBA Hall of Famer, three-time NBA champion and three-time NBA Most Valuable Player of the 1980s.
We’re talking about Larry Bird today—the 52-year-old, out-of-shape president of Basketball Operations for the Indiana Pacers.
If you’re the rest of the league, you’re not really sweating it.
That’s kind of the sense we get in the field from HIPAA privacy and security officers. Yes, they know the Health Information Technology for Clinical and Economic Health (HITECH) Act is here, and they are familiar with its provisions. But they’re not worried about it. At least not now.
Analysis: HITECH Gives HIPAA New Teeth
HITECH Act will impose stricter HIPAA requirements and stiffer penalties for violations. But at this point, the changes aren't worth losing a lot of sleep over. —Elyas Bakhtiari
More here :
http://www.healthleadersmedia.com/content/231330/topic/WS_HLM2_TEC/HITECH-Panic-Not-Now-At-Least.html
I suspect this will be the calm before the storm. Worth browsing to see what the issues are.
Third last we have:
Financial services bears the brunt
Tim Lohman 15 April, 2009 12:59
Driven by increased organised crime activity, the number of electronic record breaches has hit a five-year high according to a new report from communications services provider Verizon Business.
The 2009 Verizon Business Data Breach Investigations Report, which analysed data from Verizon’s own caseload of 285 million comprised records from 90 confirmed breaches, finds that more electronic records were breached in 2008 than the previous four years combined.
According to the report, the financial services industry bore the brunt of these data breaches accounting for some 93 per cent of all compromised records, with some 90 per cent of these records involved groups engaged in organised crime. Financial services also counted for 30 per cent of all breaches analysed.
Rather than being caused by disgruntled employees, 74 per cent of breaches resulted from external sources the report said. These external data breach sources continue to show high activity in Eastern Europe (22 per cent), East Asia (18 per cent) and North America (15 per cent).
“Eastern Europe is known as a notorious haven for organised cybercrime outfits which played a major role in breaches throughout 2008,” Peter Tippett, vice president of research and intelligence at Verizon Business Security Solutions, said in a statement.
“We have a great deal of evidence that malicious activity from Eastern Europe is the work of organised crime. On the bright sight, efforts with law enforcement led to arrests in at least 15 cases (and counting) in 2008.”
Much more here:
http://www.computerworld.com.au/article/299375/electronic_record_breaches_hit_5-year_high_2008_verizon?eid=-6787
Just a reminder it is hardly safe ‘out there’!
Second last for the week we have:
State to help doctors e-file prescriptions
By NED B. HUNTER
nhunter@jacksonsun.com
Reducing fraud, mistakes and unhealthy prescription drug interactions are at least three reasons the state is helping health care providers send prescriptions electronically.
The Tennessee Office of e-Health Initiatives awarded $14.6 million in grants - funded by the Tennessee General Assembly - to 1,830 Tennessee physicians, advanced practice nurses and physician's assistants to help them purchase the hardware, software and other materials needed to send prescriptions via a secure Internet connection, said Dean Flener, office spokesman.
Grant amounts of up to $3,500 for qualified physicians and up to $2,500 for qualified nurses and physician's assistants were awarded.
Regional health information organizations such as West Tennessee Healthcare received a $350,000 grant. Other local organizations that received grants included the Woman's Clinic, Jackson Regional Women's Center, Ultimate Health Clinic, Wellness Clinic and Family Care and North Jackson Family Clinic. The grant program does not include pharmacists, who receive grants under another program.
More here:
This is certainly one way to get action – provide funds! Especially since if you don’t have the technology in place in a year or two there will be Federal Govt penalties in the US! Carrot and Stick.
Last for this week we have:
http://www.jacksonsun.com/article/20090414/BUSINESS/904140303
Carrie Vaughan, for HealthLeaders Media, April 14, 2009
Attendance was "off" at the HIMSS09 conference held this past week in Chicago, but the hospital, physician, and health plan executives who were in attendance were the "more serious buyers" and the "decision makers," according to the chief information officers and vendors that I spoke with during the event. Providers scaled back their attendance and some vendors had less elaborate booths for obvious budgetary reasons. However, there were still billiard tricks, a green man group, and other gimmicks on the exhibition floor. Here's a quick glance at some of the key takeaways from the conference.
There are still no real answers about the definition of "meaningful use" of certified EHR technology or what the payment schedule will be for doling out stimulus funds. HIMSS did create a discussion forum on the definition of meaningful use and you can post comments through April 17th. Here are a few of the thoughts attendees shared with me about what "meaningful use" should include:
- The ability to quantify and report improved patient safety, quality outcomes, and cost reductions.
- Disease management and decision support tools for patients and families.
- CPOE and e-prescribing.
- The ability to track and communicate public health issues.
- Community health information exchanges between hospitals, clinics, physicians, and patients.
Much more here:
http://www.healthleadersmedia.com/content/231473/topic/WS_HLM2_TEC/HIMSS09-Recap-Stimulus-Interoperability-and-More.html
This is really a good clear summary HIMSS wrap-up.
There is an amazing amount happening. Enjoy!
David.