Thursday, October 08, 2009

International News Extras For the Week (05/10/2009).

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

First we have:

Thursday, September 24, 2009

HHS Holds Keys to Next Generation of Health Information Privacy

by Deven McGraw and Harley Geiger

While lawmakers continue to debate health reform, health IT already is poised to be a major factor in changing how health care is delivered. Recognizing health IT's potential to enhance efficiency and quality of care, Congress made a substantial taxpayer investment in health IT earlier this year through the American Recovery and Reinvestment Act of 2009.

Congress also recognized that digitized health records pose privacy issues that, if left unresolved, can profoundly undermine patient trust in the health care system. Consequently, ARRA devotes significant attention to strengthening the privacy and security of health information.

However, stronger laws are not enough. Effective implementation -- including education, outreach and oversight -- will be needed to embed better privacy and security practices throughout the health care system, particularly as we move into the age of digital health records.

To realize the promise of health IT, we need a new generation of health privacy that can be accomplished best with proactive and consistent privacy leadership from HHS. Specifically, HHS should:

  • Capitalize on opportunities provided in ARRA to strengthen and more effectively implement and enforce privacy and security protections for digital health information;
  • Ensure effective communication and coordination on privacy policy among its subagencies and offices, as well as with other federal agencies; and
  • Serve as an ongoing resource for stakeholders on the law and on effective privacy and security practices.

Much more here (including links):

http://www.ihealthbeat.org/Perspectives/2009/HHS-Holds-Keys-to-Next-Generation-of-Health-Privacy.aspx

This is an important review of the trends that need to be watched as the US moves forward. Worth a browse.

Second we have:

On the Watch for Flu and More
Health Agencies Create Post-Vaccine Monitoring Systems

Associated Press

Monday, September 28, 2009

More than 3,000 people a day have a heart attack. If you're one of them the day after your swine flu shot, will you worry that the vaccine was to blame and not the more likely culprit, all those burgers and fries?

The government's system to track possible side effects of mass flu vaccinations will begin next month, aimed at detecting any rare but real problems quickly, and explaining the inevitable coincidences that are sure to cause some false alarms.

"Every day, bad things happen to people. When you vaccinate a lot of people in a short period of time, some of those things are going to happen to some people by chance alone," said Daniel Salmon, a vaccine safety specialist at the Department of Health and Human Services.

Health authorities hope to vaccinate more than half of the population in just a few months against swine flu, which doctors call the 2009 H1N1 strain. Vaccination is voluntary, and how many get it depends partly on confidence in its safety.

"The recurring question is, 'How do we know it's safe?' " said Gregory Poland of the Mayo Clinic.

Enter the intense new monitoring. On top of routine vaccine tracking, there are these government-sponsored projects:

-- Harvard Medical School scientists are linking large insurance databases that cover as many as 50 million people with vaccination registries around the country for real-time checks of whether people see a doctor in the weeks after a flu shot and why. The huge numbers make it possible to quickly compare rates of complaints among the vaccinated and unvaccinated, said the project leader, Richard Platt, Harvard's population medicine chief.

-- Johns Hopkins University will direct e-mails to at least 100,000 vaccine recipients to track how they're feeling, including the smaller complaints that wouldn't prompt a doctor visit. If anything seems connected, researchers can call to follow up with detailed questions.

-- The Centers for Disease Control and Prevention is preparing take-home cards that tell vaccine recipients how to report any suspected side effects to the nation's Vaccine Adverse Event Reporting system.

More here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/27/AR2009092702913.html?hpid%3Dmoreheadlines&sub=AR

I wonder what is in place in Australia? I have not heard of an approach like this to pro-actively see how we are going. Anyone know?

Third we have:

Zakaria and Meyerson: How to Fix Health IT

By Sammy Zakaria and David A. Meyerson
Thursday, September 17, 2009 7:22 PM

President Obama's address to Congress on health-care reform overlooked one of the most important issues: the poor state of health information technology.

Last week, a 62 year old woman, whom we will call Mrs. B, came into our office complaining of shortness of breath. She also mentioned a history of severe hypertension, coronary artery disease and dialysis-dependent kidney failure. We discovered that she had been admitted several times in the past year to five different area hospitals. Beyond these bare facts, we had no other information. We had no reliable details of her recent testing, treatment or medications. Also, she could not recall the names or dosages of her sixteen pills, and she knew that she was severely allergic to a certain heart medicine, but she couldn't remember its name, either. We were understandably reluctant to prescribe new medications or therapies without obtaining her recent records.

Mrs. B's situation is all too common. Information is fragmented and not readily accessible. Even the most prepared patient carrying copies of previous medical records is handicapped by the difficulty in deciphering handwriting and medical notations. It is common for duplicate tests to be ordered, increasing health-care costs by perhaps 15 percent or more.

The comments continue here:

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/17/AR2009091703734.html

I would say the diagnosis is right – but the solution of going to a single standardised EMR to solve interoperation issues is a trifle naive I think. Where ever there has been a situation like what it proposed here it has met substantial resistance – everywhere from HealthSMART to the UK NHS. (I know I have commented on this before (last week) – but have given the article a second read and thought)

Fourth we have:

Achieving paperless health care

Shift to electronic medical records is transforming patient care by improving safety, efficiency and lowering costs

By GUY KOVNER

THE PRESS DEMOCRAT

Published: Saturday, September 26, 2009 at 3:00 a.m.

Last Modified: Saturday, September 26, 2009 at 11:45 p.m.

The bar code on a Kaiser Permanente patient’s wristband may seem the epitome of impersonal medicine, but it’s part of a digital revolution aimed at cutting costs, boosting efficiency — and promoting health.

WHAT IS EMR?

Electronic medical records, known as EMR, is a computerized system that provides instant and complete patient information to medical offices, emergency rooms, hospitals and other health facilities.

• A system typically includes patient history, diagnoses, X-rays and other images, test results and communications with health care providers.

• Patient files can be accessed 24/7, expediting diagnosis and treatment of acute illnesses, management of chronic conditions and reducing duplicate testing.

If the magnetic reading by a nurse doesn’t match the bar code on a drug about to be administered at Kaiser Medical Center in Santa Rosa, an alert will sound, intended to avoid the kind of medication mixup that nearly killed actor Dennis Quaid’s newborn twins in 2007.

About 7,000 Americans die every year from medication errors.

And when Dr. Steve Levenberg saw a woman with an ankle problem at his Rohnert Park office, a few computer keystrokes gave him the patient’s medical history, including lab tests and X-rays from her recent visit to an orthopedic surgeon in Sacramento.

“My laptop computer,” Levenberg said, “is a clinical tool, just like my stethoscope.”

The healing arts, as old as humankind, are rushing to pursue and refine the use of electronic medical records, known as EMR, across Sonoma County, from rural health clinics to megasystems like Kaiser.

Medicine is a relative latecomer to the digital revolution, which has transformed many endeavors — engineering, architecture, publishing, moviemaking, warfare and personal communication — over the past 30 years.

Medical record-keeping, until recently, relied on rooms full of paper files that were easily misplaced and filled with hurried, handwritten entries that could be hard to read. Electronic records hold orderly, keyboard-entered data that never leaves a hard drive and have the potential to move seamlessly from a primary care provider’s office to an emergency room or specialist’s suite.

Coinciding with the national debate over health care costs and efficiency, EMRs — which received $19 billion in economic stimulus funding — are a prescription for making health care more efficient and less costly.

Much more here :

http://www.pressdemocrat.com/article/20090926/ARTICLES/909269945/-1/WEATHER?Title=Achieving-paperless-health-care

This is a good long article that explains where things are up to with some EMR leaders.

Fifth we have:

Orion wins Northern Ireland ECR deal

28 Sep 2009

Northern Ireland has named Orion as the winner of a procurement for a proof of concept project for a province-wide electronic care record (ECR).

The one-year deal will be to develop a new portal-based electronic health record, predominantly for use in secondary care but linking hospitals and practices, with the potential to also link social care.

Brian McKeown, head of ICT planning, commissioning and performance management with the Health and Social Care Board for Northern Ireland, said the deal was worth just under €100,000.

He said: "We want to get something up and running to pull out data from the various systems. Essentially it will be used in secondary care-unscheduled care and particularly for those with chronic conditions.”

In the proof of concept project two hospitals and two GP surgeries will be connected to an ECR, intended to be used in A&E, and for out-of-hours services.

Lots more here:

http://www.e-health-insider.com/news/5240/orion_wins_northern_ireland_ecr_deal

http://computerworld.co.nz/news.nsf/news/3DE991D4F27CE0FCCC25763C0018BB49

Health sector tackles patient record access

HealthLink-Medtech stoush brings issues into the spotlight

By Rob O'Neill Auckland | Monday, 28 September, 2009

Health bodies have converged to address issues with access to patient medical records, highlighted by a dispute between to ICT vendors Medtech Global and HealthLink earlier this year.

The Ministry of Health hosted an interoperability and standards workshop this month to address the safe sharing of information, says the deputy director-general of health information, Alan Hesketh. He says the effort aims to put in place “common approaches” to the commercial arrangements for interoperability between IT systems used in the health sector.

Hesketh says the ministry’s position is two-fold: how to share information safely and privately and how to do this so the commercial terms between ICT providers do not add costs into the health system.

Members of the New Zealand Health IT Cluster, which represents health technology vendors, participated in the meeting and the cluster is taking action to put in place agreed approaches, Hesketh says. He adds that it isn’t just about Medtech and HealthLink, but also about iSoft and Orion and a host of other players.

The Health Information Strategy Advisory Committee (HISAC) is one of several groups interested in the records review. HISAC, which advises the Minister of Health on the direction of health IT, is driving to have electronic referrals between primary and secondary health providers implemented nationwide by the middle of next year, says chairman Graeme Osborne.

Osborne and Hesketh both say there is no dispute about the ownership of health records: they belong to the patient and are held in trust by health providers. Where issues get trickier is at the integration point between systems, Osborne says.

It seems clinical information sharing issues are causing a few ructions in NZ. Australia has a similar mixed base of client systems and more messaging providers so this will need to be watched.

Seventh we have:

E-health technology adopted in Radius rest homes

Monday, 28 September 2009, 1:02 pm
Press Release: Radius Residential Care

For immediate release

Monday 28th September 2009

Revolutionary new e-health technology adopted in Radius rest homes

Radius Residential Care rest homes are among the first in the country to employ a new e-health technology initiative that is revolutionizing the way doctors can access rest home patient clinical notes.

The leading edge computer technology system ‘NZHealthNet’ enables doctors to remotely link into their patients medical notes when attending rest home patient care appointments.

Doctors can easily refer to and update clinical patient notes, order laboratory tests, write referrals and print prescriptions with NZHealthNet - all without the need to carry confidential patient records during routine visits to rest homes.

“One of the main benefits of this new e-health technology is that patient safety is improved due to doctors having real time access to patient records and data. And for rest home patients the new technology will allow them all the benefits of a regular GP visit but without leaving the comfort of their own surrounds“, says Kirsten Stone, CEO Rotorua General Practice Group (RGPG) who have developed the new technology.

Radius Glenbrae Estate was the first rest home to adopt the new technology which was implemented by RGPG onsite last week. Other rest homes within the wider Rotorua region are also expected to become ‘online’ before the end of the month.

More here:

http://www.scoop.co.nz/stories/BU0909/S00727.htm

This looks like very interesting work indeed from the Shaky Isles!

Eighth we have:

September 28, 2009

E-Records Get a Big Endorsement

By STEVE LOHR

The nation’s drive toward computerized medical records is getting a push from big hospitals, which hope not only to improve patient care but to gain an edge on competitors.

And an effort to be announced on Monday by a big New York regional hospital group may be the most ambitious effort of this type yet — a sizable investment intended as a linchpin in the group’s $400 million commitment to digitize patient records throughout its system, including 13 hospitals.

North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years.

The federal program includes $19 billion in incentive payments to computerize patient records, as a way to improve care and curb costs. And the government initiative has been getting reinforcement from hospitals. Many are reaching out to their affiliated physicians — doctors with admitting privileges, though not employed by the hospital — offering technical help and some financial assistance to move from paper to electronic health records.

Efforts by hospital groups to assist affiliated doctors include projects at Memorial Hermann Healthcare System in Houston and Tufts Medical Center in Boston. But the size of the North Shore program appears to be in a class by itself, according to industry analysts and executives.

Big hospitals operators like North Shore, analysts say, want to use electronic health records that share data among doctors’ offices, labs and hospitals to coordinate patient care, reduce unnecessary tests and cut down on medical mistakes.

But hospitals are seeking a competitive edge, too. Digital links, analysts say, can also tighten the bonds between doctors and the hospital groups that subsidize the computerized records. In most local markets, independent physicians typically have admitting privileges at more than one nearby hospital, and so hospitals compete for doctors as well as patients.

“The North Shore-L.I.J. program is larger than other programs,” said Wes Rishel, a health technology expert at Gartner. “And it punctuates a trend of hospital groups trying to solidify and tighten relationships with physicians in their communities.”

In other words, the government-backed campaign to hasten the adoption of electronic health records has the potential not only to change how health care is delivered. It could also influence which institutions emerge as leaders in delivering care, as some local markets consolidate further.

Full article here:

http://www.nytimes.com/2009/09/28/technology/28records.html?_r=1&ref=health

This is a pretty considerable investment to get rolling.

Ninth we have:

Former ONC chief Kolodner announces retirement

By Joseph Conn / HITS staff writer

Posted: September 28, 2009 - 11:00 am EDT

Robert Kolodner, the former head of the Office of the National Coordinator for Health Information Technology and more recently a senior advisor to ONC, has retired from federal government service after 31 years.

More than 28 of those years were spent at the Veterans Affairs Department and the Veterans administration, where Kolodner started in 1977 and worked as a psychiatrist and in increasingly higher levels of leadership in healthcare IT. The VA's Decentralized Hospital Computer Program, later renamed VistA, was developed during that period.

More here:

http://www.modernhealthcare.com/article/20090928/REG/309289951

A true friend of Health IT – who no doubt made a big difference!

Tenth we have:

Tennessee gave doctors wrong fax number in privacy breach

Patients' private medical records faxed out of state

By Chris Echegaray
THE TENNESSEAN

The Tennessee Department of Human Services said it accidentally sent the wrong fax number to 100 medical providers across the state, leading them to erroneously send sensitive patient information to an Indiana businessman.

"We're extremely embarrassed, and we're working to remedy the situation," said Michelle Mowery Johnson, spokeswoman for DHS. "We hope it doesn't happen again."

The state sent an e-mail blast to 29,000 medical providers with the correct toll-free fax information on Monday.

The problem was first reported by The Tennessean.

More here:

http://www.tennessean.com/article/20090929/NEWS01/909290346/Tennessee+gave+doctors+wrong+fax+number+in+privacy+breach

Old technology causing trouble!

Eleventh for the week we have:

Survey Highlights Power, Limits of EHR Data

HDM Breaking News, October 1, 2009

More than three-quarters of 732 surveyed executives at provider, payer and pharmaceutical organizations believe secondary use of data from electronic health records will be their organizations' greatest asset during the next five years.

But respondents also cite multiple barriers to best use of de-identified and aggregated health information. They also cite the necessity of guidelines for the usage of secondary data that is to be shared. New York consulting firm PricewaterhouseCoopers conducted the e-mail survey in June, getting replies from 482 providers, 136 insurers and 114 pharmaceutical/life sciences organizations.

Sixty-five percent of surveyed providers use secondary data to some degree, as do 54% of payers and 66% of pharmaceutical firms. Besides EHRs, this data can come from claims, clinical trials, laboratory and radiology reports, employers, and disease management companies. Those surveyed expect their use of such data to rapidly grow and already report such benefits as quality improvements, reduced costs, increased revenue and higher patient/member satisfaction.

More here:

http://www.healthdatamanagement.com/news/survey-39069-1.html?ET=healthdatamanagement:e1033:100325a:&st=email

More information is available at pwc.com/us/en/healthcare/publications/secondary-health-data.jhtml

Very interesting survey indeed.

Fourth last we have:

Practice Fusion to offer ARRA-based EHR guarantee

By Joseph Conn / HITS staff writer

Posted: September 30, 2009 - 11:00 am EDT

Another electronic health-record system developer has joined the growing ranks of those offering a guarantee that providers using their EHRs will meet the so-called “meaningful use” critieria under the American Recovery and Reinvestment Act of 2009.

San Francisco-based EHR developer Practice Fusion said its program provides “a guarantee that physicians using Practice Fusion's EHR will qualify for meaningful use before the economic stimulus payments begin in January 2011” and that amounts to “effectively guaranteeing payout of stimulus package money.”

Much more here:

That Federal Money is certainly having the desired effect of getting the software industry motivated etc.

It is a bit of a worry that this is a free, advertiser supported EHR. We know all about this in Australia!

Third last we have:

Tuesday, September 29, 2009

Technology Incentives Not So Stimulating for Dentists

by George Lauer, iHealthBeat Features Editor

Although the HITECH Act includes dentists among the "eligible professionals" in line for federal stimulus money, some dental advocates are worried oral health might get short shrift in the push toward electronic health records.

Efforts are well under way to get medical care providers in position to earn incentives under Medicare and Medicaid if they adopt and make "meaningful use" of certified EHRs, but similar efforts on behalf of dentists are less organized and not as nationally focused, according to some dental advocates.

"Dentistry is included in the stimulus language, but in practical terms, the stimulus money for electronic records isn't going to have much of an impact on most dentists," said Paul Glassman, director of Community Oral Health at the University of the Pacific School of Dentistry in Stockton, Calif.

"There's a process going on right now, largely spearheaded by California activists, to try to figure out what can be done to change that," Glassman said. "State government, statewide foundations, academics and at the national level the ADA (American Dental Association) are trying to figure out how dentistry can have more of an impact in the move toward EHRs. We're working on answering questions like what are the barriers and what can be done about them," Glassman said.

Much more here:

http://www.ihealthbeat.org/Features/2009/Technology-Incentives-Not-So-Stimulating-for-Dentists.aspx

It seems the dentists are not thrilled!

Second last we have:

Free PHR a Hit at Indiana University

HDM Breaking News, September 25, 2009

The Indiana University Health Center in Bloomington early this year began testing a free personal health record for students. The goal was to work out bugs, and offer the PHR to the incoming freshman class this fall (see healthdatamanagement.com/issues/2009_67/-28272-1.html).

Just weeks into the new semester, 3,100 of 7,200 incoming students--40% of the class--have activated a PHR and entered some data, says Pete Grogg, associate director at the health center. And half of those with a PHR are sharing data with the center as they start seeking treating. "We're very happy, we weren't quite sure what to expect," Grogg says.

.....

More information is available at Indiana.edu/~health/ and nomoreclipboard.com.

More here:

http://www.healthdatamanagement.com/news/PHR-39019-1.html?ET=healthdatamanagement:e1029:100325a:&st=email

This is interesting – and good news!

Last, and very usefully, we have:

Women With Diabetes at Increased Risk for Irregular Heart Rhythm

Kaiser Permanente study finds association between diabetes and atrial fibrillation

PORTLAND, Ore., Sept. 28 /PRNewswire/ -- Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.

While other studies have found that patients with diabetes are more likely to have AF, this is the first large study--involving nearly 35,000 Kaiser Permanente patients over the course of seven years--to isolate the effect of diabetes and determine that it is an independent risk factor for women.

"The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm," said the study's lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes."

Much more here:

http://www.prnewswire.com/news-releases/women-with-diabetes-at-increased-risk-for-irregular-heart-rhythm-62289407.html

There is an amazing amount happening. Enjoy!

David.

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