Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, June 19, 2009

Report Watch – Week of 15 June, 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:

Information governance

Data breaches continue to hit the headlines, even though there is plenty of guidance and more than a few products on the market to help stop them. Daloni Carlisle reports.

Now let’s be clear about this: data security is not just important, it is career limiting. And that’s not just for the home “flipping” ministers or the moat-owning MPs whose expenses were leaked to the Daily Telegraph.

These days, losing confidential patient data could mean the axe for NHS chief executives and often does mean the chop for the staff directly involved. This is a change from 18 months ago, when the loss of child benefit records by HM Revenue and Customs sparked a data security review across government and the public services.

Of course, the public sector in general and the NHS in particular did not suddenly start losing data in 2007; but the HMRC scandal put a new focus on the problem. Ever since, week after week, newspapers have been gleefully reporting the loss of laptop here, a USB stick there, ratcheting up the political need to be seen to be doing something.

Clear expectations

The NHS was, in fact, in a reasonable position to respond to the initial outcry. NHS chief executive David Nicholson and then chief information officer Matthew Swindells sent out a series of letters asking NHS organisations first to review their data security and then giving some strong and clear guidance on what they should do to protect it.

“There has been some very clear guidance from both the Cabinet Office and the Department of Health,” says Harry Cayton, chair of the National Information Governance Board. “There is no doubt that chief executives across the system recognise that information governance is a serious matter.”

The report length discussion is found here cited here:


An important topic and well worth a browse.

Second we have:

Study Looks at Genetic Testing Privacy

HDM Breaking News, June 5, 2009

Personal genetic testing services can help consumers learn of their genetic risks for disease, but consumers also need to be aware of risks to their privacy, according to a just-published study.

Personal genetic information is relevant not only for the individual who got a test, but for other family members, says Sandra Soo-Jin Lee, PhD, a co-author of the study and senior research scholar at Stanford University School of Medicine's Center for Biomedical Ethics. "For example, if you receive information on your breast cancer risk and share it with others, you might also be sharing information about your daughter's risk for breast cancer--even though she never consented to have that information shared."


Much more here with links :


The new study, "Research 2.0: Social Network and Direct-to-Consumer Genomics," was published in the June 5 issue of the American Journal of Bioethics. Registration is required and the cost is approximately $35. The special double-issue also has numerous other articles and studies assessing genomic ethical considerations.

For more information, visit bioethics.net/journal.

This is surely an area that will become more important going forward.

Third we have:

KLAS Report Takes a Comprehensive Look at Potential Components of ‘Meaningful Use’ for Hospitals

Study evaluates which acute care EMR vendor solutions have shown the most success at driving clinician adoption

OREM, Utah – June 8, 2009 – As the healthcare IT (HIT) industry awaits a formal definition for the meaningful use of electronic medical records (EMRs), HIT research firm KLAS has released a comprehensive report outlining which acute care EMR products are best positioned to achieve whatever meaningful use standard is adopted. The report, Meaningful Use Leading to Improved Outcomes, takes a broad look at the EMR market, assessing how well core clinical vendors are delivering solutions for CPOE, nursing automation, medication administration and other key areas.

“Since the introduction of the stimulus package and its provisions for health IT, much of the market rhetoric and industry debate has centered on the concept of meaningful use – what will it entail and how will it impact the receipt of stimulus dollars,” said KLAS Founder and Chairman Kent Gale. “Whatever the final definition of the term, if improved patient outcomes are indeed the ultimate goal, then some form of clinician adoption will be critical.

“In particular, deep adoption among physicians is pivotal to the overarching success of an EMR implementation,” Gale said.

The Need for Physician Adoption

The KLAS report notes that while EMR vendors Cerner, Eclipsys and Epic are the most successful with regard to physician adoption, Meditech has the largest number of clinical information system (CIS) customers over 200 beds (327 hospitals), followed by Cerner (263) and McKesson (242). However, the Meditech customer base, encompassing the MAGIC and C/S product lines, has the smallest number of hospitals over 200 beds with deep CPOE adoption – that is, where more than 50 percent of all orders are entered electronically by doctors. Only 3 percent of Meditech customers have achieved this level of adoption. Among the CIS market share leaders, McKesson exceeds Meditech in this area with 5 percent of its customer base enjoying deep adoption, while Cerner leads both McKesson and Meditech at 23 percent. GE, QuadraMed and Siemens also enjoy some success with CPOE adoption.

Beyond CPOE, the report also evaluates vendor offerings for nurse charting, an electronic medication administration record (eMAR), patient-monitor interfaces to the EMR, electronic flow sheets and barcoding at the point-of-care (BPOC) for medication administration. For each solution area, KLAS evaluates the risk the vendor poses to provider customers who want to achieve a comprehensive EMR implementation.

No vendor is perfect in every area, but Cerner and Epic are the strongest, followed by Eclipsys. Within this threesome, only Cerner extends to really meet the needs of both larger facilities over 200 beds and some community hospitals. Meditech has a broad install base across all hospital sizes and covers virtually every aspect of automation, with nurses using the product across the country; but Meditech’s Achilles’ heel is the lack of adoption by physicians. Other vendors deliver functional solutions but face a variety of challenges that have hindered deployment, such as the lack of tight integration among McKesson’s core clinical modules or Siemens Soarian clients awaiting version C6 availability.

More here:


There is more detail in the press release and the full report can be purchased from KLAS.

Fourth we have:

Electronic Medication Reconciliation: A Work in Progress

Electronic medical reconciliation and process redesign lessen potential for adverse drug events.

In 2005, the Joint Commission on Accreditation of Healthcare Organizations mandated medication reconciliation as a national patient safety goal. Establishing an accurate list of a patient’s current medications intuitively seems like a prerequisite for high-quality care, but few rigorous studies have been designed to assess whether medication reconciliation improves patient outcomes.


Comment: Because this study was not designed to examine healthcare use or actual adverse drug events, we can say only that it provides an interesting look at how information technology and interdisciplinary collaboration potentially improve patient safety. As the authors note, the intervention was far from perfect (1.05 PADEs per patient in the intervention group), but I would expect this rate to improve as hospital teamwork becomes more pervasive and software integration evolves.

Neil H. Winawer, MD, FHM

Published in Journal Watch Hospital Medicine June 8, 2009


Schnipper JL et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: A cluster-randomized trial. Arch Intern Med 2009 Apr 27; 169:771.

More here (subscription required):


Links to articles are in text.

Fifth we have:

Consumers want technology to help keep them healthy, survey shows

June 05, 2009 | Bernie Monegain, Editor

REDMOND, WA – A new survey from Microsoft Corp. shows that Americans want their doctors and their health plans to use technology to help them become healthier.

The Microsoft Health Engagement Survey 2009, conducted by Kelton Research, found that consumers want electronic coaching via e-mail and phones to help them improve health habits, self-manage conditions and better coordinate care with providers.

Kelton Research conducted the Microsoft Health Engagement Survey 2009 in March 2009 among 1,002 Americans, ages 18 and older.

"Insurers can no longer wait for consumers to self-manage their chronic conditions through standalone Web tools," said Dennis Schmuland, MD, U.S. health insurance industry solutions director at Microsoft. "Consumers want their providers and insurers to team together to help them replace bad health habits with good ones, reduce their health risks and equip them to self-manage their conditions. This requires a new generation of technology designed to proactively improve health and coordinate care at the individual and community levels."

According to the survey, 66 percent of Americans are interested in receiving health-related encouragement or reminder e-mails from their health insurance company and 52 percent would be open to receiving e-mails that provide them with feedback on their health progress. In addition, 62 percent of Americans believe that personal health record services are valuable.

Much more here:


The full report is here:


Sixth we have:

NQF panel recommends nine EHR measures

By Jean DerGurahian / HITS staff writer

Posted: June 10, 2009 - 11:00 am EDT

An expert panel established by the National Quality Forum is making nine recommendations to advance the development of standardized electronic health-record data measures.

The forum’s Health Information Technology Expert Panel, the second version of HITEP, established last November, looked at ways to expand the use of quality data sets and other electronic data sources out of guidelines first established in 2007. The panel’s report provides details on establishing a quality data set—including standard elements, quality data elements and data flow attributes—and sources of data for specific quality information.

More here:


The links are found in the text.

Seventh we have:

Video Decision-Support Tool Is Effective for Advance Care Planning in Dementia

A video depiction of advanced dementia persuaded older people to choose comfort care.

Visual images can enhance healthcare communication and decision making. In this randomized trial, Boston investigators determined the effects of a video decision-support tool on older people’s (age, 65) preferences for future care if they develop advanced dementia.


Comment: Unsurprisingly, older people who hear and watch depictions of advanced dementia are more likely to prefer comfort care for dementia and have more stable preferences than patients who only hear a description of dementia. These results should encourage development of video decision-support tools for other scenarios (e.g., life-sustaining technologies such as hemodialysis, left ventricular assist devices). The video is available online.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine June 11, 2009


Volandes AE et al. Video decision support tool for advance care planning in dementia: Randomised controlled trial. BMJ 2009 May 28; 338:b2159. (http://dx.doi.org/10.1136/bmj.b2159)

Original article (Subscription may be required)

Medline abstract (Free)

More here (subscription required):


The videos are here:


I must say it is hardly surprising this works!

Last we have:

Report: VA Lacks I.T. Controls

HDM Breaking News, June 10, 2009

The Office of Inspector General within the Veterans Administration is voicing concern that the VA is not effectively managing its information technology capital investments.

The OIG conducted an audit after the VA failed to meet a deadline to submit documentation to justify funds for I.T. capital investments for budget year 2010. The documentation is called Exhibit 300s.

More detail here:


For the full OIG report, click here.

Enough for one week!



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