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 24, 2009

International News Extras For the Week (20/07/2009).

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

First we have:

State helping to shape US efforts to digitize health records for all

By Scott Kirsner, Globe Columnist | July 12, 2009

Almost 50 years ago, a Harvard-educated president gave voice to a lofty ambition: to send men to the moon before the end of the 1960s. A collection of brainiacs at MIT and Raytheon designed and built the electronic navigation system that safely guided six Apollo spacecraft to the lunar surface.

Earlier this year, another Harvard-educated president laid down another big challenge: By 2014, every American will have an electronic medical record, with the goal of cutting the cost - and improving the quality - of healthcare.

While having your healthcare history digitized may not be as inspirational as seeing Neil Armstrong step off that ladder, it’s likely to affect your life much more directly over the next decade.

On the job this time is a posse of Massachusetts-based doctors, professors, entrepreneurs, and information technology experts from local hospitals and insurers, armed with $20 billion of stimulus money. And local companies like Westborough-based eClinicalWorks Inc. and athenahealth Inc. of Watertown, which sell software and services to maintain electronic records, will be likely beneficiaries of that spending.

“Massachusetts is like the Silicon Valley of healthcare information technology,’’ says Paul Egerman, who began writing medical records software in the early 1970s, after he took a job at Massachusetts General Hospital.

Egerman went on to start one company, IDX Systems Corp., that was bought by General Electric for $1.2 billion, and another, eScription Inc., that was acquired by Nuance Communications Inc. last year for $363 million. He is now a volunteer adviser to David Blumenthal, the national coordinator for health information technology - and a former Harvard professor and Mass. General physician.

Much more here:


I suspect this just about gets right the scale of what President Obama is trying to do in e-Health!

Second we have:

Killer Smartphone Apps for On-the-Go Physicians

Cynthia Johnson, July 10, 2009

After Michelle Eads, MD diagnosed her pregnant patient with a bladder infection, she quickly reached for her Apple iPhone. The Colorado primary care doctor wasn't planning to call an urologist for a consult, however. She used the smartphone to research antibiotics that are safe for pregnant women using Epocrates, a comprehensive drug and disease reference application developed by San Mateo, CA-based Epocrates, Inc.

Eads doesn't have a list of antibiotics that are safe for pregnant women committed to memory. But, she does know that physicians need to be very careful about prescribing medications that may harm an unborn baby.

"With Epocrates, I'm able to research very quickly and figure out what the safest options are, review them with the patient, and make a decision," she says.

Eads is one of a growing number of physicians using smartphones—mobile phones that combine online access to information with PDA functionality. According to an April report by Manhattan Research, the number of physicians using smartphones more than doubled to 64% over the past year.

The results of the survey indicate that physicians like Eads are spending more time online using smartphones to access medical and pharmaceutical resources during the course of their busy day.

"It's rare for me to have an encounter—whether it's a phone visit, a virtual visit, or an office encounter—that I don't use Epocrates," says Eads. "If I'm getting ready to talk to a patient and I want to know what the different alternatives and side effects are, I do a little research before the appointment. I'm using it constantly."

Avoiding medication errors

Eads primarily uses the Epocrates application to look up drug interactions, side effect profiles, adverse reactions, and contraindications. Epocrates, Inc. launched the application in 1999 and offers users a free version of the tool as well as subscription-based versions with additional functionality. Michelle Snyder, Epocrates senior vice president of subscriptions, says over one in three doctors in the United States are actively using the application on a mobile device.

According to Eads, this use of her smartphone increases her productivity. If a patient is concerned about stomach upset, for example, Eads looks at antibiotics that are least likely to cause that.

It also allows her to look up drug interactions, including drug herbal interactions, which she says are somewhat popular with residents in Colorado. "There are a lot of people on some strange things out here," she says.

In a study of how examining if Epocrates helps doctors reduce medication errors, researchers at Brigham and Women's hospital found that 50% of Epocrates physicians surveyed reported averting one to two errors per week.

"It really helps them prescribe the right medication and avoid adverse drug events," says Snyder. She says when a drug is recalled, the company is able to update their drug database within the hour so physicians are constantly accessing the latest information.

Eads can view different types of medications in the same family or the same class. The application also tells her what the patient's copayment will be given their insurance plan (not all insurers pay Epocrates to include this information). Eads says this allows her to find lower copayment options for her patients. It also reduces the need for a callback from the patient's pharmacy if a particular drug isn't covered by the patient's insurance plan.

"My patients like that I can check and find out what medicine they can use given their insurance," she says. "It's nice to have that information to give them more choices."

According to Snyder, when the new Medicare part D program went into effect, Epocrates had all of the plans already loaded into their application. "That was a huge help to physicians. It's difficult for the physician to keep track of what's covered under which plan."

In general, the response that Eads has gotten from her patients regarding her use of the smartphone has been extremely positive. "My patients know that I'm very technology oriented and that it allows me to spend more time with them."

She says they don't view her reliance on the phone's reference applications as a weakness. "I don't know absolutely everything," she says. "I think they're glad to see that I'm double checking things and also making sure that there aren't interactions or problems."

For example, when she has a patient who isn't quite sure of the name of the medication he or she is taking but can describe what the pill looks like, Eads can use the search function in the application and show the patient a picture of it.

"So many times people say it's the little red pill that I need to have refills on. Finding the actual picture is very helpful."

The infectious disease information in the Epocrates application is also helpful, she says. If she is treating a patient who has sinusitis, it allows her to see what the current recommended antibiotic is.

"If you have an idea of what you're treating, then you can search for it by what part of the body is affected with the infection and you can find out what the recommendations are."

Lots more here (including a top applications list for the iPhone):


It is amazing just how quickly the application capability of the iPhone has been adopted and exploited.

Third we have:

Surescripts merger 1 year old as ARRA pushes e-Rx

By Joseph Conn / HITS staff writer

Posted: July 13, 2009 - 11:00 am EDT

Part one of a two-part series:

This month marks the one-year anniversary of the merger of the two largest electronic-prescribing exchanges, SureScripts and RxHub, creating a market-dominant, privately held, for-profit company just in time for the federal government to all but mandate that physicians e-prescribe.

So, how is the merger going? The answer depends on who's talking.

“The question you may be asking is, has the merger yielded any benefits and we're happy to say, it absolutely has,” said Harry Totonis, CEO of the merged company, now called Surescripts.

Totonis only recently joined Surescripts—in April—after serving as head of adviser services at MasterCard, and previously working 14 years as a consultant with Booz Allen Hamilton, which works extensively in healthcare as well as for the federal government in defense and national security and intelligence programs.

“E-prescribing volume has just skyrocketed and we've handled that without adding a lot of new people,” Totonis said. “We're processing twice as many transactions with relatively the same number of people. The efficiency we get is benefiting everyone.”

Justin Barnes is a vice president of Carrollton, Ga.-based Greenway Medical Technologies. In that post, he oversees corporate development, strategy, marketing and government affairs for the electronic health-record system vendor. Barnes also serves as chairman of the Electronic Health Record Association, a trade group for EHR vendors that is an arm of the Healthcare Information and Management Systems Society.

Vendors, Barnes said, while not hostile to Surescripts having such predominance, are “not completely comfortable” with the situation, either.

“It's kind of pushed on us,” Barnes said. “When you have no competition, they may not want to listen to people. Competition breeds excellence at the end of the day. It always has and always will.”

The merger, which seems natural now, pooled the resources of two competing companies whose rival sponsors that either are themselves or have members that are still battling for market share in prescription drug sales. Both SureScripts and RxHub were formed in the aftermath of the 2000 bursting of the dot-com bubble that wiped out scads of e-prescribing startup companies.

Reporting continues here (registration required):


There just might be a lesson here for Australia in having for-profit companies involved in e-Prescribing.

Part 2 is here, and provides useful insights on areas like data-mining of prescription data:


Fourth we have:

AMDIS recognizes eight for IT achievements

By Elizabeth Gardner

Posted: July 13, 2009 - 7:00 am EDT

Getting a healthcare institution to embrace meaningful clinical automation takes dedication, drive and deep knowledge of what clinicians need. For the past 10 years, the Association of Medical Directors of Information Systems has recognized outstanding achievement in applied medical informatics.

This year, the eight winners include two institutions, one team and five individuals. There were 43 nominees. The judges were: William Bria, M.D., AMDIS president and chief medical information officer at Shriners Hospital for Children system, Tampa, Fla.; Howard Landa, M.D., CMIO, Hawaii Permanente Medical Group, Honolulu; Harris Stutman, M.D., executive director of research, MemorialCare Medical Centers, Long Beach, Calif.; Blackford Middleton, M.D., director of clinical informatics research and development, Partners HealthCare System, Boston; Ray Aller, M.D., director, automated disease-surveillance systems for the Los Angeles County Health Department; Bill Childs, executive vice president, R3 Health Partners, Santa Ana, Calif.; John Glaser, chief information officer, Partners HealthCare; and Brian Malec, professor of health administration, health sciences department, California State University at Northridge.

Much more here (registration required):


This list of winners shows how some good things are being done at the bleeding edge.

Fifth we have:

July 13, 2009, 5:30 am

Electronic Health Records: A Texas Model

By Steve Lohr

The Obama administration this week will outline what the nation’s doctors and hospitals must do to qualify for billions of dollars in government support to adopt electronic patient records. The most closely watched part of the announcement will be further definition of what the economic stimulus legislation called the “meaningful use” of digital health records.

The draft due Thursday from the office of the national information technology coordinator, Dr. David Blumenthal, will not be the final word. There will be time for public comment, and lobbying, until the end of the year.

But the work done so far by Dr. Blumenthal and his team, health experts say, is encouraging. The tentative plan, they say, calls for a requirement that physicians and clinics be able to first report health quality measures, like blood pressure and cholesterol levels of patients. Then, step by step, year by year, the administration foresees moving health providers from electronic reporting to being reimbursed for better health outcomes, such as a higher percentage of a doctor’s diabetes patients keeping their blood sugar levels at recommended levels.

The technology approach, health experts say, is pretty much agnostic. The focus is not on a specific technological path but on using computing tools to capture, track and monitor data.

More here:


If incentives are to be paid to clinicians using desired clinical outcomes seems a pretty good way to be going about it.

Healthcare reform needs to ‘go beyond digitizing a broken system’

17 July 2009

The Institute for e-Health Policy’s Steering Committee on Telehealth and Healthcare Informatics held a meeting this week where Harris Corporation vice president of Healthcare Solutions Jim Traficant spoke to members, telling them that an integrated, interoperable enterprise system was needed to transform the nation’s healthcare infrastructure.

The Institute for e-Health Policy’s Steering Committee on Telehealth and Healthcare Informatics is an educational and research-based organization that produces educational sessions and healthcare information technology demonstrations for members of Congress, congressional staff, key federal agency officials, industry professionals and the general public.

Honorary Steering Committee Co-chairs are: Senators Kent Conrad (D-ND); Mike Crapo (R-ID); John Thune (R-SD); Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R-VA); Rick Boucher (D-VA); Bart Gordon (D-TN); Allyson Y. Schwartz (D-PA); and David Wu (D-OR).

As part of the team that developed the software for the National Health Information Network (NIHN) CONNECT Gateway, Harris VP Traficant told the Institute that a centralized, reliable network was needed to connect the nation’s fragmented systems. “Healthcare reform must go beyond digitizing a broken system to enable an integrated, interoperable one.”

Much more here:


An obvious but important point!

Seventh we have:

Doctor improperly accessed women’s medical records at Fletcher Allen

By Sam Hemingway, Free Press Staff Writer

A Fletcher Allen Health Care family physician has admitted he accessed the medical records of eight women without their permission or for any medical purpose, according to the state Medical Practice Board.

The women were not his patients at the time he accessed their medical records, the board said.

The actions by the doctor, Joshua A. Welch, were deemed by the board to be a violation of the Health Insurance Portability and Accountability Act, or HIPAA, as well as the Vermont Patient’s Rights Act, the board said in publicly reprimanding Welch.

The board, in an interim stipulation and consent order issued earlier this month, said it was alerted to Welch’s actions in September, 2008, by a woman who said she had a “personal relationship” with Welch and had learned that he had accessed her medical records without her permission.

Much more here:


This is something that is, very occasionally, inevitable. The important thing is to have the systems to identify the breeches, punish offenders and discourage most from indulging their curiosity / evil intent.

Eighth we have:

Laptops in ambulances boost emergency care

Ability to access patients' records while en route to the hospital may be unrivalled

By Shari Rudavsky

Metro-area ambulance crews are among the first in the world with the power to tap into patient medical records in the field.

Wishard Health Services began testing the system on Marion County's 40 or so ambulances this month. Hamilton County emergency medical vehicles also are equipped with laptops that link to hospital records.

The ability to check a patient's medical history from afar will help paramedics provide better care, experts say, and open the door for research into which emergency treatments produce the best outcomes.

Full article here:


An inevitable next step I guess.

Ninth we have:

Senate Allocates $3.3 Billion In IT Funds For VA

Much of the money would go toward electronic medical records projects at the Veterans Administration.

By J. Nicholas Hoover, InformationWeek

July 10, 2009

Under a spending authorization bill approved Monday by the Senate Appropriations Committee, the Veterans Administration would get $3.31 billion to spend on information technology in 2010, an increase of 30% over the agency's 2009 budget.

Much of that money would go toward electronic medical records projects at the VA, as well as the integration of those medical records with the medical records kept by the Department of Defense. In all, the committee recommendation includes $800 million for new program development.

"The committee understands that effective healthcare delivery in the 21st century requires robust and modern IT systems and remains strongly dedicated to providing the VA with the resources it needs to accomplish this modernization," the committee said in a report accompanying the bill.

More here (registration required):


That is certainly a serious sum – especially the $800 Million for new projects!

Tenth we have:

Canada issues alert on virus attack on EHR service

By Joseph Conn / HITS staff writer

Posted: July 13, 2009 - 11:00 am EDT

The Office of the Information and Privacy Commissioner of Alberta in Canada has issued an alert to the public that the provincial electronic health-record service, Alberta Netcare, had been attacked by a computer virus designed to steal data.

More here (registration required):


Not a good look at all!

From this it looks like it was actually quite serious.


Alberta Breach Wallops Thousands

Eleventh for the week we have:

Telephone check-in system cuts re-admissions by 54%


Posted 2 days ago

A daily telephone check-in system for heart failure patients has cut readmission rates by 54 per cent, according to a study by the University of Ottawa Heart Institute.

A new study of heart failure patients shows that a telehealth monitoring system that lets patients dial in their daily blood pressure, weight and medication levels helps keep them healthy and out of hospital.

The hospital followed 121 heart failure patients in 2007- 2008 and found only 14 per cent of those who were tracked by the telehealth monitoring were readmitted.

This compared with 69 per cent of patients readmitted at least once in the six-month period who were not getting the daily telephone monitoring.

More here :


That looks like a pretty good outcome for a fairly simple intervention.

Twelfth we have:

KLAS report: Digital mammography provides ROI

July 09, 2009 | Molly Merrill, Associate Editor

OREM, UT – Digital mammography is providing a strong return on investment for healthcare providers, according to a new KLAS report.

KLAS, an Orem, Utah-based research and marketing firm, interviewed more than 200 healthcare professionals about their use of full-field digital mammography (FFDM) solutions. According to the FDA, roughly half of the Mammography Quality Standards Act (MQSA)-certified facilities in the United States have now adopted digital mammography equipment.

The KLAS report shows many of those who have made the switch to FFDM systems have increased their capacity for patient throughput, leading to a strong ROI for the new technology.

More here:


Hardly a surprise, but important to know.

Thirteenth we have:

Scotland delivers e-prescription service

Tags: Scotland

14 Jul 2009

Scotland has announced that it has become the first country in the UK to deliver an electronic prescription service, with more than 90% of prescriptions now submitted electronically.

Scottish health secretary Nicola Sturgeon said the electronic Acute Medication Service (eAMS) was the first national system of its kind to go live anywhere in the UK and was now enabled in 99% of Scottish GP practices and pharmacies.

The eAMS prints a barcode on prescriptions at a GP surgery and sends a message to Scotland’s ePharmacy Message Store.

When a patient presents at a pharmacy with their barcoded prescription, the pharmacist can scan the barcode to pull down the prescription and dispense the medicine.

Dispensing a prescription triggers the creation of an electronic claim message to NHS National Services Scotland (NSS).

The Scottish government said eAMS cuts the risk of errors between GPs and pharmacists, delivers improvements such as the use of universal codes for virtually all medicines, and boosts efficiency.

More here:


Seems like Scotland beat eRx to it! And it is standards based and the information can be used for research etc sponsored by Government. A much better plan!

Fourteenth we have:

Seven Ways to Get Value From Your EMR

Carrie Vaughan, for HealthLeaders Media, July 14, 2009

EMRs were thrust once again into the national spotlight when the Obama administration committed nearly $19 billion in stimulus funding for health IT as part of the American Recovery and Reinvestment Act of 2009. The objective is to use electronic medical records to make the health system more efficient, safer for patients, and, ultimately, to reduce costs and improve quality.

While EMRs have the potential to meet those objectives, implementing the technology simply isn't enough. A lot depends on how organizations use the systems, which is why the HITECH Act calls for providers to be deemed "meaningful users" of certified EMR technology before they qualify for stimulus dollars. The legislation uses a carrot and stick approach. It offers providers incentive payments if they can meet the meaningful use criteria, however, organizations and physicians that are not meaningful users of HIT by 2015 will start incurring penalties.

Implementing the technology in a short timeline will be a difficult for providers. But the real challenge will be getting value out of the systems put in place.

For the July issue of HealthLeaders magazine, I spoke to executives at four hospitals and health systems about how they were moving past implementation and getting value from their electronic medical records systems ("Where's the Value?").

Much more here:


A sensible set of points to consider in moving forward.

Fifteenth we have:

Kaiser Permanente Survey Shows Seniors Embrace Internet to Manage Their Health

New Data Show Medicare Beneficiaries are Overwhelmingly Satisfied with My Health Manager, Kaiser Permanente's Personal Health Record

By: PR Newswire

Jul. 14, 2009 08:31 AM

OAKLAND, Calif., July 14 /PRNewswire/ -- New data show that Medicare beneficiaries registered to use My Health Manager, Kaiser Permanente's personal health record, are overwhelmingly satisfied with using the Internet to manage their health care online. Results from the recent Kaiser Permanente survey examining Web site usage and Medicare beneficiary satisfaction were presented today at the World Health Care Congress' 5th Annual Leadership Summit on Medicare in Washington, D.C.

The e-mail survey received 4,560 responses and had a response rate of 23 percent. It looked at respondents' comfort in using computers, Internet use habits, and current health status, including chronic conditions and prescriptions. More than 87 percent of respondents were satisfied or very satisfied with My Health Manager on kp.org.

Vastly more here:


It is good to see there is good usage of quality PHR services among older people.

Sixteenth we have:

Reminder Program Dramatically Increases Mammography Rates, Kaiser Permanente Study Finds

Posted : Tue, 14 Jul 2009 07:01:03 GMT

Largest Study to Examine Electronic Health Records-assisted Mammogram Reminder Program PORTLAND, Ore., July 14
PORTLAND, Ore., July 14 /PRNewswire/ -- A reminder program aimed at screening for breast cancer when it is most treatable boosted mammography rates by more than 17 percentage points, according to a new study by Kaiser Permanente's Center for Health Research in the August issue of the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls.

The study of 35,000 Kaiser Permanente members is the largest to test a reminder program involving this three-pronged approach. By the second year of the program in 2008, mammography rates jumped from 63 to more than 80 percent among women aged 50-69.

Much more here:


Again we have proof of how quality clinical directed decision support can improve health system performance.

Fourth last we have:

Enhancing access to health care

July 15, 2009 (Toronto, ON) – Northern Ontario is once again at the leading edge of an important new e-health service. The service, called a Diagnostic Imaging Repository or “DI-r” will enable electronic transfer of medical images and the associated doctors’ reports between hospitals in Northern and Eastern Ontario. Today marked the official opening of the repository’s data centres in Thunder Bay and in Sudbury with a visit to the Thunder Bay Data Centre by representatives of Canada Health Infoway (Infoway) and eHealth Ontario, the project’s funders.

Forty hospitals in the North West and North East Local Integration Networks (LHINs) and 19 hospitals in the Champlain LHIN (the greater Ottawa region) are involved in the project; also referred to as NEODIN – the Northern and Eastern Ontario Diagnostic Imaging Network. When completed in 2011, sharing of images and reports through the NEODIN DI-r will service almost two million Ontarians across 840,000 square kilometres from the Manitoba border in the west to Cornwall and Hawkesbury in the east. The result will be better access to health care services, particularly for patients in smaller communities. The $34.8 million project is funded by eHealth Ontario and Infoway.

Much more here:


For all the ups and downs we do seem to be getting some distinct progress happening all over Canada.

Third last we have:

How a robot can terminate medical errors for kids

RIVA the robot is ready with an IV and the right dosage

By Eric Lai

July 14, 2009 04:59 PM ET

Computerworld - In a children's hospital, dispensing medicine is more complicated than putting pills in a bottle. Youthful patients come in a wide variety of ages and sizes, which means their dosages must be individually tailored.

Hundreds or thousands of medicines must be made up and delivered daily. Combine that with the breadth of not-always-easy-to-distinguish medicines and dosages and even careful pharmacists and other medical personnel can slip up when tired or distracted.

Now, technology has arrived that its makers promise can drastically cut down on drug-related errors. The Robotic Intravenous Automation (RIVA) device made by Winnipeg-based Intelligent Hospital Systems is a robotic arm that can prepare sterile IV syringes and bags behind its glass case.

More here:


Sounds like a useful and interesting advance.

Second last for the week we have:

Spotlight on CCHIT's future during HIT policy meeting

By Joseph Conn / HITS staff writer

Posted: July 15, 2009 - 11:00 am EDT

Not surprisingly, when a work group of the federally chartered Health Information Technology Policy Committee met Tuesday for a day-long discussion on certification and adoption of healthcare IT systems, the past, present and future role of the federally supported Certification Commission for Healthcare Information Technology, or CCHIT, was on the agenda.

CCHIT was established in 2004 by the Healthcare Information and Management Systems Society, the American Health Information Management Association and the National Alliance for Health Information Technology at the behest of David Brailer, the first head of the Office of the National Coordinator for Health Information Technology at HHS.

More here:


This is important to get right as the CCHIT has certainly motivated some improvements and forward planning.

Last, and very usefully, we have:

Tieto and InterSystems create Swedish National Patient Summary Record

The first stage of the Swedish National Patient Summary project was successfully deployed on 4 May in Örebro County Council and the Municipality of Örebro.

Mats Sandstrom, InterSystems’ country manager, Nordics, explains how the project is a vital part of a wider programme to implement the national IT strategy for the healthcare and welfare sector in Sweden, and discusses some of the legal, consent and technical issues that have been overcome so far.

The National Patient Summary service (known as the NPÖ) is part of the Swedish national IT strategy for the healthcare and welfare sector, which focuses on common solutions to improve the accessibility, quality and safety of healthcare services.

At the moment, a patient will often have access to services from several care providers, many of whom will have their own system for medical records.

In consequence, it can be difficult to get a comprehensive overview of previous medications, laboratory results and diagnoses; which, in turn, may complicate or delay treatment, particularly in an emergency, when there may not be time to get information from other care providers.

In 2008, the Swedish Healthcare Advisory Organisation (Sjukvårdsrådgivningen SVR AB) selected Tieto to deliver the development, implementation and hosting of the NPÖ. This is the first national electronic health record for Sweden, and one of the first of its kind in the world.

Tieto chose InterSystems HealthShare as its health information exchange software platform. It took just over a year from the contract award to establish the legal context, patient consent and IT infrastructure for the service, and to connect the first healthcare region - Örebro County Council and the Municipality of Örebro.

Vital information

The National Patient Summary makes it possible for authorised healthcare and welfare professionals to obtain important patient information from the county councils’, municipalities’ and private care providers’ patient record systems.

Professionals access the NPÖ through a web interface with the consent of the patient concerned; but the information displayed is recorded and kept in the local healthcare system of the relevant provider.

InterSystems HealthShare is the innovative software product that creates this overview. HealthShare provides aggregation and sharing of clinical data among multiple provider organisations on a regional or national basis – up to, and including, a full electronic health record.

It can be easily extended to provide additional functionality, such as e-prescribing or order communications, through the addition of business rules and business processes, composite applications, and applications provided by InterSystems’ partners.

Much more here:


Note carefully the approach – use data from local systems and assemble it for access – rather than have a separate Shared Record. Much better idea and more trustworthy that the NEHTA IEHR plan in my view.

There is an amazing amount happening. Enjoy!


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