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, June 11, 2011

Weekly Overseas Health IT Links - 11 June, 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.



May 30, 2011

Breaches Lead to Push to Protect Medical Data


Federal health officials call it the Wall of Shame. It’s a government Web page that lists nearly 300 hospitals, doctors and insurance companies that have reported significant breaches of medical privacy in the last couple of years.

Such lapses, frightening to consumers, could impede the Obama administration’s effort to shift the nation to electronic health care records.

“People need to be assured that their health records are secure and private,” Kathleen Sebelius, secretary of health and human services, said in an interview by phone. “I feel equally strongly that conversion to electronic health records may be one of the most transformative issues in the delivery of health care, lowering medical errors, reducing costs and helping to improve the quality of outcomes.”

So the administration is making new efforts to enforce existing rules about medical privacy and security. But some health care experts wonder if the current rules are enough or whether stronger laws are needed, for example making it a crime for someone to use information obtained improperly.



Data mining, EHRs help target dangerous drug combo

May 26, 2011 | Healthcare IT News Staff

STANFORD, CA – Data mining and electronic health records helped researchers at some of the country’s most prestigious universities discover a dangerous side effect of a common drug combination.

A widely used combination of two medications may cause unexpected increases in blood glucose levels, according to a study conducted at the Stanford University School of Medicine, Vanderbilt University and Harvard Medical School. Researchers were surprised at the finding because neither of the two drugs – one, an antidepressant marketed as Paxil, and the other, a cholesterol-lowering medication called Pravachol – has a similar effect alone.



Friday, May 27, 2011

Chocolate Teapot Not Otherwise Classified

The methodological approach which underlies this blog is based on the position of ontological realism. One standard objection from the HL7 community to this position is that the ontological realist strives for 'perfection', where HL7 and its ilk, more sensibly, strive for mere 'practical utility'.

Examination of the concrete proposals made under the ontologically realist heading prove, however, that they are (a) quite modest, and (b) of considerable practical utility.



By Joseph Conn

No transparency with the treasure of VistA

If you've been to Yosemite, you know the meaning of a "national treasure."

So, just imagine if the National Park Service announced plans to hand over stewardship of Yosemite to a "custodial agent." And suppose the park service put the agency contract up for bid.

Wouldn't you want to know who the bidders and their financial backers were? And wouldn't you want the park service to lay out all the bids for public inspection?

I would, too.

That's standard operating procedure. State government, counties, cities and even small-town park boards must open bids and disclose bidders in public under open-records law. It's just good civic hygiene.

Which brings us to Roger Baker, the U.S. Veterans Affairs Department's IT maven. He announced at a meeting of the WorldVistA community in Fairfax, Va., last week that the VA intends to launch an open-source development project to upgrade VistA, the VA's electronic health-record system.

For nearly a decade, the WorldVistA folks have been pleading with the VA to make open-source improvements to VistA. They gave Baker a standing ovation. Developed at taxpayer expense, VistA is both a U.S. treasure and an increasingly important global healthcare asset. And yet the VA has let VistA slide.



Health Information Exchange To Test Unique Patient Identifiers

June 2, 2011

The Western Health Information Network (WHIN) has received a grant from the Robert Wood Johnson Foundation's Pioneer Portfolio for a pilot project to test how unique patient identifiers can increase patient control over their clinical information and improve the quality of medical records. The pilot project will involve issuing personal identifiers using the Voluntary Universal Healthcare Identifier (VUHID) system provided by Global Patient Identifiers, Inc. (GPII). VUHID allows participating providers to more accurately identify patients' and access healthcare records at the time of the visit.



Wednesday, June 01, 2011

Déjà Vu: Debate Over Medicare Claims Database Heats Up

by Kate Ackerman, iHealthBeat Managing Editor

In 1979, Jimmy Carter (D) was president, Sony released the first-ever walkman, a gallon of gas cost 86 cents and "My Sharona" by The Knack was the number one song for six weeks. Suffice to say, a lot has changed in the past 32 years.

We've seen five U.S. presidents since Carter, cassette tapes are essentially a thing of the past, the cost of gasoline has more than quadrupled and the Billboard charts now are dominated by artists like Adele and Lady Gaga.

But one thing hasn't changed much since 1979 -- the debate over whether the public should have access to the Medicare claims database.



The $80 Billion Question

Gary Baldwin

Health Data Management Magazine, 06/01/2011

Four years ago, management and I.T. consultant Joan Duke's difficult lesson in health care inefficiency came to a sad end when her mother passed away. During the previous three years, Duke's mother, suffering from congestive heart failure and other complications, was in and out of emergency departments throughout Florida, while the beleaguered daughter-the founder of Baltimore-based Health Care Information Consultants-struggled from afar.

Her mother was treated at multiple hospitals, where caregivers-disconnected from one another-started treatment regimens from scratch. "Her record didn't follow her around and it was impossible to coordinate care," recalls Duke, who is now semi-retired. "There was a tremendous amount of excessive, wasteful and uncomfortable care." Her mother received over a dozen CT scans during her final years, an excess that Duke believes could have easily been avoided with electronic data sharing. "If the overall health system worked better, and had better data, it would be more efficient, deliver better care, and reduce the unnecessary treatments caused by a lack of information," she sighs.

No doubt, health care is an industry beset with staggering costs. According to numerous federal and private industry studies, national spending topped $2.5 trillion in 2009, with health-related expenses accounting for more than one-sixth of the nation's economy-and on an inflationary spiral many have described as unsustainable. Worse, by many measures, the United States lags behind in quality measures attained by countries that spend far less. Against the backdrop of fragmented care and the corresponding rise in outlays, electronic health records may indeed hold the keys to the kingdom of fiscal constraint. Washington, D.C., is betting so, with its $40 billion-plus EHR meaningful use incentive program.


209,000 Doctors At Risk For E-Prescribing Penalties

Healthcare providers who don't write prescriptions electronically may be subject to a 1% Medicare payment reduction in 2012.

By Neil Versel, InformationWeek

June 01, 2011

URL: http://www.informationweek.com/news/healthcare/policy/229700246

Unbeknownst to many medical practices, as many as 209,000 physicians and other healthcare providers may already be in line for a 1% Medicare payment reduction in 2012 for not writing prescriptions electronically. The Centers for Medicare and Medicaid Services (CMS) is looking at claims for the first six months of 2011 to determine who will be penalized starting next year.

"The concern now, really, is the timing," said Robert Tennant, a Washington-based senior policy advisor for the Medical Group Management Association. "There are a lot of practices that are scrambling to come up with a solution."

The 2008 Medicare Improvements for Patients and Providers Act (MIPPA) instituted a Medicare e-prescribing program that pays small incentives to doctors who write at least 10% of their prescriptions electronically, with some exceptions. The bonus was 2% of eligible Medicare Part B charges in 2009-10, 1% in 2011-12, and 0.5% in 2013. But deductions for noncompliance start at 1% in 2012, then climb to 1.5% in 2013 and 2% in 2014.



Hospitals compete for IT talent with funding at stake

EHR use benefits patients but presents health care providers with hiring challenges

By Fred O'connor, IDG News Service

May 31, 2011 05:20 PM ET

Health care providers in the U.S. are encountering a lack of qualified candidates as they race to meet federal government deadlines for EHR (electronic health record) and health IT use.

The challenge, medical CIOs say, is to find enough IT staff who can help hospitals and medical practices migrate from paper records to EHRs and manage the large amount of patient data generated from practicing medicine. At stake is US$25 billion in funding allocated in 2009 by the American Recovery and Reinvestment Act, for spending on EHRs and health IT. Medical providers will be compensated for the cost of the systems if they meet criteria by certain dates, with four key deadlines coming in the next six months.

With the government spending almost as much as the health care industry's total value of $27 billion, "you can imagine there's going to be a fair amount of hiring," said John Halamka, a doctor at and CIO of Beth Israel Deaconess Medical Center in Boston.



Despite incentives, cost is a barrier to small provider EHR use

June 02, 2011 | Mary Mosquera

The cost, physician practice size, and lack of technical resources still present barriers for small healthcare providers in adopting electronic health records and participating in the meaningful use incentive program.

Solo practitioners and small practices find it difficult to locate a lender willing to offer them an unsecured loan, said Dr. Sasha Kramer, a solo practitioner dermatologist in Olympia, Wash. Others who try to finance their electronic health record (EHR) system with the vendor have no leverage in negotiating terms because of their limited market share.

Kramer was among public and private health IT experts and physicians who spoke at a June 2 hearing of the House Small Business Committee’s health care and technology subcommittee.



Do laws control the clouds?

By Jeff Rowe, Editor

In an age so defined by technology, two seemingly contradictory assertions seem pretty safe.

First: the legal system will always be playing catch-up to technological change. Second: those who decide to use new technologies would do well to understand current law, regardless of whether or not it’s up-to-date.

Take, for example, the use of cloud computing to store personal health information.

As these attorneys ask: “Can HIPAA-covered entities (e.g. health care providers and health plans) store protected health information (PHI) in the cloud and still comply with HIPAA privacy and security regulations?”

Given the growing interest in cloud services among healthcare providers, that question will likely be on the minds of a growing number of people. And the answer, these attorneys say, is: “It depends. It depends on the cloud computing service provider and how that provider sees itself and its obligations to protect the privacy and security of the data.”



Lost medical records complicate Joplin hospital's tornado recovery


Thursday, June 2, 2011 12:05 am

One of the less tragic but still serious losses in the Joplin tornado were the medical records scattered across neighboring towns and counties.

The tornado's path included St. John's Regional Medical Center, where five patients and one visitor died. The heavily damaged hospital will be closed indefinitely.

The circumstances of the deaths in the hospital are still being investigated. Meanwhile, medical records and X-rays have been found as far as Springfield, 75 miles away.



Bipartisan Policy Center: Need for greater consumer engagement, more public-private collaboration in health IT

By Jessica Zigmond

Posted: June 3, 2011 - 12:01 am ET

Engaging patients through new technologies and expanding public-private collaborations are among the recommendations in a new report from the Washington-based Bipartisan Policy Center about leveraging health information technology to address problems in healthcare.

The report, Building a Strong Foundation for America’s Health Care System: The Role of Health Information Technology is part of the center’s health information technology initiative, which aims to identify and share policies and best practices to facilitate the effective use of health IT. At a discussion on Thursday when the study was released, former Sen. Tom Daschle (D-S.D.), the center’s co-founder, said the Centers for Disease Control and Prevention has reported that 25% of office-based physicians have adopted some form of health IT.



ONC seeks comments on ID management

By Joseph Conn

Posted: June 2, 2011 - 12:00 pm ET

The Office of the National Coordinator for Health Information Technology is soliciting public comments on approaches to manage digital certificates for verifying the identity of parties involved in communicating within health information exchanges.

The request is part of an effort by the Standards and Interoperability Framework, an ONC program launched in January, that seeks healthcare IT industry collaboration in addressing challenges to the interoperability of health IT systems needed to meet meaningful-use targets under the American Recovery and Reinvestment Act of 2009.



House hears about docs' barriers to EHR use

By Rich Daly

Posted: June 2, 2011 - 2:30 pm ET

Costs and lengthy installation times continue to keep most small-practice and solo providers from participating in the federal electronic health-record incentive program, according to testimony at a Thursday congressional hearing.

Both Republican and Democratic members of the House Small Business Healthcare and Technology Subcommittee said their constituent physicians have shied away from the program because of the costs involved. That aversion remains despite federal payments of up to $63,750 over six years for implementing and meaningfully using EHR systems.


HHS: Patients should know who views their EHR

June 2, 2011 — 10:17am ET | By Janice Simmons

Upon request, patients would get a chance to see a detailed report of who has accessed and viewed their electronic health records (EHRs) under a proposed privacy rule released by the Department of Health and Human Services on May 31.

Under current Health Insurance Portability and Accountability Act (HIPAA) rules, physicians, hospitals, health plans, and other healthcare organizations are required to track access to electronically protected health information. However, they currently are not required to share this information with patients.

If the proposed rule is approved, providers will be required to inform patients that they can request the detailed privacy report beginning Jan. 1, 2013, assuming the rule takes effect. The rule comes two weeks after audit reports by HHS's Office of the Inspector General criticized current federal efforts to enforce HIPAA security provisions.



Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., Paulina Deming, Pharm.D., Summers Kalishman, Ph.D., Denise Dion, Ph.D., Brooke Parish, M.D., Thomas Burke, B.S., Wesley Pak, M.B.A., Jeffrey Dunkelberg, M.D., Martin Kistin, M.D., John Brown, M.A., Steven Jenkusky, M.D., Miriam Komaromy, M.D., and Clifford Qualls, Ph.D.

June 1, 2011 (10.1056/NEJMoa1009370)


The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases.

We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response.

A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, −9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites.

The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.)



Use of electronic health records increases

By NICOLE BLAKE JOHNSON | Last Updated:May 27, 2011

The Health and Human Services Department has doled out $1.7 billion in stimulus money to build programs to spur the adoption of electronic health records.

So far:

• More than 2,000 graduates in April completed six-month community college training for health information technology professionals and are seeking jobs.

• Regional extension centers are working with 67,000 primary care providers to become certified as "meaningful users" of health IT.

• More than $83 million in Medicaid incentive payments have been issued to eligible providers and hospitals to encourage them to adopt health IT for their Medicaid accounts, and the first Medicare payments were disbursed last week.

• Thirty percent of primary care physicians nationwide were using electronic health records in 2010, up from 20 percent a year earlier.



June 1, 2011, 12:00 a.m. EDT

Digital health-data push launches Wild West market

Doctors face hurdles, onslaught by tech firms in converting to electronic records

LOS ANGELES (MarketWatch) — Two years ago, Dr. Gonzalo Venegas decided to bring his medical practice into the Information Age.

But the move turned out to be so costly that his business, which employs five physicians, ended up on financial life support.

An obstetrician-gynecologist, Venegas and his colleagues specialize in treating women in a low-income section of Dallas. They wanted to take advantage of government incentives that would pay them back for the investment they made in digitizing their medical records.

The group installed a system from a small vendor based in Georgia, at a cost of $80,000 per doctor, or $400,000 in all. As if the capital outlay wasn’t enough, the practice now is contending with a smaller income because the doctors are struggling to adapt to new ways of treating patients. And Venegas says it looks as though he’ll only recover roughly one-sixth of his investment through subsidies.



JAMIA: EHR data can help determine medication adherence

Written by Editorial Staff

May 31, 2011

Medication orders in an EHR can enhance clinicians’ ability to estimate medication adherence, but identifying definitive medication orders is a challenge, according to a brief published online first in the Journal of the American Informatics Association.

Nikki Carroll, MS, of the Kaiser Permanente Colorado Institute for Health Research in Denver, and colleagues developed a medication order algorithm to identify from EHRs the medication order intended for dispensing. They identified medication order data from EHR tables, obtained orders and linked the orders to dispensed medications. These steps were then used to identify patients who had been newly prescribed antihypertensive, antidiabetic or antihyperlipidemic medications and to determine the adherence group of each patient.



Collaborative pushes for EHR data use in clinical research

May 26, 2011 — 4:33pm ET | By Ken Terry

Electronic health record systems are not designed to generate data for clinical research, and providers engaged in clinical trials may be using a number of different, incompatible EHRs. Yet a high-powered consortium of medical research centers, pharmaceutical companies, medical advocacy groups and health IT organizations is trying to find ways to overcome these and other obstacles so that electronic patient data can be mined for research purposes.

Known as the Partnership to Advance Clinical Electronic Research, or PACeR, the year-old collaborative recently completed Phase 1 of its initiative to create a clinical research network in New York using EHR data. PACeR aims to use the data to identify candidates for clinical trials more efficiently, and to improve protocol modeling and data collection.



Will doctors heed IBM's Watson? History indicates otherwise

May 23, 2011 — 5:00pm ET | By Ken Terry

Watson, the IBM supercomputer that recently generated headlines by beating top Jeopardy players, is being groomed to advise doctors about diagnoses and treatments. But even if Watson delivers more accurate answers faster than other decision support tools, there's no guarantee that physicians will heed its advice.

When it's ready, perhaps two years from now, Watson will analyze the answers to questions about a patient's symptoms and medical history and suggest the most likely diagnoses. It will use the same approach to recommend treatments.



EHRs needed for comparative effectiveness research, too

May 28, 2011 — 5:19pm ET | By Ken Terry

A year-old consortium of academic medical centers, pharmaceutical companies, and information technology firms is trying to find a way to harness electronic health records for clinical research. The Partnership to Advance Clinical Electronic Research (PACeR) is to be commended for its efforts, which could help researchers identify clinical trial subjects and improve protocol modeling and data collection.

As important as this undertaking is, however, there's another project that could have a far greater and more immediate impact on public health. In contrast to PACeR, this project is receiving no private funding, because it won't help any drug company make money. What I'm referring to is the use of EHRs in comparative effectiveness research (CER). What's most urgently needed now is to set up "pragmatic clinical trials" that compare the efficacy of different tests and treatments in typical practice situations, so that physicians will be likely to incorporate the results into their medical decisions.



How Private Are Electronic Health Care Records?

posted by: Kristina Chew

There are many arguments in favor of electronic health care records, including fewer medical errors and reduced costs, not to mention the sheer amount of paper saved. Unfortunately, such electronic records are not nearly as secure as we would like, especially considering the highly personal information in medical records, from Social Security numbers to mention of pre-existing conditions to notation of what medications you are taking. Recently the likes of Lockheed Martin, PBS and Sony have all had their websites hacked and, as it turns out, electronic health care records are just as vulnerable.

The US government's Office of Civil Rights has a website dubbed the "wall of shame" on which are listed some 300 hospitals, doctors and insurance companies who have reported significant breaches of medical privacy in the past few years. A quick skim through the list reveals that huge HMOs such as Kaiser Permanente Medical Care Program, New York Presbyterian Hospital and Columbia University Medical Center have all suffered security breaches of medical records. These have occurred through the loss or theft of a laptop or other portable electronic device (an employee of Massachusetts General Hospital left the paper records of 192 patients on a Boston subway train in March); improper disposal of records; hacking and the unauthorized accessing of computer records.



Government agencies eye hybrid clouds for the future

May 24, 2011 | Tom Sullivan, Editor

Of the three most common cloud computing models – public, private and hybrid – government agencies are planning to adopt the hybrid model more than others. But an alarmingly high percentage of agencies aren't thinking about how to get their data back should they need to.

That’s according to a Norwich University study commissioned by Quest Software.

“What was most striking to me was that government and higher ed IT professionals have clearly expressed their preference for private and hybrid cloud models,” said William Clements, PhD, dean and professor at the School of Graduate and Continuing Studies at Norwich University.



Why Health Care Reform Won't Work

Joseph Goedert

Health Data Management Blogs, May 27, 2011

I recently had my 50+ physical with all the blood work that goes with it. While I have a high-deductible health plan with a health savings account, the labs are supposed to be fully paid by my insurer as preventive care. But the lab order wasn't properly coded and I was billed for about $400.

My regional hospital where the labs were done told me to call my physician and ask her to resubmit the order coded to indicate preventive care. I asked why the hospital doesn't just call its affiliated provider and was told they don't do that. So I called my physician's office, explained which codes had to go where and asked to resubmit the order. The office did so, incorrectly, again.

My hospital called again and insisted it was my obligation to make sure the paperwork was properly submitted. Another request that someone at the hospital pick up the phone and call an affiliated physician was refused.



Maudsley builds PHR on HealthVault

26 May 2011 Lyn Whitfield

South London and Maudsley NHS Foundation Trust is to develop an online personal health record to encourage clinicians and patients to share information, based on the Microsoft HealthVault platform.

The mental health trust, which provides treatment to a population of 1.1m people in south London, plans to develop a web portal that uses HealthVault to give patients access to health records and new applications to help them manage their condition.

The portal will interface with the trust’s own Electronic Patient Journey System, which was developed with Strand Technology, which has become an approved HealthVault partner for the project.



Wales issues strategy for GP IT

27 May 2011 Fiona Barr

NHS Wales has published a new five year strategy for GP clinical systems, setting out plans to standardise GP infrastructure services, improve interoperability and migrate GPs to web-based technologies.

The strategy follows the publication earlier this week of a tender for a new framework to supply GP practices in Wales with IT systems. The NHS Wales Informatics Service is seeking three suppliers to deliver systems to GPs from 2012.

The Service said the latest strategy has been produced in consultation with a range of stakeholders, including both the BMA and the Royal College of GPs.



NHS Direct launches mobile apps

27 May 2011 Shanna Crispin

NHS Direct has launched an application enabling people to access its health advice via their mobile.

The 24 hour helpline service has developed an application for Android smartphones and says that an application for the iPhone is likely to be released next month.

The smartphone version can be downloaded from the Android Marketplace or from the Android app store on the phone, for free.

Once downloaded, people can access 37 NHS Direct health and symptom checkers, which cover everything from dental pain, diarrhoea and vomiting to rashes, back pain and burns.




No comments: