Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, January 31, 2011

Weekly Australian Health IT Links – 31 January, 2011.

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.

General Comment:

Well, Australia Day has passed and 2011 has begun in earnest.

The main news last week was dominated by discussions about what should happen to HealthSMART. It will be interesting to see how it plays out.

My suggestions are here:


There are also some good comments from the readers.

We can expect a similar review in NSW within weeks of the March 2011 election there - which it looks like the Coalition will win in a landslide or more. Will be interesting to see how that plays out also.

We also need to see some answers from NEHTA and DoHA on key forward directions real soon now - as the year has really now begun!



Computers usurp GP during consultations

The presence of computers has altered the dynamics of a GP consultation, with patients now subconsciously relating more to the computer than the doctor as the ultimate source of information, a Melbourne study suggests.

Video analysis of patients’ body language during 141 GP consultations has shown that the doctor-patient relationship has become ‘triadic’ by also involving the computer.

Writing in the Journal of the American Medical Informatics Society (online 24 Jan), study author Dr Chris Pearce says computers have shifted the balance of power in the doctor-patient relationship, allowing patients to set or alter the agenda of the consultation.

Patients presenting for a prescription or test results, for example, may gaze intently at the computer screen rather than the doctor, and thus shift the focus of the consultation.

”No longer are doctors seen as the ultimate authority in the consultation. In fact, the computer was often brought into play by patients to directly challenge the doctor’s authority,” Dr Pearce observes.



GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).



NEHTA congratulates Dr Mukesh Haikerwal (AO)

Congratulations to Dr Mukesh Haikerwal who was made an Officer (AO) in the General Division of the Order of Australia "for distinguished service to medical administration, to the promotion of public health through leadership roles with professional organisations, particularly the Australian Medical Association, to the reform of the Australian health system through the optimisation of information technology, and as a general practitioner."



Doctor applauds colleagues and community

January 26, 2011

TWO years after a brutal assault that nearly claimed his life, a Williamstown doctor has been recognised in the Australia Day honours for his work helping others.

Mukesh Haikerwal will today be appointed an Officer of the Order of Australia.

In September 2008, he underwent emergency surgery at Footscray's Western Hospital to remove blood clots from his brain after being bashed with a baseball bat near his Williamstown home.



Orion in 'the right place at the right time' for e-health growth

NEW Zealand software company Orion Health is the surprise linchpin of emerging e-health consortiums both globally and in Australia.

Orion is on an expansion drive, with its e-health records and information exchange products boosting revenue 80 per cent in the first half of 2010-11 compared with the previous year.

With 22 major projects in 12 countries, Orion believes prospects are finally looking up in Australia, with the federal government's new emphasis on e-health.

Late last year, Orion, with consortium leader Accenture and partners IBM, Oracle and Hewlett-Packard, bagged a $146 million contract to deliver Singapore's national e-health records (NEHR) project.

Singapore's Ministry of Health says NEHR is a key part of its vision for "one Singaporean, one health record" for 5 million citizens. It builds on previous investments in integrated clinical management systems, a hospital records exchange hub and a GP IT program.



Aussies blinkered in vision race: local researchers face global competition in bionic market

WHEN this picture ran on the front page of The Australian in April 2008, Minas Coroneo and his tiny team had a prototype bionic eye ready for human trials. All that was missing was $200,000- $300,000 to run the trials with the 10 volunteers.

"While the device will not immediately achieve 20-20 vision, as the technology advances the bionic eye will evolve," he said then, adding that simply having the ability to navigate "would be a huge breakthrough" for people with impaired vision.

Since then much has happened, none of it foreseen by Coroneo, an ophthalmologist, researcher and chairman of the Genetic Eye Foundation in Sydney.

Following former prime minister Kevin Rudd's 2020 summit, the government committed $50 million over four years to support development of a functional bionic eye. Bionic Vision Australia received $42m; Monash Vision Group got $8m for its direct-to-brain bionic eye project; and Coroneo's group, nothing.



Health myki faces axe

Kate Hagan

January 24, 2011

THE state government is considering abandoning Victoria's trouble-plagued $360 million health technology program, with Health Minister David Davis admitting he faces ''a genuine dilemma with 'the myki of the health system' ''.

The HealthSMART program - five years late and $35 million over budget - is supposed to link computer systems in hospitals and introduce processes such as electronic prescribing.

But clinical applications are only partially running in just four hospitals, and doctors say patient safety is compromised by inadequate procedures that causes them to duplicate paperwork, chase test results and compete for access to computer terminals.



Health IT program Healthsmart faces the axe

  • Jessica Craven
  • From: Herald Sun
  • January 24, 2011 12:43AM

THE future of a $360 million program designed to improve care in Victorian hospitals is under a cloud.

The Australian Medical Association has called for an additional $260 million to be invested in the botched HealthSMART program, which is five years late and $35 million over budget.

The patient management system was designed to link hospital computer systems.

Health Minister David Davis told the Herald Sun the program was under review but would not be drawn on reports the Government was considering axing it.



System is sick, not dead

Dr Harry Hemley

January 25, 2011

FOR those unfamiliar with computer systems in Victoria's public hospitals, you would probably have to cast your mind back to the early 1990s to realise just how poor the information technology networks are in our supposedly world-class health program.

We're talking paper-based records, people queuing to use the available computer terminals and the difficulty sharing information with off-site colleagues. For patients in our public hospitals, the ramifications of poor IT systems are serious.

The problem starts from the time a person is treated in the emergency department and doctors and nurses aren't able to get access to the person's history of care with their general practitioner.



'Too late' to kill e-health program

Kate Hagan

January 25, 2011

THE state government should stick with Victoria's bungled $360 million health technology program because it was finally starting to deliver some benefits, an e-health expert has argued.

Mukesh Haikerwal, who is the federal government's clinical advisor on e-health, said the HealthSMART program had ''a long tortuous history'' but cost savings would not be made by ditching it, only to start again from scratch to build an electronic system to share patient information in hospitals.

The Age revealed yesterday that the state government was considering abandoning the program, which is five years late and $35 million over budget.



Victoria’s e-health system may still yield benefits: Experts

24. January 2011 21:22

By Dr Ananya Mandal, MD

According to e-health experts, the state government should continue to patronize Victoria’s $360 million health technology program because it was finally starting to deliver some benefits.

According to Mukesh Haikerwal, who is federal government’s clinical advisor on e-health added that the HealthSMART program may not have been a roaring success but abandoning it now would only mean starting from the scratch to build an electronic system to share patient information in hospitals. There has been news that the state government was considering abandoning the program, which is five years late and $35 million over budget. Health Minister David Davis said the new government faced “a genuine dilemma with the make of the health system.”



iSOFT apps now on BlackBerry

Wednesday 26th January 2011

iSOFT Group Limited has joined the BlackBerry Alliance Program as a BlackBerry Alliance Elite Member under moves to introduce applications for care beyond traditional settings and hospital walls.

The company is working on a range of applications to help clinical staff deliver care more efficiently and patients to manage their conditions more effectively. These include apps for doctors to download daily workloads and appointments, for community nurses to record patient details and for patients to check vital signs, arrange appointments and referrals, and order repeat prescriptions.



Thousands of nurses to miss registration deadline

Julia Medew

January 25, 2011

THOUSANDS of Victorian nurses and midwives are at risk of being unable to work next week because they have not registered with the new national registration and accreditation scheme for health professionals.

A spokeswoman for the regulation agency, Nicole Newton, said about 5000 of the state's 84,000 nurses had not had their applications processed yesterday, despite being told last year the deadline was December 31.

She said a grace period of one month meant any nurse or midwife not registered by Monday would not be able to practise and would have to start the registration process again rather than transferring from the Victorian register to the national one.

Comment: Remember this agency is meant to provide the source information for NASH and the HI Service.



Qld Health starts iPad trial

By Renai LeMay, ZDNet.com.au on January 25th, 2011

Queensland Health this week revealed it was running a trial of Apple's hyped iPad tablet, deploying the device within its administrative employees, although tests with clinical staff have not yet kicked off.

The department's executive director of ICT service delivery, Phil Woolley, said the department was running a limited pilot program to determine potential solutions and services suitable for iPads and other similar devices. However, Woolley said, the deployment was restricted to administration staff only and the iPads have not been trialled for clinical purposes yet.

"Queensland Health has not formulated a view on the performance or usability of the iPad in clinical environments at this stage," he said.



You want a drink? Give us your fingerprints

Natalie O'Brien and Eamonn Duff

January 30, 2011

THOUSANDS of clubbers and pub patrons are being forced to submit to fingerprint and photographic scans to enter popular venues, seemingly unaware of the ramifications of handing over their identity.

Biometric scanners, once the domain of James Bond movies, are flooding the pub market as the fix-all solution to violence and antisocial behaviour. The pubs are exerting more power than the police or airport security by demanding photos, fingerprints and ID. Police can only do it if they suspect someone of committing a crime and they must destroy the data if the person is not charged or found not guilty.

Yet one company boasts that the sensitive information collected about patrons can be kept for years and shared with other venues in the country - in what appears to be a breach of privacy laws.

There are no official checks and balances on how the data is collected, stored, used or shared. Federal Privacy Commissioner Tim Pilgrim has warned he does not have the power to audit the systems and the lack of regulation has even industry players calling for tighter controls.



Web addresses drying up

THE internet is running out of addresses.

With everything from smartphones to appliances and cars getting online, the group entrusted with organising the web is running out of the "IP" numbers that identify destinations for digital traffic.

The touted solution is a switch to a standard called IPv6 that allows trillions of internet addresses, while the current IPv4 standard provides a meagre four billion or so. "The big pool in the sky that gives addresses is going to run out in the next several weeks," said Google engineer Lorenzo Colitti, who is leading the internet giant's transition to the new standard. "IPv6 is the only . . . solution."



Google's guru puts the case for IPv6

AFTER years of talk, internet pioneer Vint Cerf says it's time to act on switching to the new internet address standard, IPv6.

Google's chief internet evangelist said he would "do everything I possibly can" to get Google involved in demonstrations and testing over coming months.

"The IP version 4 address space will be formally exhausted from ICANN's (Internet Corporation for Assigned Names and Number) point of view within the next few weeks, maybe less," he said at an Internet Society of Australia reception in Sydney.

"The allocation of the last of the IPv4 blocs to regional internet registries is an important milestone.



LibreOffice 3.3 released, first since OpenOffice split

More enhancements scheduled for February 2011

LibreOffice, the fork of the open source OpenOffice.org productivity suite, has released it’s first stable product in version 3.3, now available for download.

LibreOffice is a project of the newly formed The Document Foundation which started in September last year following Oracle’s acquisition of Sun Microsystems, the principal sponsor of the OpenOffice.org project.

Since its inception, LibreOffice has grown from 20 to more than 100 contributors, many of whom left the OpenOffice.org community project.




AusHealthIT Poll Number 55 – Results – 31 January, 2011.

The question was:

Should The New Victorian Government Cancel / Review and Modify the HealthSMART Program?

The answers were as follows:

Yes - It is a Mess

- 24 (66%)

Maybe a Major Review

- 8 (22%)

It Just Needs Some Tweaking

- 1 (2%)

No - We Just Have to Be Patient

- 3 (8%)

Votes : 36

Oddly at about day 3 the poll went a bit odd - never done it before. The count seemed to have reset. The count then was 27/10/1/2.

Whatever happened the answer that it is a mess that needs a major review seems to be strongly supported!

Again, many thanks to those that voted! Sorry about the glitch!


Sunday, January 30, 2011

The RACGP Provides A Budget Submission for 2011/12. In E-Health They Seem To Have Got A Bit Lost!

This report a few days ago prompted me to go and have a look what the RACGP had to say in the e-Health Domain - given their close sponsored relationship with NEHTA.


GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).

“The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training,” the association’s submission reads. “General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.”

While GPs are widely recognised as key stakeholders in the widespread implementation of e-health, they are often stereotypically portrayed as Luddites and obstacles to cultural change within the health system.

However, according to the association this was largely due to the relative lack of technical resources available to individual doctors, leading to poor processes and security culture when using electronic equipment such as e-health records.

As a result, the submission argues for ongoing education and training programs as well as incentives provided to doctors to encourage adoption of e-health standards.

Here is the e-Health text of their submission.

The College summarised the overall submission thus:

Key messages

The RACGP advocates that the Federal Government should:

  • Continue significant investment in e-health
  • Build the capacity of general practice
  • Enhance health outcomes for regional, rural, and remote communities
  • Enhance the health of Aboriginal and Torres Strait Islanders communities
  • Recognise and reward for general practice
  • Support international medical graduates.

The document is here:


The specific e-Health component of the submission is here (Pages 4 and 5):

1. Investing in the future of e-health - readiness for a Personally Controlled Electronic Health Record (PCEHR)

The implementation of an efficient and effective e-health system is a long-term undertaking across the stages of planning, implementation, and financing. The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training. The method of delivery of general practice services will need to evolve in order to incorporate nationally established guidelines and solutions, ultimately achieving safer, more accessible, and efficient health services.

The RACGP supports and encourages a national standards based approach to e-communication, and acknowledges the work of NeHTA in establishing standards that will build consistent messaging and communication between different software solutions. However training and support is required to up-skill the general practice profession in the technical and functional interoperability of e-health solutions.

A Personally Controlled Electronic Health Record (PCEHR) will be available from July 2012. Expansion of investment in e-health, to include support to develop user skills and knowledge in the importance of quality patient information, will be well received by health care providers.

To prepare general practice for the PCEHR and to be e-health ‘ready’ will require an investment across:

· Change management within the practice

· Training and education of practice staff

· Implementation of systems (technical systems).


  • Invest in the national implementation of e-health guidelines and standards and ensure access to e-health communication tools and decision support solutions.

1.1 Technically ready for the PCEHR

An essential pre-requisite for an efficient and effective e-health system is the electronic exchange of accurate and relevant patient information across the health sector, including different health care providers, private and public sectors, and patients. General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.

General practice requires investment in development or enhancement of existing software systems to better address patient identification and authentication, and investment in hardware infrastructure to securely share patient health information via the PCEHR.


· Invest in general practice software and hardware to ensure that practices have the technical capability to support implementation of the PCEHR.

1.2 Functionally ready for the PCEHR

Uptake of the PCEHR by health care providers will be aligned to confidence in the quality and usefulness of the PCEHR in being able to support continuing care across geographical and professional boundaries.

Further investment is needed to deliver change management and education and training in general practice to ensure rapid dissemination of new knowledge, support change, and guarantee adoption of the new technologies and systems.


· Invest in education and training for general practice staff in the use and benefits of the PCEHR.

· Provide incentives for general practices to dedicate human resources specifically for the quality analysis, and quality improvement, of data in GP e-health summaries outside of the patient consultation through either Practice Incentive or Service Incentive Payments.

1.3 Information Security

Increased use of e-health initiatives must be combined with effective security measures. These security measures must be designed to ensure that highly sensitive and confidential information relating to: individual patients; the health professionals who provide care; and the business component of the general practice is securely managed.

General practice has specific needs for computer and information security, as it can often be a challenge for general practices to find security experts and technical service providers who understand the business of delivering care in the general practice environment.

Some issues contributing to this challenge include:

· Inadequate risk analysis and identifying gaps in security

· Lack of designated authority (person) to ensure robust security processes are documented and adopted

· Poor data management processes to ensure that information is backed up and can be recovered easily if there is a system failure

· Inadequate business continuity and disaster recovery planning

· Lack of and/or poor password security

· Lack of security ‘culture’ and leadership.


· Introduce a national strategy aimed at providing ongoing education and training for general practitioners, practice nurses, and practice staff regarding data security in primary healthcare.

---- End Extract.

I think a few comments on this are warranted - remembering that this is a Budget Submission - i.e. a request for funds for General Practice:

1. Despite all the wonderful stories the RACGP publishes with NEHTA about how wonderful things are in e-Health the very first paragraph says more ‘evolution’ is needed.

2. The College then goes on in paragraph two to suggest that GPs need more training and support to move forward on e-Health.

3. In paragraph 3 they rather bizarrely seem to suggest that improving user ( public ) skills and knowledge in ‘quality patient information’ will be well received by health care providers and that the PCEHR will all be available by July 2012. I don’t know many providers who are looking forward to patients providing their view of ‘quality patient information’. Do you?

4. Before this date we are alerted to the need for change management, training and education and to actually get new improved systems in place.

5. Then we are told we need investment in national implementation of ‘e-Health guidelines and standards to ensure access to e-health communication tools and decision support solutions’. Does anyone actually know what that collection of words actually means?

6. The rest of the section then goes on to ask for support for new improved systems and all the activities to foster their adoption and use.

7. As best as I can tell there is not a single dollar amount attached to any of this.

Bottom line is that this is the sort of budget submission you put in, on e-Health, when you really don’t know what the PCEHR is, what impact it might have and how you may be impacted.

They would have done better to say ‘we think we will need some help with aspects of the PCEHR once we are clear what it will actually turn out to be and when it will be ready’. That way they would not have had to put in this rambling un-costed and un-scoped drivel.

I note there is not one word on the place of General Practice in provision of clinical summary information for the PCEHR. I wonder why that is?

I wonder which marketing genius in the College came up with these 2 pages and how closely the e-Health Subcommittee scrutinised what was done?


Saturday, January 29, 2011

A Useful Set of Comments for the US Government on the Presidential Commission’s Health IT Proposals.

The following was provided to the US Government as week or so ago.


An Information-Rich Ecosystem

Collaborative Comments in Response to the Office of the National Coordinator’s Request for Information regarding the PCAST Report on Health IT

January 19, 2011 | Collaborative Comment

Markle Connecting for Health Community

Markle Connecting for Health collaborators respond to HHS's request for information on PCAST's report on health IT.

Download Executive Summary

Download Collaborative Comments

The President‘s Council of Advisors on Science and Technology (PCAST) report Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans1 envisions an information-rich health ecosystem. Like PCAST, we seek to accelerate the use of modern information tools to improve health outcomes, increase the cost-effectiveness of care, and encourage innovation while protecting privacy.

Markle Connecting for Health, a public-private collaborative of more than 100 organizations across the spectrum of health care and information technology (IT), appreciates the opportunity the Office of the National Coordinator for Health Information Technology (ONC) has provided for commentary on this very important report.

Our comments fall into three parts. We start by addressing the basic parameters of the PCAST vision, one that has many parallels to the Markle Connecting for Health Common Framework (Markle Common Framework). Next we provide input on some of the specific recommendations of the report, and here our comments fall into two categories: As in all of our past work, we emphasize the importance of starting with clear goals and a policy framework to guide technology choices and solutions, and we consider some of the novel technology approaches that PCAST proposes and their implications for the vast, heterogeneous environment that characterizes US health care today. Lastly, based on the collective experience of our broad collaboration, which has worked together on solutions to health IT challenges for nearly a decade, we provide ONC a set of forward-looking recommendations that we believe can accelerate the use of health IT to improve health outcomes and cost effectiveness while protecting privacy.

A Vision Supported by the Markle Connecting for Health Common Framework

The PCAST report offers a compelling vision for an information-rich health care system that we support. The Markle Common Framework is aligned with and supportive of the PCAST vision for:

  • A nationwide capability for secure health information exchange using the Internet, not a new network.
  • A distributed network for information-sharing.
  • A model for linking patient information across sites of care using existing identifiers.
  • An approach to technology that emphasizes innovation and a diversity of solutions to support broad participation and new entrants.
  • A comprehensive set of privacy and security practices to support trust in information sharing.
  • A universal exchange language for sharing health information securely over the Internet.
  • Population health improvement and analysis using distributed networks.

However, we also identify areas for further development and analysis based on our experience with three foundational principles. These principles, which have guided our work for nearly a decade, most notably the Markle Connecting for Health Common Framework, offer grounding for our comments on the PCAST report.

----- End Quotation.

This material is well worth a download and browse! They have a range of very interesting proposals and ideas to take forward what has been suggested.


Friday, January 28, 2011

Weekly Overseas Health IT Links - 28 January, 2011.

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.


Mobile, Analytics Lead Health IT Trends

Researchers say healthcare providers and insurers will invest heavily in business intelligence tools, wireless technologies, and cloud computing in 2011.

By Nicole Lewis, InformationWeek

Jan. 18, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229000824

Insurance companies and physicians face many challenges in 2011 as new models of care emerge, machine-to-machine transmission of health data increases, more business intelligence tools to analyze health data are used, and the adoption rates for mobile health devices grows.

Published last month, the IDC Health Insights report, "U.S. Connected Health IT 2011 Top 10 Predictions: The Evolving IT Landscape for Payers and Providers," identifies several major trends that will impact the payer and provider IT landscape this year. Among the trends noted in the report are the emergence of new care and reimbursement models and the expanded use of wireless networks to transmit health information from personal monitoring devices.



Survey: Docs Skeptical of EHRs, Hate Reform

HDM Breaking News, January 20, 2011

A recent survey of nearly 3,000 physicians shows high levels of displeasure with the Affordable Care Act--and a lot of them don't like electronic health records either.

Of the 2,958 physicians surveyed in September, only 39 percent believe EHRs will have a positive effect on the quality of patient care. Twenty-four percent believe EHRs will have a negative effect on quality, and 37 percent forecast a neutral factor.

HCPlexus, publisher of the The Little Blue Book reference guide for physicians, developed and conducted the survey with content vendor Thomson Reuters. The survey sample came from physicians in HCPlexus' database. The fax-based survey was done in September 2010, with additional information directly gathered via phone or e-mail from hundreds of the surveyed physicians in December and January.



Top 10 external factors for EHR success in hospitals

January 18, 2011 | Molly Merrill, Associate Editor

FALLS CHURCH, VA – Meaningful use, improved patient care and competition among providers are a few of the reasons electronic health records are succeeding at hospitals, according to one expert.

David Lewis, principal at CSC Consulting, shared with Healthcare IT News his top 10 list of why EHRs are gaining more positive traction, based on what he's seeing from his hospital clients.

In November, Healthcare IT News also interviewed Karen Fuller, a principal with CSC's Health Delivery Group, who weighed in on her top 10 list of why EHRs are succeeding today. The difference between the two lists is that Fuller focused on internal factors that had an impact on EHR implementation, such as leadership and governance, whereas Lewis's list focuses on external factors, such as the government's meaningful use incentives.



EMR not boosting productivity? It could be a mismatch between system and specialty

A study highlights how technology doesn't guarantee results if the system isn't right for the practice.

By Pamela Lewis Dolan, amednews staff. Posted Jan. 17, 2011.

If it's been many months since you bought your electronic medical records system and you're still seeing fewer patients as you did before you got it, the problem might not be you -- it might be your EMR.

Specifically, it might be that the EMR you bought isn't designed or customized to work with your specialty -- a problem technology industry experts say could become more common and acute as practices rush to buy systems to gain federal financial incentives.

Researchers at the University of California at Davis studied how an EMR implementation at six primary care offices affiliated with the same academic medical center affected physician productivity levels. They found that after an initial dip in productivity during the training period -- which is normal -- internists were able to increase productivity above pre-EMR rates, while pediatricians and family physicians were never able to regain their pre-EMR productivity. Why? Because the EMR system more closely matched the work flow of the internists.



Accenture contract will examine EMR real-world use

January 20, 2011 — 1:45pm ET | By Janice Simmons - Contributing Editor

Under a new contract, Accenture will be working with the Office of the National Coordinator for Health Information Technology to develop and manage real-world "use cases" that ONC will use to help in the exchange of data across the healthcare system.

The use cases will focus on patient‑related information--ensuring that care providers' certified EMR systems can handle patient requests for clinical summaries, according to the Reston, Va.-based consulting and technology services company.



What can we expect for Stage 2 of Meaningful Use?

January 20, 2011 — 9:24am ET | By Janice Simmons - Contributing Editor

Survey data released this month by the Office of the National Coordinator for Health Information Technology (ONC) showed promising figures in terms of adoption of electronic health records during the first stage to achieve meaningful use.

In survey data prepared by the American Hospital Association, 81 percent of hospitals said they plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of those hospitals (65 percent) responded that they will enroll during Stage 1 of the incentive programs during 2011-12.



Why is it difficult to implement e-health initiatives? A qualitative study

Elizabeth Murray, Joanne Burns, Carl May, Tracy Finch, Catherine O'Donnell, Paul Wallace and Frances Mair

Implementation Science 2011, 6:6doi:10.1186/1748-5908-6-6

Published: 19 January 2011

Abstract (provisional)


The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.



KLAS Looks at Clinical Decision Support

HDM Breaking News, January 20, 2011

A new report from vendor research firm KLAS Enterprises examines provider use of clinical decision support software.

Many providers, according to the Orem, Utah-based firm, primarily are focusing on decision support requirements under Stage 1 of the electronic health records meaningful use program.

The report covers order sets, multi-parameter alerting, nursing care plans, reference content and drug information databases, along with non-EHR vendors providing such tools and content.



Lessons from EHR Pros

HDM Breaking News, January 20, 2011

Consultancy firm Accenture estimates nearly 90 percent of U.S. hospitals will have to install or upgrade electronic health records systems during the next three years to become meaningful users.

Consequently, Accenture recently conducted comprehensive interviews of 15 CIOs from delivery systems that have reached at least Stage 4 on the HIMSS Analytics' scale of EHR achievement to learn their lessons.


For the full report on survey results, click here.



Security and identification

One baseline requirement to protect security in a health information exchange is to make sure the record being accessed belongs to the patient in question.

The Privacy & Security Tiger Team, a work group of the federally chartered Health Information Technology Policy Committee, spent a couple of hours Tuesday wrestling with some of the thornier issues of medical records matching.

Absent a national patient identifier, most health information exchanges in the U.S. use some form of probabilistic matching of a handful of data elements to link patients to their records across multiple repositories. Commonly, those data fields include first and last names, date of birth, ZIP code, street address and gender. Cell phone numbers are becoming increasingly useful; Social Security numbers are waning in importance.



CCHIT launches custom-EHR certification

By Maureen McKinney

Posted: January 19, 2011 - 11:30 am ET

The Certification Commission for Health Information Technology has launched an alternative electronic health-record certification program crafted specifically for hospitals that have uncertified legacy software, customized systems or EHR systems developed in-house.

The EHR Alternative Certification for Hospitals, or EACH, will offer specialized assessment tools, online learning and preparation programs and support, according to a CCHIT news release.



New technology can be the best medicine

By Mike Snider, USA TODAY

We all know that smartphones, tablet computers and big-screen TVs are transforming the workplace and home. But the newest gadgets could also be a tonic for medicine and health care.

Cellphones have already proven to be a potent medical instrument in improving patient outcomes. Diabetes patients who are sent videos on their cellphones and actually view them are more likely to check blood sugar levels and comply with their care regimens, said U.S. Army Col. Ron Poropatich, who spoke at the International Consumer Electronics Show in Las Vegas last week.



Cancer survivor aims to raze treatment, research barriers with an app to enable collaboration

SAN FRANCISCO — In the late 1990s, Marty Tenenbaum was a hotshot e-commerce entrepreneur riding high on the dot-com boom when he noticed a lump on his body.

His doctor told him it was nothing, but when he finally had it removed, he learned he had melanoma, the deadliest form of skin cancer.

He beat the disease, but he never got over the sense of frustration he felt as he clawed his way through the maze of treatment options, clinical trials and research in search of a way to survive.

Now 67, Tenenbaum still believes he would not have made it if he hadn't had personal connections at the National Cancer Institute who guided him toward cutting-edge experimental treatments that saved his life.



ONC will simplify guides for establishing exchange standards

By Mary Mosquera

Tuesday, January 18, 2011

The Office of the National Coordinator for Health IT plans to develop a clearer set of technical descriptions for establishing the standard clinical document formats for exchanging summary information as patients move across settings of care.

ONC will also consolidate into a consistent template-based guide the advice offered by multiple organizations for implementing the standard document formats used to share data about patients’ medications and problems.

These are among the first projects that ONC has launched for its Standards & Interoperability Framework, which will tackle persistent challenges that healthcare providers face in successfully exchanging information in order to meet meaningful use requirements of electronic health records (EHRs), according to Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.



Electronic Health Record Deployment Techniques

SA Kushinka of Full Circle Projects

January 2011

Starting in 2006, the California Networks for Electronic Health Record Adoption (CNEA) initiative has worked to speed adoption and lower the cost of electronic health records (EHRs) in California's community clinics and health centers. In August 2008, seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. In 2010, CHCF began publishing a series of tactically oriented issue briefs that highlight lessons learned since the initiative began.

The first issue brief in the series, Chart Abstraction: EHR Deployment Techniques, examines the process of entering or "populating" the electronic chart with clinical data from the paper record. This process entails an inevitable decrease in productivity due to disruption in workflow, user training, and the need to maintain both paper and electronic records during the transition period. Through clinical committees or other consensus building forums, CNEA grantees developed strategies that defined what information would be entered, when, and by whom - weighing the value of the information versus the cost of entering it. The clinics' experiences with these techniques and a discussion of pros and cons are included.



JAMA: PHRs must be patient-centered to work

Written by Editorial Staff

January 18, 2011

Personal health records (PHRs) have great potential to help patients manage their health, but the technology must be designed with the patient in mind—which means doing more than helping patients merely access their health information, according to an editorial in the Jan.19 issue of the Journal of the American Medical Association.

In the editorial, Virginia Commonwealth University (VCU) family medicine physicians Alexander Krist, MD, associate professor in the department of family medicine in the VCU School of Medicine; and Steven Woolf, MD, professor in the department of family medicine and director of the VCU Center for Human Needs, describe a model to guide the creation of more patient-centered PHRs.

PHRs should include five key functions, according to the model:

  • Collect and store information from the patient;
  • Collect and store information from the patient’s doctor;
  • Translate clinical information into lay language;
  • Tell patients how to improve their health based on their personal information; and
  • Make the information actionable for patients.

Using principles from their model, Krist and Woolf’s research team has created a patient-centered PHR for prevention which shows patients their medical information and tells them what it means in a way they can understand. Further, it guides them to the next action steps.



CCDs help UPMC coordinate care across various settings

January 18, 2011 — 10:07am ET | By Ken Terry - Contributing Editor

The continuity of care document (CCD), a standardized care summary designed for information exchange among different kinds of electronic medical records, has not been widely used up until now. But the University of Pittsburgh Medical Center is relying on CCDs to coordinate care as patients move through the system--which will help the hospital and its physicians in meeting requirements for Stages 2 and 3 of meaningful use.

When primary-care physicians in the community refer patients to specialists employed by UPMC, they're encouraged to send CCDs from their EMRs. When the consultants send the patients back, they transmit CCDs to update the doctors on what has happened with the patient. And as patients move from one care setting to another--whether it be the oncology department, the transplant program, or the emergency department--their CCDs go with them online.



Colorado HIE efforts spotlight privacy issues

January 17, 2011 — 10:17pm ET | By Ken Terry - Contributing Editor

A recent Denver Post article about the Colorado health information exchange reveals the disconnect between the nationwide effort to connect health records online to improve patient care and safety and the continuing worries about the security of online medical records.

To those who follow this field, the most important fact in the piece is that the Colorado HIE--one of 56 state and territorial HIE initiatives that are in line to get federal grants--has already signed up 800 providers. But the major focus of the article was on the critics who say that HIEs will increase the already high risk of unauthorized individuals getting their hands on personal health information. Sure, that's a problem, and one that technology should be able to address. But at this point, what's critical is to get all the information silos connected.



More 'on-ramps' could accelerate provider connectivity to HIEs

January 18, 2011 — 10:34am ET | By Ken Terry - Contributing Editor

Considering that the federal government is pouring $563 million into the states to build health information exchanges, it's not surprising that some of the largest technology and telecommunications companies are moving into the business of electronic connectivity.

Hewlett Packard's just-announced foray into information exchange with the Texas Medicaid program is the latest in a barrage of announcements from tech giants within the past nine months.

Covisint, which provides the platform for the American Medical Association's physician portal, recently said that it's expanding its relationship with the Northeast Pennsylvania HIE. Covisint currently provides the exchange with secure clinical messaging. It now will deliver clinical and administrative data to providers at the point of care, as well.



E-Health Systems: For Love or Money?

Gienna Shaw, for HealthLeaders Media , January 18, 2011

Healthcare providers are marching toward certification and meaningful use of their electronic health systems and thinking about how they'll spend the financial rewards for doing so. But are they doing it for the love of e-health technology? Or are they doing it because the government is all but forcing them to?

A recent survey conducted by the HealthLeaders Media Intelligence Unit, E-Health Systems: Opportunities and Obstacles, suggests healthcare leaders are feeling positive that they'll meet meaningful use requirements. In fact, 91% said they will be ready by 2016 at the latest. And 41% said their systems are already certified by an approved ONC certifying body.



HDM, University to Test EHRs

HDM Breaking News, January 18, 2011

The Polytechnic Institute of New York University and Health Data Management magazine have launched a new health care software testing facility.

Health Data Tech Labs (www.healthdatatechlabs.com) will provide physicians and hospitals with expert, independent reviews of electronic health records software. Reports evaluate installation and maintenance, system configuration, user training and "test drive" use-case scenarios. They also incorporate a unique self-evaluation process that enables professionals to match systems to their own specific requirements. The Tech Labs service will not certify EHRs as meeting meaningful use requirements. It is intended to help providers during the vendor selection process.



Medical records technology helps with drug recall

January 17, 2011 8:56 AM

Jared Janes

The Monitor

McALLEN — When the U.S. Food and Drug Administration issued a recall on the prescription painkiller Darvocet due to heart-related side effects, the use of medical technology saved Dr. Juan Salazar’s nurses countless hours trying to identify his patients on the drug.

Salazar implemented electronic medical records in his clinic on East Nolana Avenue some 14 months ago in advance of federal government guidelines that aim to put the nation’s health care providers on computerized records by 2015. So when the Darvocet recall was issued in late November, Salazar’s staff could use his clinic’s computerized database to quickly identify more than 50 patients on the prescription.

“We got on the computer, pulled data that showed all the patients we prescribed the Darvocet, and it gave us all their phone numbers” to notify them of the recall, Salazar said. “Without (electronic medical records), we would have to go manually through all of my paper charts, which would have been impossible. It would have taken several people and lots of manpower hours to do so.”



Will Digital Technology Reduce Gap in Health Between Rich and Poor?

Experts Worry Low-Income Clinics Cannot Afford Electronic Health Records

By Emma Schwartz | January 11, 2011

Two years ago, the Ethio American Health Center opened its doors in the nation’s capital, promising the country’s largest community of Ethiopian immigrants a place where doctors spoke their language and understood their culture.

Many of the community’s poorest quickly flocked to the center. But for all the specialized services the center offers patients, there’s one area where it’s fallen short: moving from paper files to electronic health records. They don’t even have a website.

“It would be great, but we can’t afford it,” said Dawit Gizaw, the center’s administrator.

The center is not alone. Although the federal government is directing billions of dollars in economic stimulus money to get electronic health record technology into hospitals and clinics nationwide, some doctors and small clinics indicate they’re unlikely to meet the Obama administration’s goal of going digital in the next five years.



ONC will focus on interoperability in 2011

By Mary Mosquera

Thursday, January 13, 2011

The Office of the National Coordinator for Health IT will focus in 2011 on activities that will enable healthcare providers to perform complex exchanges of information and on the technical foundation to support secure sharing.

ONC is considering a set of tasks it needs to undertake “in short order” to make it possible for stage 2 of meaningful use to have a more robust exchange of information, said Dr. David Blumenthal, national health IT coordinator, at the Jan. 12 meeting of the advisory Health IT Standards Committee.

Those activities are centered around standards and certification criteria, privacy and security protections, governance of exchange, and the assurance that the public will need that organizations involved in exchanging information have accomplished the conditions that foster trust and interoperability, he said.



MP warns Health CIO: don't sign NHS IT deals with CSC or BT for now

A 2.7bn NHS deal with CSC is imminent – but an MP on the Public Accounts Committee says that signing a deal now could breach civil service responsibilities.

Richard Bacon MP, a long-standing member of the Public Accounts Committee, says in his letter, dated 13 January 2011, to Christine Connelly, the CIO at the Department of Health,

“As you know, the National Audit Office is now beginning a further urgent inquiry into developments in the NPfIT, and in particular of the awarding of former Fujitsu sites to BT.

"I would suggest that this inquiry will review a great deal of evidence that is relevant to the question of whether proposed contract renegotiations with BT and CSC really do represent good value to the NHS and taxpayers.