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March 25th, 2011
The new National Coordinator for Health Information Technology will take over a vastly different office from the one that David Blumenthal, MD, assumed in March 2009.
Blumenthal faced a challenge comparable to a start-up CEO suddenly infused with large amounts of venture capital for an idea with great potential and long in the making. Of course, in this case the injection of billions of dollars came from the appropriation of taxpayer money under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, and with it also came very aggressive implementation deadlines, public scrutiny and congressional oversight.
At a dot-com pace and with vigorous public input, Blumenthal had to build the Office of the National Coordinator (ONC) staff, stand up infrastructure such as regional extension centers, develop a certification process for “qualified” health IT, create demonstration programs such as the Beacon Communities, and, most importantly, establish ambitious but achievable targets for “meaningful use”—the rules by which new federal financial incentives under HITECH will be paid to doctors and hospitals for using health information technology (IT).
More than 60 healthcare and health IT organizations are supporting the federal government's push for authenticated, encrypted health information to be shared with trusted recipients over the Internet.
By Nicole Lewis, InformationWeek
March 30, 2011
If the Direct Project's objectives continue to be advanced at a fast clip, widespread adoption of universal addressing and access to secure direct messaging of health information could soon be provided to healthcare stakeholders that serve up to 160 million Americans.
Those are the latest figures from officials at the Direct Project, a program that began one year ago to specify a secure, scalable, standards-based way for healthcare participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.
Microsoft is moving full-steam ahead with its healthcare push, while Google may be pulling back — and possibly pulling out all together — from the electronic medical records space.
Up until early March, Microsoft had been treating its Health Solutions Group as an “incubation,” even though that group was staffing up and fielding a variety of cloud and on-premises health services and software. But on March 7, Microsoft moved the Health Solutions Group into the Microsoft Business Solutions organization headed by Corporate Vice President Kirill Tatarinov. (The analysts at Directions on Microsoft pointed out this organizational change, which a Microsoft spokesperson confirmed for me this week.)
HDM Breaking News, March 31, 2011
The information technology capabilities that accountable care organizations will need under the proposed rule establishing a Medicare Shared Savings Program could go far beyond what's necessary to prove Stage 1 electronic health records meaningful use. And the Shared Savings Program starts Jan. 1, 2012, during Stage 1 of meaningful use.
Compliance with coordination of care requirements "may" involve a range of strategies which "may" include:
* Use of predictive modeling to anticipate likely care needs,
* Remote monitoring of patients,
* Comparative benchmarking, and
* "The establishment and use of health information technology, including electronic health records and an electronic health information exchange to enable the provision of a beneficiary's summary of care record during transitions of care both within and outside of the ACO," according to the proposed rule, issued today and available here.
March 30, 2011 | Mary Mosquera
Widespread adoption of health information technology and changes in how primary care providers are paid for their services are critical to drive transformation of the U.S. healthcare system, according to a recent report.
Neither is sufficient by itself, but both are necessary to fuel major delivery system reform, according to the March 30 report Better to Best: Value-Driving Elements of the PCMH and ACO, about the benefits of patient-centered medical homes and accountable care organizations and what's needed to realize them.
For example, electronic tools, such as electronic health records and standards for health information exchange, can enable secure email, referral management, shared decision report and performance reporting.
HDM Breaking News, March 30, 2011
Drug and disease reference content software vendor Epocrates Inc. has started beta testing of a mobile- and Web-based electronic health records system it is developing to target solo and small physician practices.
Posted: March 31, 2011 - 2:00 pm ET
Data from electronic health records will be used in a new quality-improvement program launched by three major health and disease research organizations to help physicians use evidence-based guidelines in patient care.
The Guidelines Advantage is an outpatient-based collaboration of the American Cancer Society, the American Diabetes Association and the American Heart Association/American Stroke Association. It will use information from EHRs to measure provider performance against standards and benchmarks developed by the three groups.
Posted: April 1, 2011 - 11:45 am ET
There are two new wrinkles to electronic prescribing standards from the pre-eminent standards development organization for that genre, the Scottsdale, Ariz.-based National Council for Prescription Drug Programs.
The NCPDP has announced changes to its SCRIPT Standard commonly used by providers through their electronic health-records systems or stand-alone e-prescribing tools to communicate electronically with the corner drug store.
Posted: April 1, 2011 - 12:01 am ET
Health information technology will be a critical aspect of a new HHS plan to eliminate health disparities, according to a blog post at Health IT Buzz, the blog of the Office of the National Coordinator for Health Information Technology.
On April 5, HHS will convene a health IT disparities work group that will measure IT adoption and implementation outcomes in medically underserved communities, discuss projects designed to shrink any digital divide encountered and establish "sustainable channels of communication between agencies" to achieve the previous two objectives, according to the blog post.
Intense lobbying from the governor and healthcare providers led the state legislature to overturn previous rejections of federal EHR funding.
By Nicole Lewis, InformationWeek
March 31, 2011
The Montana Senate has voted to restore $35 million in federal incentives for electronic health records (EHRs) for hospitals and community health centers across Montana. The Senate voted 45-5 for the motion on Monday.
The Montana legislature had four times denied, on party-line votes, the state's Department of Public Health and Human Services (DPHHS) the authority to accept and distribute federal incentive payments to hospitals. Montana was the only state to turn down federal EHR incentive funds.
By Jeff Rowe, Editor
In recent weeks, the impending departure of ONC’s Dr. David Blumenthal has led to considerable speculation regarding who might step in to take the reins at ONC, as well as what that person’s priorities should be moving forward.
To this observer, whoever takes over at ONC needs to know that, as he succinctly puts it, the work is only beginning.
After reviewing several of the steps ONC has rapidly taken in just the past couple of years, he turns to the issue of Meaningful Use, the provisions to which, in his view, will provide ONC with its greatest challenge moving forward.
HDM Breaking News, March 31, 2011
A new report from the Institute of Medicine recommends the collection of data on sexual orientation and gender identity be part of the objectives for achieving meaningful use of electronic health records.
The report assesses unique health disparities that lesbian, gay, bisexual and transgender individuals experience and calls on the National Institutes of Health to implement a research agenda to advance knowledge about LGBT health. "Although a modest body of knowledge on LGBT health has been developed, these populations, stigmatized as sexual and gender minorities, have been the subject of relatively little health research," according to the report.
Two of seven recommendations to advance understanding of LGBT health involve the collection and management of data. The IOM also recommends that data on sexual orientation and gender identity be collected in federal funded surveys from the Department of HHS and other relevant federal surveys.
March 31, 2011 — 10:48am ET | By Janice Simmons
The departments of Defense and Veterans Affairs (VA) are falling short on efforts to provide care to injured combat personnel because their IT systems lack compatibility, according to a new report by the Government Accountability Office (GAO).
In 2007, following reports of poor case management for outpatients at Walter Reed Army Medical Center in Washington, the Departments of Defense and VA jointly developed the Federal Recovery Coordination Program (FRCP) to coordinate clinical and nonclinical services needed by severely wounded, ill, and injured service members and veterans.
30 March 2011 Linda Davidson
A new strategy which the government says will save millions currently wasted on public sector ICT was published by the Cabinet Office today.
The new strategy promises to end “big bang” solutions, break the “oligopoly of big business” supplying government IT and create opportunities for SMEs.
It also heralds a move to scale back the size of government IT programmes by creating a presumption against projects having a lifetime value of more than £100m.
Thursday, March 31, 2011
In a recent iHealthBeat Perspective, Protima Advani of the Advisory Board Company suggested that health care providers wait until fiscal year 2012 to demonstrate meaningful use of electronic health records. But waiting until 2012 might not be the right solution for every health care provider. In some cases, 2011 might be a better goal date.
Achieving meaningful use requires, for most organizations, a profound number of cultural and workflow changes. Rushing to meet meaningful use might result in a lack of firm cultural foundations and poor adoption of new workflows. However, if an organization already has a solid plan for EHR adoption and is close to meeting meaningful use requirements, moving forward in 2011 might help prevent a loss of momentum and provide public relations benefits.
By Mary Mosquera
Tuesday, March 29, 2011
The Health IT Standards Committee has begun exploring some of the functions that electronic health records (EHRs) should be capable of performing in stage 2 of meaningful use, with the use of health information exchange by providers to send patients their information to a personal health record (PHR) a prominent example.
Healthcare providers will have a choice in health information exchange in later stages of meaningful use now that different methods are taking shape. Certification and standards criteria in meaningful use stages 2 and 3 should support various methods of exchange when they are coupled with standards and robust testing, according to committee members at their meeting March 29.
Dr. John Halamka, committee co-chair, posed the question about whether the committee should consider recommending as a stage 2 objective that a provider be able to perform certain kinds of transaction using one of the methods of exchange.
HDM Breaking News, March 29, 2011
Since releasing the "Federal Health IT Strategic Plan for 2011-2015" on March 25, the Office of the National Coordinator has posted 24 industry comments. Here are three samples:
1. "One concern is that ONC may not have done an extensive enough review of available standards for vocabularies used in data exchange. For example, SNOMED, while comprehensive, is often convoluted and difficult to map to, particularly for use at the point of care. To date, it has also been difficult to determine how to consult or give input to ONC on available standards for vocabularies for data exchange, specifically those that are in widely adopted by EMR systems (both in the public and commercial arenas) already, but not 'accepted' for exchange by ONC."
Cheryl Clark, for HealthLeaders Media , March 30, 2011
The American Medical Association is making its first foray into the software development world with a free CPT (current procedural terminology) code glossary application.
So far, the app includes just 129 codes classified for evaluation and management, for consultations, critical care services, domiciliary, ED, home services, hospital inpatient, hospital observation, inpatient neonatal, newborn care, non face-to-face, nursing facility, preventive medicine, and prolonged services. But it has detailed descriptions of each code's levels of care. More codes are planned in updates.
For example, for office or other outpatient visit, one can find definitions for whether the patient visit was problem-focused, expanded problem focused, detailed, or comprehensive. Decision-tree logic and quick search options are available. And users may save frequently accessed codes by location or type of service
But the AMA wants to go beyond this single app and is offering $2,500 in cash and prizes, plus a trip to the AMA's meeting in New Orleans, for ideas to generate "the next great medical app, in the 2011 AMA App Challenge."
Posted: March 29, 2011 - 12:00 pm ET
In a joint effort to help small clinics and physician practices safeguard their patients' health information, the Healthcare Information and Management Systems Society has partnered with the Medical Group Management Association to produce a specialized set of easily accessible informational tools.
Called the HIMSS Privacy and Security Toolkit for Small Provider Organizations, the interactive online resource allows users to share best practices and submit new privacy- and security-related tools for consideration, according to a HIMSS news release.
Insurers and healthcare providers are increasingly using Web portals to comply with meaningful use, give patients ready access to medical data and other relevant information.
By Marianne Kolbasuk McGee, InformationWeek
March 29, 2011
Under the government's meaningful use guidelines, healthcare organizations must provide a patient with a copy of his or her medical data within 48 hours of their requesting it. To accomplish that, many healthcare organizations are deploying patient portals. And while they're at it, they're also building in other features, like appointment scheduling and messaging.
Health insurers have been early adopters of Web portals, providing help checking the status of claims and locating doctors in their health plans. But some insurers are taking those services further, making it easier for members to find other information, such as information on illnesses, treatment cost comparisons, and physicians in a certain zip code that care for a particular condition.
Aetna is one of the insurers doing this via its Web portal, powered by software from Healthline Networks, which recently introduced a new suite of "Medically Guided" tools that feature semantic search technology, which uses the context of terms to help locate information.
By Bonnie James
Qatar will establish an effective and integrated national e-health system ensuring full compatibility across all levels of care and full participation by all healthcare providers.
This has been announced in the National Development Strategy (NDS) 2011-2016 launched on Monday.
It is envisaged to raise the percentage of primary care practitioners accessing the online diabetes registry from 0% to 25%.
It will be ensured that 100% of medical images taken at hospitals are digitally stored and shareable among physicians.
The percentage of community pharmacies submitting dispensing information to the e-prescription system is to be raised from 0% to 25%.
By a staff reporter March 31, 2011
Mafraq Hospital in Abu Dhabi has launched a new electronic system for maintaining medical records, which will ensure up-to-date and easy access of medical information for both doctors and patients.
With the advent of the new completely electronic mechanism to keep patients’ medical records, the hospital officially said ‘goodbye’ to paper records.
The Cerner Electronic Medical Record System (EMR) has been introduced as part of overhauling the entire information system to provide global standard patient care and administration practices at the hospital, a top health official said.
The 11th annual IHE European Connectathon, to be held in Pisa, Italy, April 11-15, has expanded to a week-long program of activities.
The core activity remains the IHE-Europe Connectathon, an intensive connectivity marathon where for five days more than 300 IT engineers will test 117 systems for the interoperability of their applications used in health information systems.
Joseph Conn Blog
I wrote a story for this week's Modern Healthcare magazine about the Alembic Foundation, which is assuming a caretaker role in the future development of the government-founded Connect Gateway project. The Federal Health Architecture program—overseen by the Office of the National Coordinator for Health Information Technology—started the project in 2008.
I asked Dr. Robert Kolodner, former ONC head and Veterans Administration informaticist, about why open-source technology appears, finally, to be gaining some traction in health IT circles.
Kolodner said open source is in vogue because "right now, the government is more open to it." For example, he said, the ONC also is coordinating the Direct Project, another open-source software and standards package for peer-to-peer communications.
Posted: March 28, 2011 - 4:00 pm ET
Racial and ethnic minority patients are far less likely than whites to adopt an online personal health record to access and coordinate their health information, according to a study published in the March 28 issue of the Archives of Internal Medicine.
The study is the latest of many to point to a "digital divide," the term used to describe the disparity in access to the Internet and other forms of technology.
Posted: March 24, 2011 - 4:30 pm ET
Advocate Health Care, Oak Brook, Ill., established its eICU telemedicine program in 2003. Eight years later, it's still tweaking the program—and still working to assert the program's value to clinical staff.
The continual evolution of information technology—and, of more importance, IT's use in a clinical setting—was a major theme in “Achieving Clinical Value in the ICU with Strategic IT Utilization,” a presentation from Advocate executives Dr. Michael Ries and Cindy Welsh.
“All we hear about is IT,” said Ries, Advocate's medical director of adult critical care and eICU and an assistant professor of medicine at Chicago's Rush University. But “you cannot bring it in and expect it to change your organization.”
Published: Wednesday, 23 Mar 2011 | 10:21 AM ET
By: Bertha Coombs
There are two things Dr. Larry Nathanson can’t work without when he's on duty in the emergency ward: his stethoscope and his iPad.
After nearly a year using the tablet, it has become an integral tool for treating patients.
“As I am walking from room to room, I know who I need to see next,” he explained, scrolling through the virtual emergency room patient board on the iPad.
“I definitely feel lost when I don’t have this on a shift," he said.
- MARCH 28, 2011
The shift to electronic medical records makes it easier to recruit patients—and keep them
For developers of new drugs and treatments, one of the toughest hurdles has nothing to do with medicine. It's recruiting patients for clinical trials. And when it comes to recruiting minority patients, the challenge is even greater.
New approaches are being tried that can dramatically speed up the recruiting process and reach more patients from groups frequently underrepresented in studies.
At the heart of these new methods is the shift to electronic medical records, which makes patient searches faster and more methodical—in part by also allowing researchers to involve patients in trials from day one of their treatment.
In addition, some drug companies have had success reaching out to patient advocates and other experts who know what clinics and doctors are treating the kinds of patients the firms need to test certain drugs, like those used in treating HIV.
March 23, 2011 — 4:35pm ET | By Ken Terry
Southeast Texas Medical Associates (SETMA), a primary care group based in Beaumont, Tex., is using IBM business analytics software to gain greater insight into hospital readmissions. The software helps the 29-doctor group identify the causes of readmissions and design interventions to prevent patients from being readmitted.
In the first six months of this project, SETMA has been able to cut the number of its hospital readmissions by 22 percent by enabling doctors to identify trends and adjust treatment protocols to improve post-discharge care.
Using the IBM application, SETMA's staff compared the characteristics of patients who were readmitted against those who were not. Among the factors they looked at were ethnicity, socioeconomic status, the follow-up care received, and how quickly they received that care. Equipped with the results of this analysis, SETMA instituted new post-acute-care treatment plans to help patients recuperate and stay out of the hospital.
March 27, 2011 — 11:55am ET | By Ken Terry
Where will health IT be in 2015? If we achieve all of the goals of the updated Office of the National Coordinator strategic plan, it will be in an ideal state.
Everybody will have electronic health records (EHRs); all information systems will all be interoperable; EHR us ers will all achieve meaningful use (stages 2 and 3 included); there will be no more security breaches; patients will be using electronic copies of their records to manage their own health; and health IT will help healthcare reform attain its goals, including effective population health management, superb care coordination, lower costs, and optimal patient outcomes.
Of course, this is only an aspiration; nobody really believes that this vision will be achieved within five years, just as nobody believes that EHRs will be universal by 2014, as President Obama and, before him, President Bush demanded. Bush's time frame was 10 years -- roughly the same amount of time it took us to land a man on the moon. The reason why it won't happen within that time frame is that widespread health IT adoption and the ultimate goals of meaningful use are much harder to achieve than winning the "space race" was in the 1960s.
Monday, March 28, 2011
SAN DIEGO -- Health care leaders gathered for the Health 2.0 Spring Fling Conference last week, a two-day event organized around three main themes:
- Wellness 2.0, prevention, exercise and food;
- The evolution of health research; and
- Making health care cheaper.
The conference at the La Jolla Hilton Torrey Pines in California highlighted technological innovations in health care services and information management. It also emphasized technology's potential to encourage healthier lifestyles, which in turn could help drive down the cost of care.
Technology's Role in Prevention
The conference's keynote address -- delivered by Dean Ornish, founder and president of the Preventive Medicine Research Institute -- focused on the role of technology in changing environment and behavior to facilitate healthier lifestyles. According to Ornish, 75% of the $2.5 trillion currently spent on health care in the United States is related to chronic diseases, most of which can be prevented or reversed by diet and exercise, a fact we've understood for years, he says. "We don't need a breakthrough in science but a change in implementing it, which is why 2.0 is so important," Ornish told the crowd.