Again there has been just a heap of stuff arrive this week.
First we have:
August 21, 2009 | Kyle Hardy, Community Editor
ANN ARBOR, MI and DANVILLE, PA – A five-year ongoing study involving 10 large physician practices across the country has so far shown improved quality of care for chronic disease patients from the use of health information technology.
The study, named the Medicare Physician Group Practice Demonstration, was launched by the Center for Medicare and Medicaid Services to enable physician practices to demonstrate that proactive and coordinated care has the potential for larger revenue savings. It is the first Pay-for-Performance project to work directly with physician practices.
The clinics that are taking part in this study include Billings Clinic, Billings, Mont; Dartmouth-Hitchcock Clinic, Bedford, N.H; The Everett Clinic, Everett, Wash.; Forsyth Medical Group, Winston-Salem, N.C; Geisinger Clinic, Danville, Pa.; Marshfield Clinic, Marshfield, Wis.; Middlesex Health System, Middletown, Conn.; Park Nicollet Health Services, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.: and the University of Michigan Family Group practice in Ann Arbor, Mich..
Of these 10 physician practices, the Geisinger Clinic and the University of Michigan Family Practice Group were two that showed improvements in a least 29 of the 32 quality measures tracked in the third year of the project.
"We focused on hardwiring reminders and alerts into the electronic health record to enhance care consistency and reliability particularly related to diabetes and coronary care as well as ensuring adults receive preventative health screenings," said Frederick Bloom, MD, assistant chief qualify officer, Geisinger Health System.
The Geisinger Health System, which encompasses 40 community practices in central and northeast Pennsylvania, has experienced improved quality of care while lowering the cost to patient from participation in the project. Through the use of their EHR system, the clinic was able to improve care on all 32 categories that include continuing programs for diabetes and coronary artery disease, adult preventative care, and hypertension.
"By participating in this project, we're able to develop more effective ways of consistently bringing quality and value to all our patients, not just the Medicare beneficiaries who are the focus of the demonstration project," continued Bloom.
Results were similar with the University of Michigan Family practice group. Of the 32 measured categories, the UM Family practice group improved care on 29 fronts. Care improvements were made in areas that included diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.
"The UM Faculty Group Practice invested significant time and resources in this project because it provided the opportunity to develop and test potential interventions that could improve clinical outcomes and reduce costs for patients with chronic disease," says David Spahlinger, M.D., senior associate dean for clinical affairs. "Our investments have enabled better coordination of care."
Much more here:
This is an important study –as help for the chronically ill is an area where there is increasing evidence e-Health can make a real difference and save money.
Second we have:
Computer-generated prescriptions were completed with an 11.6 percent error rate at a large Brisbane hospital, twice the 5 percent error rate computed for handwritten prescriptions by the same staff employees, it found.
- Aug 21, 2009
A new study warns the Australian government's plan to use electronic prescribing in hospitals by July 2012 could increase medication errors unless staffers receive enough training. The study, done at a Brisbane hospital and selected acute wards in Queensland, was conducted for the Australian Commission on Safety and Quality in Health Care. The study found computer-generated prescriptions were completed with an 11.6 percent error rate at the hospital, twice the 5 percent error rate computed for handwritten prescriptions by the same staff employees, Sydney Morning Herald health reporter Louise Hall reported Aug. 20. The Queensland trial was halted early, she added.
The review was published in the journal Australia and New Zealand Health Policy, which has announced it will cease publication in December 2009. The study identified "poorly designed software that automatically filled out scripts to the maximum dose and ordered unnecessary repeat courses," Hall wrote.
The commission's CEO, Chris Baggoley, said electronic prescribing can reduce medication errors and adverse events, but "there is a risk of introducing new errors if the systems are not correctly planned, implemented, and integrated into all the other systems of information operating in a hospital," according to Hall's report in the newspaper.
This just shows how misinformation published in the so-called mainstream press can just plain mislead people all over the globe.
See here for a discussion of what rubbish this article is:
Third we have:
By Mary Mosquera
Saturday, August 22, 2009
The Health and Human Services Department needs updates on a continuous basis on the number of available hospital beds available during the H1N1 flu season starting in the fall.
HHS consequently wants to collect data electronically through an online system called HAvBED, which it already uses in an emergency preparedness program to determine the bed capacity of the nation’s 6,000 hospitals.
During the H1N1 response earlier this year, HHS did not have an adequate understanding of the severity of the outbreak or the resources needed to respond to the crisis, such as ventilators and intensive care unit beds, HHS said in a notice in the Aug. 20 Federal Register.
A number of countries in the southern hemisphere have recently experienced a surge in seriously ill patients, leading U.S. federal health officials to anticipate a similar situation here in the next few months.
Reporting continues here:
An obvious and important part of preparing for the US flu season.
Fourth we have:
RFI asks vendors to submit ideas by Oct. 1
- By Alice Lipowicz
- Aug 21, 2009
The Health and Human Services Department wants industry help to identify the current scope of health information exchanges and how best to foster a nationwide exchange for quality and outcome reporting.
The Centers for Medicare and Medicaid Services (CMS) on Aug. 20 published a request for information for the National Gap Analysis and Readiness Assessment for the Health Information Technology Infrastructure. The project is an outgrowth of the economic stimulus law, which provided HHS with $45 billion to be distributed to doctors and hospitals that buy and "meaningfully use" electronic medical records.
According to the RFI, vendors are invited to submit ideas by Oct. 1 on how to conduct a national scan of existing health IT infrastructures and how to “generate an initial national strategic framework for a national health information infrastructure,” according to the synopsis on the Federal Business Opportunities Web site. There is no guarantee of a procurement, the notice states.
The project’s goal is to support the adoption of electronic health records in the near term and lay the groundwork for broad exchange of patient data.
The entities to be included in the gap analysis and scan are federal agencies, such as CMS, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, state Medicaid agencies, state public health departments, health information exchanges and networks and health providers.
It is important to evaluate and analyse as you go along if you are going to be successful at the end of the day.
Fifth we have:
Assessing the Reliability of Medical Advice
August 23rd, 2009 - 08:11 pm PT
While the Web is now a major resource for mental health information, many users and health experts are wondering about the quality of these e-resources when it comes to treating depression and preventing suicide.
From medical e-dictionaries and scientific online journals to virtual counselors and interactive message-boards, e-health sites focus on the exchange of information via email, the use of chat groups and the provision of 24/7 anonymous peer-group support under professional supervision.
According to the World Health Organization, depression will be second largest killer after heart disease by 2020 with studies showing that depression is already the second largest cause of death for those 15 to 44, for both sexes. The current credit crunch has exacerbated work pressures and family strain resulting in more people being diagnosed with some form of mental illness.
In Australia, independent health professionals and the Australian Department of Health and Aging increasingly direct attention to interactive, monitored communication forums, including BeyondBlue.com.au, depressionservices.org.au or webmd.com.
Much more here (registration required):
Good to see there is some positive reporting on these excellent Australian efforts.
Sixth we have:
The U.S. Centers for Disease Control uses a range of Internet services, including Twitter, YouTube, and even games, to help spread flu-protection messages.
By Mitch Wagner, InformationWeek
Aug. 24, 2009
The Centers for Disease Control is preparing several electronic remedies to head off the spread of the H1N1 flu virus. The agency is planning to make use of Twitter, YouTube videos, and text messaging, as well as more traditional tools like e-mail blasts and Web pages. The goal is to saturate the Internet with information about how people can protect themselves against the flu.
The CDC is gearing up its efforts with the approach of autumn, and the flu season, and the possibility of a resurgence of the swine flu virus.
Central to the campaign is putting information on other Web sites, rather than requiring people to come to CDC.gov for information, said Janice Nall, director of the CDC's e-health marketing division. "We're trying to reach people where they are, not necessarily expecting them to come to us," she said. "All of our distribution is on channels that people are already using."
The agency has had some good experience with this approach, Nall said. H1N1 videos on CDC.gov have gotten about 100,000 page views, but the same videos on YouTube got 2.01 million views.
People look for videos on YouTube but not necessarily on the CDC.gov site. The videos are "nothing fancy," Nall said, some are just talking heads. "It's not like they're exciting, sexy videos," she said. "We're just trying to get the content out in video format."
This is interesting inasmuch as the CDC is planning for their next winter in high summer. Looks like they will be able to make a difference.
Seventh we have:
Depressed people should get online counselling, study says
People suffering from depression should get counselling online to avoid long waiting times to see a doctor, according to new research.
Published: 7:00AM BST 21 Aug 2009
A study of almost 300 patients found that those given cognitive behavioural therapy (CBT) were two-and-a-half times more likely to recover from their mental health problems that those who received standard care from a GP.
One in six adults suffer from depression or chronic anxiety, and online CBT may offer an alternative to the growing problem.
Dr David Kessler, a senior primary care researcher at the University of Bristol and a part time GP, said: "The patients get up to ten one hour appointments which are carried out online by instant messenger.
"Maybe it is the writing things down that helps so much because you have to think more when you do this. It is like being in a chat room with your therapist.
"It would greatly improve access to therapists for people who are disabled, housebound or living in remote locations.
"And you don't have to be some whizzy computer geek to use it. Some of our patients were in their seventies although the average age of people with depression is surprisingly young – around the 30s and 40s mark."
In the study, patients aged from eighteen into their 70s were recruited from Bristol, London and Warwickshire and 149 were given online CBT along with the usual care while 148 got the customary GP sessions.
Another positive report on e-Health and Mental Illness support
Eighth we have:
By Paul McCloskey
Thursday, August 20, 2009
The Office of the National Coordinator’s Federal Health Architecture office is developing a version of its "Connect" software that would help expand health information sharing between Medicaid and other state health offices, as well as with federal and commercial health service agencies.
The project is a collaboration between FHA and the Center for Medicare and Medicaid Services’ Division of State Systems to produce a version of Connect that is enabled for the Medicaid Information Technology Architecture (MITA). MITA is a technology and business roadmap for Medicaid system modernization.
The joint-effort was announced at the Medicaid Management Information Systems conference in Chicago this week.
Leaders of the project envision that Connect could help turn legacy state Medicaid Management Information Systems (MMIS) into engines of health information sharing across states, where health and social services agencies have traditionally been disconnected from one another.
Connect is a software pipe designed by 20 federal health care agencies that allows organizations to exchange health information according to standards for the National Health Information Network.
Full article here:
This work is gradually sending its tentacles out to all sorts of different areas of the US health sector.
Ninth we have:
BARCODES are being added to all prescription forms issued by GPs in a bid to improve safety.
It is hoped that the two-dimensional barcodes will make it safer for patients as community pharmacists dispense prescribed medicines.
More than 1.5 million prescription items are processed each week by pharmacists.
The barcodes will help to eliminate errors that can occur when information is keyed into a computer from a traditional paper prescription.
GP practices across Wales will issue prescriptions containing a barcode, which stores the patient’s prescription information.
This can then be scanned – like a tin of beans in a supermarket – when the patient hands in the prescription to their local community pharmacy.
Information held in the barcode is then entered automatically into the community pharmacy’s dispensing system.
The barcode contains all the prescription information as well as the unique drug codes for each of the medications or preparations prescribed.
Each barcode can hold information for up to four prescription items.
Much more here:
Good to see Wales pushing ahead in this important area.
Tenth we have:
HDM Breaking News, August 25, 2009
As the nation moves toward a national health information network, some claims clearinghouses have noted that such a national infrastructure--the electronic data interchange networks for routing claims and related transactions--already exists.
Now, clearinghouse vendor NaviNet is making an overt pitch for state- and regional-level health information exchanges and regional health information organizations to use its network--for free--to transmit clinical transactions.
The Cambridge, Mass.-based vendor has sent a letter to the governors of all 50 states offering to make its NaviNet Health Information Exchange network available at no cost. The company would generate revenue via transaction fees paid by HIE users. The platform also would be free to regional HIEs and RHIOs that are state-designated entities. "If I'm the state, I don't need to build the toll road," explains Kendra Obrist, chief marketing officer at NaviNet. "The toll road is in place."
Each letter explains the company, its scope of business in the state and an estimate of annual savings generated in the state by use of the NaviNet network. The letter to California Gov. Arnold Schwarzenegger, for instance, notes 67,637 providers in the state are NaviNet users and saved an estimated $45 million during the past year through the efficiencies of electronic communications.
"Yet, while the benefits of establishing health information exchanges are clear, so are the challenges. In the last 20 years, we have seen community health information networks and regional health information organizations fail due to expensive and complex technologies, lack of funding and poor adoption," the letter states. "By utilizing NaviNet at no cost, California has an immediate opportunity to improve healthcare services for all of your citizens, reduce cost and create a better, more efficient healthcare system."
This can’t be a bad thing!
Eleventh for the week we have:
Posted: August 25, 2009 - 11:00 am EDT
A computer glitch mistakenly led more than 1,200 veterans to believe they had a fatal illness. According to the National Gulf War Resource Center, the Veterans Affairs Department erroneously sent out letters to veterans telling them they had “a diagnosis of amyotrophic lateral sclerosis,” or ALS, otherwise known as Lou Gehrig's disease.
As a result, the Gulf War veterans group was barraged by phone calls from veterans concerned that they had a terminal illness. “Many of these veterans went to private clinicians to get a second opinion. This second opinion outside of the VA is very expensive and can range from $1,000 to $3,000 or more,” the center said in a written statement on its Web site.
More here (registration required):
Not a good look at all – more care definitely needed!
Twelfth we have:
Posted: August 28, 2009 - 5:59 am EDT
The HHS officials in charge of setting up a national extension service to aid office-based physicians and other providers in the deployment and “meaningful use” of health information technology fleshed out details of the $694 million program during a Web-and-telephone conference Thursday.
As many as 1,250 participants logged- or dialed-in to hear and ask questions about the ground rules to apply for $643 million in grant money to be awarded over a four-year period to about 70 not-for-profit organizations that will run the regional extension centers.
The bulk of the money, $598 million, will be spent in the initial two years, beginning in 2010, getting the regional centers up and running. During that startup period, an estimated 90% of the funding for the regional extension program will come from federal dollars, with the balance coming from state or local matching government funds, foundation grants or fees the centers will be allowed to charge providers for their services.
The government estimates its subsidies of the centers will shrink to $45 million during the second, two-year period, as the centers move to self-sustainability and obtain 90% of their funding from local sources and fees. After four years, the regional centers will be on their own, expected to continue operations on whatever revenue streams they can muster without federal support.
A formal set of instructions on how to apply for the regional extension service grants and a separate summary of the program were published last week on the Web site of the Office of the National Coordinator for Health Information Technology at HHS.
Another $50 million has been allocated to a National Health Information Technology Research Center, which will serve as a resource for the regional program.
More here (registration required):
The details seem to be coming quite quickly and attracting interest as expected.
Thirteenth we have:
Posted: August 27, 2009 - 11:00 am EDT
Sen. Edward Kennedy, who championed healthcare information technology legislation during his nearly 50 years on Capitol Hill, died Tuesday night at his home on Cape Cod after a year-long battle with brain cancer. He was 77.
“He will long be remembered as a champion for the causes he believed in. He leaves behind a long list of bipartisan legislative accomplishments, the impact of which will continue to be felt for generations to come,” said Sen. Mike Enzi (R-Wyo.), Kennedy's co-sponsor on the Wired for Healthcare Quality Act.
The wide-ranging health information technology bill, even though it passed preliminary legislative hurdles, ultimately died over privacy and other concerns.
The healthcare IT industry as well as the U.S. insurance market were profoundly influenced by Kennedy's legislative work.
Kennedy teamed with former Sen. Nancy Kassebaum (R-Kan.), who, as healthcare historian Paul Starr recounts, Kennedy referred to as “the kinder and gentler” senator from Kansas, in co-sponsoring a piece of bipartisan health reform legislation in 1996, then known as the Kennedy-Kassebaum bill. (Republican Bob Dole was the senior senator from Kansas at the time.)
More here (registration required):
Senator Kennedy certainly did some important stuff in the Health IT domain. Vale Edward M. Kennedy.
Fourteenth we have:
Thursday, August 27, 2009
by Scott Cowsill and Liz Quam
The Imaging e-Ordering Coalition's goal is to promote electronic ordering of diagnostic imaging services through the use of computerized clinical decision-support tools (e-Ordering). These physician-friendly tools help guide clinicians to order the most appropriate diagnostic test: the right test (evidenced-based) every time. Additionally, the process electronically documents the appropriateness of each order, providing value-assurance to the patient and measurable, comparable data to the payer (insurer).
We believe that robust and swift health provider adoption of e-ordering for diagnostic imaging services is a key method to achieving the continuous quality improvement, cost savings, patient safety and care coordination goals of the Obama administration. Therefore, we are advocating that Congress move to include e-Ordering for Medicare beneficiaries in the final health reform package.
Further, there is currently an opportunity to incorporate a strong and more timely provision to promote electronic ordering of imaging studies with real-time clinical decision-support and with tracking and reporting functions into the administration’s definition of “meaningful use" of electronic health records. The members of the Imaging e-Ordering Coalition firmly believe that continuously improved care, with cost reduction for imaging services, can be achieved through the use of computerized order entry that includes an evidence-based electronic decision-support tool with a reporting function, and the ability to facilitate appropriate consultation with a board certified radiologist. These capabilities can and should be included in both ambulatory and inpatient EHR systems.
The e-Ordering tools are available for real-time support, derived from best-practices guidelines developed by the American College of Radiology, the American College of Cardiology, the American College of Physicians and other significant groups focused on clinical appropriateness. Such real-time, electronic tools must be able to attach the decision-support feedback regarding appropriateness to the claim and the record, thereby allowing quality reporting and measurement. Additionally, these tools can and must facilitate the ability of the ordering physician to undertake a collaborative discussion, when appropriate, with an expert radiologist to help guide the ordering decision.
Much more here:
Interesting stuff and clearly important.
Fifteenth we have:
28 Aug 2009
Bradford Teaching Hospitals NHS Foundation Trust is due to take Lorenzo live in a ward environment in the middle of September.
The trust initially deployed the electronic patient record system from iSoft in a weekly joint replacement clinic in April.
In a statement for E-Health Insider, the trust said: “The use of Lorenzo in our consultant clinics continues to go well, and further roll-out work continues to accelerate.
“The go-live data for ward-based requesting is scheduled for mid-September, enabling us to take advantage of a new software release that allows the system to be upgraded without any downtime. It also coincides with the arrival of our new intake of junior doctors.”
More here (registration required):
Good to see Lorenzo is making steady headway.
Fifth last we have:
By JOE LAMBE
The Kansas City Star
In Kansas and Missouri, new laws say a methamphetamine cook shouldn’t be able to get enough of his key ingredient to make a good-size batch.
Except that neither state can afford to fund the laws, which are intended to link pharmacy records and prevent multiple purchases of cold medicine.
As a result, a meth cook can go from one store to another, buying the legal maximum of cold medicine — a source of the key meth ingredient — at each store until he has all he needs.
That should change with the pharmaceutical industry’s offer to fund a linked database in Kansas and Missouri.
It is a move designed to better combat meth labs, and also could fend off attempts to legislate cold medicine into a prescription drug.
Final touches are being put on public-private agreements with the Consumer Healthcare Products Association.
Seems like industry trying to do something really useful with technology
Fourth last we have:
HDM Breaking News, August 28, 2009
The Medicare and Medicaid incentives for adopting electronic health records will lead to a gradual build in demand for the software, rather than a surge, one investment analyst says. “That’s because some portion of the market will want to wait to see the final rules,” says Raymond Falci, managing director of Cain Brothers & Co., New York, who tracks public health care I.T. firms.
On Aug. 20, David Blumenthal, M.D., national coordinator for health information technology, predicted that the final definition of the “meaningful use” of electronic health records that will be used to determine eligibility for incentive payments under the economic stimulus program will not be available until the middle or end of spring 2010. The preliminary definition of meaningful use requirements will be issued by the end of this year, followed by a 60-day comment period, Blumenthal said.
This timing for defining meaningful use, which is later than many expected, may mean demand for EHRs will ramp up more gradually than if the details were known sooner, Falci says. Regardless, health care organizations are dividing into two camps: Those that are moving forward with plans to qualify for federal electronic health records incentive payments and those that are waiting for the final regulations on incentives, he says.
“A lot of hospital CIOs and group practice administrators have told me that they need to get started now” to ensure they qualify for maximum incentives by having a qualifying EHR in place by 2011, the analyst says.
Falci speculates that the federal government might wind up pushing back all the deadlines called for under the American Recovery and Reinvestment Act, much as it did when creating the rules to carry out HIPAA. “My guess is, in the big picture of what the government is trying to accomplish, they’re going to have to modify the timeline.”
Lots more here :
I suspect the comments that demand will build only reasonably slowly will prove to be true.
Third last we have:
HDM Breaking News, August 27, 2009
The law firm Nixon Peabody LLP recently sent to clients an article explaining provisions of the Department of Health and Human Services' recent rule governing breaches of unsecured protected health information. Health Data Management received permission from the firm to publish the article. The firm emphasizes that the article is intended as an information source and readers should not act upon the information without professional counsel. Linn Freedman, a partner and head of the firm's health information technology division, is the author. The following is the article:
HHS issues breach notification requirements for covered entities and business associates
On August 19, 2009, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued an interim final rule ("the Rule") related to the Health Information Technology for Economic and Clinical Health Act (HITECH) requiring covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and their business associates to provide notification to individuals of breaches of unsecured protected health information to unauthorized individuals. In addition, HHS issued an update to its guidance specifying the technologies and methodologies that render protected health information (PHI) unusable, unreadable, or indecipherable. Section 13402 of HITECH, enacted on February 17, 2009, requires HIPAA covered entities and their business associates that "access, maintain, retain, modify, record, store, destroy, or otherwise hold, use, or disclose unsecured protected health information" to notify the affected individual and the Secretary of HHS following the discovery of a breach of unsecured PHI. In addition, in some instances, HITECH requires notification of a breach to the media. Covered entities must provide the Secretary of HHS with a log of breaches on an annual basis, and the Secretary of HHS will post the list of entities that experienced breaches of unsecured PHI involving more than 500 individuals on the HHS website.
Much more here:
This is a useful discussion of the issues around data breaches in the US Health System environment of personal health information. There are ideas here we might consider.
Second last we have:
"Since the Internet's earliest days, patients have used the Web to share experiences and learn about diseases and treatments. But now [advocates say] online communities have the potential to transform medical research," the New York Times reports. The latest development was spurred in part by patient groups like the LAM Treatment Alliance, which hopes to speed research on the fatal respiratory disease that afflicts young women. The group created "LAMsight, a Web site that allows patients to report information about their health, then turns those reports into databases that can be mined for observations about the disease."
This is a trend worth keeping an eye on – especially for the more unusual diseases it seems to me.
Last, and very usefully, we have:
Carrie Vaughan, for HealthLeaders Media, August 25, 2009
This past week, Vanguard Health Systems, which operates 15 hospitals in four states, joined a growing list of healthcare organizations and employers that plan to offer personal health records to patients or employees. Vanguard joined the Dossia Consortium of employers that have pledged to implement PHR software for their employees.
I wrote about whether personal health records would be a temporary fix or here for the long haul in the August 2009 issue of HealthLeaders magazine PHRs: Worth the Effort.
Given the emphasis on personal health records in the "meaningful use" recommendations by the HIT Policy Committee, it seems that PHRs are here to stay, which I, for one, believe is a good thing.
However, not everyone is convinced that PHRs are the right path for healthcare to take. Some physicians are concerned that the "art" of medicine is being replaced by templates and checklists and that electronic health records along with PHRs could suffer from the quality of data that is entered and exchanged. Other executives believe that the patient web portal may be the better solution.
That is the route Group Health Cooperative in Seattle took when it implemented its patient Web portal. Its philosophy is that the medical record should be a shared document between patients and caregivers that provides the same data to both of them, says Ernie Hood, vice president and chief information officer. The patient view of the information does include some additional definitions and health management information, he explains.
The challenge of PHRs is that until a large number of providers are interfacing with PHR products their use will be for the patients only--and a relatively small number of people currently maintain and actively use them, Hood says. Still, he acknowledges that PHRs will play an important role in the continuity of patient information as patients move between providers.
Much more here:
This and the link in the text are well worth browsing. Good perspectives on PHRs.
There is an amazing amount happening. Enjoy!