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."

Saturday, April 30, 2011

Weekly Overseas Health IT Links - 30 April, 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.



Do Decision Support Tools Make Docs Look Dumb?

Gienna Shaw, for HealthLeaders Media , April 19, 2011

While interviewing sources for my story on evidence-based medicine for this month's issue of HealthLeaders magazine, one surprising sentiment came up over and over. The healthcare leaders and industry experts I spoke with said some docs don't like decision support technology because they think it makes them look dumb.

When face-to-face with a patient, these sources say, docs don't want to seem reliant on finding the answers on a computer. Is it true?

Well, one study suggests that it is. In the study, researchers read various scenarios to waiting room patients about physicians who used decision support and heeded the recommendation or ignored it in favor of a less aggressive or more aggressive treatment. Participants in the 2008 study, published in the journal, Medical Decision Making, "always deemed the physician who used no decision aid to have the highest diagnostic ability" on a five-point scale, the researchers said.



CHIME Weighs In on ONC Federal HIT Strategic Plan

Margaret Dick Tocknell, for HealthLeaders Media , April 19, 2011

The College of Healthcare Information Management Executives has submitted comments to the Office of the National Coordinator on the proposed federal health information technology strategic plan.

CHIME supports the plan's goals but wants to see refinements that will increase the likelihood for effective and widespread adoption of IT by healthcare providers.

The comments are contained in an April 18 letter to Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology. The letter is signed by Richard A. Correll, president and CEO, and Lynn Vogel, MD, who chairs the CHIME board of trustees.



ONC to fine tune technical guides for standards in stage 2

April 20, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT intends to fine tune standards involved in realizing stage 2 meaningful use recommendations and fill in where missing details exist during the next four months.

ONC plans to “refresh and reload” adopted certification criteria and new or updated technical descriptions to guide vendors to establish standards, said Dr. Doug Fridsma, ONC director of standards and interoperability. He described it as ONC’s health IT “summer camp.”

The goal is to make it easier for vendors to effectively encode standard functions in electronic health records (EHRs) so healthcare providers can apply the standards to meet measures in meaningful use stage 2, he said at the Health IT Standards Committee meeting April 20.



Health IT work group considers EHR usability testing

By Joseph Conn

Posted: April 22, 2011 - 12:00 pm ET

At a meeting in Washington on Thursday, a work group of the federally chartered Health Information Technology Policy Committee tackled the question of whether and how it's possible to test the usability of electronic health-record systems—and opinions on the viability of such testing ranged from outright skepticism to absolute confidence.

The committee's adoption and certification work group heard testimony from an array of EHR experts, including providers, developers, testers and market watchers.

Dr. Christine Sinsky, an internist at Medical Associates Clinic in Dubuque, Iowa, said she has worked with an EHR system as both a clinician and a technical adviser since 2003. She described a litany of usability problems she has experienced personally or that have been reported to her. These included "death by PDF" when 50 scanned documents were stuffed into a patient's electronic record and needing 10 minutes for one EHR system to place an order for a mammogram.


IT Drives Patient Education

Computer-generated questionnaires, medication resolution programs, and sophisticated videos are making a difference in patient care.

By Paul Cerrato, InformationWeek

April 20, 2011

URL: http://www.informationweek.com/news/healthcare/patient/229401919

In an earlier column, I complained that IT spends a lot of time providing electronic tools for clinicians--electronic health records (EHRs), computerized physician ordering systems (CPOS), etc.--but not enough time developing tools to improve patient education.

I was wrong. Digging deeper into this area has convinced me that there are all sorts of practical technology-based resources to help patients understand their treatment and how to comply with their doctors' advice.

Simple But Effective

A closer look at the marriage between IT and patient education reveals that even simple measures can make a big difference. An innovative program set up at the Mayo Clinic is a perfect example.



Denver Health sees dividends with Microsoft chronic condition management

April 20, 2011 | Mike Miliard, Managing Editor

DENVER – A chronic condition management platform, deployed by Microsoft at Denver Health Medical Center, a safety net hospital in Colorado, is helping clinicians improve case management, customer outreach and analytics – and is reducing the costs associate with the readmission of diabetes patients.

Officials say the platform could well lay the foundation for a larger program designed to encourage patients to self-manage conditions.

"The onset of an aging population and the increase of chronic diseases is adding extreme costs to our healthcare system," says Jack Hersey, general manager, U.S. Public Sector Health and Human Services at Microsoft. He points out that roughly 83 percent of all healthcare spending is on managing chronic illness, and that diabetes alone costs U.S. $83 billion annually.



HealthVault Adds Medical Imaging

HDM Breaking News, April 20, 2011

A new feature of Microsoft HealthVault's personal health records platform with supporting tools enables users to upload their diagnostic medical images from a CD or DVD to their PHR, and burn discs to share the images with providers.



Electronic records can speed genetic study

Published: April 20, 2011 at 8:32 PM

EVANSTON, Ill., April 20 (UPI) -- Time-consuming collection of data for genetic disease clues can be done faster and cheaper by mining existing electronic medical records, U.S. researchers say.

Northwestern University researchers say the arduous and expensive process of recruiting thousands of patients to collect such health data can be replaced by gathering patient information already found in electronic records from routine doctor's office visits.

In a study, researchers were able to cull patient information in electronic medical records at five national sites that all used different brands of medical record software, a university release said Wednesday.



Caution urged as smartphone technology expands into medicine and health

By Jane M. Von Bergen

Inquirer Staff Writer

The airline passenger was in deep trouble - not breathing, no heart rate - when a fellow passenger, Raina Merchant, then a resident in emergency medicine, tried to save his life.

"The patient survived the flight, but, sadly, not much longer," said Merchant, who performed cardiopulmonary resuscitation on the passenger.

That was seven years ago.

Now Merchant, a University of Pennsylvania physician whose research centers on resuscitation, is developing a mobile-phone app that would, with one push of a button, provide oral instructions for CPR. The app would even say, "Press, press, press," to allow the right rhythm for chest compressions.



Many ambulatory EMR users not ready for MU

April 21, 2011 — 10:18am ET | By Janice Simmons

More 80 percent of the nearly 600 ambulatory providers interviewed by KLAS who have purchased an electronic medical record (EMR) are confident they will qualify for Meaningful Use in 2011. However, additional research finds that many of those users still have significant gaps to fill in to meet the MU requirements, according the research firms latest report.

For instance, more than two-thirds of the surveyed providers--who are using 25 different EMR systems--were not sharing EMRs with patients, and nearly half had not implemented clinical decision support rules. These are two key MU requirements, reports the company, which monitored vendor performance in eight key MU areas: progress notes, drug-drug and drug-allergy alerts, computer-provider order entry, data mining tools, ePrescribing, clinical decision support rules, patient electronic access to medical records, and viewing active medication, allergy, and problem lists.



Thursday, April 21, 2011

Wireless Medicine's Promise: Less Cost, Better Care

by David Gorn, iHealthBeat Contributing Reporter

PHILADELPHIA -- The future of health care is here. It just left a text message on your phone.

According to Mohit Kaushal of the West Wireless Health Institute in San Diego, the promise of wireless technology is multifaceted, encompassing a range of devices, including the ubiquitous cell phone.

"Everyone has them, across most income levels, so you can leverage them to take better care of people," Kaushal said. Take the issue of non-compliance, he said, where patients forget to take medication that could help keep them out of expensive crisis care. Physicians currently have little control over such a situation.



Health Care Providers Form Working Group to Maximize Value of e-Prescribing

April 21, 2011 (Toronto, ON) - A new working group of clinicians from various disciplines will help shape the future of e-Prescribing in Canada, announced Richard Alvarez, President and CEO, Canada Health Infoway (Infoway).

"Infoway greatly values the advice and knowledge health care providers have shared with us over the years," said Alvarez. "We are continuing this practice by forming an e-Prescribing Working Group, to bring leadership to our efforts to promote electronic prescribing. The goal is to contribute to the efforts of provinces, territories and the private sector to integrate e-Prescribing functionality into the clinical systems used by health professionals."



Tiger Team Seeks Comment on HIE Security

HDM Breaking News, April 20, 2011

The Privacy and Security Tiger Team federal advisory workgroup is seeking public comment as it develops a privacy and security framework for health information exchange.

The workgroup has released a summary document of principles and its current recommendations, and seeks comment on remaining gaps to be addressed.



Tiger Team asks public for feedback on exchange trust issues

April 21, 2011 | Mary Mosquera

An advisory panel has asked for public feedback on issues it should take up next as it continues to flesh out a comprehensive privacy and security policy framework for electronic health information exchange.

The framework builds on current law, specifically the Health Insurance Portability and Accountability Act (HIPAA), and is based on fair information practice principles, according to Deven McGraw, chair of the Privacy and Security Tiger Team, a work group of the advisory Health IT Policy Committee. McGraw is also director of the health privacy project at the Center for Democracy and Technology.

“The tiger team is eager to hear from the public about gaps in this framework that still need to be addressed,” according to McGraw and panel co-chair Paul Egerman in an April 19 announcement.



Cloud computing, digital signatures speed clinical trials

April 15, 2011 | Mike Miliard, Managing Editor

FT. LEE, NJ – A new whitepaper has demonstrated that the use of interoperable digital identities, digital signatures and cloud computing helps accelerate the initiation of a clinical trial while lowering costs.

The study, titled Research Collaboration in the Cloud: How NCI and Research Partners are using Interoperable Digital Identities, Digital Signatures and Cloud Computing to Accelerate Drug Development, shows the results of a 2010 pilot program in which researchers at the National Cancer Institute’s Cancer Therapy Evaluation Program (NCI/CTEP), the world’s largest sponsor of cancer clinical treatment trials, and Bristol-Myers Squibb used cloud-based IT to eliminate reliance on paper forms in clinical trials.


Healthcare Providers Frustrated By Excessive EHR Alerts

The flood of notifications coming from electronic health records distracts medical personnel from addressing urgent messages about patients' abnormal test results.

By Nicole Lewis, InformationWeek

April 19, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/229401847

Clinicians say they receive far too many alerts from electronic health record (EHR) systems. In addition to test-result alerts, they get many unnecessary notifications that complicate the task of reviewing the more urgent alerts. The flood of messages--up to 150 a day--adds to their already heavy clinical workloads, leaves them with very little time for the task of alert management, and frustrates the process of providing timely follow-up care.

That's the conclusion of a research report published in the April 12 issue of BMC Medical Informatics and Decision Making, which evaluated how Department of Veterans Affairs (VA) personnel are utilizing EHRs.


PTSD iPhone App Launches For Veterans

The Departments of Defense and Veterans Affairs launch the free PTSD Coach to help veterans suffering from post-traumatic stress disorder seek immediate help or manage their symptoms.

By Elizabeth Montalbano, InformationWeek

April 19, 2011

URL: http://www.informationweek.com/news/government/mobile/229401873

Veterans suffering from post-traumatic stress disorder (PTSD) now can turn to their mobile devices for help, thanks to a new application from the Department of Veterans Affairs (VA) and the Department of Defense (DOD).

The two agencies have developed the PTSD Coach application to help veterans dealing with symptoms of PTSD. The app can link them to local sources of support and even help manage their symptoms in the moment, according to the VA.

The free application, now available via the iTunes store for the iPhone, also provides people with accurate information about PTSD, so the agencies are encouraging family members and friends of veterans suffering from it to download it as well. The agencies also plan to release an Android version of the app by mid-June.



Patient data access will kickstart PCAST exchange vision

April 18, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT could include measures for the use and promotion of patient portals and direct access to their data in the next stage of meaningful use. Patient data could also be downloaded to a personal health record.

The portal could go a step further and give patients the option of receiving their summary information with tags that allow data to be broken down into smaller pieces or data elements and be shared as the first step toward a broad vision of health information exchange that a presidential commission outlined last year.

An advisory panel has come up with exchange uses that link meaningful use and the report from PCAST (President’s Council of Advisors on Science and Technology), where they intersect at the importance of engaging the patient.



Tuesday, April 19, 2011

Supreme Court Case on Rx Data Mining Requires Nuanced Understanding of Privacy

by Deven McGraw

On April 26, the U.S. Supreme Court will hear arguments in a case that could have significant implications for patient privacy. Sorrell v. IMS Health, Inc., et al. challenges the constitutionality of a Vermont statute that prohibits the use of drug prescribing information for the purpose of marketing drugs to physicians and other prescribers, without the consent of the prescriber. The case has the potential to do real damage to privacy protections, but understanding the various risks posed by the case requires some careful unpacking of the ways in which "privacy" is -- and is not -- at issue.

Vermont legislators wanted to control the costs associated with increased prescribing of brand-name drugs and to address safety issues related to increasing off-label drug uses. So they adopted a law saying that drug companies cannot obtain data about doctors' prescribing habits and use the information to market drugs to prescribers unless the doctors have consented.



Doctors could learn something about medical handoffs from the Navy

Mistakes commonly occur when a doctor goes off duty and transfers responsibility of a patient to another doctor. Handoffs are being studied and revamped to ensure continuity and consistency of communication and care.

By Rahul Parikh, Special to the Los Angeles Times

April 18, 2011

Consider the following story, from a doctor during his training: During a night on call, a patient he was "cross covering" — caring for during the night shift — went into cardiac and respiratory arrest. Dutifully, the resident and his team began to resuscitate the patient.

They performed CPR for well over a minute. Then, suddenly, they stopped — and not because the patient was beyond saving. Another team member had reviewed the patient's chart and learned he was not a "full code." The patient, in other words, had requested as part of his treatment plan that he not be revived should his body fail. Trying to save him had been wrong.



Privacy bill requires consent for collection of personal health info

April 13, 2011 — 3:27pm ET | By Ken Terry

Sens. John Kerry (D-Mass.) and John McCain (R.-Ariz.) have introduced a commercial privacy bill to protect consumers against the unauthorized collection, use, and dissemination of their personal information. While the bill mentions personal health information, it's not clear how it might affect health data exchange.

The bipartisan bill--the Commercial Privacy Bill of Rights Act of 2011--would create a framework for data use that "does not allow for the collection and sharing of private data by businesses that have no relationship to the consumer for purposes other than advertising and marketing," McCain said in a statement.



Top EHRs 'interfaced,' not integrated

April 15, 2011 — 9:27am ET | By Ken Terry

Many leading electronic health record vendors claim their ambulatory-care and hospital systems are integrated, but most are actually interfaced "under the covers," health IT consultant Vince Ciotti (pictured) tells FierceHealthIT in an interview. This applies to almost every vendor that developed either a hospital EHR or an ambulatory-care EHR and then acquired an EHR in the other sphere.

For example, Allscripts' ambulatory-care products are leaders in that field, just as Eclipsys' are in the hospital market, says Ciotti, a principal of H.I.S. Professionals, LLC, based in Santa Fe, N.M. Likening Allscripts' purchase of Eclipsys last year to a "shark swallowing a whale," Ciotti says, "If you're a hospital that uses Eclipsys, you're probably not going to start forcing your physicians to convert to Allscripts, and vice-versa. They're unrelated products, written by different programming teams, for different markets. They have no true integration like Epic and Cerner do, which alone run on the same hardware platforms and data bases."



Transition to hospital employment will accelerate EHR adoption

April 17, 2011 — 11:39am ET | By Ken Terry

The epochal shift of office-based physicians to hospital employment promises to have as big an impact on the adoption of electronic health records as the government's HITECH incentives will.

A recent study published in Health Affairs shows that in 2007 and 2008, the probability of physicians employed by healthcare systems having basic EHRs was 22 percent greater than for solo practices. In contrast, the likelihood of a doctor in a physician-owned group practice having an EHR was only 8.3 percent greater than for a soloist.

There are two underlying reasons why hospitals are buying EHRs for their employed doctors at a faster rate than private practices: First, hospitals have deeper pockets than most physician-owned practices; second, many hospitals see a need to become accountable care organizations (ACOs) in order to prepare for future changes in reimbursement. As Donald Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS), recently pointed out, health IT will be a core functionality of ACOs, which will need it for care coordination and quality measurement.



San Francisco launching new Health Information Exchange

By: David Chiu, Arieh Rosenbaum and M.D. 04/17/11 10:45 PM

Special to The Examiner

San Francisco is on the cusp of launching a groundbreaking new health care initiative that will transform medical care in our city for the better.

The San Francisco Health Information Exchange will allow the city’s health care providers to securely and efficiently exchange patient health information. It will additionally allow patients access to their personal community health record. This program will dramatically improve patient care in San Francisco and save millions of dollars in overall health care costs.



Toshiba releases self-erasing drives

The Toshiba Self-Encrypting Drives perform a crypto-erase when connected to an unauthorized host

By Lucas Mearian

April 13, 2011 02:50 PM ET

Computerworld - Toshiba Wednesday unveiled its first family of self-encrypting hard disk drives (HDDs) that can also erase data when connected to an unknown host.

The new Toshiba Self-Encrypting Drives (SED) (models MKxx61GSYG) enable system manufacturers to configure different data invalidation options that align with various end-user scenarios.

The new 2.5-in, 7,200 rpm drives are targeted for use in PCs, copiers and multi-function printers, along with point-of-sale systems used in government, financial, medical, or similar environments that need to protect sensitive information.

The drives come in capacities ranging from 160GB to 640GB, and have 16MB of buffer memory, and use the serial ATA (SATA) 2.0 specification, which affords up to 3Gbit/sec throughput.



E-prescription market headed to $204.6M

April 15, 2011 | Healthcare IT News Staff

SAN JOSE, CA – The U.S. e-prescription market is set to reach $204.6 million, according to a new report by market research firm Global Industry Analysts (GIA).

The research report titled "E-Prescription Systems: A US & European Market Report" announced by Global Industry Analysts Inc., provides a comprehensive review of the e-prescription systems markets, current market trends, key growth drivers, recent product launches, recent industry activity, and profiles of major/niche market participants.

It provides annual sales estimates and projections for e-prescription systems market for the years 2009 through 2017 for the following geographic markets - US and Europe. Key segments analyzed include integrated e-prescription systems, and stand-alone e-prescription systems. The report also analyzes the adoption of e-prescription systems by hospital practice and general practice. Also, a six-year (2003-2008) historic analysis is provided for additional perspective.



Imaging Under Scrutiny

Cora Nucci, for HealthLeaders Media , April 14, 2011

Widespread availability of computed tomography, magnetic resonance imaging technology, and positron emission tomography has contributed to a surge in the use of high-tech diagnostic imaging scans in hospitals.

Despite growing concerns about long-term risks of exposure to high doses of radiation, several developments are driving physicians to order HTDI tests: increased availability of CT scanners, the superiority of CT scans over x-rays for diagnosing certain emergent conditions, and concerns about malpractice lawsuits. But the tests come with a hefty price tag. According to a report from America’s Health Insurance Plans, the cost of diagnostic imaging is growing by 18% to 20% annually. By comparison, prescription drug costs, the group says, are growing by 6% to 8% annually.

Health information technology offers a solution in the form of clinical decision-support systems. Such systems can guide providers to evidence-based decisions about which imaging tests to order and deliver benefits to patients and payers, as well.



Barriers slow switch to electronic medical records

11:55 AM, Apr. 18, 2011

Thousands of patient charts fill the shelves at Kaplan Barron Pediatric Group — “paper everywhere,” Dr. Emily Johnson says.

Electronic medical records could rein in the clutter, make charts more legible and better track care, she said, but the Bardstown Road practice isn't quite ready to take that step into the digital age.

“The main reason is financial. It's just so expensive,” she said of e-record systems, which can cost $100,000 or more for small practices and millions of dollars for large practices and hospitals. “Also, we'd have to take time out of the day and do training. It would be expensive to learn this new thing.”



Move gradually on PCAST report recommendations: ONC work group

By Joseph Conn

Posted: April 18, 2011 - 12:01 am ET

A work group of the federally chartered Health Information Technology Policy Committee concluded in a presentation delivered last week to the Office of the National Coordinator for Health Information Technology that it was feasible to move in the direction pointed to by a White House technology advisory council but that the ONC should proceed by making incremental changes from its present technological course.

In December, the President's Council of Advisors on Science and Technology issued a 108-page report that called on ONC to use its leverage to create and adopt a universal exchange language and use so-called meta-data tagging to facilitate records search and retrieval. The tags also could host privacy and security constraints that would follow the data from user to user.



EHR reminders can help docs avoid unnecessary treatments: study

By Maureen McKinney

Posted: April 18, 2011 - 12:01 am ET

Electronic clinical-decision support reminders can successfully steer physicians away from ordering unnecessary treatments, according to results of a new study published in the journal Pediatrics.

Researchers from the Stanford University School of Medicine and Lucile Packard Children's Hospital, both in Palo Alto, Calif., built automated alerts into the hospital's electronic health-record system to determine whether they would help physicians adhere to recently updated guidelines for ordering red blood-cell transfusions.

The system alerted physicians ordering red blood-cell transfusions whenever a patient did not meet the clinical criteria for receiving the procedure. Researchers determined that the reminders prevented 460 unnecessary transfusions, for a total cost savings of $165,000 over one year.



Children's Hospital Boston Rises to Top of EHR Ladder

Gary Baldwin

Health Data Management Magazine, 04/01/2011

Ask Marvin Harper, M.D., how long the electronic health records journey at Children's Hospital Boston took, and he says "forever." It's a colorful exaggeration, but the ascension of the 392-bed pediatric medical center to the top of the EHR ladder, as measured by HIMSS Analytics at least, was certainly an exercise in patience.

The hospital-one of the largest pediatric centers in the nation-deployed its first electronic systems back in the early 1980s, explains Harper, who has worked with the information systems department since the mid-1990s, the last two years as chief medical information officer. And even though additional, almost equally challenging I.T.-enabled projects await Children's, executives there can bask in the knowledge that their accomplishment of hitting Stage 7 on the HIMSS scale late last year puts them in rare company.



Medical Groups Oppose Patent on Genes

HDM Breaking News, April 11, 2011

The American Medical Association and five other medical societies recently filed an amicus brief with the U.S. Court of Appeals in support of a lower federal court ruling that invalidated patents held by Myriad Genetics on two genes, known as BRCA1 and BRCA2.

The associations contend that human genes should not be considered property and enabling the patenting of genes will harm opportunities for scientific research and medical care because research on specific genes could be limited.