Friday, October 08, 2010

Weekly Overseas Health IT Links - 07 October, 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.


  • September 27, 2010, 8:01 PM ET

Study: Computerized Order Entry System Has Unintended Consequences

When researchers at the University of Pennsylvania proposed a randomized study to see if a computerized physician order entry system could prevent doctors from prescribing a potentially harmful drug combination, the institutional review board almost didn’t want to allow it.

The anti-clotting drug warfarin and a certain antibiotic can produce hazardous effects when taken together. So it seemed obvious a system set up to block the drugs from being combined would be safer for patients — so obvious that the board thought it would be unethical for any patients to be randomized to the existing system of using the pharmacist as gatekeeper.


Blumenthal: 2013 meaningful use to ramp up HIE, decision support

By Mary Mosquera

Tuesday, September 21, 2010

Dr. David Blumenthal, the national health IT coordinator, sent a strong signal to healthcare providers and vendors to expect that more complex requirements for health information exchange and clinical decision support tools will be among forthcoming requirements for the next stage of meaningful use.

The Office of the National Coordinator for Health IT is now beginning to do “early reconnaissance” around development of stage 2 meaningful use requirements, according to Blumenthal.

“We know there were a set of unfinished tasks, things we passed over in the effort to get the first stage of meaningful use out the door,” he said at an industry event Sept. 21 about states which are leading in electronic prescribing and where he took the opportunity to communicate some future plans.


Time to make the EHR leap: Benjamin

Several of the photographs projected on a screen during the keynote speech of U.S. Surgeon General Regina Benjamin at the American Health Information Management Association convention Tuesday were of paper records.

Stacks of patients' paper records.

The stacks were lined up side by side, all down the sidewalk leading to the door of Benjamin's Bayou La Batre (Ala.) Rural Health Clinic.


Friday, October 01, 2010

Doubts About Qualifying for Stage 1 'Meaningful Use' Incentives Growing

by Fred Bazzoli

For the first half of this year, an incredible amount of health care industry attention was focused on proposed rules that would affect health care organizations' ability to qualify for federal stimulus funding for "meaningful use" of electronic health records.

Proposed rules governing meaningful use received significant focus. Thousands of comments were received by federal agencies, most of those voicing concern over the multitude of requirements that providers would need to meet to qualify for payments.

It's no wonder that the final regulations, published in mid-July, were greeted with almost giddy relief. The federal government listened to the many voices that called for relaxation of meaningful use requirements, and many providers had renewed hope that they would be able to qualify.


Monday, September 27, 2010

Unconscious in the Emergency Department

As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I'm often asked "but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I'm lying unconscious in the Emergency Department and cannot give a history?"

Here are my thoughts about the trajectory we're on and how it will lead us to supporting the "Unconscious in the ED" use case.

Meaningful Use Stage 1 is about capturing data electronically in EHRs. Getting healthcare data in electronic form is foundational to any data exchanges. By 2011 we should have medication lists, problem lists, allergies, and summaries available from EHRs.


Blue Cross and Blue Shield pilot program aims to cut health care costs

By MARK ANDERSEN / Lincoln Journal Star | Posted: Wednesday, September 29, 2010 11:55 pm

Nebraska's largest health insurer kicks off a six-month experiment Friday, betting costs will fall and people will get healthier if doctors walk into exam rooms with better patient information.

The program will start with about 1,200 diabetic patients in nine Nebraska cities, including Lincoln.

Blue Cross and Blue Shield of Nebraska hopes to expand the approach quickly, moving toward a system that rewards doctors for making patients healthier rather than paying per procedure.


Medical Students Optimistic About EHRs

The majority say electronic health records adoption will be driven by the technology's benefits to medical practice, not government incentives.

By Nicole Lewis, InformationWeek

Sept. 29, 2010


A majority of medical students say their decision to take a job at a healthcare organization will be heavily weighted in favor of those that have adopted an electronic health record (EHR), according to a new survey.

Of 710 medical students surveyed, 70% said having an EHR is a very important factor in deciding where they will practice medicine. The students also noted that the benefits to medical practices will be the main driver for EHR adoption, rather than government initiatives. Respondents also indicated that they have had early exposure to EHR systems, and more than half said they are satisfied with the level of training their program provided on EHR use.


Privacy Expert To Congress: Mandate More Protections

HDM Breaking News, September 30, 2010

The Center for Democracy & Technology is recommending to Congress a series of steps to go beyond the HITECH Act and further improve the privacy and security of health information. These include denying meaningful use incentive payments to provider organizations that significantly violate the HIPAA privacy and security rules, giving patients a limited right to sue for privacy violations, and mandating certain strong security safeguards, including encryption.


EHR certifiers issue first stamps of approval

By Joseph Conn / HITS staff writer

Posted: October 1, 2010 - 12:30 pm ET

The pipeline of certified electronic health-record systems is now open.

The Certification Commission for Health Information Technology and the Drummond Group, Austin, Texas, both recognized by HHS' Office of the National Coordinator for Health Information Technology as authorized EHR testing and certification bodies under new federal guidelines, have tested and certified their first batches of EHRs and component parts, or modules, the organizations have announced.


Hospitals report breaches of thousands of paper, electronic records

September 30, 2010 — 10:20am ET | By Neil Versel

Another week, another breach of patient records. Make that two breaches--one paper, one electronic; one on the west coast, one on the east coast.

First, the Los Angeles County Department of Health Services and the Los Angeles County Sheriff's Department announced that 33,000 patient records were missing from a supposedly secure location at the Martin Luther King, Jr. Multi-Service Ambulatory Care Center in South Los Angeles.


Halamka, Microsoft's Crounse tout PHRs as 'electronic medical home'

September 30, 2010 — 1:11pm ET | By Neil Versel

The promise of personal health records is that they will put patients firmly in control of their own health data and make patient-centered care truly possible. Despite what you may read elsewhere, PHRs haven't gained much traction to date, but that hasn't stopped some leading physician technologists from trying to sell the idea to an indifferent public and medical establishment.

"I'm often asked 'but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I'm lying unconscious in the Emergency Department and cannot give a history?'" Dr. John Halamka, CIO of Harvard Medical School and CareGroup Health System, writes on his Life as a Healthcare CIO blog.


Vendor viability should be a top concern in EHR selection

September 29, 2010 — 7:00pm ET | By Rob Tholemeier

With the government now working on Stage 2 and Stage 3 requirements, EHR "meaningful use" and certification remain confusing but important issues when planning EHR deployments. But if an EHR is like any other business application, matching application capabilities to the business problem and making sure the vendor has the vision and staying power to meet future business requirements should be your primary concern.

In other words, if you treat EHR like any other business application, then vendor viability becomes the most critical decision criterion. Consequently, the big question has to be: will the EHR product you are using or evaluating today be around in three to five years?


ONC awards nearly $1 million to Institute of Medicine to study health IT use

By Joseph Conn / HITS staff writer

Posted: September 29, 2010 - 6:15 pm ET

The Office of the National Coordinator for Health Information Technology at HHS has awarded the Institute of Medicine, an arm of the National Academies of Science, a contract valued at nearly $1 million to study the use of healthcare IT to evaluate the technology's effects on patient safety.

According to a news release from HHS, the study will summarize known effects of health IT on patient safety with an eye to preventing potential problems.


Swedish National Patient Overview halted

24 Sep 2010

The National Patient Overview in Sweden, which provides an electronic summary of a patient’s record, has been halted following concerns about the amount of information patients are receiving about the project.

The NPO first went live in Örebro County Council in June last year, following a four year deal with InterSystems and Tieto to provide and implement a system to provide patient identity information, alerts, diagnosis, care services and medications.

However, E-Health Europe has learned that the project has been at a standstill for the past two months.

Swedish health IT expert Rikard Lövström, told EHE that the information campaign had not been successful in informing patients about the information that care providers will have access to.


EU study says EU is leading on e-health

28 Sep 2010

The European Commission has published the preliminary findings of a study into National eHealth strategies that concludes Europe is leading the rest of the world when it comes to eHealth advances.

The study, commissioned by the EC and carried out by Empirica, says virtually all EU member states have either started or will shortly start the implementation of national systems to make basic patient data available to healthcare professionals.

The study, which compares the prominence of eHealth activities in national strategies in 2006-2007 and in 2010, shows that member states now publish far more policy documents, and that many contain concrete eHealth goals, implementation measures and past achievements.


2010: Operators, payers finally interested in mHealth

Thursday - September 23rd, 2010 - 12:50am EST by Brian Dolan

This past week I served as co-chair of the second annual Mobile Healthcare Industry Summit in London. Fresh off a red-eye flight into London Tuesday morning, I joined Qualcomm’s Vice President of Healthcare Don Jones on-stage to conduct a one-on-one interview for the more than 100 attendees present. Jones outlined a number of strategies for mobile health startups, batted away a number of oft-cited challenges for the mobile health industry and offered an insider’s perspective into how the key stakeholders of wireless health view the opportunities today.

BD: This morning’s discussion is focused on whether 2010 is “The year of mobile health”. Don, you and I were talking earlier: “Mobile health” is not a term that Qualcomm uses. Why is that?

DJ: Well, we use the term “wireless health” for a couple of reasons. One, is that we sell wireless technologies. So, it’s rather direct from that perspective. But the other thing I like to say is that “not all mobile health is wireless” and “not all wireless health is mobile”. A lot of the opportunities that we see using cellular technology actually don’t require that the end-user device actually be mobile itself. So, if you think about all the different kinds of radio technologies that are involved in our industry—ultra low power radios, WiFi, personal body area network technologies, and then moving up through to the wireless wide area radio technologies—there’s just a lot of different technologies in that arena and when you look at the use cases there may or may not be a mobility issue. The mobility issue may be, for example, “How do we ship a product into somebody’s home?” That may be the mobile part. And once it’s in the home it may no longer be mobile.


September 28, 2010

ClearPractice's Nimble brings a comprehensive EMR to the iPad


While over 500 medical apps have been created for the iPad since its launch in April of this year, few attempt to bring an entire electronic medical record system onto the device. Today, St. Louis-based medical software company ClearPractice is releasing Nimble, which the company says is “the first comprehensive EMR solution developed in iOS to run natively on the iPad”.


CPOE hard-stop alerts hurt patients

September 29, 2010 — 11:21am ET | By Sandra Yin

How hard or soft should a computerized physician order entry alert be?

The answer seems to be a moving target.

At first, soft order alerts were supposed to pop up on the computer screen to help alert clinicians to potential problems associated with specific prescription orders. They also were supposed to offer other treatment options, according to researchers involved in a study published in the Archives of Internal Medicine. But clinicians have been quick to override these soft alerts.


Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

From Medscape Medical News

Computerized Physician Order Entry Nearly Hard-Stop Alert May Effectively Change Prescribing

Laurie Barclay, MD

September 27, 2010 — An electronic nearly hard-stop alert as part of an inpatient computerized physician order entry (CPOE) system seemed to be extremely effective in changing prescribing but resulted in clinically important treatment delays in some patients, according to the results of a randomized controlled trial reported in today's issue of the Archives of Internal Medicine.


Healthcare: IT allows patients more control

By Sarah Murray

Published: September 28 2010 16:11 | Last updated: September 28 2010 16:11

The question for healthcare companies when it comes to information technology is: “Buy or build?” And until recently, the answer – particularly for larger hospitals and healthcare centres – has often been “build”.

However, that balance is shifting, as IT providers rush in to claim their share of the market, and healthcare providers recognise the advantages of standardisation, interoperability and information exchange.

For a variety of reasons, providers have tended to go it alone when introducing new technologies into their systems. “At places such as Johns Hopkins, 30 years ago, we were developing our own solutions,” says Baltimore-based Stephanie Reel, chief information officer for both Johns Hopkins University and Johns Hopkins Medicine.


A sea change in health info exchange

· By Erik Pupo

· Tuesday, September 21, 2010

The use of the National Information Exchange Model (NIEM) to promote health information exchange represents a major shift of direction by policymakers working on expediting use of the Nationwide Health Information Network. The NIEM (pronounced “NEEM”) is a working model for standardizing information exchange that has been operating among federal, state and local government agencies in areas such as emergency management and law enforcement.

Up to now, its use has been driven by the need – especially in the post 9/11 world – to share information in a common format rapidly among agencies and across jurisdictions. It has been used successfully to enable information sharing among disparate federal, state and local law enforcement agencies.

The same NIEM processes that have driven interoperability and secure data sharing in homeland security scenarios can also be repurposed to promote information exchange in the critical area of health care – and not just among all levels of government. The NIEM process can help promote standardized data exchange between the public and private sectors.


CT Breach Notification Case Proves HITECH's Worth

Dom Nicastro, for HealthLeaders Media , September 28, 2010

Editor's note: Senior editor Dom Nicastro covers the government health information data regulations for HealthLeaders Media and its parent company, HCPro, Inc. In a guest column this week, he writes about how the HITECH act is impacting state-level HIPAA compliance.

HITECH brings to light how much of a better job the healthcare industry must do to protect the privacy of its patients. Take one look at the Office for Civil Rights (OCR) breach notification website—you'll find 166 reasons why this is true.

That website is great to have: It is a public list where healthcare organizations can share lessons learned, analyze numbers and trends, and get a good look at which facilities are making big mistakes, some of which affect millions of patients.


Scotland plans Key Information Summary

23 Sep 2010

NHS National Services Scotland has announced it will develop a Key Information Summary that will be fully integrated with its Emergency Palliative Care Summary record.

Speaking at the BCS Health Scotland conference, Jonathan Cameron, programme manager of the National Information Systems Group for NHS NSS, told E-Health Insider that the new summary would build on the success of the EPCS but would add considerably more information to the record.

Cameron said: “The Key Information Summary (KIS) aims to replace paper notes being faxed from GP practices to NHS24, provide support for electronic anticipatory care plans, long term conditions and mental health by utilising the existing EPCS infrastructure.”


Tuesday, September 28, 2010

Federal Policies Help Drive More Growth in E-Prescribing

by Kate Ackerman, iHealthBeat Senior Editor

The use of electronic prescribing has increased significantly in the past year, and observers say that growth will continue as key federal policy initiatives take effect.

At the fifth annual Safe-Rx Awards on Capitol Hill last week, e-prescribing network Surescripts announced that more than 200,000 office-based prescribers -- or one out of every three physicians, nurse practitioners and physician assistants -- now use e-prescribing. That's up from 156,000 e-prescribers at the end of 2009 and 74,000 at the end of 2008.

According to Surescripts, 47 states more than doubled their use of electronic prescription routing, and 29 states more than doubled their use of electronic prescription benefit information.


The world gets a national broadband plan

By Matthew Lasar | Last updated 7 days ago

In case you didn't get enough of Ars Technica's coverage of our Federal Communications Commission's National Broadband Plan, you'll be pleased to know that lots of other countries have them too. In fact, it turns out that there's an NBP for the whole world, just released by the United Nation's International Telecommunications Union.

"In this brave new world of 'digital opportunity', we believe the burning issue is what price will be paid by those who fail to make the global, regional, national and local choices for broadband inclusion for all—choices which must be made sooner rather than later," the "Outcomes" section of ITU's world Broadband Report warns.

Tipping point

ITU estimates that there are now over 1.8 billion Internet users and over five billion mobile device subscribers, most located in the developing world. All governments should build upon this to extend broadband to half the world's population by 2015, the organization says (the current human population of the globe is getting close to 7 billion folks, by the way).

In an accompanying press statement, the survey asks global leaders to make broadband access a "basic civil right."


Study: Privacy Key Obstacle To Adopting Electronic Health Records

For Immediate Release

Dr. David Baumer | 919.515.6950

Release Date: 09.20.2010

Filed under Releases

The United States could achieve significant health care savings if it achieved widespread adoption of electronic health records (EHRs), but insufficient privacy protections are hindering public acceptance of the EHR concept, according to a new paper from researchers from North Carolina State University. The paper outlines steps that could be taken to boost privacy and promote the use of EHRs.

“Electronic health records could reduce costs in the U.S. by an estimated $80 to 100 billion each year,” says Dr. David Baumer, head of the business management department at NC State and co-author of the paper. “Using electronic records allows the health-care system to operate more efficiently, minimizes duplicative testing, et cetera. But you can only get those cost reductions if everyone, or nearly everyone, makes use of the records, from health-care providers to pharmacies to insurance companies.”


Hospital Workers Sharing Music? They May Also Be Sharing Your Medical Records

Health care workers using Gnutella or other peer-to-peer (P2P) networks to share music and video, may be putting you at risk for medical identity theft, Dartmouth researchers find

HEMORRHAGING DATA: A team of Dartmouth researchers found peer-to-peer (P2P) networks littered with sensitive health care information inadvertently made available by employees of hospitals and other health care facilities, as well as their collection agencies and other business partners.

If Pres. Obama has his way, the medical records of every American will be digitized by 2014. The stimulus package (read the text here) includes $19 billion in funding to pay for the effort and calls for the appointment of a chief privacy officer to advise the U.S. Department of Health and Human Services on how best to protect this sensitive information. If a new study of how easily your medical records can be found online by others is any indication, the new chief privacy officer (to be appointed over the next 12 months) will have his work cut out for him because an increase in digital medical records would likely mean an increase in medical identity theft.

Using software written specifically for scanning Internet-based peer-to-peer (P2P) file sharing networks, Eric Johnson, an operations management professor at Dartmouth College's Tuck School of Business in Hanover, N.H., and colleagues recently found confidential medical files, involving thousands of people, including patient billing records and insurance claims containing Social Security numbers, birth dates, medical diagnoses and psychiatric evaluations. (The same type of information could have been found without the special search software, although not as quickly because the researchers would have had to search individual computers on each of the P2P networks they visited.)


CMS developing 'meaningful use' guidance to remove contradictions

September 27, 2010 — 12:37pm ET | By Neil Versel

It was inevitable, given the short timeline and the apparent seat-of-the-pants nature of the rulemaking process, but CMS is preparing a guidance document intended to clarify several details and fix some inconsistencies in the final Stage 1 rule for "meaningful use" of EMRs.

At last week's meeting of the Health IT Policy Committee's workgroup on meaningful use, Tony Trenkle, director of the CMS Office of e-Health Standards and Services, said the guidance will provide more detail on the objectives and measures in the rule and "should help clarify issues and help the [committee] plan for recommendations for future stages," Government Health IT reports. The clarifications should be out "shortly," Trenkle promised.


Still no consensus on patient use of Internet for health information

September 27, 2010 — 12:08pm ET | By Neil Versel

"I think patients are savvy enough to realize everything they read on the Internet is not the gospel and they should take it with a grain of salt," Charlotte, N.C., internist Dr. Marshall Silverman said at a public forum last week, the Charlotte Observer reports.

Other physicians are not so forgiving when it comes to patients sharing with their doctors information they find online. "Often we spend time basically discrediting inaccurate information they read online before they got to the doctor's office," Dr. Jim Starman, a resident in orthopedic surgery at Carolinas Medical Center, said. "People need to be aware the information they're getting may not be objective and it may not be complete, and it's no substitute for talking with their doctor."


Regenstrief first to share public-health data via NHIN

September 27, 2010 — 10:48am ET | By Neil Versel

Score another first for Indiana University's Regenstrief Institute. Thanks to the Indianapolis-based research organization, Indiana has become the first state in the nation to transmit electronic public-health data to federal authorities via the Nationwide Health Information Network.

Working on behalf of the Indiana State Department of Health, Regenstrief reports sending de-identified information on influenza, pneumonia and other flu-like illnesses from 76 emergency departments statewide and sent the information electronically to the Centers for Disease Control and Prevention. With the NHIN, Regenstrief and the participating EDs can simultaneously share data with state officials and, as long as the Department of Health consents, the CDC.


Easily preventable privacy breaches cost hospitals millions

September 27, 2010 — 11:33am ET | By Neil Versel

Though there is the perception in many quarters that HIPAA privacy enforcement has been lax over the years, the HHS Office for Civil Rights investigated and resolved at least 11,421 cases of alleged violations from the time the regulations took effect in April 2003 through July 2010, a new report says.

The report, in the form of a white paper from data-monitoring firm FairWarning, St. Petersburg, Fla., says that a typical healthcare provider that does not have an active privacy monitoring system is likely to have 25 to 100 privacy breaches related to electronic patient data per month. And breaches can be expensive. In its survey of 300 hospitals and 1,400 clinics among its customer rolls, FairWarning found that some breaches resulted in fines of more than $2.25 million. If an incident attracts media coverage, internal management costs can run between $6.5 million and $15 million for per breach, according to Infosecurity (USA).


Far from home, academics explore the future of health IT

September 27, 2010 — 1:45pm ET | By Neil Versel

If all had gone as planned, I would have recently returned from South Africa, but schedule and finances would not allow such a trip.

I had been hoping to go to Cape Town earlier this month for MedInfo 2010, the triennial meeting of the International Medical Informatics Association. That's once every three years. As in, not very often.

MedInfo, with a heavily academic and scientific program, is probably the largest event of its kind in the world. I went to the previous two--2004 in San Francisco (an easy trip) and 2007 in Brisbane, Australia (a little more involved). In fact, I paid my own way to Brisbane three years ago and, as the only full-time journalist from either North America or Europe to attend, generated enough work to cover my considerable expenses--plus, I got a pretty great vacation out of that trip.


Docs' need for efficiency driving ambulatory EHR market

September 23, 2010 | Molly Merrill, Associate Editor

BURLINGTON, VT – It's not ARRA incentives that are encouraging doctors buy EHRs: rather, they're making the purchase because they want more efficiency in their practices, according to a new study.

Healthcare technology research and advisory firm CapSite released its 2010 U.S. Ambulatory EHR and Practice Management Study, a strategic analysis of the U.S. Electronic Health Record market in response to the Health Information Technology for Economic and Clinical Health (HITECH) component of the American Recovery and Reinvestment (ARRA) Act.


National coordinator posts meaningful use FAQ

By Mary Mosquera

Friday, September 24, 2010

The Office of the National Coordinator posted a set of frequently asked questions to help health care providers understand and meet requirements for the meaningful use rule. The 20 questions and answers cover topics ranging from reporting clinical quality measures to certification of electronic health records (EHRs).

Most of the questions address scenarios in which providers already use EHRs or modules to report data and what steps providers need to take to ensure they meet meaningful use.




No comments: