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Why Health Care Is Going Home
Steven H. Landers, M.D., M.P.H.
October 20, 2010 (10.1056/NEJMp1000401)
In Albuquerque, New Mexico, and Buffalo, New York,1 acutely ill patients have been sent out of the emergency department for hospital-like care at home. In Baton Rouge, Louisiana, and Little Rock, Arkansas, home health agencies provide chronic care management services, emphasizing care coordination and support for patients' management of their own conditions. In San Diego, California, physicians arrive at patients' homes with a new version of the black bag that includes a mobile x-ray machine and a device that can perform more than 20 laboratory tests at the point of care. Several engineering and electronics companies have developed products for monitoring health at home. Massachusetts General Hospital in Boston is experimenting with Internet videoconferencing to permit virtual visits from patients' homes.
In my Cleveland Clinic practice, I work in my patients' homes, using a cellular broadband connection to the same electronic record system used by my colleagues in offices and hospitals. I learn practical information about my patients' medications, management of chronic illnesses, and nutrition and check in on how their caregivers are coping. Patients often see the home visit as a gesture of caring, and many of my older patients express nostalgia for an era when house calls were common. Hundreds of other U.S. physicians are also emphasizing home-based care, many of them now as members of the American Academy of Home Care Physicians.
In the past century, health care became highly concentrated in hospitals, clinics, and other facilities. But I believe that the venue of care for the future is the patient's home, where clinicians can combine old-fashioned sensibilities and caring with the application of new technologies to respond to major demographic, epidemiologic, and health care trends. Five major forces are driving health care into the home: the aging of the U.S. population, epidemics of chronic diseases, technological advances, health care consumerism, and rapidly escalating health care costs.
October 19, 2010 | Bernie Monegain, Editor
LONDON – Reduced prices and improved quality are boosting the adoption of telemedicine videoconferencing systems, according to new analysis from research and consulting firm Frost & Sullivan.
The practice of telemedicine has been undergoing significant evolution paralleled by technological advancements in the world of videoconferencing, according to the report "Visual Collaboration Applications in Healthcare." These changes open new opportunities for videoconferencing service providers as they continue to address a market that remains highly under-penetrated. Hence, healthcare practitioners are increasingly adopting interactive video or videoconferencing applications for providing enhanced access to healthcare as well as improving the quality of such services at lower prices across the globe.
On top of all the regional and local health information exchanges, the federal government has a national exchange in the works.
By Marianne Kolbasuk McGee, InformationWeek
Oct. 16, 2010
On top of all the regional and local health information exchanges, the federal government has a national exchange in the works. The Nationwide Health Information Network is a set of standards, services, and polices to enable secure sharing of health data over the Internet.
NHIN, being developed by the Department of Health and Human Services with input from the healthcare industry and others, aims to let health information follow patients as they move among caregivers and institutions locally and around the country. The ability to electronically exchange data is expected to be one of the requirements healthcare providers have to meet to demonstrate "meaningful use" of e-health records and qualify for federal incentive money.
Online access to your medical info helps you get better and safer care
By Carol Diamond, MD, MPH
updated 10/18/2010 5:29:45 PM ET 2010-10-18T21:29:45
Imagine no more telephone tag with the doctor’s office just to get your medical records sent to a specialist. Imagine no more digging through stacks of paper to find an old immunization record.
Medicare beneficiaries and veterans now have something we all should have — the option to click a blue button to download key aspects of their personal health information. This simple step marks a significant milestone in an effort to put the power of information — your personal health information — at your fingertips.
When you go to the doctor’s office, do you get a summary of the visit afterward? Can you log in to a secure website and look up your recent laboratory results? If you are like most Americans, the answers to both questions are no.
October 14, 2010
Emerging research suggests kids’ social network postings reflect their real-life behavior. Should that information be used in their medical care?
Not long before some teenagers who’d been bullied on MySpace and Facebook started committing suicide in 2006, a doctor of adolescent medicine named Megan Moreno began hearing from her patients that social networking sites were making them sick. One girl started getting stomachaches after peers posted photos of her on MySpace. Another worried that the sexual references on her boyfriend’s profile meant she’d have to do things she didn’t feel ready for.
Moreno was troubled but intrigued: If MySpace, and more recently, Facebook, could so powerfully influence a teen’s health for the worse, might the same information on the sites that was making teens ill — the prolific reports on their moods, drinking, drug use and sex lives — be harnessed to promote well-being?
HDM Breaking News, October 21, 2010
Two affiliated Medicaid managed care plans in Pennsylvania have acknowledged that an unencrypted flash drive containing protected health information on 280,000 members went missing on Sept. 20.
AmeriHealth Mercy Health Plan and Keystone Mercy Health Plan did not disclose the lost drive until a Philadelphia Inquirer reporter learned of the incident and called in recent days, according to the newspaper. The plans will be notifying affected members, according to a statement.
HDM Breaking News, October 21, 2010
The Privacy and Security Tiger Team of the HIT Policy Committee is seeking public comment on authentication "trust" rules for provider organizations.
"For purposes of this discussion, authentication is the verification that a provider entity (such as a hospital or physician practice) seeking access to electronic protected health information is the one claimed, and the level of assurance is the degree of confidence in the results of an authentication attempt," the Tiger Team explains in an entry on the Federal Advisory Committee Blog.
HDM Breaking News, October 21, 2010
Standards development organization Health Level Seven International will host a free Web seminar on Oct. 26 to explain the Electronic Health Record System Functional Model and the Personal Health Record System Functional Model.
The models define the functions that should be in EHRs and PHRs. The EHR model, for instance, contains about 1,000 conformance criteria across more than 100 functions, according to Ann Arbor, Mich.-based HL7.
October 21, 2010 — 3:04pm ET | By Neil Versel
On the cover of its September issue, Wired magazine declared the web "dead" but also proclaimed, "Long live the Internet." Instead of searching through a browser, people are increasingly turning to specific online applications to find the information they need or the online experience they seek.
As usual, healthcare is a bit further behind the rest of the world, according to consultant Vince Kuraitis, and is only beginning to move away from the "walled garden" approach that early Internet leaders Prodigy, CompuServe and AOL found success with, only to be overtaken by the open web once broadband took hold.
Kuraitis, author of the e-Care Management blog noted this Wednesday at the Mobile Health Expo in Las Vegas while attempting to assess whether the HITECH section of the American Recovery and Reinvestment Act was working. "Health IT has been a series of walled gardens, locking docs into a particular [EMR] company, but is moving toward open platforms," Boise, Idaho-based Kuraitis said.
Posted: October 21, 2010 - 11:30 am ET
David Blumenthal, the National Coordinator for Health Information Technology at HHS, said planners developing Stage 2 meaningful-use criteria under the federal electronic health-record incentive program will have slightly more strategic-thinking time than they had in creating Stage 1 criteria.
"We're mindful of the fact that the first go-round was very rushed,” Blumenthal told members of the federally chartered Health IT Policy Committee.
Working under such tight deadlines "didn't allow for careful forward planning," Blumenthal said. "I want to do better this time."
Thursday, October 21, 2010
Health care futurist Jeff Goldsmith says health IT adoption has lagged in the U.S. because there's no definable return on investment. Goldsmith -- president of Health Futures and an associate professor of public health sciences at the University of Virginia -- warns that health IT adoption, combined with the current U.S. payment system and quality measurement requirements, is actually hurting productivity.
Goldsmith spoke with iHealthBeat about whether the federal government's "meaningful use" incentive program will be successful in driving health IT adoption, what he would have done differently in designing such a program and which country the U.S. could learn from when it comes to health IT.
Published: 21 October 2010
New EU laws allowing patients to travel across borders for health care will be crucial to putting in place the legal framework for the development of e-health services in Europe, according to EU Health Commissioner John Dalli.
What benefits can you see in adopting eHealth technologies?
We want to put patients' rights, patient safety and access to health services at the heart of policymaking. eHealth is a tool for delivering all of this, which is why I've made innovation in health care a priority. eHealth can help make health systems more efficient and give patients access to expertise from anywhere.
Daniel M. Keller, PhD
October 19, 2010 (Washington, DC) — An online wound (OW) electronic medical record (EMR) can contribute significantly to a decrease in amputation rates in patients with diabetes and lower extremity wounds, according to a study presented here at the American College of Surgeons 96th Annual Clinical Congress.
Senior author Jason Maggi, MD, from the Department of Surgery at the New York University Langone Medical Center in New York City, said that because of the number of people involved in the care of patients with diabetic foot ulcers (DFUs), a centralized EMR is needed to coordinate patient care.
19 Oct 2010
The Belgian national eHealth platform is calling for views on whether patient privacy and exchange of data should be governed by an ‘opt-in or opt-out’ approach on data be held on the system.
A consultation is now underway on whether the platform should be set-up on an opt-in system, in which the informed consent of the patient is required prior to communicating the data; or an opt-out system, where the data exchange takes place unless the patients oppose it.
Warning against a "new digital divide," Health and Human Services officials have urged healthcare IT vendors to adopt electronic health records in underserved areas.
By Marianne Kolbasuk McGee, InformationWeek
Oct. 20, 2010
In an open letter, national health IT czar Dr. David Blumenthal is urging the health IT vendor community to help bolster e-health record adoption rates among healthcare providers in underserved, minority communities.
The letter, co-signed by Blumenthal and Dr. Garth Graham, director of the office of minority health, cited a Centers for Disease Control and Prevention National Ambulatory Medical Care survey indicating that EHR adoption rates “remain lower among providers serving Hispanic or Latino patients who are uninsured or relied upon Medicaid.”
20 Oct 2010
NHS Wales has announced an agreement with four healthcare IT suppliers to deliver the Individual Health Record across the country.
Out-of-hours IT system supplier Adastra and GP system suppliers EMIS, iSoft and INPS have all signed an agreement to provide the technical solution that will make the IHR widely available.
The IHR is the Welsh equivalent of England’s Summary Care Record and Scotland’s Emergency Care Summary, but access is limited to individual health boards.
Tuesday 19th October 2010
Real-time data streaming via EMIS Web – the new system from leading GP software supplier EMIS – is one of the components that will deliver the Individual Health Record (IHR) service being introduced by NHS Wales.
EMIS is one of the four main suppliers of GP computer systems in Wales who have signed an agreement with NHS Wales to provide the technical solution that will make the IHR available across the country.
The IHR is a Welsh Assembly Government initiative that allows important patient information to be securely shared between GPs, emergency care and out of hours services – with the patient’s consent. It gives an electronic view of key information held on the GP’s practice computer system.
19 October 2010
UNCTAD - Published October 14, 2010
The Information Economy Report 2010, will centre on the theme of "Information and communication technologies (ICTs), enterprises and poverty alleviation", examining the possible implications for poverty reduction of production and enhanced use of ICTs by domestic businesses
By Joseph Conn
Posted: October 18, 2010 - 3:45 pm ET
The much-feared digital divide now is being recognized as having racial and ethnic components that the government and health information technology vendors should address, according to the federal health IT czar.
In an open letter posted online to the health IT vendor community, David Blumenthal, the National Coordinator for Health Information Technology at HHS, asked health information technology vendors for their help "in making sure that we are not creating a new form of 'digital divide.' " Blumenthal also asked vendors of electronic health-record systems to ensure that they "include providers who serve minority communities in their sales and marketing efforts."
Last month, a Texas online news site, the Austin Bulldog, published a lengthy investigative report on the sale and gifting of patient-level hospital data by the Texas Department of State Health Services.
Reporter Suzanne Batchelor's remarkable story found that if you're a Texan, your healthcare data can be given away or sold without your consent. And the Health Insurance Portability and Accountability Act, the main federal health information privacy law, won't—or can't—protect you.
In Texas, the health services department gathers claims data from hospitals by law—providers can be fined as much as $10,000 if they don't hand it over. But the department isn't a so-called “covered entity” as defined by HIPAA. So, the state isn't covered under the HIPAA privacy rule if it does anything that would be a violation if performed by a data-providing hospital.
Texas requires researchers to sign data-use agreements, analogous to business associate agreements under HIPAA, which bar re-identification of individual records and ban allowing "others to release any information that identifies persons, directly or indirectly."
Enforcement is tasked to the Texas Health Care Information Council and to the Texas attorney general's office. Abusers who "knowingly or negligently" release patient records face civil penalties of not more than $10,000. There have been no enforcement actions requested or taken against Texas data buyers, according to Texas agency spokesman Chris Van Deusen.
18 Oct 2010
The Department of Health has launched a three month consultation on proposals to deliver an “information revolution” to users of the NHS.
The consultation paper launched this morning on the DH website says that with modern technology playing “an ever increasing part in our everyday lives” too much of the health and care system still relies on “face to face contact and paper based transactions, even when it is neither necessary nor appropriate.”
It also says change is needed to deliver the “no decision about me without me” promise at the heart of the government’s recent white paper, ‘’Equity and Excellence, Liberating the NHS.’
To deliver on this, the paper says the public, carers and patients not only need good information but “a culture that enables people to make use of it.”
It says this culture must be based on “accurate and up to date health and care records” since these “form the basis of information systems for patients and service users.”
Reboot NHS Information
18 Oct 2010
E-Health Insider’s managing editor, Lyn Whitfield, takes a first look at the three month consultation paper on a new information strategy for health and social care: ‘Liberating the NHS: an information revolution.’
The latest consultation on an information strategy for the NHS opens with a bold claim. “Much of the frustration within today’s care system has, at its root, information,” it says.
Not lack of money. Not poor structures. But having to repeat information, to hang around for test results, and “being unable to compare one service with another.”
Having identified this problem, ‘Liberating the NHS: an information revolution’ goes on to say that what is needed is information that puts people in control.
Gienna Shaw, for HealthLeaders Media , October 19, 2010
There are plenty of benefits to using cloud computing to share health data. Of course, the cloud isn't perfect. When it comes to diagnostic imaging, for instance, massive file sizes make even online access tricky.
But when you pair benefits such as ease of use with improvements such as greater efficiency and lower costs, it's easy to see why more organizations are turning to cloud computing solutions to gather and share digital records.
By Mary Mosquera
Friday, October 15, 2010
The U.S. Army is looking for a vendor to deploy WorldVistA EHR, an open source version of the Veterans Affairs Department’s VistA medical record system, for the Iraq Ministry of Defense. It will connect with the government’s healthcare system, enhance patient record-keeping and improve the level of healthcare in Iraq.
The WorldVistA EHR is used elsewhere in the Middle East, such as at the National Cancer Institute of Cairo University in Egypt, and in Jordan’s national health system.
The primary location for training and EHR use in Iraq is the Al Muthana Military Hospital in Baghdad, according to an Oct. 14 announcement on the Federal Business Opportunities Web site. The hospital, which opened in 2009, offers care for medical conditions requiring hospitalization, emergency care, initial wound surgery, and post-operative treatment.
By Mary Mosquera
Monday, October 18, 2010
Healthcare providers should supply patients with layered and easy to understand notices of how their information will be used and protected when it is exchanged, an advisory panel of the Health & Human Services Department recommended.
Physicians should include this description in a short summary in the privacy practices notice that is required by HIPAA, and that patients receive and sign at office visits, it said at an Oct. 15 meeting. But more detailed information exchange explanations should be readily available to patients.
When written, the Health Insurance Portability and Accountability Act (HIPAA) did not foresee the broad exchange of personal health data.
Posted by Marianne Kolbasuk McGee on October 19, 2010 03:55 PM
Financial sustainability has been the hardest nut to crack for many health information exchanges. And even with the feds providing $564 million in stimulus funding for states to build and expand HIEs, the sustainability issue will likely remain one of the toughest challenges.
Under the American Recovery and Reinvestment Act, the Department of Health and Human Services awarded grants to states ranging from $4.6 million to $38.8 million. However, that money is designated for establishing or advancing the HIEs, including infrastructure, software, hardware costs. The grant money can’t be used for operations.
So once the HIE is running, there’d better be a well thought-out, solid plan to keep it going. The recent past is littered with promising health data exchange efforts that didn’t last after public or private grant money ran out.
FierceHealthIT: A top federal health IT official said there is a workforce shortage in the sector that could hinder the widespread adoption of electronic medical records, but federal aide is on the way, for that, too. David Blumenthal, the national health IT coordinator, said federal training programs would meet 85 percent of the demand, which he estimated as a shortage of about 50,000 workers. "He notes that the University of Texas at Austin, a beneficiary of some of the government funding, recently graduated its first class of health information management and exchange specialists, and that the school will add three more health IT certificate programs next year" (10/18).
HDM Breaking News, October 18, 2010
Whether he is discussing systems implementations, standards, federal policies, favorite vegetarian dishes or the beauty of New England, John Halamka's blog, "Life as a Healthcare CIO," is worth reading. Two recent posts bear particular notice for health information technology professionals.
Halamka, a practicing physician, serves as CIO of Beth Israel Deaconess Medical Center and Harvard Medical School. On Oct. 18, he posted the hospital's information systems operating plan for fiscal year 2011. Top projects include achieving meaningful use for 1,700 clinicians and go-live of a suite of new laboratory information systems that replace 13 major applications.
October 18, 2010 — 12:04pm ET | By Neil Versel
Verizon Communications is making a broader push into health IT by expanding its cloud-based Verizon Medical Data Exchange to support interoperability of digital images and test results, in addition to dictated and transcribed notes. Additionally, the exchange is now open to a wider range of providers, including rural hospitals and small physician practices, the telecommunications giant says.
"The expanded capabilities of our data exchange will help accelerate the shift from paper-based to electronic-based medical records, and in the process help speed patient diagnoses and drive productivity and cost efficiency throughout the U.S. healthcare system," Peter Tippett, vice president of technology and innovation at Verizon Business, says in a press release.
October 18, 2010 — 1:33pm ET | By Neil Versel
Ready for another threat to individual privacy? Less insidious, perhaps, than phishing, but potentially as damaging is a relatively new technique called "scraping."
Scraping is the practice of trolling social networking sites, message boards and chat rooms looking for personal information that can help firms target the right people with their marketing efforts. And instead of being cloaked in the guise of a Nigerian prince or other shady character, scraping is being sponsored by some big-name, legitimate companies, and it's starting to find its way into healthcare.
The Wall Street Journal reported last week that media research firm Nielsen Co.--you know, of TV viewership ratings fame--was caught copying messages off the message boards of consumer healthcare support site PatientsLikeMe. PatientsLikeMe identified and blocked Nielsen from its site and sent notices to registered users, but the damage had been done.
Monday, October 18, 2010
You can't improve what you don't measure; you can't measure what you don't understand; and you can't understand what you don't collect. And, it's at this intersection of understanding where the National Quality Forum (NQF), measure stewards, "meaningful use," "retooling" and "eMeasures" meet.
NQF has played a key role in setting national priorities and goals for performance improvement and for endorsing national consensus standards for measuring and publicly reporting on performance. To date, most performance measures have been developed and are available in a paper-based format. This means data collection to understand performance, compare outcomes, and define key data inputs and outputs requires manual review and abstraction.
In 2009, HHS, motivated by the HITECH Act and the meaningful use regulations, requested that NQF manage the "retooling," or conversion, of a set of 111 measures from the traditional paper-based format to the electronic measure, or "eMeasure," format that is readable by electronic health records. Working in close collaboration with its measure steward partners, NQF is 61 measures down the path toward completion and expects to complete all measures by the end of 2010. This conversion should ensure that performance measure data are consistently defined, implemented, and usable in the context of an EHR and support the meaningful use requirements.
Open-source system lets health care organizations exchange records securely and efficiently
- By Edmund X. DeJesus
- Oct 15, 2010
Until recently, there wasn’t an easy way for federal agencies to securely and efficiently exchange health care information with one another or other organizations.
But a standards-based, open-source approach orchestrated by the Health and Human Services Department's Office of the National Coordinator for Health IT promises to do just that via the Connect program.
The Connect program supplies free software that government agencies and private-sector health care providers can use to exchange patient information.
Federal agencies that provide health-related services often face conflicting requirements. They must provide the best possible medical care for people, and they must make sure that patients' medical records remain private and secure. Moreover, they need to share health information using Nationwide Health Information Network (NHIN) standards. In addition, each federal agency has its own regulations about medical information.
October 6, 2010
THE expression “sharing is caring” was coined long before the Internet and social media like Facebook and Twitter made it easier for information, opinions and advertising to be shared among multitudes.
Starting on Thursday, the Web site Sharecare.com is to arrive, offering what its proprietors call an interactive social Q.& A. platform to provide consumers with what they want to know on health and wellness subjects — with the A’s being contributed by, among others, marketers.
Those behind Sharecare, a company formed last year to operate Sharecare.com, hope its features will enable the new Web site to thrive in a crowded field. Others in the online health care category include About.com, AOL, CNN, eHow, Everyday Health, Health.com, MSN, WebMD and Yahoo.
Sharecare.com will begin with content contributed by organizations like AARP, the American Cancer Society, the American Heart Association, the American Red Cross, the Cleveland Clinic, Johns Hopkins and the National Academy of Sports Medicine, along with medical professionals like Dr. Mehmet Oz.
The use of Information and Communication Technology (ICT) or e-Health is seen as essential for a modern, cost-effective health service. However, there are well documented problems with implementation of e-Health initiatives, despite the existence of a great deal of research into how best to implement e-Health (an example of the gap between research and practice).
This paper reports on the development and formative evaluation of an e-Health Implementation Toolkit (e-HIT) which aims to summarise and synthesise new and existing research on implementation of e-Health initiatives, and present it to senior managers in a user-friendly format.