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Alliance of Chicago’s dashboards can track performance at a glance, including Type II Diabetes quality measures. Screenshot courtesy of Chicago Alliance of Community Health Centers
Connecting clinical decision support (CDS) to evidence-based medicine can mean assembling or linking to knowledge bases, having reliable access to the latest research and practice-based evidence, and figuring out who pays and how. And those decision support systems better be workflow-sensitive. But organizations that take the CDS-evidence-based medicine plunge have a lot to gain, as do their patients.
In a recent review of 70 controlled trials, researchers from Duke University Medical Center and Old Dominion University’s College of Health Sciences found that CDS systems significantly improved clinical practice in more than two-thirds of trials. The research identified four CDS features that are predictors of improved clinical practice:
- Automatic provision of decision support as part of clinician workflow
- Provision of recommendations, rather than assessments only
- Provision of decision support at the time location of decision making
- Computer-based decision support
Of 32 systems possessing all four features, 30 (94 percent) significantly improved clinical practice, according to the researchers.
In the scope of meaningful use, the Department of Health and Human Services (HHS) defines CDS systems or tools as those that provide practitioners with “general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.”
Cheryl Clark, for HealthLeaders Media, August 11, 2010
Avoidable medical errors added $19.5 billion to the nation's healthcare bill in 2008, according to a claims-based study conducted by Millman, Inc. on behalf of the Society of Actuaries (SOA). The report lists the 10 most expensive errors in healthcare settings.
Most of that amount, $17 billion, was the cost of providing inpatient, outpatient and prescription drug services to individuals affected by medical errors, says Jim Toole, chairman of SOA. "While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."
Pressure ulcers—the most frequent type of expensive error—were most often preventable, the authors wrote.
The other nine errors include postoperative infections and problems related to devices and prosthetics, among other complications.
10 Aug 2010
I went to the EMIS Web event at the Reebok stadium last week and was impressed. EMIS Web is the company’s ‘next generation’ system and it looks ready.
Some may say ‘about time’, but apparently EMIS is going through accreditation. EMIS Web is already running it in four practices, with the hope of 100 more this year and a couple of thousand next year.
Demand may be huge, though, and this will need to be managed by EMIS and by primary care trusts (at least until they are abolished and replaced by commissioning consortia).
04 Aug 2010
The European head of Magic Software surveys progress on HL7 – and the integration approaches that can be taken to using it.
On 28 August 2005, Hurricane Katrina hit the southern coast of the US with devastating effect. More than 1,800 people lost their lives, and the total destruction of homes and property was estimated to top out at more than $81 billion.
In the resulting cleanup operation, the Health Level 7 (HL7) capabilities of the Houston-Harris County Immunization Registry enabled a total of 38,360 vaccination records to be searched in rapid time. The net result was 13,377 matches that saved more than $1.5m in needless vaccinations.
Posted: August 18, 2010 - 12:15 pm ET
The federally supported National Institute of Standards and Technology has published a set of procedures for testing health information technology as part of a certification program that will determine healthcare providers' eligibility for government subsidies for the purchase of electronic health-record systems.
The NIST procedures are to be used by testing and certification organizations recognized by the Office of the National Coordinator for Health Information Technology. Providers must use a certified EHR in a "meaningful manner" to qualify for federal IT incentive payments provided under the Medicare and Medicaid programs and authorized by the American Recovery and Reinvestment Act of 2009.
The 45 test procedures "evaluate components of electronic health records such as their encryption, how they plot and display growth charts, and how they control access so that only authorized users can access their information," according to a statement from the NIST.
Patients treated at hospital emergency rooms that use all-digital-records systems are more likely to have shorter stays than at hospitals with paper or basic digital-records systems, according to a study by an Arizona State University professor.
The findings come at a time when several Arizona hospital systems and physicians seek to bolster their use of electronic health records while the federal government prepares to provide up to $27 billion to compel hospitals and doctors to adopt digital-records systems.
August 19, 2010 — 9:44am ET | By Neil Versel
A week ago, FierceEMR reported that the man who would be top doc at the Pentagon--Dr. Jonathan Woodson, President Obama's nominee for assistant secretary of defense for health affairs--wants the development of an advanced EHR to be among his top priorities, should he be confirmed for the job. As it turns out, some of the gears already are turning.
Posted: August 19, 2010 - 12:45 pm ET
The College of Healthcare Information Management Executives has just published The CIO's Guide to Implementing EHRs in the HITECH Era, an 80-page booklet aimed at assisting chief information officers and other IT executives in electronic health-record implementation and meeting the meaningful-use requirements to qualify for federal health IT subsidies provided for under the American Recovery and Reinvestment Act of 2009.
CHIME, an Ann Arbor, Mich.-based organization with some 1,400 members, noted that its latest guide evolved out of a similar publication, the Health Care Leader Action Guide on Implementation of Electronic Health Records (PDF), that it released this past July with the American Hospital Association.
By TEDDY WAYNE
Although the number of “cyberchondriacs” — people who research health information online — is at an all-time high, those who are afflicted with chronic conditions are less likely to have Internet access, according to data from Pew.
A Harris poll also found that, while Internet access has remained stable in the last five years, the percentage of frequent health information searchers leaped in the past year. The mean number of monthly searches for health information is 6.0, with 17 percent looking 10 or more times in the last month.
August 17, 2010 | Molly Merrill, Associate Editor
SAN FRANCISCO – Patients worry about not being able to access their paper medical records when they need them the most, placing that above concerns about whether their records contain inaccuracies or are stolen, according to a new survey.
The survey, which polled 500 female adults and 500 male adults on their paper medical records, was conducted by GfK Roper for Practice Fusion, a San Francisco-based EHR company.
According to the survey, inability to access medical records remained consistent as the top concern (26.7 percent) across all patient income levels, genders and regions.
Draft plan sets goals for 2010 to 2015
- By Alice Lipowicz
- Aug 13, 2010
The Health and Human Services Department is emphasizing adoption of health information technology and the fostering of innovation among its objectives for its new Draft Strategic Plan for Fiscal Years 2010-2015.
The strategy outlines three major goals: transforming the health care system, advancing knowledge and improving health. Within each goal, there are several objectives and specific projects.
By Mary Mosquera
Tuesday, August 17, 2010
The federal privacy and security tiger team said health information exchanges cannot share sensitive patient information beyond a simple point-to-point exchange without first obtaining a patient’s consent.
The panel, which advises the Health Policy Committee, clarified the matter at an Aug. 16 meeting of the team. Its previous guidance was unclear about the privacy obligations of health information exchange organizations, according to panel members.
More specific language was required because some health information exchanges (HIEs) provide both multipoint exchange services among a provider community but also handle direct point-to-point exchange services.
Posted: August 20, 2010 - 12:00 pm ET
The federally chartered Health IT Policy Committee accepted a number of recommendations from its various work groups Thursday, including its Privacy & Security Tiger Team, but from the latter, acceptance came not without some controversy.
The tiger team presented its final list of proposed policy guidelines approved by the group last week. The group's recommendations targeted the exchanges of health information needed for providers to meet the meaningful-use requirements of the electronic health-record system subsidy program provided for under the American Recovery and Reinvestment Act of 2009.
Posted: August 18, 2010 - 11:45 am ET
Gov. Arnold Schwarzenegger officially launched the California Telehealth Network on Tuesday at the UC Davis Cancer Center in Sacramento.
In a news briefing, Schwarzenegger lumped the telecommunications network's development in with construction of bridges, highways and other concrete-and-steel projects included in his administration's $60 billion infrastructure development program, but he also pointed to the special role information technology plays in saving lives and improving public health.
"Here, we're talking about the digital highway, broadband, that is also part of the infrastructure," Schwarzenegger told briefing attendees, including U.S. Chief Technology Officer Aneesh Chopra and state and local health IT officials. "A lot of people are not aware of that, but there are a thousand people a year dying in California of just someone misreading a prescription or not having the total medical records and so on, so this is inexcusable." With the launch of the California Telehealth Network, he said, "We are changing that, and reducing errors, and saving money at the same time."
August 19, 2010 — 1:04pm ET | By Sandra Yin
Telehealth, which can shrink the distance between patients and specialists and cut costs while improving patient outcomes, got a big boost when California Gov. Arnold Schwarzenegger launched what will become the largest telehealth system in the country Tuesday, the Los Angeles Times reports.
The California Telehealth Network is a peer-to-peer network that allows providers to share X-rays and other diagnostic test results instantaneously, and view treatments and procedures from remote emergency rooms or surgical centers in real time, according to InformationWeek. The network consists of a broadband stream that will be dedicated to healthcare information only and kept separate from the mainstream information highway, the Times reports.
Two-thirds of the quality reporting requirements aren't captured in current hospital electronic health record systems, finds CSC study.
By Nicole Lewis, InformationWeek
Aug. 16, 2010
As hospitals gear up to meet Stage 1 of the meaningful use requirements under the federal government's electronic health record (EHR) incentives program, a new report concludes that EHRs will only be able to provide about a third of the data requirements for Stage 1 quality measures outlined in the final rule.
Not only is time working against putting in place the necessary technology to meet the requirements for computerized physician order entry (CPOE), problem list, and so forth, but the quality reporting requirement adds to the duties. In short, hospitals, doctors, and other clinicians have their work cut out for them.
16 Aug 2010
UK telehealth firm Docobo Ltd has announced an exclusive deal to distribute ComCare, an Australian community care client management system.
The ComCare product has been developed, and is widely used by, Silver Chain - a Western Australia-based, not for profit, charity that provides district nursing and care services to 40,000 clients annually.
ComCare is a client management application designed for community and residential health care organisations.
The system covers both staff and patient management system, and is designed to run on mobile devices, enabling case co-ordination and the support and management of community based staff.
13 Aug 2010
Remote monitoring of patients with heart failure can reduce deaths and hospital admissions, according to a research review.
A Cochrane Database Systematic Review found those patients whose condition was being monitored remotely were 34% less likely to die than those without access to technology.
Among people taking part in a programme to remotely monitor heart failure, there were 102 deaths per 1,000 patients compared with 154 deaths per 1,000 patients who did not receive remote monitoring.
The review, which looked at 245 studies covering 9,500 patients with chronic failure and 2,710 undergoing monitoring, found a difference between remote monitoring involving digital or wireless transmission of data to a clinician and telephone support in which patients reported their own data over the telephone.
The report found that deaths were lower among patients offered telephone support, although the difference was less marked.
13 Aug 2010
Microsoft’s international business development lead has told E-Health Insider that the company “stands ready” to work with the government on personal health records.
Should the coalition want to move forward with plans to introduce PHRs, Microsoft says it would hope to support them with its HealthVault platform.
EHI TV asked whether Microsoft is disappointed by the lack of action by the coalition government in developing PHRs, as suggested in last year’s Independent Review of NHS IT commissioned by the Conservatives.
In response, Mark Johnston said: “We stand ready to help support the ambition of the leaders in the government as well as the NHS.
Tuesday, August 17, 2010
by Kate Ackerman, iHealthBeat Senior Editor
As of September 2008, 77 million residents lived in the country's 3,059 mental health professional shortage areas, or HPSAs, according to the Kaiser Family Foundation. The foundation reported that it would take an additional 5,145 mental health care providers to meet a population to practitioner ratio of 10,000 to 1.
Telemedicine often is cited as a potential solution to the country's mental health provider shortage. However, synchronous telemedicine -- which involves live, two-way interactive video -- presents its own scheduling and technological challenges.
Peter Yellowlees -- professor of psychiatry and director of the health informatics graduate program at University of California-Davis -- noted that a large barrier to live telemedicine consultations is the difficulty of coordinating "five or six people to meet together at one time in two locations."
By Mary Mosquera
Friday, August 13, 2010
The Office of the National Coordinator (ONC) has created a new workgroup to make recommendations on establishing a set of high-level rules-of-the-road for organizations participating in the nationwide health information network (NHIN).
With creation of the “governance” panel, ONC wants to host discussions from the health IT community on what to include in a formal rulemaking on the issue planned for early next year.
HDM Breaking News, August 13, 2010
Electronic data interchange vendor Emdeon Inc. is testing open source software to facilitate the exchange of clinical data.
The Nashville, Tenn.-based company is piloting the hData application developed by The MITRE Corp., McLean, Va. Emdeon sells revenue cycle management software and operates the nation's largest claims clearinghouse. It also electronically transmits lab orders/results and electronic prescriptions via its EDI network.
Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted Aug. 16, 2010.
Investing in an electronic medical records system was not something many physicians late in their careers were probably thinking about a few years ago. But the introduction of incentive pay for adopting an EMR -- and the penalties for not adopting -- have older physicians wondering if such an investment is worthwhile.
Starting in 2011, physicians will have the opportunity to earn up to $44,000 over five years in Medicare incentives, or $64,000 in Medicaid incentives, for "meaningful use" of an EMR as defined by the federal government. But if a physician plans to stay in practice more than five years and does not adopt an EMR, he or she can expect Medicare reimbursement to start declining in 2015, leading to a 5% total cut by 2019.
Todd Sherman, lead partner of the Sherman Sobin Group, a Mount Laurel, N.J.-based financial consulting group that specializes in physician retirement planning, said meaningful use is a hot topic for those deciding whether to invest in technology this late in a career.
August 13, 2010 | Bernie Monegain, Editor
ORLANDO, FL – Orlando Health will implement a Web-based decision support checklist tool to assist physicians with diagnosis decisions.
The $1.7 billion not-for-profit healthcare organization with a community-based network of hospitals, tapped Isabel Healthcare for an automated system that it will make available to more than 2,000 physicians.
Orlando Health executives say the initiative is part of Orlando's commitment to quality and patient safety.
While most diagnoses are reached through the experience and knowledge of the physician, in 10 to 15 percent of cases they are more difficult to determine, according to industry reports. Isabel assists by accelerating the process for determining the diagnosis of a patient in those situations where there is some question.
HDM Breaking News, August 16, 2010
The Patient-Centered Primary Care Collaborative has released a guide describing the features and benefits of comprehensive medication management under the medical home model of care.
The Washington-based collaborative represents 600 employer, insurer, provider and consumer member organizations promoting the medical home model. The guide outlines the rationale for comprehensive medication management and the necessary steps to promote best practices and improve quality.
The medication guide is available at pcpcc.net/files/medmanagement.pdf.
Posted: August 16, 2010 - 11:45 am ET
For the third year running, the supply-chain standards organization GS1 Healthcare US held a small roundtable discussion dinner for media, healthcare supply-chain professionals and suppliers during the annual Association for Healthcare Resource & Materials Management conference. This year's event occurred on the second evening of AHRMM's four-day conference, held this month in Denver.
The discussion had me thinking about the ongoing effort to implement a universal tracking system. GS1 has been politicking for several years to become top dog in the medical-products tracking standards arena, but healthcare reform has created a new sense of urgency to close the deal among proponents of the standards. Additionally, more than a few of the proponents are concerned that federal regulators aren't moving fast enough to develop rules and guidance that will ensure that standards for tracking the use of medical devices and products are appropriately linked to electronic health-record systems and useful to healthcare providers and patients.
Posted: August 17, 2010 - 11:00 am ET
Ingenix's voracious appetite for acquisitions is fueled in part by federal subsidies for electronic health-record systems under the American Recovery and Reinvestment Act of 2009.
In two of its three deals announced in the last month, Ingenix, an Eden Prairie, Minn.-based division of insurer UnitedHealth Group, has pointed to the stimulus law as a driving factor.
Ingenix's most recent deal is a definitive agreement to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen. The stimulus act provides $783 million in near-term direct funding for the implementation of statewide and regional health information exchanges, in addition to the $36.5 billion it provides in incentives for hospitals and physicians to make meaningful use of EHRs, Ingenix noted in its news release announcing the deal.
Posted: August 16, 2010 - 4:30 pm ET
Ingenix, Eden Prairie, Minn., said it has a definitive agreement in place to acquire Axolotl Corp., San Jose, Calif., which provides health information exchange services. Terms of the deal are not being disclosed, according to Ingenix spokesman Kyle Christensen
August 16, 2010 — 1:24pm ET | By Neil Versel
A recent article in Forbes reports how patients in Britain are able to go to least a dozen websites for online consultations with doctors they've never met and have physicians prescribe medications. The sites are completely legal and regulated by an agency called the Care Quality Commission.
"The British websites are definitely an exception, but they are the start of a trend we will soon see everywhere," Norwegian telemedicine expert Dr. Steinar Pedersen told the business magazine. Pedersen was unable to name any other countries that allow physicians to prescribe medication remotely for patients they've never seen in person.
In countries including Canada, Denmark, Norway, Germany, and France, doctors are only allowed to treat patients online if they have previously seen them in person," Forbes reports. "In the United States, several companies offer online medicine," the article says, "but patients must typically speak to a doctor on the telephone or set up a videoconference for a live, face-to-face chat."
By Mary Mosquera
Wednesday, August 11, 2010
The Veterans Affairs and the Defense departments have agreed on a single common personal identifier, one of the keys to its efforts to build an electronic record that can be follow military service members throughout their lifetimes.
The agreement is a significant step toward making the complex Virtual Lifetime Electronic Record (VLER) project a reality because it will identify a service member whether they are seeking healthcare services or payment benefits and on active duty or retired, according to a senior VA official.