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 18, 2011

Weekly Overseas Health IT Links - 18 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.



A Direct route to more pertinent patient information

June 02, 2011 | John Morrissey

By cmeans

Created 2011-06-02 11:47

A doctor in Rhode Island, per his daily routine, has just updated and closed a patient's chart in the practice's electronic health record. As he punches up the next record or heads to the exam room, a routine of another sort is underway between the EHR and the state's health information exchange database.

The EHR signals the HIE network to send what amounts to a self-addressed envelope, attaches the record and automatically moves the message to a gateway that applies the patient's pre-set consents to share information fully or with limitations. Then it's on to the HIE net, which detaches the record, breaks it into discrete data, checks for and eliminates elements previously entered in the database and uploads the rest.

No interfaces were built between the two points of exchange; it's a direct, uncomplicated, securely conducted event.

"What's exciting about that is that it's all behind the scenes – no doctor has to remember to do it. It doesn't get involved in their workflow," said Laura Adams, president and CEO of the Rhode Island Quality Institute, which operates the HIE network.


EMRs Need Better Usability To Support Improved Care

Most electronic medical records do little more than create an electronic version of a paper chart, according to an exec at a healthcare IT vendor.

By Neil Versel, InformationWeek

June 07, 2011

URL: http://www.informationweek.com/news/healthcare/interoperability/230300041

Electronic medical records haven't fulfilled their promise of safer, more efficient, lower-cost care, and won't until usability improves for physicians and nurses and until systems are more interoperable, according to one health IT vendor.

"The objective has got to be to improve the quality of the care," said Rick Kneipper, co-founder and chief strategy officer of business process services firm Anthelio Healthcare Solutions, a Dallas-based company formerly known as PHNS. He noted that recent studies from Rand and Stanford University found issues with the ability of EMRs to improve quality.


New EHRs Perform Better, But Transition Pains Doctors

Many physicians remain unconvinced that new electronic health records systems will improve the ability to deliver care.

By Nicole Lewis, InformationWeek

June 09, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/230500154

For many physicians looking to apply for federal incentive payments when they adopt electronic health records (EHRs), switching to newer EHRs will be necessary as they update their health information technology to demonstrate meaningful use. However, while newer systems come with improved features, the transition between systems poses significant problems, a study from Weill Cornell Medical College shows.

The study, which was supported by funding from the Agency for Healthcare Research and Quality, was conducted by a team of physician-scientists from Weill Cornell Medical College, who monitored the prescription errors of 19 physicians in an adult ambulatory clinic before the switch from an older EHR to a newer system, then again 12 weeks after the switch and once again a year later.



Fears for patients' data after hackers hit NHS

NHS patients face a potential security breach after computer hackers gained access to health service passwords.

10:00PM BST 09 Jun 2011

The group, which calls itself LulzSec, said yesterday that it had accessed a system that handles sensitive patient data. Last week it stole a million data records from a Sony website.

It published an email showing that it had informed the NHS of the security breach and saying “we mean you no harm and only want to help you fix your tech issues”.

It had taken master “admin” passwords from the system “months ago” while searching the internet for other materials, but had not exploited them.



Healthcare will take up nearly 20% of the U.S. economy by 2019

Consumers will spend billions on health-related video games and mobile health apps, says PricewaterhouseCoopers

Lucas Mearian

June 8, 2011 (Computerworld)

Healthcare spending will represent nearly one-fifth of the U.S. gross domestic product by 2019, and much of that money can be attributed to new regulations requiring better information technology and mobile health apps, according to a report by consulting firm PricewaterhouseCoopers.

For example, in 2010, health providers spent $88.6 billion on developing and implementing electronic health records (EHRs), health information exchanges, and other health IT initiatives, making healthcare a rich market for IT jobs.

PwC's report, titled "The New Gold Rush" (registration required), states that nearly one in three American adults have worked, now work or would like to work in healthcare. Jobs in healthcare increased 65% between 1990 and 2009, while the rest of the workforce increased 16% over the same time period.



Preserving EHRs: Time to Worry?

Elizabeth Gardner

Health Data Management Magazine, 06/01/2011

With meaningful use taking up all the top slots on the national EHR to-do list, record retention and preservation don't even make the first page: Data storage is so cheap, so the popular thinking seems to be, we'll just keep everything and worry about it later. But Milton Corn, M.D., deputy director for research and education at the National Library of Medicine, thinks we should worry about it now.

He's been worrying about it since shortly after the American Recovery and Reinvestment Act allocated billions of dollars for EHRs and he first began to consider the torrents of electronic medical data that will result.



ONC names ANSI permanent accreditor

By Joseph Conn

Posted: June 9, 2011 - 5:30 pm ET

HHS' Office of the National Coordinator for Health Information Technology has named the American National Standards Institute as its designated accreditor of organizations certifying electronic health-record systems.

Under the American Recovery and Reinvestment Act of 2009, the ONC was authorized to establish a process for both testing and certifying electronic health-record systems as capable of meeting meaningful-use standards that providers must meet to qualify for federal IT incentive payments.



DoD rolls out global EMR for 9.6M patients

June 9, 2011 — 10:24am ET | By Janice Simmons

In a process that has taken more than 23 years, the Department of Defense finally completed a worldwide rollout of a clinical documentation system working with San Diego-based CliniComp International at 59 military inpatient treatment facilities. Thirty-six of those facilities were completed in just under two years.

The CliniComp Essentris EMR is being used by 24,000 physicians to provide care to 9.6 million beneficiaries within the Military Health System. More than 5,500 beds will be covered.



Patients want you to share their EHR data

June 9, 2011 — 10:14am ET | By Janice Simmons

A majority of cancer patients said they were willing to share their electronic health information--keeping privacy in mind--if it meant improving the quality of their overall care, according to findings from a University of Pittsburgh Medical Center study released this week at the American Society of Clinical Oncology meeting in Chicago.

The researchers reviewed two data sources to determine patient perspectives on electronic health information: a 2010 survey of more than 7,400 cancer patients by LIVESTRONG (the Lance Armstrong Foundation) and results from the National Cancer Institute's 2007 Health Information National Trends Survey that queried the general public.



Thursday, June 09, 2011

Proposed Rule on E-Rx Incentive Program Offers Some Relief

In response to loud complaints from a variety of health care provider groups, CMS has issued a proposed rule that would modify its electronic prescribing incentive program.

The proposed rule -- published in the Federal Register on June 1 -- seeks to address many of the concerns raised by the medical community by providing additional exemptions for health care providers who plan to participate in the program but face barriers to using e-prescribing systems or meeting program requirements. The proposal also aims to better align CMS' e-prescribing incentive program with its meaningful use incentive program.

Under the 2009 federal stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicare and Medicaid incentive payments.



By Joseph Conn

Little breaches add up—to 32,000

Just another quick note here about lax health information security: It's worse than you think.

We've written repeatedly about the number of breaches of 500 or more records reported to the Office for Civil Rights at HHS.

Since September 2009, the American Recovery and Reinvestment Act has mandated that organizations confess these misdeeds. Through May 31, 2011, there have been 281 of these big goofs posted online involving nearly 11 million records.

These high-profile breaches often become big-dollar expenses for the organizations that make the headlines.

Under the stimulus law, however, organizations with breaches involving fewer than 500 records also are supposed to report them to the OCR, and the regulator is to compile all breach information in an annual report to Congress.



Researchers seek health IT tools for seniors

By Andis Robeznieks

Posted: June 8, 2011 - 12:00 pm ET

A five-year study funded by a $9.5 million grant from the Agency for Healthcare Research and Quality will investigate ways in which communication and information technology can improve healthcare services for—and, in turn, the health of—older adults.

Three University of Wisconsin research centers will collaborate on the project, which will be led by David Gustafson, a research professor of industrial systems and engineering. They will explore ways in which technology can help seniors live independently in their homes for as long as possible, according to AHRQ's website. They will also examine technology's applications for reducing unnecessary healthcare utilization, expanding service networks, and developing innovative practices to put research findings into practice.



Meaningful-use work group recommends extra time for Stage 2

By Joseph Conn

Posted: June 8, 2011 - 10:00 am ET

A work group of the federally chartered Health Information Technology Policy Committee is calling for a one-year delay in the scheduled implementation of Stage 2 meaningful-use criteria for healthcare organizations that will comply with the Stage 1 requirements this year.

In a 12-page draft letter (PDF) to Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology and chairman of the Health IT Policy Committee, the meaningful use work group states that sticking to the original timeline of implementing Stage 2 by 2013 "poses a nearly insurmountable timing challenge for those who attest to meaningful use in 2011."



App for mobile phones helps diagnose concussions

The next tool in the campaign against concussions might be your smartphone.

A doctor at the University of North Carolina teamed with other head-trauma researchers to develop an application for mobile devices that helps determine whether someone may have suffered a concussion.

Jason Mihalik of UNC's brain injury research center joined Justin Smith of Psychological Assessment Resources Inc. and the Children's National Medical Center in developing the program.

Smith says it's the first observer-based concussion app. After the user answers a series of questions, the app determines the likelihood of a concussion and can email information to a doctor. Mihalik said Thursday that the basis for the app's question flow comes from materials provided by the Centers for Disease Control.



Ponemon Institute: Inefficient Access to Patient Information Costs Hospitals $2M Each Year

Written by Jaimie Oh | June 01, 2011

The average clinician spends 122 hours a year trying to access various forms of electronic medical records, and the lost time is costing hospitals nearly $2 million every year, according to research conducted by Imprivata and the Ponemon Institute.



Computerized communication breakdowns common between PCPs, specialists

June 06, 2011 | Healthcare IT News Staff

INDIANAPOLIS – A new research study investigates the challenges that pen and paper workarounds or computerized communication breakdowns pose to the use of electronic health records. Understanding these challenges may lead to improved coordination of care supported by health IT.

Focusing on referrals by primary care physicians to specialists and communications from the specialists back to the referring physician, "Paper Persistence, Workarounds, and Communication Breakdowns in Computerized Consultation Management" appears in the July 2011 issue of the International Journal of Medical Informatics. It is a follow-up to a pilot study, "Exploring the Persistence of Paper with the Electronic Health Record," published in the September 2009 issue of the same journal.

"We sought to develop an understanding of the current challenges to the outpatient consult management process in the Veterans Health Administration, which uses an electronic health record to support consultations requested by primary care physicians with specialists such as cardiologists, gastroenterologists or neurologists. We also wanted to see if two years after our pilot study, paper workarounds remained popular with the medical staff," said Regenstrief Institute investigator Jason Saleem, Ph.D., a research health scientist at the Health Services Research and Development Center on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis.


Should Mobile Health Apps Be Regulated By FDA?

App developers and mobile device makers better pay close attention because the FDA says it's looking for "greater regulatory clarity."

By Marianne Kolbasuk McGee, InformationWeek

June 07, 2011

URL: http://www.informationweek.com/news/healthcare/mobile-wireless/230300034

With the growing popularity of tablets and smartphones--and the explosion of E-health record products for clinicians and patients--we're seeing lots of useful, innovative mobile health tools hit the market. Will the threat of increased fedetal regulation stifle this rush of innovation? That's a question a lot of developers are probably asking themselves as they hear the latest news from the FDA.

Until fairly recently, most mobile health apps have been geared to consumers, including those who want handy access to information online about a health topic of interest--or to track details about their own health and wellness. But a growing number of mobile health apps are also aimed at patients with chronic conditions, measuring parameters like blood glucose, blood pressure, and the like.



Are we ready for Europe's e-health revolution?

Published 08 June 2011

Gary Finnegan argues that Irish health services have been slow to embrace technology and need to mobilise its staff to catch up.

"Electronic patient records, access to specialist services from home, and more efficient use of scarce resources are just some of the much-vaunted benefits touted by advocates of eHealth. But while technology has transformed most industries and public services, healthcare has been notoriously slow to embrace the high-tech revolution.

And, for its part, Ireland is behind the pack in terms of healthcare IT. The HSE spends just 0.75% of its budget on IT; our frontline staff are not as tech-savvy as some European neighbours; and just 0.4% of the health workforce are IT specialists – a few hundred computer wizards kept busy with mundane maintenance tasks.

Any hope of playing catch-up will depend on the willingness of the health workforce to buy into the promise of eHealth at a time when budget cuts and staff ceilings are sapping goodwill from the system.



A Clinical Drug Trial Via Phone, Computer


Pfizer Inc. is conducting a drug trial in which patients participate from their homes using computers and smartphones rather than visiting a clinic.

The company plans to compare the results to those obtained from a previous, traditional trial of the same drug. The study involves the company's overactive-bladder drug Detrol.

If successful, the methods used in the study might eventually be used to help drive down the high cost of bringing new medicines to market.



Leaders: EMRs Aren't the Answer to Safety Issues

Gienna Shaw, for HealthLeaders Media , June 7, 2011

Poor communication, such as exchanging important clinical information about patients during shift changes, is the largest barrier to achieving patient safety goals, healthcare leaders say. And electronic medical records systems? Well, despite the fact that they're an effective tool to improve datasharing and, in turn, quality, healthcare leaders aren't exactly raving about how much they're helping.

Numbers from the most recent HealthLeaders Media Intelligence Report, The Drive to Patient Safety, suggests leaders are underestimating—or discounting altogether—just how much electronic data can improve communications.

When asked to describe the patient safety benefit that electronic medical records have provided their healthcare organizations, 31% of respondents said that IT has been an integral part of patient safety and that their organization is seeing gains because of it.

But only slightly fewer respondents (25%) described patient safety gains from IT as "episodic." Another 16% were even more down on EMRs—saying they have not seen the patient safety gains they hoped to gain from their IT platform.



Tuesday, June 07, 2011

360 Degrees of Health: The Limitations of Mobile Apps

The market for mobile health is one of the brightest lights of the economy, based on forecasts published during the first half of 2011. In-Stat expects that the market for wireless health will reach $4.5 billion in 2014. Meanwhile, McKinsey gauges the "global mHealth opportunity" at $50 billion.

These are heady numbers driving venture capital dollars into mobile health applications this year, such as the $10 million venture capital investment in Doximity (started by Epocrates founder Jeff Tangney) and the $48 million investment in Cellnovo's mobile diabetes product. MobiHealthNews tallied over $60 million of venture capital funding for mobile health just in the first quarter of 2011.

Adding to mobile health hope is the view of Kaiser Permanente's chief medical information officer, John Mattison, who calls mobile phones, "the new wellness delivery channel."



Patient privacy concerns loom large as providers shift to the cloud

May 31, 2011 — 4:40pm ET | By Ken Terry

The cloud is all the rage today, and healthcare providers are storing personal health information (PHI) on remote servers for an increasing variety of purposes. In a commentary on iHealthBeat, healthcare attorneys Bruce Merlin Fried and Rebecca Fayed urge doctors and hospitals to consider the HIPAA implications of dealing with "computer cloud providers."

HIPAA regulations make healthcare providers responsible for obtaining assurances from their "business associates" that they will safeguard PHI that providers disclose to them. For an electronic health records (EHR) vendor that serves its product remotely, it's obviously a bad business move to violate this admonition. But there are many other cloud providers who just store data and have clients outside the healthcare industry. Fried and Fayed, thus, recommend that healthcare entities obtain written business associate agreements from every cloud provider they use.



HealthVault Gets Mobile Enhancements

Joseph Goedert

HDM Breaking News, June 2, 2011

Microsoft Corp. has added mobile capabilities to its personal health records product line and plans more enhancements in the next few months.

HealthVault users now can immediately see their health information on their mobile devices, and Microsoft also is trying to make more user-friendly the "reconciliation process" of having visit summaries, medication and allergy lists, and other information incorporated into a HealthVault PHR.



By Joseph Conn

A call to do more on privacy

The Office of the National Coordinator for Health Information Technology recently took a white-paper whipping from the HHS inspector general's office.

I had a chance during a telephone interview last week to hear from a rebuttal witness, privacy lawyer Joy Pritts, chief privacy officer at the ONC.

Pritts said the government is in large part already heading in the same direction in which the inspector general was pointing, "but these things take time."

One criticism in the inspector general's report was that ONC should better use its powers to improve what it called general security controls. The inspector general specifically mentioned ONC should push for standards for two-factor identification—security measures for participants in electronic health information exchange.



A question of privacy in health records research

Researchers from Harvard and other institutions announced last week that they had identified a potentially harmful interaction between two commonly prescribed drugs, Paxil and Pravachol.The drug interaction likely would have been ignored if the researchers hadn't had access to hundreds of thousands of electronic health records, including those of Partners HealthCare patients.

Hospitals and doctors, under pressure from the federal government, are increasingly converting to electronic record systems. Because the new systems provide huge, searchable databases of health information for millions of patients, they are becoming an important tool in public health research. But they also raise serious ethical questions. I talked with Dr. David Bates, executive director of the Center for Patient Research and Practice at Brigham and Women's Hospital, about the balance between research and patient privacy.



Barely visible, big-impact health IT projects

June 02, 2011 | Tom Sullivan, Editor

Technological underpinnings. They're everywhere, but oftentimes they're not even seen by the masses.

Take the Direct Project, for instance. What has essentially been considered a set of protocols for secure e-mail is proving to be so much more: The foundation for future healthcare wherein Electronic Health Records automatically populate state-based Health Information Exchanges – routing the right information to the best place at a time appropriate for doctor and patient alike.

As Laura Adams, president and CEO of the Rhode Island Quality Institute (RIQI), which operates one such HIE, tells John Morrissey. The exciting thing about Direct "is that it's all behind-the-scenes. No doctor has to remember to do it, it doesn't get involved in their workflow."

Direct is a grand vision that will take considerable work to achieve, but like early cloud computing initiatives in the federal government, it's an effort already in motion. Indeed, as Bob Violino reports, cloud-based services and applications are rolling into agencies including the HHS, USDA, the Military Health System of the Department of Defense, and the Centers for Disease Control. Each is in its own unique phase of plotting or using cloud applications.




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