Friday, October 15, 2010

Weekly Overseas Health IT Links - 14 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.


Pilot Study of Providing Online Care in a Primary Care Setting

  1. Steven C. Adamson, MD, and
  2. John W. Bachman, MD


OBJECTIVE: To study the use of e-visits in a primary care setting.

PATIENTS AND METHODS: A pilot study of using the Internet for online care (“e-visits”) was conducted in the Department of Family Medicine at Mayo Clinic in Rochester, MN. Patients in the department preregistered for the service, and then were able to use the online portal for consultations with their primary care physician. Use of the online portal was monitored and data were collected from November 1, 2007, through October 31, 2009.

RESULTS: During the 2-year period, 4282 patients were registered for the service. Patients made 2531 online visits, and billings were made for 1159 patients. E-visits were submitted primarily by women during working hours and involved 294 different conditions. Of the 2531 e-visits, 62 (2%) included uploaded photographs, and 411 (16%) replaced nonbillable telephone protocols with billable encounters. The e-visits made office visits unnecessary in 1012 cases (40%); in 324 cases (13%), the patient was asked to schedule an appointment for a face-to-face encounter.

CONCLUSION: Although limited in scope, to our knowledge this is the largest study of online visits in primary care using a structured history, allowing the patient to enter any problem, and billing the patient when appropriate. The extent of conditions possible for treatment by online care was far-ranging and was managed with a minimum of message exchanges by using structured histories. Processes previously given as a free service or by nurse triage and subject to malpractice (protocols) were now documented and billed.


The electronic health record meets the iPad

By: Grant Buckler On: 05 Oct 2010 For: CIO Canada

The Ottawa hospital's CIO sees an opportunity to extend the benefits of his e-health efforts by adding mobile computing technology from Apple into the mix. Why iPhones will be the next step

Early in 2009 Dale Potter, chief information officer at the Ottawa Hospital, asked physicians how much of the information they needed in their work was available in the hospital’s electronic health record. On average they said about 30 per cent of it was. When he asked again at the beginning of this year, all but two respondents said everything they needed was there.

“I was quite proud of that statistic,” says Potter, who became the hospital’s CIO in fall 2008 after stints as a private-sector IT boss at Alcan Engineered Products and Bombardier Transportation. The improvement resulted largely from Potter’s efforts to address what he sees as a serious lag in the health-care sector’s adoption of information technology.

But when Potter tagged along on clinical training unit rounds, his pride in getting all that medical information online was somewhat dented.


Epic, Cerner Dominated CIS In 2009

A KLAS report finds that almost 70 percent of Clinical Information System purchases by 200-bed and larger hospitals were from one of the two vendors.

By Anthony Guerra, InformationWeek

Oct. 4, 2010


Nearly 70 percent of CIS purchases in 2009 by hospitals over 200 beds were an Epic or Cerner integrated solution, according to a new KLAS report, "CIS Purchase Decisions: Riding the ARRA Wave."

Although they came from about five organizations, Cerner had a solid year with 31 hospital signings. "This is a pretty good stake in the ground for Cerner," said KLAS general manager of clinical research Jason Hess. "I think people recognize that ARRA and Meaningful Use is all about interoperability and integration, and you look at who the two truly notable integrated vendors are -- its Epic and Cerner. Certainly this is kind of a two-horse race as we watched it in 2009, and then the others are kind of at a distant third."

In 2009, Eclipsys, GE, McKesson Horizon and QuadraMed all lost more hospitals than they gained, according to the Orem, Utah-based company.


Personal Robotics Market to Top $19 Billion in 2017

NEW YORK - September 29, 2010

While many consumers’ current interaction with robots is limited to those that clean their floors, pools or gutters, ABI Research, in its new market study “Personal Robotics,” forecasts that the personal robotics market will grow to more than $19 billion in 2017, driven in large part by sales of telepresence and security robots featuring high-quality cameras, microphones and processors that allow the robots to serve as interactive substitutes for human beings.

The modern robotics market has existed for nearly 30 years, but within the last decade, substantial improvements in overall functionality, levels of control, and cost structures have been achieved. While many of the advancements in robotics have been achieved in military and industrial markets where higher amounts of spending have allowed the development and commercialization of highly technical, yet costly, robots, many of the lessons learned are quickly trickling down to other market segments, including health care, business and commercial markets, and personal robotic devices.


5 EHR Myths, Busted

Gienna Shaw, for HealthLeaders Media , October 5, 2010

The best physician can make a mistake when writing a prescription, the best nurse can fail to remove a catheter on time, the most organized medical records staff can misplace a file, and even top hospitals have areas of waste and inefficiency. But electronic health records systems are supposed to make all that go away, right?

Well, not exactly.

Whatever you may hear from Washington policy-makers, EHR is not going to solve all of healthcare's quality and patient safety problems. HIM professionals at last week's meeting of the American Health Information Management Association in Orlando made that much clear.


Audits of Electronic Health Records Cloning Reveal Documentation Problems That Put Compliance at Risk

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

By Nina Youngstrom, Managing Editor (

Electronic health records (EHR) are a double-edged sword. They can reduce the time it takes physicians to document patient encounters, allow real-time access to medical records and promote legibility. But CMS and Medicare contractors are wary of classic EHR physician documentation shortcuts — cloning (cut and paste), macros and templates — and audits are bearing out their concerns.

“EHRs are a great invention as long as they are carefully used and reviewed,” said Kathleen Enniss, compliance analyst at UW Medicine Compliance, part of the University of Washington School of Medicine in Seattle, which includes three hospitals. “Each note should contain individualized data that supports the medical necessity of the visit or procedure.” When Enniss audited EHRs, she found problems stemming from use of documentation shortcuts.


October 5, 2010, 4:36 PM ET

Doctors Launch ‘’ to Give Treatment Info

Conveying how well a therapy works — and doing so in understandable terms — isn’t easy, but a group of physicians is trying to change that.

Their new website,, looks at a stat called the “number needed to treat,” which it defines as “a measurement of the impact of a medicine or therapy [that estimates] the number of patients that need to be treated in order to have an impact on one person.” (Here’s the new site’s explanation of the NNT. We’ve mentioned the metric before in a post about gauging heart risk.)

The site summarizes the evidence (taken mostly from systematic reviews like those from the Cochrane Collaboration) behind a range of treatments and therapies, including the Mediterranean Diet for post-heart attack care and antibiotics for ear infections. It also includes, when appropriate, the “number needed to harm,” which indicates how many people you’d have to treat before one is harmed by the intervention. Both stats are presented as a proportion — i.e. one in 42 people will have his or her life saved by taking aspirin after a major heart attack (an NNT of 42), and one in 167 will have non-dangerous bleeding (a NNH of 167).

A perfect NNT would be one — treat one person, and one person benefits. The higher the NNH, the better.


HHS works on framework for health IT standards

Framework will include standard vocabularies for electronic medical records

The next stage of federal efforts to spur adoption of electronic health records will involve a framework for standards and interoperability, according to a senior Health and Human Services Department official.

The goal is to build on the current foundation and develop “progressively more rigorous electronic health information exchange requirements,” David Blumenthal, HHS’ national coordinator for health IT, told the House Science and Technology Committee’s Technology and Innovation Subcommittee Sept. 30.

Blumenthal updated lawmakers on what's happening with the $20 billion in economic stimulus funding designated for promoting physician and hospital investments in health IT. HHS issued three sets of regulations in recent months to define how physicians and hospitals can become eligible for reimbursements by installing and meaningfully using the record systems.


Wednesday, October 06, 2010

Making 'Meaningful Use' Meaningful for Patients and Health Care Providers

HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, and while not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.


Romania to implement health card in 2011

04 Oct 2010

The Romanian government has announced that electronic health insurance cards will be rolled out nationally at the start of next year.

The cards will be separate to the European Health Insurance Card, and will hold personal information, proof of health insurance payments, applications for medical services, information on life-threatening medical diagnoses, and the cardholder's blood type.

Health Minister Attila Cseke, said: "By introducing the national health insurance cards, we make an important computerisation step. We can cut red tape to prove the identity of the insured."


Czech Republic registers 2m for EHR

01 Oct 2010

The IZIP electronic health record programme in the Czech Republic has hit its target of registering 2m users by the end of the summer 2010.

More than a fifth of the country’s population is now using the eZK (electronic health record) that allows patients to access their own health information - including information on visits, results and prescribed drugs - via a web based electronic health record.

The records are provided free to those insured by the VZP, the largest state owned health insurer in the Czech Republic. They also used by more than 15,000 practitioners to share information with each other, when given consent.


ONC lists all certified EHRs on website

By Joseph Conn / HITS staff writer

Posted: October 6, 2010 - 11:30 am ET

The Office of the National Coordinator for Health Information Technology at HHS has opened the official federal website for listing health IT products that have been independently tested and certified as eligible for incentive payments under the American Recovery and Reinvestment Act of 2009.


No unemployment here

The nation is suffering from the highest unemployment rates in almost 30 years, and yet healthcare industry IT leaders are worried that workforce shortages may jeopardize their hospitals' chances at obtaining federal IT incentive payments.

One out of 10 chief information officers responding to a recent survey indicated that workforce shortage "definitely would affect" their chances to implement electronic health-record systems and qualify for federal IT reimbursements. Just over half—51%—of CIOs predict that staff shortages possibly would put their health IT projects at risk, according to a membership survey by the College of Healthcare Information Management Executives.


Scanning Medication Reduces Errors, Hospital Says

Briefings on The Joint Commission, an HCPro publication , October 5, 2010

In April 2008, Baystate Medical Center (BMC), a 653-bed teaching hospital in Springfield, MA, began implementation of its Bar Code Point of Care technology to positively impact medication administration in reducing errors.

In the early pilot programs, BMC reported a 50% bedside scanning rate for all medications and a medication error rate of 1.2 errors per 1,000 patient days.

Following the implementation of an organization-wide bar code scanning process in September 2008, BMC improved its medication scanning rates to 87%—90%. The medication error rate also decreased to 0.3 errors per 1,000 patient days, a 75% reduction.


EHI Awards 2010: the winners

07 Oct 2010

A system that lets paramedics hand over patient details to A&E staff has electronically scooped the top prize in the E-Health Insider Awards 2010 in association with BT.

The cab-based terminal developed by the Scottish Ambulance Service was judged the overall winner at the awards at the Grand Connaught Rooms in central London last night, having earlier won ‘best use of mobile technology in healthcare’.

The healthcare IT champion of the year award, which is decided by EHI readers, went to John Thornbury, ICT director at Worcestershire Acute Hospitals NHS Trust.

Jon Hoeksma, editor of EHI, said: “The awards are a bellwether for the health and vitality of this important sector and they show that healthcare IT is still producing great innovation and excellent work by teams and individuals.


Groups push infection-prevention framework

By Maureen McKinney / HITS staff writer

Posted: October 7, 2010 - 11:30 am ET

A coalition of infectious-disease groups are calling for the widespread adoption of a new prevention framework that they say can eliminate healthcare-associated infections. The groups outlined the framework in a white paper (PDF) that appeared Thursday in the American Journal of Infection Control and the journal Infection Control and Epidemiology.

The key elements of the framework are data collection, evidence-based practices, system-wide infection-prevention strategies and enhanced medical knowledge, according to the paper’s authors, who include representatives from the Centers for Disease Control and Prevention, and the Society for Healthcare Epidemiology of America.


E-health drug data saves $436M: study

Last Updated: Wednesday, October 6, 2010 | 9:11 AM ET

CBC News

Canada is seeing e-health gains in the area of medication, with an estimated $436 million in cost savings and efficiencies this year, a report released Wednesday says.

Drug information systems, which are hooked up now mainly in the western provinces and Prince Edward Island and to a lesser extent elsewhere, allow pharmacists and health-care providers to electronically access records of a patient's prescription medications.

And they provide a full and accurate medication history so that potential drug interactions or allergies can be caught before they happen.

The $436-million tally and report were compiled by Deloitte for Canada Health Infoway, a federally funded organization that was founded in 2001 and charged with helping provinces and territories to adopt electronic health-record projects.


ONC studying risks of de-identified patient records

By Mary Mosquera

Friday, October 01, 2010

The Office of the National Coordinator has begun a study on how to overcome the privacy and security risks of using health information that otherwise has been stripped of its personal identifiers such as a patient’s name and address.

One danger is that the data might be able to be re-identified through the use of additional records publicly available on the Internet, according to Dr. David Blumenthal, the national health IT coordinator.

But health care experts say that the use of de-identified data is critical for tracking population health over time and for research purposes.


Guest Columnist

Approaches to statewide patient identification: pros and cons

By Dr. Scott Schumacher

Thursday, September 30, 2010

Determining the best way to identify patients statewide or nationally is one of the hottest topics of debate within today’s health IT community.

We all agree on the importance of identifying patients – of ensuring that information about a patient is accurate and accessible regardless of where that patient is being treated.

We also agree on the importance of eliminating risks and securing patient information – of maintaining patient privacy and securing their protected health information (PHI).

What we cannot seem to agree on is the best way to achieve successful patient identification while eliminating risk.


E-Health Intelligence Report

5 October 2010

Scientific Articles

:: Effectiveness of telemedicine: A systematic review of reviews

International Journal of Medical Informatic. 2010

A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant.

:: 10 Years Experience with Pioneering Open Access Publishing in Health Informatics: The Journal of Medical Internet Research (JMIR).

Stud Health Technol Inform. 2010;160:1329-33.

Traditional medical informatics journals are poorly cited and the visibility and uptake of articles beyond the medical informatics community remain limited....The paper summarizes some of the features of the Journal, and uses bibliometric and access data to compare the influence of the Journal on the discipline of medical informatics and other disciplines.


States ramping up encounter data reporting

By Kathryn Foxhall

Thursday, September 30, 2010

The largest collection of hospital all-payor, multi-year, encounter-level data is now more usable due to state-level efforts to provide better information faster, Agency for Healthcare Research and Quality experts said Wednesday.

AHRQ’s “Healthcare Cost and Utilization Project,” (HCUP) collects hospital administrative data on hospital inpatient, emergency department and ambulatory surgery care.

Much of the information is now available much sooner, “because states have been very innovative in turning around their databases,” said Dr. Claudia Steiner, a research medical officer within AHRQ who has worked on HCUP for a number of years.


Connelly outlines NHS info ‘revolution'

01 Oct 2010

The NHS' director general of informatics, Christine Connelly, has outlined an information revolution for the health service to match the root and branch reform promised by the Conservative-Liberal Democrats government.

“The model for healthcare in its entirety is being redesigned and recast. Given this change we need to re-design the model for informatics in step," Connelly told a conference in central London.

“We need to start to design that now. What does a commissioning world look like? What does a provider world look like?”

She said that the government was planning “very new kinds of structures and organisations, and a new approach to information is needed to build bridges to connect the different parts."


Only 1 in 15 docs e-mails with patients: study

By Andis Robeznieks / HITS staff writer

Posted: October 7, 2010 - 11:30 am ET

Despite indications that e-mail access to physicians increases patient satisfaction, only 6.7% of office-based physicians routinely use e-mail to communicate with their patients, according to a report from the Center for Studying Health System Change. The report is based on a 2008 survey of 4,258 physicians (anesthesiologists, pathologists, radiologists, and residents and fellows were excluded).

Only 34.5% of survey respondents said their office was equipped to handle electronic communication about clinical issues with patients, and among them, only 19.5% reported e-mailing with patients routinely.


Comparative Effectiveness Could Save Medicare Billions, Study Says

Roxanna Guilford-Blake for HealthLeaders Media , October 7, 2010

The "comparative effectiveness" of different treatments for the same medical condition became a hot-button issue in the healthcare reform debates. But despite federal funding for research into how to compare various treatments, the Affordable Care Act limits the abilityof the federal government to draw on comparative effectiveness research to determine what can be covered under Medicare.

Politics aside, using such research to determine how much to pay for newly covered services could yield billions of dollars in savings without threatening patient choice, according to a paper in the October issue of Health Affairs.


How to Evaluate Patient Portal Efficiency

Carrie Vaughan, for HealthLeaders Media , October 5, 2010

When Riverside Health System implemented its EMR in 1996, the idea was that it would be able to use the data to help drive improvements in care.

"We thought we'd have all of the data fields in our notes," says Charles Frazier, MD, vice president of innovation. "Everybody thinks we'll get all this data and be able to do all of this stuff with it, but it is a difficult thing."

After 10 years, the Richmond, VA-based health system—which consists of four acute care hospitals, rehabilitation and long-term care facilities, and the Riverside Medical Group, a 350-member multispecialty physician practice—was still working on problem lists, lab values, medications, and elements such as gender and age. Today, the health system is still continually trying to improve how it puts information into the EMR, Frazier says.


Telecom apps take the Hippocratic Oath

Diagnostic medicine is increasingly going mobile, but path isn’t smooth

By Kim Hjelmgaard, MarketWatch

LONDON (MarketWatch) — At home. On the go. During a meeting. Take your pick. The good doctor gets around these days.

If you have diabetes, asthma or heart disease, there’s almost certainly an elegant smartphone interface at your disposal.

If you’re overweight or if it’s the scourge of meningitis you fear — or even if you simply don’t know where to look for judicious diagnostic advice and treatment — the wireless medical world is at hand.


PHR Privacy Report a Work in Progress

Federal Officials to Hold Event to Gather Ideas

October 4, 2010 - Howard Anderson, Managing Editor,

Federal officials are still months away from submitting an overdue report to Congress on privacy and security requirements for personal health records vendors, which are not covered by HIPAA.

Section 13421 of the HITECH Act called for the Department of Health and Human Services to submit a report by last February on the requirements for PHR vendors and others not covered by HIPAA. But the report has been delayed while the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology worked on other projects, says Joy Pritts, ONC's chief privacy officer. She expects the report to be completed early in 2011.

Personal health records are initiated and maintained by patients. They can include information entered by patients as well data from other sources, such as a doctor's electronic health records.


October 3, 2010

2 Brothers Await Broad Use of Medical E-Records


There is no silver bullet for reforming America’s health care system, but medical experts have long agreed that digital patient records and electronic prescribing can help improve care and curb costs.

It seems straightforward. Just combine technology skills with investment money, and then develop innovative products. But to date, the push for a digital revolution in doctors’ offices has brought mostly frustration for the many companies big and small that are trying to conquer the field.

Just ask the Doerr brothers — John Doerr, the well-known venture capitalist who was an early backer of Google and Amazon, and Dr. Tom Doerr, a physician and software designer.


Data Virtualization Interest Is On the Rise

A recent survey suggests data virtualization may make inroads in healthcare applications

By John DeGaspari A survey conducted by Composite Software, Inc., San Mateo, Calif., a supplier of data virtualization products, has found increasing interest in the use of data virtualization as part of enterprise-wide data integration strategies. Robert Eve, executive vice president, says the findings are pertinent for large enterprises, such as healthcare providers, which have various sources of data.

Eve describes data virtualization as a way of pulling together data from multiple sources. He says it is a lower cost alternative to data warehousing. In his view, data virtualization is especially useful for “wide, shallow” types of queries, such as requesting a single patient’s information across various sources.

The results of the survey are based on the replies of 143 respondents, including CIOs, business intelligence consultants, database administrators and developers. About 10 percent of the respondents were involved in some way with the healthcare industry. Overall, 47 percent of all respondents expressed interest in using data virtualization in their organizations; those involved with the healthcare industry were in line with that figure, Eve says.


HIEs show their value to community physicians

October 01, 2010 | Patty Enrado, Special Projects Editor

SAN FRANCISCO – Trying to build a critical mass of physicians to adopt electronic health records (EHRs) and participate in health information exchanges (HIEs) is one of the more difficult tasks for HIEs and regional health information exchanges.

Three executives offered up their best practices at Axolotl's 9th Annual Customer Conference in San Francisco on Sept. 30.

Quality Health Network, a nonprofit quality improvement collaborative based in Grand Junction, Colo., has achieved an 88 percent adoption rate among physicians in its region. One of the reasons QHN achieved such a high adoption rate is that it built a governance infrastructure that included many local stakeholders, who were then responsible for making critical and often tough decisions, said executive director Dick Thompson.


Telemedicine aids early diagnosis: study

By Shawn Rhea / HITS staff writer

Posted: October 4, 2010 - 11:45 am ET

A new telemedicine study has found that review of electronically transmitted heart images by remote specialists allowed for earlier diagnosis and treatment of pediatric heart problems.

The study was conducted by researchers at Children’s Mercy Hospital and Clinics in Kansas City, Mo., and presented at the American Academy of Pediatrics national conference, which runs through Tuesday in San Francisco. For the study, researchers looked at 905 first-time pediatric echocardiograms performed at St. John’s Regional Medical Center in Joplin, Mo., between April 1998 and October 2009 and transmitted to pediatric heart specialists at Children’s Mercy.


IOM to Launch HIT Study

John Commins, for HealthLeaders Media , October 4, 2010

The Institute of Medicine will conduct a one-year study to determine if health information technology will achieve its full potential for improving patient safety in healthcare. The study will be carried out under a $989,000 contract from the federal Office of the National Coordinator for Health Information Technology.

"Since 1999, when the IOM published its ground-breaking study To Err Is Human, the Institute has been a leader in the movement to improve patient safety," said David Blumenthal, MD, national coordinator for HIT. "This study will draw on IOM?s depth of knowledge in this area to help all of us ensure that HIT reaches the goals we are seeking for patient safety improvement."


Pharmacies sue CVS Caremark over privacy issues

October 4, 2010 — 2:33pm ET | By Neil Versel

Patient and physician privacy apparently are being compromised in all kinds of ways in Texas. In just the past few days, we've learned that:

* The Texas Department of State Health Services (DSHS) has sold or given away hospital patient data on more than 27 million hospital stays since 1999, according to a report by the Austin Bulldog, an investigative journalism nonprofit organization.

* The Texas Tribune reports that former state Rep. Bill Zedler (R-Arlington) "used his legislative authority to obtain a series of confidential records from the Texas Medical Board." Zedler reportedly reviewed files on five physicians, at least two of whom contributed to his campaign fund.

* A group of six independent pharmacies in the Lone Star State have sued CVS Caremark, charging that the company's Caremark pharmacy benefits management arm engaged in racketeering and violated HIPAA by gaining too much control over patient data and squeezed competition out of the retail pharmacy market.


Factors to consider when designing HIE networks

September 29th, 2010

by Paul Abramson, MD

What will it take to create local health information exchange (HIE) systems that fit in with the federal government's vision of local, regional and national health information exchange networks based on standards defined by the Nationwide Health Information Network (NHIN)? The fragmentation of the efforts of groups involved in the actual HIE implementation at the community, local and regional levels is just one of many challenges and obstacles facing those who are trying to meet the government's meaningful use criteria. Here are some others.

Data Models: A technical issue with security implications

Theoretically, health information exchange can be accomplished in a number of different ways. One common model is the central repository, where everyone's health information in a given city or region is cached on a central "health exchange server" which can be queried by individual entities.

Another design is the federated model, where a central "master patient index" is used to match user requests with health data residing in the electronic health records systems of individual hospitals, labs, and doctors' offices. There is a corresponding trade-off between speed and reliability with the central repository model, and potentially greater security and access control with the federated model. In practice, most HIEs will likely use some hybrid of central and federated models in order to achieve a workable compromise.




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