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."

Thursday, August 13, 2009

International News Extras For the Week (10/08/2009).

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

First we have:

EPS R2 goes live in Leeds

29 Jul 2009

Release 2 of the Electronic Prescription Service has gone live at its first site in Leeds, NHS Connecting for Health has announced.

Liptrots pharmacy and Calverley Medical Centre have become the first pharmacy and GP practice in England to use EPS R2.

They are using Cegedim’s Pharmacy Manager and TPP’s SystmOne, the first pharmacy and GP systems to be accredited for EPS R2.

EPS R2, which was originally due to go live in October 2007, delivers much of the business benefit of the electronic transmission of prescriptions, including nomination of pharmacies, electronic prescription signing and the ability for GPs to electronically cancel prescriptions.

CfH said EPS R2 was a necessary evolution from the out of date paper prescription system. It added: “With 1.5 million prescriptions being issued every day across England and the total increasing by 5% every year, the NHS needs an efficient, clinically-safe, electronic system, able to cope with this pattern of prescribing.”

Much more here:


It is interesting to see how advanced the functionality offered with this new release is.

Second we have:

Maine Demonstrates Statewide HIE

HDM Breaking News, July 31, 2009

Maine's statewide health information exchange has gone live with a one-year demonstration program that will involve 15 hospitals and more than 2,000 clinicians. That includes more than one-third of practicing physicians in the state.

The demonstration follows more than three years of preparation, including developing, implementing and testing the data exchange platform during the past year. Information technology vendors for the project are Orion Health, Santa Monica, Calif.; 3M Health Information Systems, Salt Lake City; and DrFirst Inc., Rockville, Md.

Hospitals initially are supplying most of the data to be exchanged in the HIE, called HealthInfoNet. Data available in a standards-based Continuity of Care Record includes demographics; conditions, diagnoses or problems; allergies; prescription medications; laboratory results; and dictated/transcribed documents including diagnostic imaging reports. Data also is coming from pharmacy benefit management firms and two reference laboratories.

Some 70% of physicians in Maine are employed by hospitals. Along with hundreds of these doctors, four primary care physicians working at Martin's Point Health Care, a 34-member independent group practice, also are participating in the demonstration.

Lots more here:


More information is available at hinfonet.org.

This is certainly a large effort involving Health Information exchange at a very significant level.

Third we have:

Feds to host NHIN software code-a-thon

By Mary Mosquera
Friday, July 31, 2009

The Health and Human Services Department will sponsor a “code-a-thon” Aug. 27 so open source programmers can meet to collaborate on ways to improve the CONNECT gateway, software that lets organizations access the Nationwide Health Information Network.

A code-a-thon is typically held by open source communities so that programmers can collaborate for a day or a weekend on writing code for specific high priority items for an open source project.

“The code-a-thon gives programmers an opportunity to meet face to face and get to know each other rather than simply just communicating by email,” said David Riley, the CONNECT program lead for the Federal Health Architecture (FHA) program in the Office of the National Coordinator for Health IT.

Reporting continues here (with links):


This is good work that is being done as this software will certainly help provide connectivity in the US Healthcare sector.

Fourth we have:

ANSI approves new healthcare RFID standard

By Shawn Rhea

Posted: August 2, 2009 - 5:59 am EDT

The Health Industry Business Communications Council's new set of standards for using radio-frequency identification tags to label and track medical products has received final approval from the American National Standards Institute, according to a news release.

Much more here (registration required):


Another brick in the standards wall which may help as we decide to develop such standards.

Fifth we have:

Cardiovascular Consultants launches new EHR

July 31, 2009 | Kyle Hardy, Community Editor

LOS ANGELES – Cardiovascular Consultants Medical Group, a Los Angeles-based care provider, has deployed a new electronic health record.

With their implementation, CCMG hopes to be on the leading edge of IT adoption. The group specializes in consultative and interventional cardiology that includes focuses in cardiac electrophysiology with laboratories offering echocardiography services. The e-Medsys EHR will be available across the medical group's five office locations encompassing 13 physicians and four nurse practitioners.

More here:


Initiate Systems Unveils Patient Registry

px px(7/31/2009) px Initiate Systems, Inc. (Chicago) is launching Initiate Catalyst Patient Registry, a virtual software appliance designed to accelerate data interoperability for EMRs, portals, radiology information systems, PACS and other healthcare information exchange (HIE) solutions.

According to the company, the tool provides independent software vendors with entity resolution and search capability that can be embedded in their information exchange applications and portals to improve patient care.

More here:


This company is a major provider of identity management software that does not rely on UPI’s for patient linkage.

Seventh we have:

Hospital's 'Virtual Iraq' helps PTSD sufferers face their fears



FRIDAY, JULY 31, 2009

SYRACUSE — Upstate Medical University on Thursday unveiled a new treatment option for veterans of the Iraq and Afghanistan wars suffering from post-traumatic stress disorder.

"Virtual Iraq" offers an interactive, multisensory experience — like an enhanced video game — allowing soldiers to confront and gradually conquer their fears in a safe, private and controlled environment.

"The young vets seem more likely to take to this kind of therapy," said Robbi T. Saletsky, director of the university's Cognitive Behavior Program for Depression and Anxiety Disorders. "There's less stigma attached to it; it seems cool."

Ms. Saletsky demonstrated a treatment session in her office for the press. Volunteer Cristy L. Samuel, an Iraq war veteran and pre-medical student at Syracuse University, simulated the role of a patient. She is not a victim of PTSD, but said she would recommend the treatment for veterans with the condition.

During the mock therapy session, Ms. Saletsky prepared her patient to relive a moment in combat that had haunted her.

Much more here:


Important to see the range of technologies in use to help soldiers who are suffering post war.

Eighth we have:

Providers May Need Four Years to Implement ICD-10

Lisa Eramo, for HealthLeaders Media, July 31, 2009

Industry experts have repeatedly said that ICD-10 implementation must begin immediately in order for hospitals, health plans, and vendors to meet the October 1, 2013 compliance deadline. But now there is detailed evidence to prove it.

On July 20, the North Carolina Healthcare Information and Communications Alliance, Inc., (NCHICA) and The Workgroup for Electronic Data Interchange (WEDI) released a timeline that quantifies each ICD-10 preparation task in terms of the number of days it will take to complete.

NCHICA and WEDI estimate it will take providers nearly 1,286 work days to implement ICD-10. For vendors, it will take nearly 1,521 work days to complete. And the clock is ticking.

"The NCHICA-WEDI timeline shows graphically that the full time from now to October 2013 will be required to successfully meet the compliance deadline. We cannot continue to delay this effort," said Holt Anderson, executive director of NCHICA in a press release.

For providers, the figure takes into account 256 days to organize the implementation effort. The timeline also outlines 36 months for identifying process improvements (e.g., how hospitals intend to use more specific data to target education or treatment for certain patient populations), 14 months for internal system design/development, 12 months for internal testing, 12 months for vendor code deployment, and 10 months for external testing.

Although the numbers may sound daunting, the writing has definitely been on the wall since CMS' January 16, 2009 publication of the ICD-10 final rule. Hospitals should already be well on their way toward planning for the change.

Full article here:


The Americans are certainly struggling with this. Australia has been using ICD-10 for at least a decade.

Ninth we have:

Tuesday, August 04, 2009

States Preparing for Health Data Exchange Stimulus Money

by George Lauer, iHealthBeat Features Editor

At varying rates of speed and using different vehicles, states are trying to get prepared to accept and intelligently use considerable amounts of federal money to transform a paper-based health industry to one reliant on digital technology.

The American Recovery and Reinvestment Act identifies about $36 billion to be used for health IT over the next several years nationwide.

One of the first orders of business is determining whether states themselves want to coordinate the connections that will allow physicians, hospitals, insurers, pharmacies and patients to share information electronically. Some small states may elect to take on health information exchange in-house but most large states are expected to contract the job to industry experts.

In California, potential contractors are ahead of the process, with two contenders so far in a race that has yet to be declared or described.

California is expected to get about 10% of the national pie -- or $3.6 billion.

Some of the first installments -- as much as $30 million -- could be spent relatively quickly, once the state determines how to spend it.

Much more here:


It is interesting to see the plans that are evolving to deploy Health IT using the ARRA stimulus funds.

Tenth we have:

Scandal-plagued eHealth gets third CEO in 3 months, fourth by end of year

By Keith Leslie (CP) – 2 hours ago

TORONTO — The opposition parties accused the Liberal government of incompetence Tuesday after eHealth Ontario named its third chief executive officer in as many months, with a fourth to be appointed before the end of this year.

The government can play musical chairs with the CEOs all it wants, but the bottom line is Health Minister David Caplan should be fired, said Progressive Conservative Leader Tim Hudak.

"It's either incompetence or neglect, neither of which is excusable when it comes to scarce health dollars," said Hudak. "We need a new minister to come in there and clean up this mess."

The New Democrats repeated their call for Caplan's resignation, and said rotating through CEOs only creates uncertainty at eHealth and detracts from its mandate to develop electronic health records.

"It shows the government in a scramble and they're trying to plug a leaking dike, but the whole eHealth situation is one the government has fumbled very, very badly," said NDP Leader Andrea Horwath.

More here:


This is the last mention we will give this – I hope they will now move forward!

Eleventh for the week we have:

The Role of Telehealth in Medical Tourism

Scott C. Simmons and Dr. Anne E. Burdick

published online: Aug 4, 2009

Telehealth, also known as telemedicine, is the remote provision of health care services enabled by technology. A continuum of successful telehealth applications have been demonstrated over the last twenty years, ranging from the transmission of digital photographs and patient histories for diagnostic consultation, to remote monitoring of physiologic data for chronic disease management, to interactive patient physical examination using medical video endoscopes and ultrasound over high-definition videoconferencing links. The common tie among these varied applications is that technology is used to improve access to health care services independent of geography.

Telehealth can improve quality, efficiency and customer service in medical tourism applications by better coordination of care between providers in patients’ home and foreign countries, enhanced preoperative and postoperative care, and optimizing patient and family member travel. This article describes the basic principles and applications of telehealth and explores the potential roles and challenges of telehealth in medical tourism.

Much, much, more here:


I must say the link was not immediately obvious before I read this!

Twelfth we have:

CA Expands Offerings for Virtualized Data Centers, Private Clouds

CA said support for VMware vSphere 4 and Cisco Nexus 1000V will help its customers achieve lean IT by providing model-based management using CA’s integrated infrastructure availability, performance and automation management solution.

IT management software company CA announced a strategy for optimizing IT services by improving the management of next-generation virtualized data centers and private clouds. CA said its solution for unified business service assurance and automation would involve coupling comprehensive availability and performance management for VMware vSphere 4 environments and Cisco virtualized network switches.

CA is broadening the scope of its Spectrum Infrastructure Manager, eHealth Performance Manager and Spectrum Automation Manager to encompass in one integrated, end-to-end management solution both physical and virtual server and network environments, as well as databases, voice and unified communications systems and other networked applications. The products are being enhanced to support VMware vSphere 4 and the Cisco Nexus 1000V distributed virtual software switch, which is an integrated option in VMware vSphere 4.

Much more here:


This is a bit geeky, but I had not thought of the idea of a ‘private cloud’. The applications to e-Health are reasonably obvious.

Thirteenth we have:

Take Two Digital Pills and Call Me in the Morning

Silicon Valley Has a High-Tech Prescription to Cure Health Care's Swollen Costs and Inefficiencies, but the Prognosis Is Uncertain

Hospitals are costly places. Andrew Thompson hopes his company can help keep people out of them.

His Silicon Valley start-up, Proteus Biomedical Inc., is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors, along with readings about patients' vital signs.

Corventis's wireless sensor monitors patients on the go.

More here (subscription required):


It is not clear to me that there is a technological fix for the over-bloated US health system!

Fourteenth we have:

Weighty Choices, in Patients’ Hands


Diagnosed with breast cancer last year at 51, Mary Bianchi balked when her surgeon laid out an aggressive plan for treatment: a lumpectomy and removal of lymph nodes without first testing them to see if the cancer had spread. She went home and surfed the Web for information about additional options, but soon felt overwhelmed by the plethora of choices.

Patient Maria Hom, center, asks Dr. Shelley Hwang, an associate professor of surgery at the UCSF Breast Center, questions with the help of a pre-medical intern, Alexandra Teng. Interns act as coaches for patients, helping them brainstorm questions and making sure all their concerns are addressed in meetings with doctors.

Ms. Bianchi then sought a second opinion at the University of California, San Francisco Breast Care Center. The center’s Decision Services unit gave her videos and booklets on the risks and benefits of different treatment options. It also offered her a personal coach to help brainstorm questions and concerns, accompany her on doctor visits and make audio recordings of medical consultations. “It really enabled me to calm down and rationally think things through,” says Ms. Bianchi. “For the first time I felt like a participant in the decision-making process.”

For patients like Ms. Bianchi, the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to the disadvantages. The study also found that doctors often offer their opinion but much less frequently ask the patient’s own opinion.

“There are an increasing number of situations where there is not a clear-cut winner in terms of treatment, and patients don’t get the information they should about side effects and things that could go wrong before making decisions,” says Karen Sepucha, a scientist at the Health Decision Research Unit of Massachusetts General Hospital. “The result is a huge disconnect between what patients truly care about and what providers feel is most important for patients.”

Though decision-aid programs cost money to deliver, they appear to save money in the long run. Studies show that when patients understand their choices and share in the decision-making process with their doctors, they tend to choose less-invasive and less-expensive treatments than they would have otherwise received. A number of states and policymakers in Washington are considering legislation that would provide funding to study the use of shared-decision-making programs and in some cases require such programs to be offered to patients as part of the informed-consent process.

Much more here (subscription required):


There are a lot of tools cited here to assist patients in their decision making.

Fifteenth we have:

Rural hospital hinging future on federal incentive

By DAVID A. LIEB (AP) – 18 hours ago

OSCEOLA, Mo. — Electronic medical records are a life-or-death issue at Sac-Osage Hospital — not necessarily just for the patients, but for the hospital itself.

Facing a budget shortfall, the 47-bed hospital in rural western Missouri is borrowing nearly $1 million to pitch its paper medical charts and purchase a state-of-the-art electronic health records system. The hospital is hinging its survival on what it hopes will be a $3 million windfall of federal incentives for hospitals that go digital.

"If that doesn't happen, we're shutting it down," Sac-Osage CEO Jeff Speaks said. "We're rolling the dice."

It's the final gamble for a hospital that already has laid off staff, is operating on a $370,000 deficit and is warning of dozens of deaths if local voters on Tuesday don't also approve a property tax to keep its emergency room open and ambulances running.

The stimulus act signed by President Barack Obama directs $17 billion to doctors and hospitals, beginning in 2011, that make "meaningful use" of electronic medical records. In 2015, health care providers could face financial penalties if they haven't made the switch.

Much more here:


Quite a roll of the dice!

Sixteenth we have:

New Epidemic Fears: Hackers


The government is committing billions of dollars for technology systems that help healthcare providers share information. But making patient data more accessible has the unpleasant side effect of it potentially falling into the wrong hands.

Under the Obama administration's stimulus bill and other proposals, portions of a $29 billion fund are available to reimburse hospitals and doctors' offices that invest in electronic records systems and other software that might improve care and lower health-care costs. The government has stressed the need for increased security as part of this digitization initiative, but hasn't yet proposed mechanisms for how the data will be protected.

Now, many privacy advocates are concerned the administration's effort could end up making health information less secure. "If there isn't a concerted effort to acknowledge that the security risks are very real and very serious then we could end up doing it wrong," says Avi Rubin, technical director of the Information Security Institute at Johns Hopkins University.

Much more here (subscription required):


Definitely a concern that will need to be addressed.

Fifth last we have:

Practice Fusion adds PHR, cloud computing system

By Joseph Conn / HITS staff writer

Posted: August 5, 2009 - 11:00 am EDT

Practice Fusion, a San Francisco-based developer of Web-based electronic health records and practice-management applications offered free of charge to office-based physicians willing to put up with advertising on their systems, has announced it will add a personal health-record system to its EHR offering and that both will use cloud computing infrastructure and services.

More here:


Well I suppose advertising supported EHRs etc are inevitable!

Fourth last we have:

Norwegian nurses warm to robots

04 Aug 2009

A Norwegian study has shown that staff in the nursing care sector would welcome sensor and robot technology in the homes of the elderly and in nursing homes.

The study carried out for the Norwegian Association of Local and Regional technologies by SINTEF, the largest independent research group in Scandinavia, revealed that nurses saw the potential for robots to free up their time and help the elderly stay in their homes for longer.

The study was carried out to highlight and address the challenges that the nursing and care sector may face during “the elderly boom” when there will be fewer people of working age and an increasing elderly population.

More here:


Interesting report.

Third last we have:

Thursday, August 06, 2009

War Game Forecasts Future of Electronic Records

by Leonard M. Fuld and Kim Slocum

"Dateline: April 3, New York, N.Y.: Microsoft makes a play for Allscripts, then failing that attempt, pursues Kaiser Permanente to create an exclusive EHR-PHR agreement with the pre-eminent managed care behemoth. Allscripts independently cuts a deal with a large health care company to expand its sales force to aggressively penetrate the 80%-plus physicians who currently do not use EHRs."

Almost none of this has happened yet -- except within the confines of a war game used to stress test company strategies in the rapidly changing electronic health records industry. This war game, "The Battle for Healthcare Information," took place this spring, employing savvy health care-experienced business school students from Columbia, Kellogg, MIT and Wharton business schools. They formed teams, representing a variety of EHR players: Allscripts, Kaiser Permanente, McKesson and Microsoft.

If this war game proves as prescient as past public simulations, then expect most of the following predictions to become reality:

  • EHR adoption will come more slowly than expected. Entrenched interests will continue to resist EHRs. Health care system change, engendered by EHRs, means that some interests will win dollars while other traditional players, such as hospitals, may lose -- and no one wants to lose.
  • A shortage of technical manpower will slow down implementation of EHRs, no matter how much money is thrown at it.
  • The "pure players," such as Allscripts (as well as Cerner, Eclypsis, Epic and a half-dozen others) likely will be acquired in the next few years.
  • Small medical practices will band together. The market that is driving efficiencies, such as EHRs and other scalable solutions, will act as a catalyst to force small medical practices to band together or merge in the next few years.
  • No more "walled gardens". Health plans will be forced to untether their records. Tethered patient health records (PHRs) will become historical artifacts.

Much more here (with links etc):


This is just fascinating!

Second last for the week we have:

The White House's HIT man: An interview with David Blumenthal, MD

The nation's health information technology coordinator is trying to help get physicians up and running with electronic health records systems.

By David Glendinning, AMNews staff. Posted Aug. 3, 2009.

David Blumenthal, MD, came to his latest job just after it became a whole lot busier.

When President Obama on March 20 appointed Dr. Blumenthal, 60, to be the national health information technology coordinator, it was barely a month after the enactment of a federal stimulus package that included about $19 billion in net Medicare and Medicaid incentives for electronic health records adoption. A major part of the coordinator's job is to help determine how to use the EHR stimulus money and other inducements for physicians to become part of a national, interoperable health IT infrastructure.

The appointment also coincided with the release of a study authored by Dr. Blumenthal and other researchers that found only 1.5% of nonfederal U.S. hospitals use a comprehensive EHR system -- a lower adoption figure than some past estimates. A study by the same group published in June 2008 found that only 4% of physicians are using comprehensive EHRs.

American Medical News recently spoke with Dr. Blumenthal about his first several months on the job.

Question: President Bush in 2004 established a 10-year goal of getting most of the country on interoperable health records systems. Is that a goal the Obama administration shares?

Dr. Blumenthal: The goal of the Obama administration is to improve health and health care in every possible way, to make it higher in quality, more efficient, deliver better value, empower consumers and patients. We look at health information technology as one enabler to accomplishing that goal.

I think in the previous administration, it had the tendency to become an end in itself. That's not how people in my office viewed it, but it stood out there in the absence of a larger health reform agenda. The objective of getting physicians and hospitals to use computers came to assume a value independent of what I think its real purpose is, which is to make doctors better doctors, hospitals better hospitals, consumers more informed purchasers, and the health care system better.

Much more here:


Useful interview from the US Health IT Czar!

This is also very useful.


Guidelines on EHR meaningful use moving forward

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews staff. Posted Aug. 3, 2009.

Last, and very usefully, we have:

EMRs must be viewed in a wider context

August 6, 2009 — 3:36pm ET | By Neil Versel

I stirred up no small amount of controversy last week when I took the pundit class to task for missing many of the issues related to EMRs and health IT, particularly since I took my most pointed shots at Bill O'Reilly and his colleagues at Fox News Channel. I got one email from an Alaska government employee requesting that we cancel his subscription. "I don't need another liberal no-nothing lecturing me on how to think!" the writer said.

OK, at the risk of sounding like a conservative no-nothing lecturing people on how to think, I'm going to criticize something that CNNMoney.com reported last Friday: how it's been a slow process for St. Elizabeth Healthcare in Kentucky to install and make interoperable an EMR for three hospitals and 43 clinics, a three-year effort projected to cost $80 million. More specifically, I'm going to take issue with the fact that CNN neglected to report what the payoff will be: 24/7 clinician and patient access to medical records, regardless of care setting; a reduction in duplicative tests; better care planning; streamlined appointment scheduling; and hopefully, a higher quality of care at lower cost.

This we learn only from Healthcare IT News, which lifted much of the information from an IBM press release. (This is an ironic development of itself, in that IBM's contract with St. Elizabeth is only worth $1.5 million, according to CNN. Epic Systems accounts for half the total $80 million pricetag.)

Much more here:


Good stuff! All I can say is “Go Neil!”

There is an amazing amount happening. Enjoy!


1 comment:

Anonymous said...

Item 5 above appears to be an EMR, not an EHR. It may be shared across 5 practices, but that does not make it an EHR as it appears to contain only data collected by those 5 practices.

As you pointed out a week or so ago, there is a significant difference between EHR and EMR.