Quote Of The Year

Quotes Of The Year - 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, July 02, 2011

Weekly Overseas Health IT Links - 02 July, 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.



Supreme Court strikes down Vt. data-mining regulation

By Joe Carlson

Posted: June 23, 2011 - 11:45 am ET

In a victory for pharmaceutical and data-mining companies, the U.S. Supreme Court has struck down a Vermont statute that sought to outlaw the practice of pharmacies selling information to drugmakers about doctors' prescribing habits.

In a 6-3 decision (PDF) Thursday, the high court ruled that Vermont's law violated constitutional protections on free speech even though lawmakers drafted it with the goal of preventing pharmaceutical companies from using direct marketing to convince doctors to prescribe more-costly drugs to patients.

"While Vermont's goals of lowering the costs of medical services and promoting public health may be proper, (the contested law) does not advance them in a permissible way," Justice Anthony Kennedy wrote for the majority.



Health IT panel calls for metadata tagging

By Joseph Conn

Posted: June 23, 2011 - 4:45 pm ET

A federal health information technology advisory panel unanimously accepted a special work group's recommendations for implementing the measures proposed in last year's health IT report by the President's Council of Advisors on Science and Technology.

The PCAST called on HHS to speed up its efforts to promote health information exchange and adopt a specific, Web-oriented "universal exchange language" that would use metadata tagging to identify specific data elements of a patient's health records. Tagged records, according to the PCAST, would make the data easier to locate for research but also would better protect patient privacy.



ONC: Metadata proposed rule imminent

June 22, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT plans to publish “very soon” a proposed rule promoting the wider use of existing metadata standards so it can get feedback on the experience from various organizations, said Dr. Farzad Mostashari, the national health IT coordinator.

The use of metadata, or elements that describe data, is considered key to fueling more complex health information exchange.

The Health IT Standards Committee endorsed activities by ONC to explore the use of simplified and existing types of metadata standards, including for patient identity, provenance and privacy flags. It also recommended at its June 22 meeting that ONC seek feedback and evidence from real-world implementations. Provenance is the tracing of the source of data so a recipient can know if it is trusted.



Fulfilling the PROMISe

A brand new EMR is being rolled out in a midsize hospital. The EMR is exclusively based on touchscreen technology, with devices strategically placed on the floor. It provides concurrent access to medical records for all team members (physicians, nurses, pharmacists, radiologists, dieticians, secretaries) wherever they may be. Patients are also accessing the EMR. They enter their own histories and describe symptoms in detail through the same touchscreen devices. This patient-centered EMR, built by a team of clinicians and technologists working together, is taking a huge step forward in Clinical Decision Support (CDS). Physicians are not only shown differential diagnoses based on what patients and other team members entered into the system, but are also presented with individualized care plans, possible side effects, dosage recommendations and drug-drug-interaction alerts, all referencing evidence available in medical literature. Longitudinal records, test results and narratives are available by problem and by patient, and the response time is never more than half a second between the thousands of screens available. The place is Vermont, and the year is 1970.



NHS tests cloud-based health platform

By Andrew Bolger, Scotland Correspondent

Published: June 20 2011 04:09 | Last updated: June 20 2011 04:09

NHS patients could soon have control over their medical records and the power to decide who has access to their data.

A pilot scheme at London’s Chelsea and Westminster Hospital is seeking to speed up communication between patients, consultants and general practitioners by using cloud computing – accessing files via the internet.

Researchers at the hospital are working with Edinburgh Napier University to show how the paper-based system could be replaced with an e-health platform.


Health IT Can Energize National Prevention Strategy

The feds say health IT should play a pivotal role in preventing disease through expanded use of EHRs, telemedicine, and social media.

By Nicole Lewis, InformationWeek

June 21, 2011

URL: http://www.informationweek.com/news/healthcare/leadership/231000103

The Obama Administration has made several health IT-related recommendations in its National Prevention Strategy that call for expanded use of electronic health records (EHRs), social media tools, and mobile phone applications to help promote health and wellness.

The strategy was developed by the National Prevention Council, which is composed of 17 federal agencies who consulted with outside experts and stakeholders. The 122-page document is a comprehensive plan to increase the number of Americans who are healthy at every stage of life.



By Joseph Conn

How open will open-source be?

I want to bring you all up to date on the effort to establish an open-source software development project at the U.S. Veterans Affairs Department.

On Friday, the VA awarded a nearly $5 million contract to Reston, Va.-based Tiag to serve as the custodial agent of the project to upgrade the VA's VistA electronic health-record system.

No one really knows how much taxpayers have invested in VistA, which was built at taxpayer expense, starting in 1977. Last year, researchers at the Center for Information Technology Leadership in Boston took a whack at estimating the development costs of just four key VistA components, publishing their findings in the policy journal Health Affairs. The outlay: $4.1 billion. And yet, this valuable resource is largely—although not exclusively—in the public domain. That is, you or I can obtain a copy of VistA, exclusive of a few proprietary modules, for free under the Freedom of Information Act. In fact, I have a copy of an open-source version of VistA loaded onto a CD-ROM in the top drawer of my desk.



EHRs improve care coordination in medical homes

June 23, 2011 — 10:45am ET | By Janice Simmons

Using EHR-enabled care coordination resulted in numerous process improvements for patients with Type 2 diabetes and heart disease within a medical home, according to a new report from the eHealth Initiative (eHI).

Working with sanofi-aventis and Health & Technology Vector, eHI undertook a six-month exploratory project last year to understand how EHRs can be used to improve care coordination for complex patients. The study looked at use of EHRs with patients at three clinics of a community health center and with an independent practice association (IPA).

For more information:

- read the eHI report (free reg. req.)



Be careful: Copying, pasting can create false EHR data

June 23, 2011 — 11:18am ET | By Janice Simmons

Relying on copying-and-pasting materials within a patient's electronic health record (EHR) could lead to the insertion of false information in the record, concludes a group of researchers from Brigham and Women's Hospital in a recent issue of the Archives of Internal Medicine.

Previous research has shown that copying and pasting fragments of notes is common in EMRs. However, it was not known whether the resulting information was accurate," said Alexander Turchin, MD, a physician in the Endocrine Division at BWH and a Senior Medical Informatician at Partners HealthCare, in a statement. This study is the first to show in "a systematic way" that copy-and-pasted material may not be accurate, he added.



Can 'clouds' protect patient data from security breaches?

June 23, 2011 — 7:19am ET | By Janice Simmons

While cloud-based electronic health records (EHRs) have received a fair amount of publicity lately, nagging questions accompany their discussion: Are cloud-based EHRs protected from security breaches as they run across the Internet to off-site servers? Or are on-site systems the better bet for ensuring data protection?

An online study by the consulting firm, Software Advice, poses an interesting perspective on this issue this week. Author Michael Koploy, an analyst, notes that he and his colleagues speak on the phone daily with physicians who are researching EHR software. Much of the time, they hear the physicians say how afraid they are to switch to a system that puts their health data far away into the "clouds" where they could be hacked.

To determine whether those concerns are justified, Koploy looked into areas where patient data have been breached. The tool he used was the online data set compiled by the Department of Health and Human Services' Office of Civil Rights on breaches affecting 500 or more individuals.

Better known as the "Wall of Shame," it currently contains 288 security violations under the Health Insurance Portability and Accountability Act (HIPAA), starting in October 2009.

Looking at the data, physical theft and loss actually accounted for most of the reported breaches (63 percent). This was followed by unauthorized access or disclosure, which accounted for another 16 percent. However, hacking only accounted for 6 percent.



AMA: Standardize EHR User Interfaces

Joseph Goedert

HDM Breaking News, June 22, 2011

The American Medical Association at its annual meeting has called for standardization of major components of user interfaces for electronic health records systems.

Standardization would make it easier for physicians using different records systems in multiple facilities to quickly find the information they need, according to an AMA statement. "EMR user interfaces are comprised of icons, screen menus, keyboard shortcuts and control sequences that make it possible for physicians to interact with the software or operating system. Studies have documented physicians' difficulty in efficiency locating critical patient information in EMR systems due to poor user interface design."



More trusts use telemedicine for stroke

17 June 2011 Daloni Carlisle

More than 30 acute trusts have now adopted a telemedicine system designed to deliver fast and appropriate treatment to stroke victims.

The system, developed by NHS East of England and East of England Stroke Networks, enables consultants to talk to patients using video and audio links, view their scans from a lap-top and make decisions about prescribing life-saving drugs.

Damian Jenkinson, national stroke director, told Smart Healthcare Live in London that the technology was proven to be clinically safe and effective.

It has also been shown to deliver significant cost savings by reducing the number of people who are disabled by stroke.

Drug treatment for stroke – thrombolysis – must be delivered within three hours of the onset of symptoms to be effective. However, it is dangerous for patients for whom it is contraindicated.



New research shows RFID key to leaner hospital supply chain

June 21, 2011 | Healthcare IT News Staff

CINCINNATI – University of Cincinnati analysis of hospital supply chains – medicines, materials, devices and office supplies – reveals that the use of RFID technology can help hospitals cut as much as 18 percent in labor costs associated with resupplying.

The research, to be presented June 22 at the Institute for Operations Research and Management Science Healthcare Conference in Montreal, has implications for affecting many significant costs associated with hospital supplies. On average, supplies and inventory account for 30 to 40 percent of an average hospital’s budget, according to the research.



Q&A: Mostashari on the innovations electronic data will spark

By tsullivan

Created 2011-06-17 15:19

WASHINGTON – Electronic health records are only a beginning of sorts. Although a top priority for providers, the meaningful use of EHRs is not the end goal – rather, the health data that EHRs make more accessible stands to unleash a wave of applications, products and services that ultimately catalyze improvements in health care, delivery and outcomes for both individual and population health.

That is ONC’s ambitious vision, which means that National Coordinator Farzad Mostashari, MD, is essentially responsible for leading the charge. He spoke with Government Health IT Senior Editor Mary Mosquera and Editor Tom Sullivan on June 15 at the Government Health IT Conference here about the areas in which he sees innovation blossoming, the contentious nature of EHR usability, how overwhelmed providers should plan for all the incentives and unfunded mandates and why the healthcare industry will keep moving forward even if the White House administration should change next year.



Report Suggests a Surge in EHR Purchases

Joseph Goedert

HDM Breaking News, June 21, 2011

Half of more than 1,300 physician group practices recently surveyed expect to buy an electronic health records system during the next 24 months, according to CapSite, a Burlington, Vt.-based research and advisory firm. And 70 percent of those not purchasing say they already have an EHR that will be certified for meaningful use.

That kind of activity would nearly double ambulatory I.T. purchasing in 2010, the firm notes in a new report, 2011 U.S. Ambulatory Electronic Health Record and Practice Management Study. Consequently, CapSite projects a $3 billion market for ambulatory practice management and EHR systems through 2013. Half of the surveyed practices are independent and half are hospital-owned.



June 20, 2011, 7:00 p.m. EDT

Accenture Implements Nationwide Electronic Health Record System in Singapore

Phase One Launch Provides Single Patient Record for Healthcare Professionals

SINGAPORE, Jun 20, 2011 (BUSINESS WIRE) -- Accenture ACN +0.05% and MOH Holdings Singapore have launched one of the world's first national electronic health record (NEHR) systems. Aligned to Singapore's "one patient, one record" vision, the NEHR enables a single patient health record for clinicians to access across the healthcare continuum.

As patients visit providers -- including primary care clinics, acute and community hospitals -- healthcare professionals will be able to access a single patient record for medical information. The NEHR captures medical data, including patient demographics, diagnosis, medications, tests, procedures and discharge summaries, for exchange among clinicians.

"Our goal is for all Singapore health organizations to have real-time clinical information for treating patients," said Dr. Sarah Muttitt, Chief Information Officer, MOH Holdings. "This milestone represents a significant step towards achieving our vision."



ACPE offers new health IT program

By Joseph Conn

Posted: June 21, 2011 - 12:01 am ET

The American College of Physician Executives is offering a new—and largely online—health information technology leadership certificate program that can serve as a partial prerequisite for master's degrees in healthcare management from four participating universities.

The ACPE previously has offered individual courses in health information technology, but this
40-hour course is the organization's first full program leading to a certificate in health IT leadership, said Debra Sher, chief of strategic marketing for the Tampa, Fla.-based ACPE. The total program cost is $4,800, which includes the cost of tuition to a two-day "capstone course" at an ACPE fall institute.


Back To School: Courses Help Physicians Learn Health IT

ACPE certificate program aids physician leaders in understanding the lingo, technology, processes and challenges involved with implementing e-health records and other health IT.

By Marianne Kolbasuk McGee, InformationWeek

June 21, 2011

URL: http://www.informationweek.com/news/healthcare/leadership/231000124

The American College of Physician Executives has a new 40-hour course program in health IT that can help M.D. who lead hospitals, integrated health delivery networks, physician groups, and committees better understand the important health IT projects underway at their organizations.

The ACPE certificate program can also give the participants a head start for a earning a master's degree in healthcare management from several U.S. universities.



VA's open-source VistA contract worth $5 million

By Joseph Conn

Posted: June 21, 2011 - 10:00 am ET

Tags: Electronic Health Records (EHR), Information Technology, U.S. Department of Veterans Affairs

The U.S. Veterans Affairs Department will pay just under $5 million for an information technology consultant to set up and run an open-source software development project to improve its largely self-developed VistA electronic health-record system, according to a VA spokeswoman.

But the VA won't immediately release a copy of the actual winning proposal submitted by Reston, Va.-based The Informatics Applications Group, also known as Tiag. The one-year contract calls for Tiag to operate as a custodial agent "for an open-source software development community."



Welsh GPs live with My Health Online

20 June 2011 Fiona Barr

NHS Wales has announced that the first GP practices have gone live with its My Health Online service, which enables patients to book appointments and request repeat prescriptions over the internet.

GP practices using EMIS and INPS GP software have gone live the system, which is backed by £1.7m of funding from the Welsh Assembly Government.

A spokesperson for the NHS Wales Informatics Service told EHI Primary Care that the service is working with all four of its GP system suppliers - iSoft, INPS, HealthySoft and EMIS – to deliver My Health Online to all practices in Wales by autumn 2012.



GPs complain about N3 connection speeds

21 June 2011 Fiona Barr

GPs have claimed that N3 is inadequate to support the delivery of the government’s white paper objectives and called for central renegotiation of its contract.

Gloucestershire Local Medical Committee won support for a motion criticising the NHS' broadband network and claiming that it does not provide value for money at this month's national LMCs conference.

Dr Andrew Rigby, a GP at the Church Street Practice in Tewkesbury, told EHI Primary Care that the LMC had carried out a survey into N3. He said it was completed by 60% of practices; and 60% of them omplained about the speed of their connection.



Sponge Solution Remains Elusive

Cheryl Clark, for HealthLeaders Media , June 13, 2011

It might be called a hospital’s “quadruple jeopardy”: A hospital can be penalized four ways when a surgical item—most likely a sponge or lap pad, but increasingly a detached piece of metal or plastic—is unintentionally left inside a patient.

Two financial penalties will be assessed facilities that forget to remove surgical implements from Medicare patients, according to two separate sections of the Patient Protection and Affordable Care Act. And since October 2008, Medicare won’t pay hospitals for additional care necessitated by forgotten sponges
and instruments.

The fourth jeopardy came in April when CMS publicly released the names of hospitals where retained surgical items were left in patients.



Tuesday, June 21, 2011

Breaking Down the Barriers to Health IT Deployment

The Obama administration and Congress have committed billions of dollars to deploying IT that will modernize the health care system. Unfortunately, despite this investment, adoption of health IT is still lagging, especially among the office-based physicians who form the backbone of American health care.

The good news is we can still get it right. Common-sense, low-cost solutions exist. But, first we need to get real about solving the problems that impede deployment of health IT; the problems that lead physicians to frequently criticize the technology in their offices or hospitals as an impediment to productivity and care.



  • JUNE 21, 2011

New Math in HIV Fight

Statistical Method Evolves From Physics to Wall Street to Battle Against AIDS


Scientists using a powerful mathematical tool previously applied to the stock market have identified an Achilles heel in HIV that could be a prime target for AIDS vaccines or drugs.

The research adds weight to a provocative hypothesis—that an HIV vaccine should avoid a broadside attack and instead home in on a few targets. Indeed, there is a rare group of patients who naturally control HIV without medication, and these "elite controllers" most often assail the virus at precisely this vulnerable area.

Scientists have identified an Achilles' heel in HIV, the virus that causes AIDS, with a powerful mathematical method previously applied to the stock market, and think the spot could be a prime target for vaccines or drugs. Mark Schoofs explains.


How Random-Matrix Theory Found Its Way Into a Promising AIDS Study



AMA interactive tool helps docs identify HIT priorities

June 17, 2011 — 12:33pm ET | By Ken Terry

The American Medical Association's AMAGINE subsidiary has introduced an interactive online tool to help physicians identify their health IT priorities and see how those compare with their peers' objectives. AMAGINE, which operates a web-based platform with over 20 health IT products, also provides consulting help and discounts to physicians trying to get started with electronic health records and their component parts.

Physicians attending the AMA's annual meeting in Chicago this weekend can experience the "health IT index" at the AMAGINE booth. Users of the index can assign their priorities to several aspects of health IT, including electronic medical records, e-prescribing, care coordination, lab ordering and results, claims processing, clinical knowledge tools, and secure communications.



Michiana HIE shows that regional exchanges are feasible

June 19, 2011 — 10:15pm ET | By Ken Terry

A few weeks ago, I discussed two views of the future of regional health information exchanges (HIEs). A Harvard study in the Annals of Internal Medicine found that most HIEs were dependent on government grants and questioned whether the exchanges could ever be financially self-sustaining. In contrast, the eHealth Initiative, in its latest national study of HIEs, called sustainability "an attainable goal" for HIE organizations, citing that "there is a small but critical mass of sustainable organizations."

One of those HIEs is the Michiana Health Information Network, based in South Bend, Ind. Founded 11 years ago without help from state or federal grants, MHIN has been self-sustaining since at least 2006, according to Tom Liddell, the HIE's executive director. While MHIN is co-owned by a not-for-profit hospital and a not-for-profit reference laboratory, neither has put any additional capital into the enterprise in the past five years, Liddell tells FierceHealthIT. Monthly subscription fees from MHIN's participants have provided enough revenue to cover its operating expenses, allowing for growth.



Moving beyond the basics with health information exchange

By Charles Christian

Posted: June 20, 2011 - 11:00 am ET

I'm certain that most everyone reading this has heard about health information exchanges, and if you want to hit all the marks of the meaningful-use criteria, there is no question that you have to be able to at least accomplish a test or two using health information exchange capabilities and technologies. The real question is, exactly what size and type of exchange will be coming to your facility?

Should you opt for the simpler, straightforward approach of the Direct Project or hold out for a full-blown, industrial-strength health information exchange? That is a question that many of us are currently debating in the varied corners of our healthcare industry.



Chicago’s Data Exchange Takes Off

Gary Baldwin

Health Data Management Blogs, June 14, 2011

Six years ago, I interviewed Robert Steffel, the CEO of HealthBridge, an early--and then-rare—example of a health information exchange that actually worked. Back then they were called “RHIOs,” or regional health information organizations. I asked Bob what were the key factors in making the project work and he said it was primarily the spirit of cooperation, but also that the exchange partners were limited in number--their service territories did not highly overlap. Making a data exchange work in a highly competitive, and complicated urban marketplace, such as we have here in Chicago, would be very difficult.

Well, we’re about to see a test case of this notion right here in my home base, the Windy City. As Joe Goedert reported a few weeks back, the Metropolitan Chicago Healthcare Council is spearheading an HIE, one it expects to be “the largest unified metropolitan HIE in the nation, serving more than 9.4 million people.” No doubt, this is an ambitious effort, one that will deserve ongoing attention and coverage. And I plan to do just that—offer regular updates on the exchange, its accomplishments and challenges alike. The story will be a moving target.



Hospital turns to palm reading to ID patients

The infrared palm scanner thwarts ID theft

By Lucas Mearian, Computerworld

June 16, 2011 02:50 PM ET

New York University's Langone Medical Center said it is the first hospital in the Northeast to use a biometric infrared scanning system that converts a digital palm image into a unique patient ID.

The technology, called PatientSecure is a biometric reader that uses an infrared light to map an image of the blood-flow pattern through the veins in a person's palm. That digital image is then converted into a unique patient ID that can be used with the medical center's electronic health record (EHR) system.

A hand on the infrared image scanner

The technology has been deployed at about 10 other U.S. hospitals.



ONC popHealth tool automates physician quality measure reporting

June 17, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT (ONC) has made available a free tool to simplify the reporting by physicians and practices of clinical quality measures for meaningful use.

Although popHealth was just a concept a year ago, ONC has conducted real-world testing and is highlighting it as providers begin to demonstrate meaningful use.

popHealth is an open source reference implementation software service that automates the reporting of quality measures in stage one of meaningful use of electronic health records (EHRs), said Dr. Thomas Tsang, ONC’s medical director of meaningful use and quality.

popHealth also streamlines the automated generation of summary quality measure reports on the provider’s patient population to support meaningful use calculations. It can report aggregate statistics, but also gives the provider the ability to drill down into individual patient records.


Electronic Medical Records Now In All Military Hospitals

The EMR system installed by CliniComp in all 59 U.S. military hospitals worldwide is not yet connected to the military clinical information system.

By Ken Terry, InformationWeek

June 17, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/230800179

CliniComp, a San Diego-based health IT vendor, has completed implementation of a partial electronic medical records system in all 59 U.S. military hospitals around the world, according to the firm. However, the CliniComp EMR is not yet connected to the rest of the military clinical information system. It's also unclear how CliniComp fits into the ongoing integration of the Department of Defense (DoD) and the Department of Veterans Affairs (VA) EMRs.

CliniComp has installed its inpatient clinical documentation system in 36 of the 59 military hospitals since 2009. The other DoD hospitals implemented the CliniComp EMR over two decades, starting in 1987 at the Navy Medical Center in San Diego. The recent expansion of CliniComp to all military hospitals is part of the government's effort to apply commercial best practices in health care, said Mary Lamb, a health IT consultant with Suss Consulting in Jenkinton, Pa. "I see DoD's adoption of CliniComp as the use of a commercial best practice that integrates with its legacy information system."



Summary and Comment

Telemedicine in the ICU: Where Do We Go from Here?

An intensive care unit–telemedicine intervention lowered overall mortality, shortened length of stay, and increased adherence to best clinical practices.

Remote monitoring of patients in intensive care units (ICUs) by trained healthcare personnel has been promoted as a promising technology that will improve patient outcomes; however, a recent large multicenter trial failed to demonstrate mortality benefit (JW Hosp Med Jan 11 2010).

Researchers performed an unblinded prospective study of a tele-ICU intervention at a large academic medical center in Massachusetts from 2005 to 2007. Approximately 6300 adults were admitted to any of seven ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular). The off-site tele-ICU team, which included an intensivist, acted in complement with local clinicians to enforce daily goals, to review adherence to evidence-based practices, to respond to bedside alarms, and to assist in care plans for overnight admissions.




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