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."

Saturday, July 31, 2010

Weekly Overseas Health IT Links - 30 July, 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.



The Health Geeks

Microsoft’s bid to fix medical care.

by Daniel LyonsJuly 09, 2010

The more you look at the problems involved in overhauling our health-care system, the more hopeless they seem. But that is exactly what made Peter Neupert, a Microsoft millionaire and dotcom entrepreneur, want to try. “It is completely overwhelming,” he says. “My wife reminds me all the time that there are many things a lot simpler that I could be doing. But I just have a genetic predisposition for big, hairy problems.”

That’s why, in 2005, having already made two fortunes—as a Microsoft executive and then as CEO of Drugstore .com—Neupert returned to Microsoft to create software for health-care providers. His division, the Health Solutions Group, now has 800 employees and sells to hospitals nationwide.



The Economics of Privacy Pricing


I wrote a Sunday column about a San Francisco start-up that is betting the time has come to make personal information online not only an asset consumers can manage, but also a virtual currency that can be traded someday.

Others, of course, have tried making a business from trading click streams and other online personal information on behalf of consumers, like Root Market years ago. But part of the start-up Bynamite’s calculation is that these days, the data is far richer and the technology has matured enough to make such a service easy to use, effective and flexible. More people seem to be concerned about privacy today as well.

But if personal information can be made a good in an open marketplace, there is a big challenge. “There is no way to know in advance what the value of this information is,” said M. Ryan Calo, a senior research fellow at Stanford Law School’s Center for Internet and Society.

A paper by three scholars from Carnegie Mellon University does not answer that question precisely, but it does provide some insights from behavioral economics about how people value their personal information, and make money-privacy tradeoffs.

The paper — “What is privacy worth?” — was presented at a conference at the end of last year and is awaiting publication in a professional journal. Its authors are Alessandro Acquisti, an associate professor in information technology and public policy; Leslie John, a doctoral candidate; and George Loewenstein, a professor of economics and psychology.



Hospitals try new approach to patient-specific marketing

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted July 19, 2010.

Any member of a customer-loyalty program at a grocery store chain has likely noticed that, at the end of a transaction, the register spits out coupons for products he or she uses routinely. That's not a coincidence.

The ads are generated by what's called a customer relationship management system. That same technology is making its way into the health care industry so hospitals can market to patients and physicians the same way supermarkets do -- by sending information they think a customer needs or wants based on their history.

"It's about relationships and management. And at the end of the day, relationships are built with people through dialogue," said Anil Swami, an executive partner with the global management consulting firm Accenture, which helps clients implement customer relation management strategies and systems. "Our experience has been that the technology is the enabler, and the people deliver."



HIT-ting a wall on privacy of health records

By Joseph Conn / HITS staff writer

Posted: July 22, 2010 - 12:00 pm ET

The federally chartered Health Information Technology Policy Committee received from its privacy and security "tiger team" a list of policy recommendations on the use of electronically stored and shared patient information Wednesday.

And although the HIT Policy Committee unanimously accepted the recommendations, it did so recognizing that a serious division exists within the group recommending the various forms of control a national system of interconnected health IT should give patients over the sharing of their sensitive medical information.

The HIT Policy Committee and the HIT Standards Committee were created last year under the authority of the American Recovery and Reinvestment Act of 2009. Their charge is to advise the Office of the National Coordinator for Health Information Technology at HHS on health IT matters. In June, ONC quietly furloughed two privacy and security work groups, one from each committee, replacing them temporarily with what was presumed to be one smaller and more-nimble privacy and security “tiger team.”


CMS Offers Insight On Meaningful Use Stage 2

Comments from the Centers for Medicare and Medicaid Services indicate that Meaningful Use stage two will expand on stage on by making the current "menu" set part of future core requirements.

By Anthony Guerra, InformationWeek

July 22, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226100125

Much of what will become Meaningful Use Stage 2 can be found in the recently released Stage 1, according to comments from the Centers for Medicare and Medicaid Services' (CMS) Tony Trenkle, who spoke during this month's HIT Policy Committee meeting.

Meaningful Use Stage 2, he said, will expand on Stage 1 by making the current "menu" set part of future core requirements. Trenkle, director of the CMS Office of e-Health Standards and Services, said the organization also wanted to get certain administrative requirements -- which were included in the NPRM but dropped from the final regulation- along higher CPOE levels, into Stage 2.

"We would also like to look at higher thresholds for other measures," he said. "That is our intent, and it will be framed by feedback and recommendations that come from the Policy Committee."


GE Healthcare ePrescribing Solution Approved In Ohio

The Centricity electronic medical record Advanced ePrescribing solution that uses biometrics to authenticate physicians ordering patient medications has been approved by the Ohio Pharmacy Board.

By Nicole Lewis, InformationWeek

July 20, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=226000022

GE Healthcare's ePrescribing solution, which uses fingerprint-scanning technology to verify a doctor's identity before they order medications, has been approved by the Ohio Pharmacy Board for use by the state's physicians.

Announced on Monday, GE executives said the technology met Ohio's stringent ePrescribing requirements by successfully integrating biometrics technology into its Centricity Electronic Medical Record solution. By adding an external scanner, the technology calls for physicians to identify themselves by providing their fingerprint before ordering a patient's prescription.



Patient Money

Losing Weight the Smartphone Way, With a Nutritionist in Your Pocket

Published: July 16, 2010

FOR most of us, the formula for losing weight is a simple one: eat less, exercise more. But humans are anything but simple, and the majority of Americans struggle endlessly with losing pounds and keeping them off.

“We really haven’t come up with one good weight-loss solution,” said Dr. James A. Levine, an endocrinologist at the Mayo Clinic. “If we had, everyone would be using it.”

Consuming fewer calories is perhaps the most difficult part of the weight-loss equation; many dieters are daunted by the prospect of tabulating their daily intake. That’s why many experts and consumers are excited about the new weight-loss programs available for iPhone, BlackBerry and other smartphones.



Survey: EHRs number one priority for healthcare IT professionals

July 19, 2010 | Molly Merrill, Associate Editor

SAN FRANCISCO – Seventy-four percent of healthcare IT professionals reported that their existing information on meaningful use and electronic health record certification was "adequate" and that their technical implementation questions have been answered, according to a new survey.

The survey, by Embarcadero Technologies, a San Francisco-based provider of databases tools and developer software, was conducted throughout the months of March and April 2010 and primarily reflects the opinions of Embarcadero’s healthcare IT professional contacts (developers, DBAs, architects, consultants, executives) in the United States.



Mass. Hospital Breach Affects 800,000

HDM Breaking News, July 21, 2010

South Shore Hospital in South Weymouth, Mass., has announced that back-up computer files that were sent to a contractor to be destroyed have been lost, a breach that could affect approximately 800,000 individuals.

The files contained extensive amounts of protected medical and financial information. They were not encrypted because a back-up process for the files did not permit them to be encrypted. Specialized technology and knowledge, however, are required to access the files, according to the hospital.

The hospital has prominently placed a notice of the breach on its Web site, along with a sample notification letter, the steps affected individuals can take to protect their medical and financial information, and a Q&A page. The hospital also has notified state and federal authorities.



UHN establishes first telepathology system in Ontario

New system connects UHN pathologists to Northern Ontario communities over the Internet

July 21, 2010 (Toronto, ON) - Physicians in three Northern Ontario communities are now virtually linked at all times to pathology specialists at University Health Network (UHN), thanks to a revolutionary new way of diagnosing pathology cases over the Internet.

The new telepathology system is the first of its kind in Ontario. It allows physicians in rural and remote hospitals to access and consult with specialized UHN pathologists by instantly transmitting digital images of pathology samples enabling fast and accurate diagnosis for patients regardless of where they live. The first three sites connected to UHN are community hospitals in Timmins, Sault Ste. Marie and Kapuskasing all of which are over 600 kilometres from Toronto.



WIRED in Wis.: info-exchange plans detailed

By Joe Carlson / HITS staff writer

Posted: July 20, 2010 - 11:15 am ET

The Wisconsin Relay for Electronic Data for Health Board, also known as WIRED for Health, released a 164-page draft of a plan for developing and operating a statewide health information exchange. The board is soliciting public input on the proposal until Aug. 1.

The plan spells out the state's proposal for spending a $9.4 million federal grant to implement a statewide system for healthcare providers to exchange patient clinical information, with the goal of fostering both healthy competition and cooperation among providers.



Government axes £15m for children’s IT

19 Jul 2010

The government has axed £15m of funding promised by the previous Labour government to help local authorities implement integrated children’s systems.

Education secretary Michael Gove has written to directors of children’s services and chief executives to set out the details as part of the Department of Education plans to save £1 billion from its capital budget in 2010-11.

In his letter Gove said the £15m additional capital grant that had been announced by the previous government would not now be available.



Thursday, July 22, 2010

Progress Made on Stimulus Package Provisions, Funding

by Helen Pfister and Sandy Newman, Manatt Health Solutions

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes certain significant developments throughout June and July.

Health IT Policy and Standards

On July 13, CMS released the much-anticipated "meaningful use" final rule on the Medicare and Medicaid electronic health record incentive program, and the Office of the National Coordinator for Health IT released the final rule on standards for certified EHR technology.



AMA lists concerns with meaningful-use rules

By Andis Robeznieks / HITS staff writer

Posted: July 21, 2010 - 12:00 pm ET

The American Medical Association released a memo stating that although the final requirements physicians must meet to qualify for federal health IT subsidies represent an improvement over what the CMS originally proposed in December, barriers to electronic health-record adoption and implementation remain.

Regarding the rules, issued last week, the AMA said the CMS followed its recommendations to remove administrative requirements from the first stage of the program, reduce the initial qualifying criteria and reduce the volume of quality measures while granting greater flexibility.



The Vendor View of Meaningful Use

HDM Breaking News, July 19, 2010

As providers gear up to go after government incentive payments for meaningful use of electronic health records, there's been a nagging fear that vendors won't be able to increase staff and other resources quickly enough to meet demand. That's a legitimate concern, says Charles Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind.

"What others expected, we're already seeing as their resources are strained," he adds. The hospital is implementing practice management and electronic records software, which it will host for owned practices, from Chicago-based Allscripts. The hospital has about 25 physicians in 10 owned practices and expects that to double by next summer.



CMS abandons absolutes, adds flexibility to meaningful use

By Mary Mosquera

Tuesday, July 13, 2010

In its final meaningful rule published today, the Center for Medicare and Medicaid Services has abandoned its original all-or-nothing approach to offering incentives for electronic health record adoption and opted for flexibility.

Healthcare providers will now have various ways of reporting objectives to demonstrate meaningful use of EHRs, and some that are deemed too difficult to achieve by the original 2011 deadline will be delayed a year.

One of the major changes in the final rule now requires providers to meet a “core” group of objectives, such as electronic prescribing, providing patients who request it an electronic copy of their health information and maintaining an active medication list. Physicians must meet 15 of those core requirements, and hospitals must meet 14.



CMS Meaningful Use Rules Are Final: Now What?

Gienna Shaw, for HealthLeaders Media, July 20, 2010

Leaders from healthcare organizations and associations, lawyers, consultants, IT vendors, and a host of other experts are slogging their way through all 800-plus pages of the Centers for Medicare & Medicaid Services final rule for the meaningful use of electronic health records. They have plenty of opinions about what's right and what's wrong with the rules. And that's fine. But it's also a good idea to think about something more important than what could have or should have been: What happens next?

The long-awaited final rules spell out exactly what hospitals and physicians must do to qualify for their share of a pool of roughly $27 billion in bonus Medicare payments over the next ten years for using electronic health records (EHRs). Eligible professionals can get up to $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.



HHS Addresses Privacy, Security Concerns in EHR Program

Dom Nicastro, for HealthLeaders Media, July 16, 2010

HIPAA privacy and security concerns with the government's EHR certification program are so great that hundreds of practitioners have called for the program's cancellation, the Department of Health & Human Services (HHS) announced in its final rule on meaningful use released Tuesday.

It hasn't happened, of course.

The final rule, issued through the Centers for Medicare & Medicaid Services (CMS), defines "meaningful use" for the first two years (2011 and 2012) of a long-term financial incentive plan through Medicare and Medicaid under the Health Information for Economic and Clinical Health (HITECH) Act, signed into law by President Barack Obama February 17, 2009.



HHS to create online inventory of research on effective treatments

By Mary Mosquera

Friday, July 16, 2010

The Department of Health and Human Services plans to develop a national inventory of research on the treatments and medical interventions that are most effective for patients.

The collection of comparative effectiveness research and information will be available through a searchable online tool to physicians, policymakers and the public, according to a request for information posted July 16.



Certification issues remain, providers say

By Joseph Conn / HITS staff writer

Posted: July 19, 2010 - 11:45 am ET

With the final rule on meaningful use of electronic health-record systems out, there's one fewer item on the federal government's checklist for implementing the EHR subsidy program under the American Recovery and Reinvestment Act of 2009.

One looming potential problem for health information technology executives, though, is the government's long delay in establishing a procedure to recognize organizations to test and certify EHRs and their modular components.

The Office of the National Coordinator for Health Information Technology didn't publish final rules on a first-round process to name "temporary" testing and certification programs until June 18 and didn't start taking applications from organizations seeking to qualify as testing and certification organizations until July 1.



EHRs aid in abuse-screening project

By Jennifer Lubell / HITS staff writer

Posted: July 19, 2010 - 11:45 am ET

A federally funded health project has shown measurable success in helping Native American victims of domestic and sexual violence, raising the rate of women screened for abuse from 4% to 48%, according to a recently released report on the project.

Building Domestic Violence Health Care Responses in Indian Country: A Promising Practices Report, produced by the Family Violence Prevention Fund, details the progress of the initiative, which the fund developed in partnership with faculty from Sacred Circle and Mending the Sacred Hoop Technical Assistance Project.



Epocrates Files to Go Public

HDM Breaking News, July 19, 2010

Epocrates Inc., a vendor of software to access drug reference information via mobile computing devices, has filed a registration statement with the Securities and Exchange Commission to sell up to $75 million in a public offering of stock.

The San Mateo, Calif.-based company plans to use proceeds to pay $27.2 million in dividends to preferred Series B stockholders, and for general corporate purposes that could include acquisitions. The company is developing an "affordable" electronic health records system for solo and small physician practices.



'Meaningful Use' Hoists Hospital IT to Next Level

By Matthew Weinstock and Suzanna Hoppszallern

Meaningful use. Those two words have so dominated the health information technology marketplace for the past year and a half that it's been difficult to see the forest for the trees.

For most hospitals, the challenge is understanding how meaningful use fits into broader strategic, quality-of-care and patient-safety goals. Chief information officers at the 2010 Most Wired hospitals and health systems recognize that it is not an end, but a guide on the journey to create technology systems that enable clinicians to provide the best care possible.

Click here for the 2010 Most Wired Hospitals


Meaningful Use Core Requirements For Healthcare Providers

So what are the more than two-dozen core "meaningful use" requirements that healthcare providers need to meet in order to qualify for financial incentives? Take a look here.

By Marianne Kolbasuk McGee, InformationWeek

July 19, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=225900180

To qualify for the first wave of HITECH meaningful use incentives starting in 2011, hospitals have to meet 14 core requirements and eligible professionals -- such as doctors and nurse practioners -- must meet 15 core requirements.

In addition to those core requirements, healthcare providers also must meet five objectives of their choosing from a menu of 10.

Here is a summary of the core requirements healthcare providers must meet in their "meaningful use" of health IT such as e-health records and computerized physician order entry systems.




Friday, July 30, 2010

Are You Getting Tired of Studies Showing Provider EHRs Make a Positive Difference?

The following release appeared from KP a few days ago.

Kaiser Permanente demonstrates success of large-scale total joint replacement registry

July 22, 2010

A total joint replacement registry based on carefully designed and integrated technology can enhance patient safety, quality of care, cost-effectiveness and research, according to a paper published in the online and print editions of Clinical Orthopedics and Related Research, a journal of the Association of Bone and Joint Surgeons.

Kaiser Permanente's Total Joint Replacement Registry- the nation's largest such registry -- allows caregivers to analyze specific data from standardized forms and Kaiser Permanente HealthConnect®, an electronic health record, on more than 100,000 joint replacement cases by more than 350 Kaiser Permanente surgeons nationwide.

Since its inception in 2001, the TJRR has helped health care providers identify best practices, evaluate risk factors associated with revision surgeries, and assess the clinical effectiveness of implants. It also provides information that can be used to study patient demographics, implant characteristics and surgical techniques in relationship to post-operative complications such as infections, revisions and re-operations.

The TJRR also allows Kaiser Permanente to immediately identify and notify patients about recalled or defective implants prior to an official recall notice. The TJRR was instrumental in assessing more than 15 advisories and concerns with implants in 2009 alone.

In the article, the authors share insights from the organization's experience in developing, implementing and integrating the registry into KP HealthConnect®, a comprehensive health information system that is one of the most advanced and largest private sector electronic health records in the world, securely connecting 8.6 million people to their health care teams.

"To be successful, a large registry must have physician involvement, integration into workflow including rigorous validation and quality control methods, and provide ongoing feedback to participating surgeons and staff," said paper lead author Elizabeth Paxton, director of surgical outcomes and analysis at Kaiser Permanente. "Having used our registry to conduct research and translate these findings into actionable clinical-care guidelines, our total joint replacement registry shows that a national registry has the potential to improve patient safety and quality across the industry."


Provided by Kaiser Permanente (news : web)

Full release is here:


Here we go again, actionable clinical improvement from having the information on what is happening to your patients over time in a detailed accessible form. It is this stuff the planned Patient Controlled EHR simply does not address – and where a lot of the value actually is!

Enough said.


What Doctors Want in An EHR - It Would Also be Good For Patients!

I thought this was a really useful contribution from one of the Gurus

Perfecting The E-Health Record

Decision support, event-driven alerts, voice recognition, social networking--the EHR of the future should have it all.

By John D. Halamka, InformationWeek
July 24, 2010

The federal government is spending nearly $30 billion on electronic health records to improve the nation's healthcare. If I had infinite resources and time, and a greenfield for innovation, here's how I'd design the EHR of the future:

Physicians are on call round the clock, have to be in many different places, and use a variety of computing devices. Therefore, the ideal EHR would be Web-based, browser-neutral, and run flawlessly on every operating system.

It would incorporate decision-support tools and patient-specific preventive care reminders. And it would provide event-driven alerts that send critical data to doctors when immediate action is needed, such as when a patient on digoxin has a low potassium reading that increases the likelihood of dangerous changes in heart rhythm and other toxic effects from the medication.

The EHR would have an easy-to-read summary of all the patient's active problems, medications, visits, and labs. This summary would be exportable to personal health records, such as Google Health and Microsoft HealthVault.

Caregivers would pick from standard, predefined terms to describe patients' problems, and all the patient's clinicians would use specialized social networking tools to collectively maintain these problem lists--a kind of secure Wikipedia for the patient.

An e-prescribing app would link directly to payers' formularies so that doctors would know which medications are covered. It would determine eligibility for high-cost therapies in real time, link to a patients' medication histories, and check for drug interactions and allergies. A pharmacy-initiated workflow would reduce calls to physicians for refills. Here, too, the EHR would use social networking to let caregivers update, change, and comment on patient medications.

Patient visits would be documented with the reason for the visit, the diagnosis, therapies given, and follow-up expected. Notes would be entered using structured and unstructured electronic forms. All data would be searchable. Disease- and specialty-specific templates and macros would make documentation easier. Voice recognition would allow for automated entry of recorded notes. Workflow for signing and forwarding notes to other providers would be easy to use.


At Beth Israel Deaconess Medical Center, we've already achieved much of this functionality. But we'll never be done, because the perfect EHR is a continuously evolving target.

Dr. John D. Halamka is CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the New England Healthcare Exchange Network and the U.S. Health IT Standards Panel, co-chair of the HIT Standards Committee, and a practicing emergency physician. Write to us at iweekletters@techweb.com.

Do read the whole article to see all the other ideas as to what is needed.

Can I say if we could get to having what John is talking about here for all Australian clinicians the job would be near enough to done.

Both Government and Commercial providers could safely use this list to navigate a way forward.

I wish!


Thursday, July 29, 2010

Another Issue For EHR Planners to Consider - This Will Be A Hard One!

There has been a good deal of coverage of this issue in the last few days.

Can deciphering your doctor's notes improve care?


Posted: 07/20/2010 12:07:31 AM PDT

Updated: 07/20/2010 08:33:52 AM PDT

WASHINGTON—Don't be offended if your doctor writes that you're SOB, or that an exam detected BS.

The aim is to help, not insult: A project is beginning to test if patients fare better when given fast electronic access to more of their medical chart—the detailed notes that doctors record about you during and after every visit. You just might have to look up some of the technical jargon, like those abbreviations for "shortness of breath" and "bowel sounds."

Didn't know about those notes? Researchers involved in the "OpenNotes" project say they are surprised at how many patients don't.

"You really have to be a partner with your doctor to do well," says Dr. Tom Delbanco of Harvard and Beth Israel Deaconess Medical Center, who heads the study and thinks better use of those notes will help.

"It's your body. It's your record. It's your illness. You should have ready access to everything about it."

Yes, your clinic may have an electronic records system that lets you log in to make an appointment, check your cholesterol test or review your medications. But Delbanco and nursing colleague Jan Walker have found few include those doctor notes that provide details about a patient's health.

They can stretch two or three pages, as doctors mull alternate diagnoses they may not have mentioned, like a test ordered to rule out cancer.

Or doctors may jot reminders about personal issues that could complicate care—maybe the patient ignores medical advice, or is in denial, or has financial difficulties.

Doctors may detail problems in more blunt terms than they'd used face-to-face.

Hence easier access is debated. Say the doctor carefully avoids the "O" word while urging you to lose 20 pounds, only to write that "Joe is obese." Will you get mad, or be more likely to follow the advice?

To find out, three large health centers—Beth Israel, the Geisinger Health System in Pennsylvania and Seattle's Harborview Medical Center—are enrolling 115 doctors and up to 25,000 patients in the OpenNotes study.

For a year, participants will get an e-mail after each office visit saying their doctor's note is available through a secure online portal. Researchers will track if patients read it and find errors, and how they use it. Doctors' habits are being tracked, too—if they censor themselves or write more patient-friendly notes.

More here:


The same topic has been addressed here

What are you hiding from patients in their medical records?

July 22, 2010 — 1:30pm ET | By Neil Versel

Editors Corner:

Many a physician is understandably apprehensive about entering the brave, new world of "meaningful use" of EMRs. After all, it's not easy to change the way you've done things for years. What they may be most apprehensive about is not the expense, the workflow modifications or the computer skills they have to learn, but rather the requirement that they be able to give patients copies of their medical records on demand. (Actually, patients have had a right to see their records since HIPAA came along, but meaningful use adds a new dimension.)

As you may have read in FierceHealthcare this week, providing patients access to their records--paper or electronic--could open up a "Pandora's box." Imagine reading that your doctor wrote "SOB" in your chart, for example. No, it's not a commentary on your personality, but medical-speak for "shortness of breath." Same goes for "BS," which means "bowel sounds."

What happens when a doctor dances around a topic such as obesity during an office visit, but then writes the word "obese" in the record? Some are worried that it turns the doctor-patient relationship on its head.

Those are but some of the findings from planning for the Robert Wood Johnson Foundation-funded "OpenNotes" demonstration project, which will study the dynamics of providing physician notes to about 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center. Researchers studying OpenNotes plans reported their findings this week in the Annals of Internal Medicine.

More here:


The Wall St Journal also provided coverage

What the Doctor Is Really Thinking


Some doctors are taking an unusual new approach to communicate better with patients—they are letting them read the notes that physicians normally share only with each other.

When patients finish a checkup, doctors record notes on a range of topics. A new study looks at what happens when those notes become available for the patient to read electronically. Laura Landro has details.

After meeting with patients, doctors typically jot down notes on a range of topics, from musings about possible diagnoses to observations about how a patient is getting along with a spouse. The notes are used to justify the bill, and may be audited. But the main idea is to have a written record with insights into the patient's condition for the next visit or for other doctors to see.

A study currently under way, called the OpenNotes project, is looking at what happens when doctors' notes become available for a patient to read, usually on electronic medical records. In a report on the early stages of the study, published Tuesday in the Annals of Internal Medicine, researchers say that inviting patients to review the records can improve patient understanding of their health and get them to stick to their treatment regimens more closely.

But researchers also point to possible downsides: Patients may panic if their doctor speculates in writing about cancer or heart disease, leading to a flood of follow-up calls and emails. And doctors say they worry that some medical terms can be taken the wrong way by patients. For instance, the phrase "the patient appears SOB" refers to shortness of breath, not a derogatory designation. And OD is short for oculus dexter, or right eye, not for overdose.

"If you are a patient that just goes in once a year for a checkup, the doctor's notes might be not that useful. But if you have a lot of medical problems, it helps you ask the doctor the right questions and lets you know what's going on," says Jeanne Hallissey, a patient at Beth Israel Deaconess Medical Center in Boston, who began reading her doctor's notes as part of the study.

Medical providers have been stepping up efforts to improve doctor-patient communication, in part because studies show it can result in better patient outcomes. The introduction of electronic medical records in recent years has allowed patients to contact their doctors by email, log on to secure websites to get lab results and get links to health information recommended by their doctors.

The year-long OpenNotes study, funded with a $1.5 million grant from the Robert Wood Johnson Foundation, involves 25,000 patients and their primary-care physicians at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle. "We want to break down an important wall that currently separates patients from those who care for them," says lead investigator Tom Delbanco, a Harvard Medical School professor who treats patients at Beth Israel.

Lots more here:


And the

Should Patients Read the Doctor’s Notes?


Their request seemed simple enough: the patient and his wife, both in their 70s, wanted a copy of what I’d written in their medical file. During their visit, I had watched them refer to a well-thumbed collection of doctors’ notes and medication lists, so when they asked for a copy of my note just before leaving, I assumed it would simply be added to the others.

But when I mentioned the request to one of the nurses outside the exam room a few minutes later, her eyes grew wide.

“Oh no, you can’t do that,” she said, shaking her head. “I don’t think it’s legal.” The other doctors and nurses, attention piqued, moved closer to listen. “Send them to medical records,” she urged. “He can sign the release papers there.”

Another nurse in the growing crowd offered her own advice. “Do you know what’s going to happen if you give them a copy now?” she asked. “They’re going to start calling and e-mailing you with questions about what you wrote.”

The doctors and nurses began clucking in agreement. “Think about it for a second, Pauline,” one doctor said with voice lowered. “Maybe they are thinking of suing you.”

There was a collective gasp from the group now gathered around me; and I could guess what they were thinking as they craned their necks to peer into the exam room where my elderly patient was busy fussing with his papers as his wife stood adjusting the canvas fishing hat on his head.

The barbarians are at the gate.

For 40 years, the tension over patient access has been playing out in hospitals, clinics and doctors’ offices. Although medical records have always been accessible to clinicians, payers, auditors and even researchers, it was not until the 1970s that a few states began giving patients the same rights.

While a handful of physicians were vocal supporters of these early efforts, the majority of doctors were far less enthusiastic. They worried that their notes might become a source of unnecessary stress for patients. Read without an experienced clinician’s interpretation, slight abnormalities like an elevated cell count from a viral infection could turn into a life-threatening cancer in the eyes of patients.

Even routine abbreviations and jargon like “S.O.B.” (shortness of breath) and “anorexic” (a general lack of appetite, not the disease anorexia nervosa) could be confusing at best and inadvertently demeaning at worst. Doctors, already pressed for time, shuddered at the idea of suddenly being responsible for the worries of a reading public.

In 1996, despite these concerns, the Health Insurance Portability and Accountability Act, or HIPAA, gave all patients the legal right to read and even amend their own medical records. At the time, a group of national health care experts hailed this new transparency as a necessary component of better and safer care.

But today, few patients have ever laid eyes on their own records. And those who try often come back from their missions with tales of bureaucratic obstacles, ranging from exorbitant copying costs to diffident administrators. The same concerns from 40 years ago come up again and again, with little evidence to support or refute the claims of either side. Should medical records be shared as interactive documents between patients and physicians? Can transparency work, or will it end up worrying patients, muddling the patient-doctor relationship and adding more work to an already overburdened primary care work force?

Lots more here:


All I can say is that this is a really interesting study and deserves to be followed closely. All the questions raised in the various commentaries associated with these articles have some considerable relevance and deserve consideration.

Of course just how this would and can work in an electronic world just adds to the potential complexity. If people really want this sort of access – and I am sure some will and some just won’t – it will be important to come up with an approach that meets each groups needs.

We also need to make sure that what is done is evidence based and sound. This means making sure that all patients are provided with the access they want and can comprehend while not forcing unwanted material on them.

Thinking caps on time I suspect!


Wednesday, July 28, 2010

My Response To The E-Health Central Blogger.

David More July 28, 2010 at 10:23 pm

“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.

But over on his I Hate NEHTA blog, David More gets out his own egg-beater, and under the laborious heading “It Does Not Seem To Be Going Very well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Safe” declares “What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the levels of unhappiness were pretty extreme.”


I don’t hate NEHTA, I just would like some real delivery of what is promised. Also no-one pays me. I actually do this because I care what happens the the Australian Health System and the infrastructure it needs.

In the light of the recent comments on your blog are you prepared to withdraw the remarks made about Karen Dearne and myself – or do we need to let the court of public opinion expose you for what you seem to be?

At this point graceful withdrawal looks pretty good!

What you really should do is just send NEHTA’s money back and then research the issue sufficiently deeply to be able to form a serious independent view on all this.

Remember I am both a medical graduate and a PhD who has spent since 1987 in the e-Health space. I know what I am talking about, largely, do you? I know I am not anywhere near infallible but I have spent a long time giving this honest thought – and no one has paid me a cent for this work – can you grasp it might just be that as both the Boston Consulting Group and Deloittes have said – serious change at NEHTA is needed?


This is all posted here:


Frankly until the level of personal invective and rudeness disappears this is all I have to say.


NEHTA and DoHA are Heading in The Wrong Direction with their PCEHR Plans.

The following article appeared a few days ago.

Labor's e-health plan misses patient safety mark say doctors

Karen Dearne

From: Australian IT

July 21, 2010 6:28PM

DOCTORS say Labor's plan for personally-controlled e-health records is a distraction from the main game of delivering shared, secure electronic medical records that will actually improve patient safety.

Australian Medical Association president Andrew Pesce warns that patient care is "best served" when doctors have access to complete health records.

"Personal e-health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited in terms of their content, accuracy and the comprehensiveness of information," Dr Pesce said.

"Therefore, medical practitioners need a shared e-health record, in addition to any personal record (held by the patient)."

Launching an election wishlist in Canberra, Dr Pesce said the AMA welcomed the Coalition's commitment to mental health, but was disappointed these programs would be funded by money diverted from e-health and GP infrastructure proposals.

The Liberals say they will scrap the $467 million Budget allocation to personally-controlled e-health records, which Labor has promised to deliver a PCEHR to "every Australian who wants one" by 2012.

More Here:


On spotting this I thought more detail would be on the AMA web site and sure enough we find this.


10. E-health


An e-health system that connects patient information across health care settings, and which can be accessed and contributed to by treating doctors and other health professionals, will improve the safety and quality of medical care in Australia.

The benefits of e-health in making the best use of existing health care services and avoiding errors, duplication and waste are well known. To treating doctors, e-health means being able to access all of the clinically relevant medical information about a patient at the time of diagnosis or treatment.

Australia has made significant progress in developing technical specifications and standards for e-health systems. The time has come to build the overarching infrastructure to make e-health a reality.

Key issues for patients

Health care of the patient is best served when the medical practitioner has access to the full health record.

Personally controlled electronic health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited for medical practitioners in terms of their content, accuracy, and the comprehensiveness of information.

Therefore, a shared secure electronic medical record, in addition to any personally controlled health record, is needed to improve the safety of patient care.

Key issues for the Government

A commercial approach that relies solely on private investment and private engagement has not served the e-health agenda well. The next Government, with the State and Territory Governments, must drive and fully fund the development and implementation of a shared electronic medical record.

AMA Position

To make e-health a reality, the next Government must fund and build the overarching infrastructure to connect patient information and facilitate access by medical practitioners across the public and private health care sectors so that a summary electronic medical record can finally become a reality.

The medical profession must be a key driver of the design and implementation of the infrastructure to ensure that it works on the ground in medical practices.

A shared electronic medical record that links reliable and relevant medical information across health care settings will help provide treating doctors with the information required to inform clinical decisions.

The next Government must fund and implement a shared electronic medical record that:

  • Contains reliable and relevant medical information about individuals;
  • Aligns with clinical workflows and integrates with existing medical practice software;
  • Is governed by a single national entity; and
  • Is fully funded by Governments and supported by appropriate incentives, education and training.

- End AMA Position.

A few things are clear from this.

First the AMA prefers the direction of provider support and communications and information sharing as the first steps in the development of E-Health in Australia – just as outlined in the National E-Health Strategy.

Second they recognise that for any e-Health initiative to work it must involve clinicians from the outset and integrate into present clinical workflows – or at least not be a distraction and nuisance.

Third they are pretty clear that the leadership and governance of e-Health in Australia is not good enough.

Fourth they have noticed e-Health is both needed and should be properly funded and led.

Sadly what is missing is a recognition that there is no clarity at present as to just what the ‘right’ approach to establishing health information sharing between providers is, let alone how such information can be optimally shared with patients

From this article, and other things that have been reported from the UK, unless our doctors are much more trustworthy and accurate, large scale shared EHRs need a fair bit of work yet.

One in ten electronic medical records contain errors: doctors

One in ten medical records on a new electronic database contain errors which could put patients at risk, doctors have warned.

By Rebecca Smith, Medical Editor

Published: 8:15AM BST 17 Jul 2010

Doctors in Birmingham have found that 10 per cent of the records that have been uploaded so far contained out-of-date information including errors on current medication patients are taking or drugs they are allergic to.

These mistakes could put patients at risk if doctors relied on the information in an emergency and administered a drug they were allergic to or gave them a medicine which interacts with one they are already taking.

The system must be halted as it is not safe, doctors said.

So far around two million electronic patient records have been uploaded to the central database and if the error rate was the same nationwide, which doctors say is not unreasonable to presume, then around 200,000 people could be at risk from inaccurate information stored about them.

GP leaders in Birmingham told Pulse magazine that the organisation running the system, Connecting for Health, knows about the error rate and has not taken action.

Dr Robert Morley, executive secretary of Birmingham Local Medical Committee, which represents local doctors, told Pulse: "The fact that in Birmingham 80,000 patients have had their records uploaded, the majority without their consent, and one in ten have been put at risk from inaccurate data, shows we believe that the uploading of the Summary Care Record has to be stopped immediately because they are not safe."

Lots more here:


The need for a good deal more work and the need to be a bit less dogmatic approach on the part of DoHA and NEHTA would be useful first step to architecting and delivering systems that might actually do the job - i.e. save lives, improve quality of care and make the system just work better!