Quote Of The Year

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

Friday, July 10, 2009

International News Extras For the Week (06/07/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

EMIS Web links to secondary care

25 Jun 2009

Leading GP IT system supplier EMIS has unveiled its next generation IT system EMIS Web, promising interoperability with primary and secondary care providers.

EMIS claims the system will set a new standard for the NHS, by enabling clinicians outside general practice to access a patient’s GP medical record, view other patient information recorded on the system, and add to that data.

Patient data will be accessible from non-EMIS systems using an interoperability portal called the Medical Interoperability Gateway (MIG).

GP system suppliers INPS and iSoft and out-of-hours provider Adastra are also to use the MIG to share data, and yesterday EMIS said it was holding talks with other healthcare IT suppliers including Ascribe, Oasis and IMS Maxims.

Local service providers Cerner and CSC have declined to take part, saying it is outside their contractual commitments under the National Programme for IT in the NHS.

The system, which has been in development for five years, is scheduled to receive NHS Connecting for Health accreditation in November. EMIS hopes it will become widely used by GPs in 2010.

More here:

http://www.e-health-insider.com/news/4968/emis_web_links_to_secondary_care

This is just getting more and more useful and interesting.

Second we have:

Successful Demonstration of Health Information Exchange Opens ARRA Stimulus Options for California

California eHealth Collaborative announced a successful demonstration of electronic exchange of clinical information to improve patient care. The Nationwide Health Information Network (NHIN) Connect software, released by the federal government in April, was showcased in June by five separate Health Information Exchange (HIE) projects in California.

San Francisco, CA (PRWEB) June 28, 2009 -- California eHealth Collaborative announced today that five community-based health information exchange (HIE) projects in California successfully tested the exchange of clinical health information to improve patient care. Taking advantage of recently released Nationwide Health Information Network (NHIN) Connect software, Kaiser Permanente, Long Beach Network for Health, ER Connect- Orange County, Redwood MedNet and Santa Cruz HIE verified the ability to share patient clinical information among regional networks across the state. The public test demonstrated how clinicians might treat a patient within an emergency room care or other clinical settings by obtaining critical clinical information from the patient's medical record in another location.

"We are pleased to demonstrate that local provider organizations have the ability to securely share health care information with each other and to access information from previously established NHIN gateways," states Jamie Ferguson, Executive Director of Health Information Technology Strategy and Policy for Kaiser Permanente and a member of the HHS HIT Standards Committee.

This technical demonstration shows that any community-based (HIE) or provider network that conforms to the NHIN standards can securely exchange clinically-relevant data for treatment purposes. Providing local physicians and safety net providers with low cost access to data exchange technology is a key component of the Obama Administration's goal of meaningful use of electronic health records (EHR) by 2014.

"Our NHIN Gateway is a federally-funded asset and we can now use this resource to rapidly expand the ability to improve patient care by connecting with other health information exchanges in the state simply by using national standards," states Laura Landry, Executive Director of Long Beach Network for Health. "California needs the ability to share patient data across regions to the point of care, and we have just demonstrated how to do that using the Internet as the backbone and the NHIN standards as the on-ramp. Now that the technical challenge is solved, we are looking forward to the NHIN governance evolving in order to solve the policy challenges and share real patient data for patient care."

More here:

http://www.prweb.com/releases/2009/06/prweb2585014.htm

On the face of it this looks like a very considerable success. Another ”brick in the wall” as they say! That this was a fully standards based initiative is really good news. See Report Watch for links and reports.

Many of the quotes in the release make interesting reading.

Third we have:

Will New Certification Criteria Fuel Open Source E-Health Records?

Posted by Marianne Kolbasuk McGee on June 29, 2009 03:11 PM

Till now, certification requirements for electronic medical records were pretty hefty, addressing hundreds of stringent criteria that comprehensive inpatient and ambulatory systems must meet in order to get a seal of approval from the Certification Commission for Health Information Technology, or CCHIT, a non-profit federally supported group.

But moving forward, new certification "paths" recently announced by CCHIT will be a boost for modular software packages, especially those from smaller software vendors and open source developers, as well as their potential customers, including doctor practices that don't need fancier software tools, as well as health care organizations that have a hybrid mix of health IT systems featuring legacy and best-of-breed applications.

A couple of weeks ago, CCHIT announced it was replacing the single certification approach its had since 2006 with three new certification "paths."

CCHIT said the changes are meant to help support more widespread adoption and "meaningful use" of certified health IT systems by doctors and hospitals so that they're eligible to receive federal stimulus incentives that kick-in starting in 2011.

In a nutshell, CCHIT says its three CCHIT certification paths include:

• A rigorous certification for comprehensive EHR systems that significantly exceed minimum Federal standards requirements. This "EHR-C" certification would be targeted to the needs of providers who want maximal assurance of EHR capabilities and compliance.

This path includes many of the criteria that have been demanded till now for products to receive CCHIT certification.

What's new from CCHIT includes these additional paths:

• A new, modular certification program for electronic prescribing, personal health records, registries, and other technologies. Focusing on basic compliance with Federal standards and security, the EHR-M program would be offered at lower cost, and could accommodate a wide variety of specialties, settings, and technologies. It would appeal to providers who prefer to combine technologies from multiple certified sources.

• A simplified, low cost site-level certification. This program would enable providers who self-develop or assemble EHRs from noncertified sources to also qualify for the federal incentives.

Very full reporting continues here:

http://www.informationweek.com/blog/main/archives/2009/06/will_new_certif.html;jsessionid=M0EDXVAZHVYUMQSNDLPCKH0CJUNN2JVN

This is a good post on the ways the CCHIT is trying to maximise the value of certification while also providing flexibility in appropriate circumstances.

There is also long article here:

http://www.modernhealthcare.com/article/20090629/REG/306299994

Open-source advocates praise CCHIT's changes

By Joseph Conn / HITS staff writer

Posted: June 29, 2009 - 5:59 am EDT

On balance, it would appear that members of the open-source healthcare software community are satisfied with the proposed changes in the way electronic health records systems will be tested and certified by the federally supported Certification Commission for Healthcare Information Technology.

Fourth we have:

Court denies bid to limit Vt. law on prescription data

By Joseph Conn

Posted: June 29, 2009 - 2:45 pm EDT

A federal appeals court in New York has denied a request by three drug data-miners and the Pharmaceutical Research and Manufacturers of America to block a Vermont law limiting the use of prescription-drug data to profile the prescribing patterns of Vermont physicians.

The law, which goes into effect July 1, prohibits the use of a physician’s prescribing information for marketing without the physician’s consent.

Appellants IMS Health; Verispan, which was subsequently sold to SDI Health; Source Healthcare Analytics, a subsidiary of Wolters Kluwer Health; and PhRMA had asked the 2nd U.S. Circuit Court of Appeals for an injunction, but the court ruled the appellants had not demonstrated a substantial likelihood of success on the merits of their case, according to the court order, dated Friday.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090629/REG/306299960

This is getting just better and better in my view. These data-miners who assist big pharma market directly to clinicians on the basis of their prescribing, and push the newest and most expensive, should be put out of business in my view.

Fifth we have:

June 28

Five Attributes of a Successful Healthcare Solutions Architect

During HIMSS 2009, and lately as well, I have been asked by several people what qualities or attributes would help a healthcare solutions architect be successful, so I decided to initially list at least five key attributes that I consider extremely valuable:

1. Be technology agnostic:

The Healthcare IT scenario is plagued with a myriad of solutions of disparate technologies and they will continue in the landscape for many years to come. Healthcare interoperability is a huge concern and anything you design has to be able to integrate with whatever is out there. You can't be picky by going down the path you feel comfortable with.

In a hospital facility you may find current and legacy applications such as: MEDITECH, Emageon, Lawson, etc., and all of these are based on different technologies (e.g. Magic or MUMPS, Java, RPG 4).

If you are in an Integrated Delivery Network (IDN) scenario you may find that many facilities have differing technologies. One might be a MEDITECH shop while another one may be a SIEMENS one. The reason for this is that many IDNs merge new hospitals into their network and they can't swap their Health Information Systems (HIS) applications overnight. Some migrations can take several years from start to finish. Some never take place because the clinicians of the newly incorporated facility actually like, or are accustomed to, their applications or they fear the unknowns of a new information system. Most likely implementing their HIS was a painful and long process and they may not want to go through that again.

What you design will have to live inside this Tower of Babel so you may find yourself creating pieces consisting of various technologies (e.g. Java, .NET, native C++, etc.). Your products will most likely have to exchange information with legacy applications and silos are no longer welcome in the healthcare domain so be ready to create loosely coupled interfaces to the outside world.

Much more here:

http://hl7guy.tech.officelive.com/default.aspx

Special Health IT Report: Electronic Prescribing Increasing Despite Glitches

By Ann Carrns

Jun 29, 2009

Second of an occasional series on health information technology.

Fayetteville, Ark. – Dr. Marek Durakiewicz initially welcomed the opportunity to send prescriptions to drugstores electronically, using free computer equipment provided by a state pilot program.

The chief of staff at Hickman Community Hospital in Centerville, Tenn., Durakiewicz recognized the potential benefits of "e-prescribing." Special software allows doctors to see instantly if the drug they are ordering is covered by a patient’s health insurance plan; if there’s a less expensive, generic alternative, or if the patient is already taking medication that may interact dangerously with the new one. For patients, there’s no piece of paper to misplace.

Advocates say e-prescribing is a key advance toward health care’s digital future because of its potential to reduce medical errors, cut drug costs and save doctors and patients time and money. E-prescribing is growing – the number of doctors doing it is now more than 120,000, 20 percent of all office-based prescribers, according to an industry source. But kinks need to be worked out to spur more rapid acceptance.

Doctors and patients in a number of states have complaints, including Durakiewicz. Malfunctioning hardware and cumbersome security features -- such as software that logged him out automatically every 30 minutes -- left him frustrated. Patient prescription histories provided by the system weren't as current as he had expected. In addition, federal restrictions prevented him from e-prescribing certain pain medications.

Now, a year later, he doesn't use the pilot system at all. Instead, he types prescriptions into another computer and prints them out. “It’s faster,” said Durakiewicz, one of 50 doctors participating in the pilot offered by the state’s Medicaid program and the technology company Shared Health.

Emily Bagley, product development consultant with Shared Health, says electronic prescription histories should be immediately available; paper prescriptions take longer to retrieve. Log-offs, she says, result from federal regulations requiring e-prescribing software to log out doctors at regular intervals to prevent unauthorized use of systems.

Much more here:

http://www.kaiserhealthnews.org/Stories/2009/June/29/eprescribe.aspx

This is a good review of the present state of e-prescribing in the US.

Seventh we have:

Doctors Say Electronic Data-Sharing Is Saving Lives, Money

Memphis, One of a Growing Number of Areas With a Health Information Exchange, Faces a Crucial Test: What Happens When the Initial Funding Runs Out?

By Rhonda L. Rundle

Jun 22, 2009

One of an occasional series on health information technology.

MEMPHIS--When a 27-year-old pregnant woman arrived in the emergency department of a hospital complaining of severe abdominal pain, doctors suspected a miscarriage.

But the diagnosis quickly changed after the woman's medical records were retrieved from a secure Web site. Two days earlier, the data showed, the woman had undergone an ultrasound test in a doctor's office. While inconclusive, the test suggested a life-threatening possibility: a ruptured tubal pregnancy.

When he saw the results, Jerry Edwards, the emergency physician on duty at Saint Francis Hospital, rushed the woman into surgery rather than waiting for new tests. "The information saved a life that day," he says.

The Memphis area is one of a growing number of regions or states with a health information exchange, which enables electronic patient data to be shared among hospitals and physicians. Nearly all of the hospitals and public clinics participate, which allows their emergency department doctors and other authorized personnel to call up patients' blood tests, imaging scan reports and hospital discharge summaries. The three-year-old exchange is helping doctors make better decisions and avoid wasting money on duplicative tests. Records for about one million people have been collected so far.

Memphis is shaping up as a critical test at a time when emerging exchanges are looking to the federal government for capital. The $787 billion federal stimulus package contains $19 billion for health information technology, including $300 million for exchanges, sometimes called RHIOS, short for regional health information organizations.

Data exchange capabilities already exist within large medical organizations such as the U.S. Veterans Health Administration. But information sharing among unaffiliated institutions is rare because of technical, economic and legal challenges. Some hospitals and physicians worry that sharing information could weaken bonds with their patients, or make them vulnerable to lawsuits if private patient data were to fall into the wrong hands. Many providers lack the millions of dollars needed to install electronic records and their systems, built by competing companies, often don't talk to each other.

Much more here:

http://www.kaiserhealthnews.org/Stories/2009/June/22/Memphis.aspx

This is a very useful review of one Health Information Exchange. I particularly liked this paragraph:

“The board, guided by Frisse and the Vanderbilt team, made a series of key decisions. Most importantly, they didn't try to make the system do too much. Other exchanges have stalled because they "tried to build version 10.0 before there's a version 1.0," says Frisse. Vanderbilt programmers designed interfaces around the hospitals' technology, so they didn't have to switch to a common system, or make new investments. Each participant retained control over its own data, with the power to shut off outside access.”

The team at NEHTA should go a chat to these people about how to implement IT in the health sector.

Eighth we have:

June 25, 2009

Database Takes Patients for Billions, Study Finds

By THE ASSOCIATED PRESS

WASHINGTON (AP) — Congressional investigators said Wednesday that two-thirds of the nation’s health insurance industry used a faulty database that overcharged patients for seeing doctors outside their insurance network, costing them billions of dollars in inflated bills.

The flawed database was operated by Ingenix, a subsidiary of the health insurer UnitedHealth Group, which agreed in January to pay $350 million to settle allegations that it deliberately kept rates low to underpay doctors, driving up expenses for patients.

UnitedHealth has admitted no wrongdoing in its handling of Ingenix, though it agreed to close the database and help pay for a new one operated by a nonprofit group.

An investigation by Senator John D. Rockefeller IV, Democrat of West Virginia, shows that nearly 20 regional and national insurers also used Ingenix data.

Full article here:

http://www.nytimes.com/2009/06/25/business/25insure.html?_r=2

This is one issue Australia has largely avoided by having a standardised set of benefits for care both via Medicare and Private Health Insurers. Here ‘informed financial consent’ also helps minimise the risk or large and unexpected costs of care.

Ninth we have:

Orange Austria targets mobile e-health

29 Jun 2009

Orange Austria and charity Arbeiter-Samariter-Bund Österreich (Workers Samaritan Federation Austria) have begun a trial to pilot a mobile e-health solution for monitoring blood sugar levels and blood pressure.

Orange Austria and Alcatel-Lucent have equipped the Arbeiter-Samariter-Bund with the Alcatel-Lucent TeleHealth Manager solution, an off the shelf e-health platform.

The TeleHealth Manager is a tele-monitoring solution that combines intelligent end devices with the infrastructure required to provide remote monitoring and care. The equipment is claimed to be very easy to operate.

“For us as a provider of healthcare services, our number one priority is people. I am therefore delighted that this solution will enable us to provide optimum care to our patients at all times – wherever they happen to be," said Franz Schnabl, president of Arbeiter-Samariter-Bund.

More here:

http://www.ehealtheurope.net/news/4970/orange_austria_targets_mobile_e-health

This is an interesting pilot – it will be interesting to see how well it all works in real use.

Tenth we have:

Survey: Hong Kong private docs not ready for e-health record

By Computerworld Hong Kong staff

Created 2009-06-29 08:20 AM

Nearly 80 percent of private doctors in Hong Kong feel they lack IT know-how and relevant training when it comes to e-health record, though at the same time the same percentage of them support the introduction of a territory wide e-health record platform, said eHealth Consortium Monday.

Established since 2005, eHealth Consortium is a non-profit organization in Hong Kong that advocates the development of eheath in the SAR and China.

The consortium conducted a survey in mid-June this year when questionnaires were mailed to respondents via the Hong Kong Medical Association and the Hong Kong Doctors Union. A total of 342 completed questionnaires were returned, the consortium said.

More here:

http://www.infoworld.com/t/business/survey-hong-kong-private-docs-not-ready-e-health-record-403

Work continues around the world.

Eleventh for the week we have:

Smaller medical practices get help with electronic records

By Andrew Noyes, CongressDaily

The Obama administration's implementation of stimulus package incentives intended to spur nationwide adoption of electronic medical records will give special attention to solo practitioners and small group practices, HHS Health IT Coordinator David Blumenthal told lawmakers Wednesday.

He testified before the House Small Business Regulations and Healthcare Subcommittee, which heard from pediatricians, optometrists and others who fear they could be disadvantaged when the government doles out about $17 billion in Medicare and Medicaid bonuses, grants and technical assistance.

Under the statute, physicians beginning in 2011 will be eligible for up to $44,000 under Medicare for using health IT, although what constitutes "meaningful use" of that technology has yet to be determined. Starting in 2015, penalties for those who fail to demonstrate "meaningful use" will take effect. Blumenthal said HHS is setting up listening sessions around the country targeted at small practices to hear how they believe stimulus money can work for them.

Currently, 21 percent of physicians have adopted electronic medical records, but only 13 percent of small providers have done so. For that reason, Congress created grant programs to stand up regional extension centers that would assist and educate providers, with priority given to small practices and those focused on primary care, Blumenthal said.

More here :

http://www.nextgov.com/nextgov/ng_20090625_7038.php

It is going to be important to maximise affordability as the US moves forward.

Twelfth we have:

Electronic monitors provide care without doctor

Benny Evangelista, Chronicle Staff Writer

Sunday, June 28, 2009

Sean Chai tapped the screen of the tabletop home medical monitor, which began to talk.

"Put the blood pressure cuff on your arm as shown," the computerized voice told a visitor to Chai's research lab in San Leandro. "Please relax and remain still while your reading is being taken."

After uploading data from the blood pressure cuff, the monitor asked if the visitor had taken his daily medication and "do you find yourself in a depressed mood most days?"

In the future, the answers could trigger scheduling software for a doctor's appointment or initiate a direct video call to the physician. Or it might display video of admonishments from the patient's children.

Chai is the senior information technology manager for Kaiser Permanente's Sidney R. Garfield Health Care Innovation Center. His job is to imagine the future of medical technology and test gadgets such as the home monitor to see if they are practical.

"We focus a lot on what we call the human factor, how the technology interacts with people," Chai said.

The 37,000-square-foot center, located in an office complex near Oakland International Airport, celebrates its third anniversary this week as the technology research and testing lab for the nation's largest nonprofit health maintenance organization, which covers about one-third of insured Californians.

The center has a full-size mockup of a hospital floor, complete with nursing stations and patient rooms, plus an operating room, simulated home and miniclinic. Kaiser employees can use the center to test everything from new types of hospital floor material or workflow adjustments to robotic nursing assistants and high-definition operating room video screens.

More here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/06/27/BUKS18DFDR.DTL&type=business

This is important work figuring out how devices can help the elderly stay out of care longer and still get better care.

Thirteenth we have:

Queen Mary's to investigate EMIS Web

Tags: London Millennium

02 Jul 2009

NHS Wandsworth is exploring whether EMIS Web could take the role intended for Cerner Millenium at Queen Mary’s Hospital in Roehampton, London.

The primary care trust has abandoned plans to install Millenium at Queen Mary’s Hospital, as reported by E-Health Insider in May, saying the system is not suited to modern community-based services.

Last week Phil Scott, ICT director for NHS Wandsworth, told an event held to unveil EMIS Web that it was now in talks with EMIS about the possibility of using the company’s next generation system at Queen Mary’s Hospital.

Scott said the trust was beginning to scope out how EMIS could meet the needs of Queen Mary’s as a federated polyclinic.

He added: “I take the view that EMIS can really facilitate quite significant clinical recall and appointment stuff that we do in hospital patient administration systems.

More here:

http://www.ehiprimarycare.com/news/4987/queen_mary%27s_to_investigate_emis_web

EMIS Web is getting some traction it would seem.

The future is coming.

Fourteenth we have:

CCHIT provides Meaningful Use matrix

One of the most debated topics of the American Recovery and Reinvestment Act (ARRA) as it applies to EHR is the concept of "meaningful use."

In a statement to the Office of the National Coordinator (ONC), CCHIT offered:

The question of whether this EHR technology can be adopted and put into meaningful use in a timely way to meet the 2011-2012 incentives window is more difficult. The lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years. For this reason, we believe most of the measures proposed for 2011 would be difficult to achieve by providers who have not already begun EHR implementations. Given current adoption levels, the incentives would only be available to a small percentage of providers, potentially provoking disillusionment and frustration with the ARRA incentive program. Another issue is that the proposed measures -- while understandably focusing on the highest cost disease areas – are only relevant for a subset of healthcare providers and practices. Among the lessons learned by CCHIT is this: it is essential that a new program take into account the wide diversity of specialties and settings through which health care is delivered. CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013. The intervening time may be used to develop consensus-based measures tailored to as many health care specialties and settings as possible.

Much more here:

http://www.cchit.org/about/news/enews/20090701.asp

Lots of other CCHIT news at the site.

Fifteenth we have:

Wednesday, July 01, 2009

Physician Rating Web Sites Create Quite a Stir Among Doctors

by Kate Ackerman, iHealthBeat Editor

For years, consumers have been going online to read reviews of products, restaurants and hotels before making purchasing decisions. So it's no surprise that consumers now are turning to the Internet when choosing a health care provider -- an arguably much bigger decision than the location of their next meal.

Recognizing patient demand, there are more than 40 Web sites offering consumers the chance to rate and review their physicians. Patients' increasing use of these sites suggests that they are eager for more information as they take on a more proactive role in their own health care. But a lot of doctors aren't on board. They argue that the information on physician rating Web sites is of little value, could jeopardize physicians' practices and could actually harm patients.

More here:

http://www.ihealthbeat.org/Features/2009/Physician-Rating-Web-Sites-Create-Quite-a-Stir-Among-Doctors.aspx

What do you think of this development?

Sixteenth we have:

ICD-10 Will Reduce Payment Errors and Claims Denials, but Will Also Help Fraud Investigators

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

By Nina Youngstrom, Managing Editor, (nyoungstrom@aispub.com)

Payment errors should be reduced significantly under ICD-10 diagnosis and procedure codes, which must be implemented by Oct. 1, 2013. Experts say that improvements over ICD-9 — including less ambiguity, more specificity, standardized terminology and combination codes — will help hospitals improve their compliance. But at the same time, fraud investigators may also benefit from ICD-10 when it's deployed with electronic anti-fraud tools.

"This is a boon for compliance," said Rita Scichilone, director of practice leadership at the American Health Information Management Assn. (AHIMA). With 35% of overpayments identified during the recovery audit contractor (RAC) pilot related to coding errors, the new system could have a huge ripple effect, Scichilone said at a June 9 audioconference sponsored by the Health Care Compliance Assn.

Much more here (registration required):

http://www.aishealth.com/Bnow/hbd070209.html

It is interesting to see just how much benefit is seen as flowing from the ICD-10 introduction.

Fourth last we have:

Physician Resistance Remains a Stumbling Block to EHRs

Lisa Eramo, for HealthLeaders Media, July 2, 2009

What can make or break an EHR implementation? Two words: physician buy-in, says Mike Davis, executive vice president of Healthcare Information Management and Systems Society (HIMSS) Analytics in Chicago.

Hospitals either have it, or they don't. And if they don't, they need to find a way to achieve it if they want to take advantage of the $17.2 billion in incentives associated with the American Recovery and Reinvestment Act (ARRA) of 2009, he adds.

Draft meaningful use criteria is a start

Now that hospitals have a draft of the meaningful use criteria that the Health Information Technology Policy Committee unveiled June 16, there's no time like the present to begin obtaining physician buy-in. The draft criteria include a matrix that proposes several goals, objectives, and measures for 2011, 2013, and 2015.

Physicians surely play a role in all of this, particularly as one objective for 2011 is to use computerized physician order entry (CPOE) for all order types (including medications) as well as drug-drug, drug-allergy, and drug-formulary checks. The specific measure related to this goal is to capture the percentage of orders entered directly by physicians through CPOE.

Much more here:

http://www.healthleadersmedia.com/content/235393/topic/WS_HLM2_PHY/Physician-Resistance-Remains-a-Stumbling-Block-to-EHRs.html

Not exactly news – but an interesting modern take on current reasoning.

Third last we have:

S.C. pilot links rural providers to academic resources

By Frank C. Clark

Posted: July 1, 2009 - 11:00 am EDT

Most healthcare is delivered in rural settings that are far removed from academic and tertiary medical centers.

Thus, rural care providers find themselves isolated from needed medical expertise and the rest of the world. The federal government recognized this isolation and the need to connect rural healthcare providers to centers of medical expertise and the outside world.

In 2008, the Federal Communications Commission through the Rural Health Care Pilot Program funded a number of initiatives whose goal was to connect rural healthcare providers (hospitals, clinics and physicians' offices) to the academic and tertiary medical centers within their region.

Read more of the winning IT Case Studies.

We describe the effort within the state of South Carolina using Health Sciences South Carolina, a statewide collaborative, and the Medical University of South Carolina to create a broadband network called the Palmetto State Providers Network. The project took 15 months and included steps taken from the initial application: identifying eligible entities, working through all of the FCC's requirements, issuing a request for proposals, negotiating a contract, building out the network, and the healthcare benefits being accrued.

In 2008, the Medical University of South Carolina was awarded an $8 million grant from the FCC to develop and implement the Palmetto State Providers Network for the 46 counties of South Carolina. The Palmetto State network provides broadband access to most of the rural hospitals, community health centers and many rural physicians' offices across the state.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090701/REG/307019994

What a good idea – pity it is not done nationally either here or in OZ. Lots of the other case studies are worth a browse

Second last for the week we have:

Health Information Technology

Can HIT Lower Costs and Improve Quality?

The U.S. healthcare system is in trouble. Despite investing over $1.7 trillion annually in healthcare, we are plagued with inefficiency and poor quality. Better information systems could help. Most providers lack the information systems necessary to coordinate a patient’s care with other providers, share needed information, monitor compliance with prevention and disease-management guidelines, and measure and improve performance.

Other industries have lowered costs and improved quality through heavy investments in information technology. Could healthcare achieve similar results? RAND researchers have estimated the potential costs and benefits of widespread adoption of Health Information Technology (HIT). The team also has identified the actions needed to turn potential benefits into actual benefits.

HIT’s Potential Includes Significant Savings, Increased Safety, and Better Health

The RAND team drew upon data from a number of sources, including surveys, publications, interviews, and an expert-panel review. The team also analyzed the costs and benefits of information technology in other industries, paying special attention to the factors that enable such technology to succeed. The team then prepared mathematical models to estimate the costs and benefits of HIT implementation in healthcare.

HIT includes a variety of integrated data sources, including patient Electronic Medical Records, Decision Support Systems, and Computerized Physician Order Entry for medications. HIT systems provide timely access to patient information and (if standardized and networked) can communicate health information to other providers, patients, and insurers. Creating and maintaining such systems is complex. However, the benefits can include dramatic efficiency savings, greatly increased safety, and health benefits.

Efficiency savings. Efficiency savings result when the same work is performed with fewer resources. If most hospitals and doctors’ offices adopted HIT, the potential efficiency savings for both inpatient and outpatient care could average over $77 billion per year. The largest savings come from reduced hospital stays (a result of increased safety and better scheduling and coordination), reduced nurses’ administrative time, and more efficient drug utilization.

Increased safety. Increased safety results largely from the alerts and reminders generated by Computerized Physician Order Entry systems for medications. Such systems provide immediate information to physicians — for example, warning about a potential adverse reaction with the patient’s other drugs.

If all hospitals had a HIT system including Computerized Physician Order Entry, around 200,000 adverse drug events could be eliminated each year, at an annual savings of about $1 billion (see Figure 1). Most of the savings would be generated by hospitals with more than 100 beds. Patients age 65 or older would account for the majority of avoided adverse drug events.

Health benefits. The team analyzed two kinds of interventions intended to enhance health: disease prevention and chronic-disease management. HIT helps with prevention by scanning patient records for risk factors and by recommending appropriate preventive services, such as vaccinations and screenings.

The table shows the estimated effects of increasing five preventive services: two types of vaccination and three types of screening. Together, these measures would modestly increase healthcare expenditures. But the costs are not large, and the health benefits of improved prevention are significant. For example, at a cost of only $90 million each year, between 15,000 and 27,000 deaths from pneumonia could be prevented.

HIT can also facilitate chronic-disease management. The HIT system can help identify patients in need of tests or other services, and it can ensure consistent recording of results. Patients using remote monitoring systems could transmit their vital signs directly from their homes to their providers, allowing a quick response to potential problems. Effective disease management can reduce the need for hospitalization, thereby both improving health and reducing costs.

Overall Savings Are Large Compared with Costs

Costs include one-time costs for acquiring a HIT system, as well as ongoing maintenance costs. Analysis of other industries indicates that full adoption of new technology requires about 15 years. Because process changes and related benefits take time to develop, net savings are initially low at the start of the 15-year period, but then rise steeply. Figure 2 shows the net potential savings (total savings minus total costs) for HIT implementation over a 15-year period. These savings are from increased efficiency only; health and safety benefits could double the savings.

More here:

http://www.rand.org/pubs/research_briefs/RB9136/index1.html

This is an oldie but a goodie – just to remind why we need to move on e-health.

See also this on e-prescribing.

http://www.rand.org/pubs/research_briefs/RB9052/index1.html

Last, and very usefully, we have:

The state of electronic health records across Canada

Last Updated: Tuesday, June 30, 2009 | 4:21 PM

By Peter Hadzipetros, CBC News

If the health records of Canadians were a music collection, we'd still be dealing with vinyl.

According to Canada Health Infoway — the not-for-profit organization funded by the federal government to move health records into the digital age — every year, Canadians visit doctors' offices 322 million times. Around 94 per cent of those visits result in handwritten paper records.

'Every year, Canadians visit doctors' offices 322 million times. Around 94 per cent of those visits result in handwritten paper records'

Your medical history likely consists of sheets of paper, old-style film-based X-rays and hand-scribbled hospital charts — all spread across whichever parts of the country you've lived in.

Canada lags behind most of the developed world in adopting electronic health records. In the Netherlands, 98 per cent of health records are electronic. New Zealand's not far behind at 92 per cent. The U.K. boasts an 89 per cent digital rate while Australia comes in at 79 per cent. Only the United States fares worse than Canada — among developed countries — although President Barack Obama has signaled that he wants the system to get serious about digitizing health records now.

The Canada Health Infoway is aiming to having 50 per cent of Canadian medical records available electronically by the end of 2010. It's about a third of the way there.

Implementation has varied widely across the country. Alberta has long led the way towards electronic health records in Canada. Of 4,404 physicians across the province, 3,154 had wired their practices by the end of May 2009. While some use their systems mainly for billing and scheduling patients, more than two-thirds — 2,158 physicians — used their systems to maintain their patients' health records.

Much more here:

http://www.cbc.ca/health/story/2009/06/25/f-electronic-health-records-doctors-offices.html

A great local summary of where Canada is up to right now.

There is an amazing amount happening. Enjoy!

David.

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