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."

Friday, May 14, 2010

Weekly Overseas Health IT Links 12-05-2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.



Tuesday, May 4, 2010

Meaningful Interoperability is not defined by Meaningful Use

I spent an hour today on a call with NIST (along with many other HL7 leaders) regarding the testing framework they are presently developing for meaningful use. One of the issues that NIST correctly identified is that the standards selected for meaningful use are not sufficient to support interoperability. They pointed out to ONC that the SDOs have spent many person-years developing implementation guides that ensure interoperability. Because these were not selected by the IFR, NIST has been directed to fill the gaps in a few short weeks.

To resolve this problem, NIST is working with HL7 and other SDOs to identify what is enough to ensure interoperability. They are in fact, creating "baby" implementation guides. I would not want to be stuck in between their rock and hard place right now. The danger here is that years of consensus building and implementation efforts could be completely irrelevant if the wrong choices are made. Hopefully the choices that are made by NIST and the SDOs will enable use of and not conflict with existing guides; without requiring their use. Yet those same choices need to be strict enough to ensure interoperability.



Technology drastically reduces medication errors, but poor history-taking ups mistakes

May 6, 2010 — 2:34pm ET | By Debra Beaulieu

Hospitals that deploy bar-coding technology with an electronic medication administration record (eMAR) may prevent an estimated 90,000 medication errors per year, according to Dr. Eric G. Poon, director of clinical informatics at Brigham and Women's Hospital in Boston, whose new study appears in today's New England Journal of Medicine.

With bar-code eMAR in place, pharmacists send approved medication orders from physicians to the patients' charts electronically. Nurses then scan the bar code on the medication and the bar code on the patient's wristband before administering the drug. The system warns the nurse if the two bar codes do not match or if it is not the correct time to administer the drug.



Is EHR certification becoming too simplistic?

May 6, 2010 — 10:52am ET | By Neil Versel

Certification of EHRs has been controversial since the beginning. For the longest time, some small vendors' stance was that the Certification Commission for Healthcare Information Technology thought that the process was weighted in favor of large companies, and thus would put them out of business.

With the passage of the American Recovery and Reinvestment Act, control over certification is passing to the federal government. The Office of the National Coordinator for Health Information Technology is setting rules for criteria that support "meaningful use" of EHRs, while the Commerce Department's National Institute of Standards and Technology is developing testing procedures.

Along the way, certification has become highly detailed, with at least one unintended consequence. "[T]he certification process was in effect dictating particular work flows and distinct user interfaces. That was the point where the grumblings about lack of EHR usability and complaints of EHRs not being built with physicians and patients in mind, started gaining steam," Margalit Gur-Arie, a partner in St. Louis-based health IT consulting firm Gross Technologies, notes on her On Healthcare Technology blog.



IBM Looks for Health Data to Crunch

HDM Breaking News, May 6, 2010

IBM Corp. has a launched a major multi-year research program, called SPLASH, to link and analyze huge amounts of data to better understand how to improve human health.

The program initially will focus on preventing childhood obesity. Armonk, N.Y.-based IBM recently explained the program to 150 participants during its annual Almaden Institute event at its research lab in San Jose, Calif., as the company begins to seek SPLASH partners from a wide variety of sources.



Federal panel OKs recommendations on certification

By Joseph Conn / HITS staff writer

Posted: May 6, 2010 - 11:00 am ET

The Health IT Policy Committee accepted by unanimous vote recommendations on certification and privacy from two of its work groups today.

The work group on the adoption and certification of health information technology systems presented a list of 12 recommendations on tweaks to the proposed permanent program for the certification of electronic health-record systems outlined in a proposed rule published March 10 by the Office of the National Coordinator for Health Information Technology at HHS. The public comment period on the rule ends May 10.



Panel urges open source policy on VistA overhaul

By Joseph Conn

Posted: May 6, 2010 - 1:15 pm ET

A Veterans Affairs Department advisory panel has issued a report recommending that the VA should commit to a policy of open source software development in overhauling its VistA health information technology system and create a not-for-profit organization to manage the new, open source “ecosystem” that results.

The group, the Industry Advisory Council of the American Council for Technology, Fairfax, Va., which bills itself as a “non-profit, public-private partnership,” was commissioned last year by VA Chief Information Officer Roger Baker to recommend a way forward for the VA and its Veterans Health Information Systems and Technology Architecture, or VistA, clinical IT system.

The council's 101-page report was delivered to the VA on Tuesday, according to the group.



Social Media in Health Care: Barriers and Future Trends

Social media has invaded health care from at least three fronts: innovative startups, patient communities and medical centers. The Health 2.0 movement has nurtured dozens of startups with creative concepts to revolutionize health care: tools from vertical search and social networks to health content aggregators and wellness tools.

Patient communities are flourishing in an environment rich with social networks, both through mainline social communities and condition-specific communities. Meanwhile, hospitals and academic medical centers are diving into the social media mix with more than 300 YouTube channels and 500 Twitter accounts. Hospitals are moving from experimentation (Twittering from the OR to Flipcam videos) to strategic use of social media to enhance brand loyalty and recruit new patients. They are taking on monitoring and monetization of social media.


EMRs Top Priority For 58% Of Hospital CIOs

CIOs rank electronic medical records projects higher than IT managers and directors, who are focused on PC refreshes.

By Marianne Kolbasuk McGee, InformationWeek
May 6, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224700871

With $20 billion-plus worth of meaningful use bonuses from the government at stake for their organizations, E-medical records and electronic ordering systems are the top IT priorities for hospital CIOs over the next two years, according to a survey.

However, among hospital IT managers and directors, EMR projects ranked further down on the IT priority list, with only 25% naming those initiatives as "most important" for their organization over the next two years.



Panel presses for health information superhighway

May 05, 2010 | Bernie Monegain, Editor

WASHINGTON – A commission of national healthcare experts convened by the Center for the Study of the Presidency and Congress (CSPC) has unveiled a roadmap for better healthcare that calls for a "health information superhighway."

The commission presented the report Wednesday at the National Press Club in the nation's capital.

"Just as President Eisenhower built a Federal Interstate Highway System to connect communities, boost the economy and protect national security, so must we construct a health information superhighway system in the 21st century," said Rear Admiral Susan Blumenthal, MD (ret), co-chair of the Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions.


Biden: Health IT Savings Will Be Bigger Than Projected

Vice President says e-health records will save more money than Congressional Budget Office has projected.

By Nicole Lewis, InformationWeek

May 6, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224700906

When electronic health records are fully implemented in 2014, along with health information exchanges and other technologies associated with healthcare delivery, the cost of healthcare will be significantly less than the Congressional Budget Office has calculated, vice president Joe Biden said.

"We believe there's a lot more savings in the healthcare bill that we passed. The CBO, they only count what they can feel and taste. They only count what's done before, and so we think there's a lot of additional savings to be had," Biden said.



51 Healthcare Groups Call for Changes Of Federal EHR Adoption Proposal

Janice Simmons, for HealthLeaders Media, May 4, 2010

Healthcare providers need additional time and greater flexibility to meet criteria of the Centers for Medicare and Medicaid Services' proposed electronic health record rule published earlier this year, a coalition of 51 groups told Health and Human Services Secretary Kathleen Sebelius in a May 3 letter.

They wrote that while they "fully support" the purpose of the American Recovery and Reinvestment Act of 2009 to "encourage the adoption and use of EHRs," they are asking that it be done "in a manner that will remove barriers to and promote the widespread adoption of health information technology.”



Surgical Robot Examined in Injuries


DOVER, N.H.—Wentworth-Douglass Hospital, a small community hospital in this coastal New England town, used a college hockey game to showcase its new technological marvel: a $1.4 million surgical robot named after Leonardo da Vinci.

As the University of New Hampshire battled the University of Vermont last season before a crowd of 6,000, hospital representatives invited fans to try out the robot between breaks in the action.

The da Vinci robot is a massive machine that is used to perform minimally invasive surgery. But some experts warn that the robot can do more harm than good when wielded by inexperienced doctors. WSJ's John Carreyrou reports.

The da Vinci has been billed as a breakthrough in the quest to make surgery less invasive. With its four remote-controlled arms and sophisticated camera, it enables surgeons to operate through small incisions with greater precision and visibility.

At Wentworth-Douglass, however, the robot has been used in several surgeries where injuries occurred. One patient operated on days after the hockey game was so badly injured that she required four more procedures to repair the damage. In earlier robotic surgeries, two patients suffered lacerated bladders.



Health IT 'Beacon Communities' awarded $220 million

May 04, 2010 | Bernie Monegain, Editor

WASHINGTON – The government has released the names of the 15 communities across the country from Maine to Hawaii that will serve as models for the broad use of healthcare information technology under a $220 million program aimed at improving care and efficiency – and creating new jobs.

Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius announced the names Tuesday. The funds for the program are part of the American Recovery and Reinvestment Act (ARRA) and are being disbursed through the Office of the National Coordinator for Health Information Technology (ONC). The ONC received 130 applications for the program.



E-Pharmacy Catches Drug Mistakes for Rural Hospitals in Five States

Cheryl Clark, for HealthLeaders Media, May 5, 2010

It's always refreshing to hear about a big, geographically diverse hospital system that tries to find solutions for its smallest facilities, and succeeds. Especially when doing so saves tons of money and prevents medication errors that endanger patients.

Welcome to the world of e-pharmacy, and Bravo Banner Health.

The non-profit, Phoenix-based 22-hospital system that stretches across seven states, from Alaska to Nebraska, is doing just that for eight of its small, rural facilities that don't have pharmacy staff to review prescriptions around-the-clock.



Hôpital Glengarry Memorial Hospital joins diagnostic imaging network

May 5, 2010 (Alexandria, ON) – The Hôpital Glengarry Memorial Hospital is taking an important step towards providing improved access to medical specialties in the community by joining the Northern and Eastern Ontario Diagnostic Imaging Network (NEODIN). NEODIN is one of four Ontario diagnostic imaging repositories (DI-r) for medical images and associated diagnostic reports. Once complete, it will allow electronic transfer of images and reports between more than 60 diagnostic imaging departments in Northern and Eastern Ontario.

The NEODIN DI-r eliminates the need for patients to transport images and reports between doctors on CDs, films, or by fax. It also allows specialists at one facility to access the reports for images acquired at other hospitals, allowing for faster and more convenient information sharing between doctors.



Bridging to an Enterprise EMR

Penn Medicine shares lessons from its EMR implementation process.

By Glenn Fala

Implementing an electronic medical record (EMR) at a complex enterprise such as an academic medical center can take years to complete. The transition from legacy to end-state information systems can be eased by using integration technologies such as Web portals, single sign-on and enterprise data warehousing. The flexibility of these tools allows their usage to evolve over the lifecycle of the EMR rollout, helping organizations to maintain usability of these systems through the transition period.

It is characteristic of an academic medical center to have a wide mix of clinical information system applications. Such centers generally consist of multiple hospitals and physician practices which may have been acquired at different times. These entities are likely to have different information systems than the core entity. Even if they use some of the same information systems, it is likely that the implementations will differ because of unique individual requirements and workflows.



4 May 2010

eHealth Worldwide

:: Africa: World Bank and Pfizer Announce Initiative to Help Improve Healthcare Delivery (27 April 2010 - eHealthServer)

The World Bank and Pfizer Inc. announced they will collaborate to improve the healthcare infrastructure, specifically the supply chain, in developing countries, starting with Africa. The novel public-private collaboration will focus on enhanced use of Information and Communication Technologies' (ICT) transformative power to improve healthcare delivery. The project demonstrates both Pfizer's and the World Bank's commitment to improving healthcare delivery by creating a funding mechanism to expedite the identification of gaps in Africa's healthcare infrastructure and ultimately aid in the implementation of ICT solutions.

And many others.



ONC turns its attention to health reform IT

By Mary Mosquera

Thursday, April 29, 2010

Dr. David Blumenthal, the national health IT coordinator, yesterday asked his advisors to turn to one of the most vexing problems on the health reform horizon: streamlining federal and state systems for enrolling people applying for health insurance benefits under the law.

Blumenthal asked members of the Standards Committee to start to develop standards for exchanging eligibility and enrollment data electronically between what is now a hodgepodge of federal and state health and social health programs and services organizations.

In doing so, he acknowledged both a major new direction – and workload – for ONC.



Doctors not in stampede to go digital

President Obama has earmarked some $35 billion in stimulus funds to spur a nationwide rollout of computerized medical records, but even a big dose of federal cash is not enough for physicians like Dr. Robert LeBow of Southbridge.

The 66-year-old internist and geriatrician cares for more than 1,000 patients, many of them elderly, with multiple ailments with multiple medications. These are the kinds of patients who produce paper records that are inches thick, making LeBow a seemingly ideal candidate to collect $44,000 in federal funds available to doctors who install a system that would digitize all that information.

But LeBow is reluctant to embrace a technology that he believes carries hidden costs, chief among them productivity losses while he and his staff master the system. Also, for many doctors, the government subsidy would cover only a portion of a new records system’s price tag, which can easily climb to $100,000 or more.



Privacy, security concerns for PHRs declined: survey

By Maureen McKinney / HITS staff writer

Posted: May 4, 2010 - 11:30 am ET

Consumers' concerns about the privacy and safety of online personal health records have lessened slightly, according to the newly released results of an annual healthcare survey.

In the 2010 Survey of Health Care Consumers, released by the Washington-based Deloitte Center for Health Solutions, 33% of respondents reported feeling uneasy about the security of online PHRs compared with 38% last year.



Feds release $220 million for IT

By Jennifer Lubell / HITS staff writer

Posted: May 4, 2010 - 10:30 am ET

HHS is distributing $220 million in American Recovery and Reinvestment Act funds to 15 communities to pilot test the adoption of emerging health information technology.

These Beacon Community awards are part of a $2 billion effort to achieve widespread meaningful use of health IT, providing each person in the U.S. with access to an electronic health record by 2014.



Eclipsys to target “lost” NHS trusts

04 May 2010

US clinical information systems provider, Eclipsys, has said that it will bring the latest version of its Sunrise Clinical Manager product to the UK and target trusts that are being left behind or opting out of the National Programme for IT in the NHS.

The US company, which provides an integrated clinical platform including electronic patient records and order communication solutions, told E-Health Insider that it will enter the UK market by approaching trusts across the country that are “lost and searching for another option.”



More doctors make house calls – online

Mich. insurers pay for consultations that can save time, money


The Detroit News

For Dr. Earlexia Norwood, a family physician in Troy, not every office visit begins with a patient hopping up on the exam table.

Sometimes she just logs on to her computer.

"We know now there are a lot of things we can handle over the phone and electronically," Norwood said. "Doing it actually saves time and money for everyone."

It's paying off for physicians as more Michigan health insurers reimburse them for this type of care, ushering in a new era when patients will no longer have to schedule an office visit to talk to their doctors about minor concerns.



Panel: How do HIEs, EMRs affect patient-physician experience?

BOSTON–Better monitoring and understanding is needed for how EMRs and health information exchange (HIE) impact the patient’s experience of care and best practices need to be shared to improve these technologies, Barbra G. Rabson, executive director at Massachusetts Health Quality Partners (MHQP) reported Thursday at the Health IT: Creating Jobs, Reducing Costs and Improving Quality national conference, hosted by Massachusetts Gov. Deval L. Patrick.

“We are still learning about the positive and negative impacts of EMRs on patient-clinician communication,” said Rabson, adding that physicians should do a better job telling patients about the value EMRs and HIE can provide.

Rabson, along with fellow Massachusetts-based panelists, sat down to discuss the role of the patient in health IT and HIE.



Health IT funding to create 50,000 jobs

Sixty regional IT help centers will help health care facilities implement electronic medical records

Lucas Mearian

April 30, 2010 (Computerworld)

BOSTON -- Federal dollars being pumped into grant programs to spur students to enter IT careers in the health care industry should help to create between 45,000 and 50,000 jobs over the next five years, a top federal health official said on Thursday.

Speaking at the Health Information Technology (HIT) Conference here, Dr. David Blumenthal, National Coordinator for Health Information Technology, said a portion of $2 billion in discretionary spending under Office of the National Coordinator (ONC) is being targeted at education and training for electronic health record implementation.

A large part of the training is for people to staff 60 regional extension centers, which are public, private partnerships that will assist rural hospitals and physician practices with 10 or fewer doctors in rolling out electronic medical records (EMRs) and supporting technology.



Agencies, employers crack down on EHR breaches

By Gregg Blesch / HITS staff writer

Posted: May 3, 2010 - 11:45 am ET

It's perhaps like the urge to look through your big brother's dresser or the medicine cabinet at a neighbor's house. Some healthcare workers with access to medical records can't help but snoop, which is more than naughty—it's a federal crime.

Enforcement agencies and employers are getting increasingly serious about busting the snoops as electronic records proliferate and access becomes diffuse. Last week Huping Zhou, as far as prosecutors and observers can tell, became the first person to be sentenced to prison (four months) for just looking.



Researchers suggest EHRs linked to higher costs

By Joseph Conn / HITS staff writer

Posted: May 3, 2010 - 11:45 am ET

Researchers from the business school at Arizona State University say their work suggests electronic health-record systems in hospitals increase hospital costs, nurse staffing levels and the incidence of complications, but lower mortality rates for some conditions, according to a published report.

As a threatened nursing shortage looms, the ASU research team chose to test the assumption that health information technology might increase nurse productivity by improving workflow.



ASU researchers publish EHR study

By Joseph Conn / HITS staff writer

Posted: May 5, 2010 - 12:00 pm ET

Researchers from the business school at Arizona State University say their work suggests electronic health-record systems in hospitals can be linked to increased hospital costs, higher staffing levels for registered nurses and the greater incidence of clinical complications.

The report was not all bad news for hospital leaders embarked on an IT program.

The three-man research team from ASU's W.P. Carey School of Business also found that more-intensive EHR deployments are associated with lower inpatient mortality rates for medical conditions, according to a published report.

According to their 22-page article, “Electronic medical records, nurse staffing and nurse-sensitive patient outcomes: Evidence from California hospitals, 1998-2007,” published in the journal Health Services Research, the ASU team looked at financial and outcomes data from 326 California hospitals supplied by the California Office of Statewide Health Planning and Development.



Will July 15 be a Dark Day for Telemedicine?

Greg Gillespie
Health Data Management Blogs, April 30, 2010

Health I.T. is marching forward on many fronts. But July 15 might be the day, barring Congressional intervention, that telemedicine moves in the opposite direction. On that day the Joint Commission’s “privilege by proxy” program bites the dust, which could have serious ramifications for the industry.

Privilege by proxy permitted hospitals to credential telemedicine practitioners from a distant site based on the credentialing/privileging decisions at that distant site. In a nutshell, it allowed physicians from large hospitals to provide telemedicine services to small or rural facilities without having to go through the credentialing process twice (as long as both hospitals were Joint Commission-accredited).



Two Data Breaches in Kentucky

HDM Breaking News, April 30, 2010

Two Kentucky hospitals in recent days have disclosed breaches of protected health information.

Our Lady of Peace, a psychiatric hospital in Louisville, is notifying 24,600 individuals after a flash drive was came up missing on April 1. The hospital does not have a notice published on its Web site, but a notice is published on the site of corporate parent Jewish Hospital & St. Mary's Healthcare. The hospital ran a legal advertisement notifying the public in the Courier-Journal, Louisville's largest newspaper, on April 29.

The new breach notification rule under the HITECH Act requires disclosures within 60 days for breach known to affect 500 or more individuals. Smaller breaches must be reported on an annual basis.

The flash drive contained unencrypted data on patients admitted since 2002 and patients assessed, but never admitted, since 2009. Data on admitted patients included name, room number, insurer name, and admission and discharge dates. It did not include diagnoses or treatments, Social Security number, date of birth, telephone numbers or address.



Blumenthal, governor put health IT center stage in Boston

April 30, 2010 | Bernie Monegain, Editor

BOSTON – The government will announce "soon - it should be very, very soon" which 15 communities of the 130 that applied will be awarded Beacon Community grants, National Coordinator for Health IT David Blumenthal, MD, said Thursday.

Blumenthal spoke in Boston before an audience of about 600 people at the "Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality" conference called by Massachusetts Gov. Deval Patrick.

Blumenthal said he was filling in for his boss, Health and Human Services Secretary Kathleen Sebelius, who had been slated to deliver the day's first keynote talk.



ANIA: ARRA means ‘golden’ days ahead for nursing informaticists

Author: Mary Stevens

Sunday, April 25 2010

BOSTON–There are mountains of problems to overcome when it comes to automating systems and getting patient health records off of paper. And the HITECH Act has added urgency to the tasks at hand, said John Delaney, RN, BSN, director of IT outreach at University Medical Center in Lubbock, Texas. “It’s a huge job and we’ve got big problems,” said Delaney during a session at the ANIA/CARING conference last week.

Delaney’s presentation on nursing informatics’ role in the light of the HITECH Act focused on the opportunities that come with these problems. “This is the time for all of us in nursing and informatics to really look at the culture and look at the environment and figure out what [we] want to do. Because there is a lot going on and a lot of new opportunity, thanks to HITECH,” said Delaney, a med/surg nurse with 23 years’ experience at University Medical Center and more than 10 years in health IT.



Standardizing claims can save billions--just like we heard in 2002

May 3, 2010 — 12:33pm ET | By Neil Versel

Editor’s Corner

You may have heard the news that Massachusetts General Hospital researchers have determined that standardizing medical billing could save physician practices $7 billion annually. "Specifically, by using a single set of payment rules for multiple payers, a single claim form and standard rules of submission, physicians and staff could spend four and five fewer respective weekly hours on this administrative burden," reports FierceHealthcare, based on a study published Thursday in the online edition of Health Affairs.

Health economist and blogger Jane Sarasohn-Kahn suggests that the savings could go as high as $30 billion if providers and payers were to follow the recommendations of the U.S. Healthcare Efficiency Index project. That's a good chunk of money, though only 1.2 percent of the $2.5 trillion spent on healthcare each year.



Electronic medical orders may save lives: study
By Reuters Health
May 3, 2010NEW YORK (Reuters Health), May 3 - Doctors at a California children's hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20% drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

"It's the lowest rate ever observed in a children's hospital," said Dr. Chris Longhurst, of Stanford University and Lucile Packard Children's Hospital in Palo Alto, California, whose findings are published in the journal Pediatrics. "It begs the question how many lives could be rescued on a national level."



CPOE tied to lower mortality figures, study finds

By Maureen McKinney

Posted: May 3, 2010 - 12:01 am ET

Use of computerized physician order entry systems can correlate with significant drops in hospital mortality rates, according to results of a new study published in the journal Pediatrics.

In a joint collaboration, researchers from Lucille Packard Children's Hospital and Stanford University School of Medicine, both based in Palo Alto, Calif., reviewed nearly 100,000 patient discharges from the hospital from January 2001 through April 2009. In the 18 months following the hospitals' implementation of CPOE in 2007, there were two fewer deaths per 1,000 discharges, or a 20% decrease in mortality, according to the study.




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