Saturday, September 18, 2010

Weekly Overseas Health IT Links - 17 September, 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 subscription payment.


Advancing Clinical Decision Support

Clinical Decision Support

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses computerized alerts and reminders to care providers and patients, clinical guidelines, condition-focused order sets, patient data reports and summaries, documentation templates, diagnostic support, and other tools that enhance decision making in clinical workflow.

From the Office of the National Coordinator for Health Information Technology

"Advancing Clinical Decision Support" is an intensive, multi-part project funded by the U.S. Office of the National Coordinator for Health Information Technology (ONC) to address the major barriers to achieving widespread use of clinical decision support. The project is being led by the RAND Corporation and Partners Health Care / Harvard Medical School. A particular focus of the project is on making CDS more-ready to serve among the requirements for "meaningful use" of electronic health record (EHR) systems.


End of NPfIT to be announced today

09 Sep 2010

The National Programme for IT in the NHS is set to end in its current form, a ministerial statement will announce this morning.

A further £700m will also be cut from the cost of the programme, with £500m coming from ‘local savings’ and £200m from the local service provider contract with CSC.

E-Health Insider expects the ministerial statement to be made at around 10.30am.


NPfIT future is modular and locally-led

09 Sep 2010

The National Programme for IT in the NHS’ centralised and national approach is “no longer required” and trusts will instead be able to operate “a more locally-led plural system of procurement”, health minister Simon Burns has announced.

In a ministerial statement this morning, Burns said that a Department of Health review of the national programme had concluded that a new, “modular” approach to implementation should also be adopted.

The statement said that the two changes together would allow “NHS organisations to introduce smaller, more manageable change in line with their business requirements and capacity.”


See here also:

The future of the National Programme for IT

  • Published date:

9 September 2010


Tuesday, September 07, 2010

ONC Names Temporary Certification Bodies for 'Meaningful Use' Program

by Kate Ackerman, iHealthBeat Senior Editor

Last week, the Office of the National Coordinator for Health IT unveiled one of the final missing puzzle pieces of the "meaningful use" incentive program by naming the Certification Commission for Health IT and the Drummond Group as the first ONC-Authorized Testing and Certification Bodies under the temporary electronic health record certification program.

The 2009 federal economic stimulus package included Medicare and Medicaid incentive payments for physicians and hospitals that demonstrate meaningful use of certified EHRs. Prior to the announcement, no certifying groups were in place to determine whether vendors' EHR products have the functions necessary for health care providers to meet the federal government's meaningful use Stage 1 criteria.

National Coordinator for Health IT David Blumenthal said the announcement "is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems."


Peel pushes for 'informed consent' over every element of patient data

September 7, 2010 — 7:14am ET | By Neil Versel

Depending on your point of view, Dr. Deborah Peel and her Patient Privacy Rights Foundation either continue to rail against the national push for EHRs or take further steps to hold policymakers honest. (We're not going to go as far as ZDNet Healthcare's Dana Blankenhorn, who recently called Peel a "Luddite" whose organization's goal "appears to be keeping healthcare in the paper-based dark ages.")

The latest from Patient Privacy Rights is a white paper making "The Case for Informed Consent" to give patients more complete control over their personal health information. In the paper, Peel dismisses arguments that it's too technically difficult and too expensive to design health IT systems that offer patients granular control over what elements of their records healthcare organizations can share.


Health IT systems often overlook care management

September 7, 2010 — 2:02pm ET | By Neil Versel

When it comes to designing health IT systems, more than a few organizations may be missing the big picture in terms of integrating care management workflows into their technology.

A new survey of how IT is changing case management largely corroborates findings from a 2008 survey that providers, payers, case managers and others that support care coordination are making only modest progress toward automating care management.

The study, conducted by TCS Healthcare Technologies on behalf of the Case Management Society of America and the awkwardly named American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), found that just 23 percent of IT systems are fully interoperable with external applications and that a similar share of organizations had gone paperless in care management.


ONC seeks reusable approach to future NHIN services

By Mary Mosquera

Tuesday, August 31, 2010

The Office of the National Coordinator is developing an “interoperability framework” designed to eliminate the need for technical planners to start from scratch in identifying standards and services for future uses of the nationwide health information network (NHIN).

The upcoming start of health IT incentive program has put pressure on the ONC’s policymakers to come up with a streamlined approach to identifying specs and standards for new health information exchange features and services that might be created to help boost health IT adoption.

A reusable approach will reduce the time it takes ONC to identify the demand for the standards and then apply them to emerging services, according to Dr. Doug Fridsma, ONC’s acting director of ONC’s standards and interoperability office.


Chronic Medication Service launches

02 Sep 2010

Scottish health secretary Nicola Sturgeon has launched the country’s Chronic Medication Service, which aims to set up shared care records between GPs and pharmacists by the end of the year.

The service is one of four elements in Scotland’s e-pharmacy programme, which the Scottish Government has said will cost £5.2m a year to deliver.

The CMS aims to enable shared care of patients with long term conditions between GP practices and pharmacists, backed by IT links between the two.

When a patient signs up for the CMS, the pharmacy’s patient medication record will send an electronic notification to the GP’s IT system. This will allow the GP to choose whether to enter into a shared care agreement, with an option to generate serial prescriptions for up to 48 weeks.


Advances in Science, Technology, Informed Consent

Gienna Shaw, for HealthLeaders Media, September 7, 2010

Science and technology are at a fortuitous crossroads: As we’re learning more about how variations in human genetics affect health and disease, we’re expanding our use of the electronic medical records systems that make it easier to gather, store, sort, and analyze genetic data. And growing right alongside clinical and technological medical advances: The importance of informed consent and its kissing cousin, re-consent.

So, how many times do you have to get permission from patients before you use their medical data for research? From the patients’ point of view, the answer is “every time,” a new study suggests. It doesn’t matter if the data is de-identified or if they’ve already approved its use for one purpose. If you want to use it again, they want you to ask them again, say investigators at Group Health Research Institute and the University of Washington (UW) in a report called “Glad You Asked,” which was published in the September 2010 Journal of Empirical Research on Human Research Ethics.


Scribes help doctors eliminate EMR downsides

September 8, 2010 — 5:30am ET | By Debra Beaulieu

Do your physicians fret over how their productivity might slow down upon implementing an electronic medical record? Are they worried that the effort to learn the new technology will distract them from patient care? If so, you may want to consider hiring a scribe--an emerging type of medical professional who shadows clinicians and inputs all necessary data into the EMR.

Most do the job part-time as college students and plan to go on to full-time careers in medicine or nursing. Because of the valuable head start offered by the experience, scribes often are willing to work for $8 to $10 an hour with no benefits, the Los Angeles Times reports.


EMRs help to improve 'people, planet, profits'

September 9, 2010 — 11:33am ET | By Neil Versel

You want an EMR, but you also want a return on your investment. At least one non-healthcare pundit believes you should look past just the financial bottom line and see that EMRs can provide benefits for the "3 Ps" of sustainability--people, planet, profits.

A post on the Triple Pundit blog says that EMRs deliver on all three areas, with better patient care, a smaller environmental footprint and fewer write-offs of accounts receivable.


Guest commentary: Privacy issues overlooked

By Latanya Sweeney

Posted: September 9, 2010 - 11:00 am ET

From my son's pediatrician to my father's specialist, physicians are talking about electronic health records. Widespread EHR adoption is a goal of the American Recovery and Reinvestment Act of 2009, which provides financial compensation to healthcare providers and hospitals for meaningful uses of EHRs in years 2011 to 2015.

If successful, the ARRA will ignite a mass exodus from a prehistoric paper age into a tech-savvy networked cosmos called the Nationwide Health Information Network in which patient information flows seamlessly across computers, devices, organizations and locations as needed. For lasting success, special care must be taken to allow widespread sharing of patient information while protecting patient privacy, and that brings into question the recently released list of requirements from the CMS that include no privacy incentives and the current NHIN approaches from the Office of the National Coordinator that lack privacy and utility.

Read the full story here.


Physicians: Mobile Devices Expedite Decision Making

John Commins, for HealthLeaders Media, September 9, 2010

Two thirds of physicians say they are using personal devices for mobile health solutions that aren't connected to their practice or hospital IT systems, but nearly a third said their hospital or practice leaders will not support the use of mobile health devices.

As for patients, 40% would be willing to pay for a remote monitoring device that sends health information to their doctors, according to a new online survey and report by PricewaterhouseCoopers' Health Research Institute.

The findings of the survey, published in a report titled Healthcare Unwired were presented this week by PricewaterhouseCoopers at the mHealth Initiative 2nd International mHealth Conference in San Diego. Physicians' interest in mobile technologies reflects the growing market for remote and mobile health applications and business opportunities for organizations using consumer technologies to support preventative, acute, and chronic care, PWC said.


Friday, September 10, 2010

Electronic Health Records Hold Great Promise for Long-Term Care Facilities

by Eric Ford

Health IT holds great promise for improving health care quality and safety and reducing the costs of providing care in long-term care facilities. Numerous empirical studies conducted in other health settings support the view that health IT can help health care providers to reduce errors, improve safety and quality, and decrease costs. While acute care settings and physician practices are adopting electronic health record systems at a brisk pace, LTC settings, specifically licensed nursing facilities, have been slower to embrace such technologies


Medical Smartphone Apps May Need New Federal Regulation

The FDA is evaluating if medical smartphone apps require additional federal regulation, according to reports.

The Food and Drug Administration is looking into whether smartphone apps that allow patients to monitor their vital signs wirelessly should earn FDA approval before implementation.

Bradley Merrill Thompson, an attorney with law firm Epstein, Becker & Green, who studies health care issues, told GigaOM that the FDA is keeping an eye on app stores to see which medical applications for smartphones might require regulation. "The FDA is actively engaged in surveillance of various app stores to see if apps should trigger their involvement," Thompson told GigaOM for an Aug. 31 report. "Applications where a smartphone is connected in any way to imaging are under scrutiny, in particular. Any app that is used to transmit images to a medical facility requires FDA approval."


Joint Commission to Accredit Medical Homes

HDM Breaking News, September 8, 2010

The Joint Commission in 2011 will offer a "Primary Care Home" option to ambulatory organizations for accreditation of their medical home programs.

Under the medical home model, primary care practices are designated patients' "medical home" to coordinate the continuum of care. The practices are redesigned to be more functional and workflow-friendly, and new processes are developed to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.


  • September 8, 2010, 2:34 PM ET

How Much Would You Pay for a Remote Health Monitoring Device?

Patients are willing to use remote or mobile monitoring devices to transmit health info right to their physicians — they just don’t want to pay much for them.

We’ve written about telemonitoring before, in the context of managing high blood pressure and in looking at all the tech-industry companies dipping a toe into the market.

But the question of who pays for all of this looms over the entire subject. A new PricewaterhouseCoopers study finds that 40% of 2,000 consumers surveyed said they’d be willing to pay for a remote or mobile monitoring device, such as a scale, blood pressure cuff, glucose meter or heart-rate monitor — but when we asked to dig into that data, we learned that of those willing purchasers, 64% said they’d ante up only if a device cost less than $50. About 41% said they’d be willing to pay for a monthly subscription to send data automatically via a remote or mobile device to a health-care provider — but 47% of them said their limit was $5 per month.


Health IT group sets sights on NHIN road rules

By Mary Mosquera
Wednesday, September 08, 2010

A new federal health IT advisory panel has set to work on setting up a means of governing the nationwide health information network (NHIN) in a way that will earn the trust of healthcare providers and consumers and expand its use by the health care community.

There are no official rules-of-the-road for the NHIN, a basket of standards and services for enabling providers to exchange patient information securely over the Internet.


Expert view: Loukianos Gatzoulis

01 Sep 2010

The next shift in healthcare will be towards a more personalised and patient-centric care process. Information and Communication Technologies can contribute by offering personal health systems - both for chronically ill patients and for people at risk. This is a trend the European Commission is supporting through a number of research projects.

When we are ill, we suffer at home or at work. Symptoms can occur suddenly in the situations in which we need them the least. More often than not, there is no doctor or therapist available to offer immediate help or to check what is wrong.

Illness, in other words, can turn our lives upside down. But most of us tend to visit the doctor only on rare occasions, and often we wait until things go very wrong. Then we can end up being hospitalised.


Expert view: Robyn Tolley

24 Aug 2010

The managing director of NoemaLife argues the Italian experience shows that English trusts will benefit from the likely demise of NPfIT.

Three months on from the general election, we not only have a new coalition government, but a white paper that promises a radical shake-up of the NHS.

Healthcare IT managers will be hoping that ministers will also free them from the straight-jacket of the National Programme for IT in the NHS.

For the past six years, English trusts have either been grappling with the practicalities of NPfIT or weighing up the options while waiting to see what a change of government might bring.

Meanwhile, their European counterparts have been ploughing ahead, assessing and implementing technologies which are bringing new efficiencies and cost savings to their operations.

The Italian Job

Take Italy. As with the UK, there’s a strong reliance on the public sector, particularly when it comes to the nation’s health, and hospitals are managed at a regional level.

Yet Italian hospitals have had much greater flexibility and freedom when it comes to selecting what technology to invest in and, more importantly, which companies to purchase it from.

Not having a ‘one designated supplier for all’ approach has helped to keep offerings and prices competitive. Hospitals have been able to select the solution which best meets their requirements, however niche they may be.


CompuGroup targets US market in buyout

07 Sep 2010

German software company, CompuGroup Medical, has signed an agreement to purchase US company, Visionary Healthware Group.

The group, which includes American Healthcare Holdings, Visionary Medical System and Visionary RCM, is a provider of practice management software and electronic health records to more than 10,000 GPs in the US.

The company also provides laboratory information systems and revenue cycle management services across Europe.


HHS launches site for disaster medical volunteers

By Mary Mosquera

Tuesday, September 07, 2010

The Health & Human Services Department launched a Web site that provides a single point of entry for health professionals across the nation to sign up to volunteer in advance of an emergency or disaster in their state.

The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a national network of state-based programs that verifies the identity, licenses and credentials of health professionals before an emergency happens.

The Web site would makes it easier and faster to register potential volunteers by connecting them with each state’s ESAR-VHP program. Health professionals include doctors, nurses, dentists, veterinarians, medical technologists, clinical social workers, medical records technicians and mental health counselors.


eHealth Intelligence Report.

7 September 2010

Scientific Articles

:: Deployment of e-health services – a business model engineering strategy (J Telemed Telecare 2010;16:344-353

Abstract: We designed a business model for deploying a myofeedback-based teletreatment service. An iterative and combined qualitative and quantitative action design approach was used for developing the business model and the related value network. Insights from surveys, desk research, expert interviews, workshops and quantitative modelling were combined to produce the first business model and then to refine it in three design cycles. The business model engineering strategy provided important insights which led to an improved, more viable and feasible business model and related value network design. Based on this experience, we conclude that the process of early stage business model engineering reduces risk and produces substantial savings in costs and resources related to service deployment.


Healthcare Breach List Hits 150 Mark

Dom Nicastro, for HealthLeaders Media, September 7, 2010

The number of healthcare entities reporting breaches of unsecured PHI affecting 500 or more individuals has crossed the 150 mark, nearly one year after the first such breach was reported.

The Office for Civil Rights (OCR) breach notification website lists 153 entities as of Thursday, Sept. 2. The HIPAA privacy and security rule enforcer began publishing the breaches in February of this year, per the HITECH, but breaches date back to September 22, 2009.

The list is required in the breach notification interim final rule, which is in effect but under review by OCR before a final rule is submitted to the Office of Management Budget (OMB).


Diagnostic errors merit more attention: Pa. agency

By Maureen McKinney / HITS staff writer

Posted: September 7, 2010 - 12:01 am ET

Despite their potential to cause serious medical harm, instances of missed, incorrect or delayed diagnoses rarely receive the attention garnered by other patient-safety problems such as medication errors. That's according to a recently released report from the Pennsylvania Patient Safety Authority, a Harrisburg-based independent state agency charged with collecting and analyzing safety data.

For the report, the agency reviewed 100 patient-safety events related to diagnostic errors that took place between June 2004 and November 2009.

"Misdiagnoses represent a substantial unmeasured source of preventable mortality, morbidity and costs," the authors wrote in the report. "However, it is not possible to focus on misdiagnosis-related harm without first understanding the broader issue of diagnostic error."


5 Tips for Avoiding Diagnostic Errors

Cheryl Clark, for HealthLeaders Media, September 8, 2010

Now that the quality movement seems to be chugging along on a well-conceived, evidence-based track, some thoughtful person has come along tooting a horn to warn us to "wait here just a darn minute. Aren't you all forgetting something that's really, really important?"

Or words to that effect.

The man who made such a stir this week, and got my attention, is hospitalist and patient safety expert Robert Wachter MD, an author and associate chair of the University of California San Francisco Department of Medicine.

Measurements of quality—checklists, process measures, and pay for performance score cards—are all fine as ways to reduce medical errors, Wachter says. But they neglect to force us to repair an enormous defect that now exists in the way we care for patients.

Far too often we're getting the diagnosis wrong.

Turns out, the healthcare system performs rather terribly in this earliest stage of the healthcare delivery system. And hospitals, physician groups and quality experts together need to start paying attention, he says.

Wachter gave some examples in his article published this week in the journal Health Affairs "Why Diagnostic Errors Don't Get Any Respect—And What Can Be Done About Them."


Are compliance regulations failing healthcare?

September 6, 2010 — 10:58pm ET | By Neil Versel

Financial institutions suffer more data breaches than healthcare organizations, right? Wrong. It's healthcare--by a factor of three to one.

A recent report from the Identity Theft Resource Center showed that compromised data stores from healthcare organizations outstrip those in other industries. According to the ITRC, healthcare organizations disclosed 119 breaches this year through early August, compared to 39 reported breaches in the financial services industry. Why is this happening?

To start, let's acknowledge history: the financial services industry has always been safeguarding valuable assets, like money, gold, jewelry and documents. But the traditional focus of healthcare is the patient. Securing patient data is a relatively new imperative, one that has been mandated through extensive regulations.




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