Quote Of The Year

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

Saturday, May 09, 2009

Report Watch – Week of 4 May, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download or browse. This week we have a few.

First we have:

Getting Health IT Right under ARRA

Markle Foundation announces broad agreement on principles for Getting Health IT Right under the American Recovery and Reinvestment Act (ARRA).

Read Achieving the Health Objectives under ARRA (PDF, 453K)

Read the news release.

The Report links are found here:

http://markle.org/

Markle are serious contributors and their report will be worth a close read. Australia – instead of the mindless e-PIP program should be having a similar debate about how to foster e-Health here!

Second we have:

Wednesday, January 28, 2009

ROI of Personalized Medicine for Key Stakeholders Examined

A new report by the Deloitte Center for Health Solutions finds significant opportunities for the adoption of personalized medicine to produce a positive return on investment for key stakeholders in the U.S. healthcare system. The report also finds that consumers stand to gain the most significant ROI within the shortest time period.

The report, titled “The ROI for Targeted Therapies: A Strategic Perspective,” provides an analysis of personalized medicine’s economic value proposition. It examines the importance of ROI for multiple stakeholders--consumers, diagnostic companies, pharmaceutical and biotechnology companies, and payers.

More here

http://www.hfma.org/hfmanews/PermaLink,guid,9dd8115d-29a3-4118-bd13-0cbdc8fc80fd.aspx

Read the report.

This is an important area of future medical care that is very technology intensive.

Third we have:

Report: Change EHR Priorities

Hospitals should consider changing their priorities when implementing electronic health records, automating documentation of physicians’ notes earlier in the game, a new report suggests.

The change in priorities would help hospitals provide adequate data for “core measures” that many payers demand, according to a new white paper from Computer Sciences Corp., a Falls Church, Va.-based consulting firm. The Centers for Medicare & Medicaid Services, other payers and some states often require hospitals to use a set of national quality performance measures for pay-for-performance programs and other projects.

More here:

http://www.healthdatamanagement.com/news/EHR-28100-1.html

To view the full report, “Core Measures: All About the Data,” visit csc.com.

An interesting perspective from CSC.

Fourth we have:

Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events

A Cluster-Randomized Trial

Jeffrey L. Schnipper, MD, MPH; Claus Hamann, MD, MS; Chima D. Ndumele, MPH; Catherine L. Liang, MPH; Marcy G. Carty, MD, MPH; Andrew S. Karson, MD, MPH; Ishir Bhan, MD; Christopher M. Coley, MD; Eric Poon, MD, MPH; Alexander Turchin, MD, MS; Stephanie A. Labonville, PharmD, BCPS; Ellen K. Diedrichsen, PharmD; Stuart Lipsitz, ScD; Carol A. Broverman, PhD; Patricia McCarthy, PA, MHA; Tejal K. Gandhi, MD, MPH

Arch Intern Med. 2009;169(8):771-780.

More here:

http://archinte.ama-assn.org/cgi/content/abstract/169/8/771?etoc

and this article:

An Electronic Health Record–Based Intervention to Improve Tobacco Treatment in Primary Care

A Cluster-Randomized Controlled Trial

Jeffrey A. Linder, MD, MPH; Nancy A. Rigotti, MD; Louise I. Schneider, MD; Jennifer H. K. Kelley, MA; Phyllis Brawarsky, MPH; Jennifer S. Haas, MD, MSPH

Arch Intern Med. 2009;169(8):781-787.

More here:

http://archinte.ama-assn.org/cgi/content/abstract/169/8/781?etoc

Two interesting trials with full abstracts available on the site.

Additional reporting is found here:

http://www.healthday.com/Article.asp?AID=626483

Medication Errors Could Be Cut: Experts
Two reports show promise of computers, pharmacists for proper prescribing

By Steven Reinberg

HealthDay Reporter

Fifth we have:

Acceptability of a Personally Controlled Health Record in a Community-Based Setting: Implications for Policy and Design

Elissa R Weitzman1,2,4, ScD, MSc; Liljana Kaci1, BA; Kenneth D Mandl1,3,4, MD, MPH

1Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Children’s Hospital Boston, Boston, MA, USA

2Division of Adolescent Medicine, Children’s Hospital Boston, Boston, MA, USA

3Division of Emergency Medicine, Children’s Hospital Boston, Boston, MA, USA

4Department of Pediatrics, Harvard Medical School, Boston, MA, USA

Corresponding Author:

Elissa R Weitzman, ScD, MSc

Children’s Hospital Informatics Program

One Autumn Street, Room 541

Boston, MA 02215

USA

Phone: +1 617 355 3538

Fax: +1 617 730 0267

Email: elissa.weitzman [at] childrens.harvard.edu

ABSTRACT

Background: Consumer-centered health information systems that address problems related to fragmented health records and disengaged and disempowered patients are needed, as are information systems that support public health monitoring and research. Personally controlled health records (PCHRs) represent one response to these needs. PCHRs are a special class of personal health records (PHRs) distinguished by the extent to which users control record access and contents. Recently launched PCHR platforms include Google Health, Microsoft’s HealthVault, and the Dossia platform, based on Indivo.

Objective: To understand the acceptability, early impacts, policy, and design requirements of PCHRs in a community-based setting.

Methods: Observational and narrative data relating to acceptability, adoption, and use of a personally controlled health record were collected and analyzed within a formative evaluation of a PCHR demonstration. Subjects were affiliates of a managed care organization run by an urban university in the northeastern United States. Data were collected using focus groups, semi-structured individual interviews, and content review of email communications. Subjects included: n = 20 administrators, clinicians, and institutional stakeholders who participated in pre-deployment group or individual interviews; n = 52 community members who participated in usability testing and/or pre-deployment piloting; and n = 250 subjects who participated in the full demonstration of which n = 81 initiated email communications to troubleshoot problems or provide feedback. All data were formatted as narrative text and coded thematically by two independent analysts using a shared rubric of a priori defined major codes. Sub-themes were identified by analysts using an iterative inductive process. Themes were reviewed within and across research activities (ie, focus group, usability testing, email content review) and triangulated to identify patterns.

Results: Low levels of familiarity with PCHRs were found as were high expectations for capabilities of nascent systems. Perceived value for PCHRs was highest around abilities to co-locate, view, update, and share health information with providers. Expectations were lowest for opportunities to participate in research. Early adopters perceived that PCHR benefits outweighed perceived risks, including those related to inadvertent or intentional information disclosure. Barriers and facilitators at institutional, interpersonal, and individual levels were identified. Endorsement of a dynamic platform model PCHR was evidenced by preferences for embedded searching, linking, and messaging capabilities in PCHRs; by high expectations for within-system tailored communications; and by expectation of linkages between self-report and clinical data.

Conclusions: Low levels of awareness/preparedness and high expectations for PCHRs exist as a potentially problematic pairing. Educational and technical assistance for lay users and providers are critical to meet challenges related to: access to PCHRs, especially among older cohorts; workflow demands and resistance to change among providers; inadequate health and technology literacy; clarification of boundaries and responsibility for ensuring accuracy and integrity of health information across distributed data systems; and understanding confidentiality and privacy risks. Continued demonstration and evaluation of PCHRs is essential to advancing their use.

(J Med Internet Res 2009;11(2):e14)
doi:10.2196/jmir.1187

KEYWORDS

Medical records; medical records systems, computerized; personally controlled health records (PCHR); personal health records; electronic health record; human factors; research design; user-centered design; public health informatics

Full paper is here:

http://www.jmir.org/2009/2/e14/

Very important material given what the NHHRC is proposing here in Australia – needs a close read.

Last we have:

The Doctor of the Future

By Chuck Salter

In March, President Obama identified "the biggest threat to our nation's balance sheet." Not major banks on the brink of insolvency. Not paralyzed credit markets. Not a bailout tab in the trillions. The biggest threat, he warned, "by a wide margin," is "the skyrocketing price of health care."

Health care accounts for $1 in every $6 spent in the United States -- and costs are climbing at twice the rate of inflation. Every year, an estimated 1.5 million families lose their homes because of medical bills. Although we have the world's most expensive health-care system, 24 countries have a longer life expectancy and 34 have a lower infant-mortality rate, according to the latest United Nations report.

But some physicians and surgeons have been quietly rethinking and reinventing medicine for the 21st century. Often collaborating with innovative companies, these pioneers are experimenting with cutting-edge technologies, from software to robots, that have the power to revolutionize the medical landscape -- producing better outcomes, lower costs, broader access, and greater convenience. And advances on a far greater scale could emerge from the stimulus package and the $634 billion the Obama administration proposes to invest in health-care reform; the much-discussed expansion of electronic medical records (see Why Electronic Health Records Are Worth the Hype--and the Price [0]) is just the beginning. As these breakthroughs come together, they will change the world for patients, doctors, insurers, regulators -- all of us.

The doctor of the future will see you. Now.

Vastly more here:

http://www.fastcompany.com/node/1266043/print

Interesting perspectives!

So much to read – so little time – have fun!

David.

1 comment:

Larry Smith said...

Dear Dr. More,
What you say is most important. What follows, from me Larry Smith (480 899-4463)is based upon my 35+ years in designing, implementing and marketing HIS around the world, and I believe makes sense in this period we are moving through:

MedStick Corporation 3619 E Verdin Rd., Phoenix, AZ 85044 USA
Integrated Health Care Information Systems
The E-MedStick

While a few health care providers have implemented the Electronic Medical Record (and more have not – these latter perhaps preferring to let the industry ‘mature’) the fact still remains that the EMR is one of the most important items in the health care system – outside of the physician/provider themselves. The term Integrated Systems is often used to illustrate a linking to or with other systems. Mostly this is used when a certain vendor provides the systems for a specific client who may have one or more locations where the systems are installed. Thus when a patient travels to another location (within the same provider) the patient medical records are available.

An integrated system means that when patients’ medical records are electronically recorded for instance at their primary care physician that should the patient go another provider for care that their records are available, by computer, to the other provider they go. For instance, the patient lives in town A and they go to town D in a different state, province, etc., for treatment. Their records are available to the new provider they go to merely by the new provider entering the patient ID since the new provider is on the same system.

Sounds good, nice and easy – but it isn’t because the new provider the patient goes to may not be on the same system, or the new provider while on a system may not be on the same system as where the patient is from originally – while both systems may perform similar functions they still may not be compatible. Thus, this could be a major concern for both the patient and the staff at the new or other provider he is to be treated as well as for the patients’ primary care physician as by being treated at the other provider there is now new information which the primary care physician should have for his records. And what about emergencies and other health challenges? And the same goes for the new provider that treated the patient – they need to know what the primary care physician has done for the patient so they do not duplicate such treatment, prescriptions, etc.

Electronic Medical Records (EMR) in those places where they have been implemented and accepted and the people trained to properly use the systems have been found to

1.Reduce costs of providing health care
2.Reduce time of staff while improving productivity
3.Streamline patient management
4.Have a more responsive system for staff and patients
5.Provide instant access to data by multiple users
6.Promote preventative medicine
7.Reduce or eliminate transcription errors
8.Facilitate research and improve billings
9.Minimize professional liability
10. Be able to work proactively with your patients re their healthcare planning
11.Have access to treatments and procedures you perhaps do not have now
12.Have a safe secure system for staff as well as for patients
13.Facilitates quick accurate medical diagnosis and treatment
14.Helps minimize inaccurate drug prescriptions/treatments, which could lead to costly errors
15.Detailed data regarding current health, medications, allergies, surgeries and vaccinations, including records of treatments, dates and doctor reports. quickly available
16.Electronic medication renewals and appointment scheduling
17.Pre-encounter questionnaires
18.Sharing of complete medication lists- if desired
19.Easily store and displays high quality x-rays, charts and accompanying doctors reports

While the above plus other benefits are key to the understanding of and the use of the EMR it appears that many approaches by vendors and suppliers of HIS systems are not really understanding what a truly integrated system means to the provider and the patient – the true focus is in the wrong place – the provider and should be the patient.

Plus, since they, the vendors/suppliers have their own systems which while they perform exact or similar functions are usually not compatible with one another. Thus, it is difficult for a truly integrated system to be implemented since all vendors/suppliers do not have the exact same system. While one system from one vendor will work well for a specific client, that same system may not work well for another client – thus one reason of multiple vendors in the industry.

If the mindset changes to focus on the patient instead of the provider – which is exactly the same to one health care provider as every other patient with the exception each patient has different health care challenges – then it is very easy to have an integrated system which will work for all vendors/suppliers and the provider with the patient being the point of integration and focus.

What would such a system look like?

It is embodied in the newly developed E-MedStick, a small portable USB drive designed by health care professionals specifically to hold all medical data and easily inform paramedics and ER staff of your medical history, even if you cannot speak. As the patient moves from one provider to another utilizing their E-MedStick – which is instantly recognized by all HIS systems they become (and are) the integrated systems point of focus. www.e-medstick.com

They, the provider, plug the E-MedStick into their laptops right at the emergency location and instantly have the injured's med list, allergies, pertinent medical history, physician’s name and emergency contacts. This enables avoidance of medication errors such as giving aspirin to an aspirin allergic patient. In addition, it simplifies and speeds up the intake process by providing your med list instantly to the ambulance or ER staff. In the ER it might avoid unnecessary testing by listing recent studies such as stress echoes or angiography already completed. And – all your medicals from your various providers are in one location – The E-MedStick - for ease in health care planning with all your providers and safely - virtually anywhere in the world - in multiple languages!

The patient (and the E-MedStick) is the focal point of systems integration!

The E-MedStick - safe, secure, fully encrypted, photo, ID, password protected, HL7 and HIPAA compliant (USA), emergency/medical data from all providers instantly available, easy to update, compatible with hospitals and all providers, no SSA/drivers license collected, no Internet or data vault access required - all operating system programs reside on the E-MedStick, advanced directives/living wills, power of attorney can be available, organ donor info, blood type, easy to carry in pocket, purse and in vehicle, charts/graphics/scans can easily be stored, multi-lingual virtually anywhere in the world – only you have access to your own information or those whom you authorize, safe and secure – reduces stress – goes wherever you go, ideal for those who travel and for everyone!

Medical records on the E-MedStick are now the focal point, not the existing or non-existing records in the health care provider system, and are current, correct and are immediately available from the patient. The same records on the E-MedStick appear the same to each and every provider – and they work equally as easily with one or another – because the patient with his E-MedStick is now the integration point.

Each provider can then choose which system they feel will perform the best for them and yet they will in essence have a totally integrated system when the patient E-MedStick is plugged into their system.

Are you aware your present medical records (in paper form) are not safe and secure, are subject to being misused, stolen, damaged, destroyed, mutilated and can be viewed by those perhaps you would not like them to be viewed by. In addition, they are not available to those who would treat you if you are in a foreign country or away from your home (and your health care providers) – and cannot speak the language. In addition, paper records can be bulky and cumbersome to carry.

With the E-MedStickã it takes your records to a new level, implementing the safety, security and privacy they do not now have. The E-MedStickã has been developed to protect in any medical emergency, and to assist in health care planning and operation and to reduce costs.

Thank you

Larry Smith