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."

Monday, October 31, 2011

Weekly Australian Health IT Links – 31st October, 2011.

Here are a few I have come across this week.
Note: Each link is followed by a title and a few paragraphs. 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.

General Comment

It seems the Annual Report Season has struck with all sorts of reports covering the period to June 30, 2011 appearing on various sites.
Additionally today is the day for sign off of a first round of specifications from the ‘tiger teams’. It will be interesting to see what has been achieved.
Other than that we have continuing fall out from a major information breach at State Super which reminds us all how vulnerable large scale data stores can be.
Last we have a giant of the Artificial Intelligence world pass away. All in all an active and interesting week.

E-health 'tiger teams' yet to meet

  • by: Karen Dearne
  • From: Australian IT
  • October 25, 2011 3:46PM
THE so-called tiger teams expected to draft and complete new technical specifications for the $500 million personally controlled e-health system by November 30 are yet to hold their first meetings.
The National e-Health Transition Authority established the plan to fast-track delivery of critical standards needed for the PCEHR infrastructure build and by the lead implementation sites, ahead of next year's July 1 start date.
Health department chief executive Paul Madden has told The Australian the tiger teams are confident they can sign-off the first round of specs "as ready to build" by October 31, and have the rest finalised and reviewed by the end of next month.

Medicare electronic refunds take off

QUEUES for cash refunds are shorter at Medicare offices, with more claims being lodged and paid electronically.
Only 8 per cent of patients visited a service centre for a refund during the 2010-11 financial year and a mere 0.9 per cent of claims were settled by cheque, down from 10pc and 1.1pc respectively the previous year.

Instead, services paid via electronic funds transfer - where Medicare payments are made direct to a customer's bank account - rose to 4.2pc, or 13.5 million transactions - from 3.9pc a year earlier.

Telehealth MBS claims revealed

There have been 2,275 MBS items claimed for videoconferencing since July 1, with more than two thirds of the consultations being in GP practices in rural areas.
Also, about 12% were in remote areas involving psychiatric attendances, specialist consultations and a smaller number of neurosurgery and obstetric attendances, the Senate heard last week.
According to the Senate hearing, 19% of the services were in RA1, inner and outer metropolitan areas; 35% in RA2; and 34% in RA3.

New player in national e-health space

THE government-owned National Health Call Centre Network is positioning itself as a lead player in Australia's e-health space through the provision of software-based medical triage and health information services delivered over the web or by phone.
With an eye to the federal government's e-health program, the NHCCN is developing a "centralised, comprehensive and reliable" online directory of healthcare providers.
"The directory is designed to provide a searchable and up-to-date listing of medical centres, pharmacies, dental services, hospitals and community health services, giving people better information on local resources," its annual report said.
"This is a national priority project and is closely linked with the e-health agenda."

Doctors offered fee to undertake records survey

DOCTORS are being offered $80 to respond to a federal survey about electronic health records.
That amount is more than Medicare pays them to see a patient for up to 20 minutes ($34.90) and more than they get for a complex consultation that lasts longer than 20 minutes ($67.65).
Australian Medical Association state president Peter Sharley agreed the Government's survey payments were more generous than its Medicare rebates. "That's the only way you're ever going to get a GP to do it (the survey) because they are working long hours," he said.

Poor uptake for Healthcare Identifiers

  • by: Karen Dearne
  • From: Australian IT
  • October 28, 2011 5:00AM
THE largely idle $90 million Healthcare Identifier service cost $9.23m to run last year, $4.6m less than expected due to lack of interest from healthcare providers.
As operator of the service, Medicare has issued its maiden annual report, revealing there was very little activity in the year after its launch by Health Minister Nicola Roxon on July 1, 2010.
"Based on the agreed demand plan with the National e-Health Transition Authority, the original forecast cost was $13.8m," the report says.

Your thoughts on the good and bad of eHealth in primary health care?

, by Melissa Sweet
What are the strengths and limitations of eHealth technologies in primary health care?
Olga Anikeeva at the Primary Health Care Research and Information Service is drafting a “research round-up”  about the use of eHealth technologies such as electronic health records, decision support systems and e-prescribing software by primary health care providers in Australia.
If you’ve an interest or expertise in the area, and can spare a few minutes – please have a look at her draft below and send your feedback by November 3 (contact details are at the bottom of the post).
eHealth aims to improve the quality and safety of Australia’s health system by introducing a more efficient way to collect and share information such as prescriptions and test results.1 The primary health care sector could benefit substantially from the widespread use of eHealth technologies.2 The National E-Health Transition Authority is currently working with numerous stakeholders, including GPs and allied health professionals to develop an eHealth uptake plan.2 This RESEARCH ROUND up focuses on the use of eHealth technologies in primary health care, by exploring the benefits and current limitations of a number of eHealth tools.

Telstra improves its bedside manner

Telstra has won a deal expected to be worth $36.7 million over the next eight years to install more than 3,500 computers at the bedside in South Australian hospitals and also provide patients with access to a range of entertainment services including Foxtel/Austar, a dedicated phone line and filtered internet access.
While the devices are able to be used for patient entertainment their other – arguably more important - use will be to provide health professionals with access to clinical and patient information at the bedside. The devices will also be able to be used to provide access to the Personally Controlled Electronic Health Record once that is rolled out from July next year.

Nehta annual report shows operating deficit

  • by: Karen Dearne
  • From: Australian IT
  • October 28, 2011 3:37PM
THE National e-Health Transition Authority had an operating deficit of $9 million during the last financial year, but reports a $32.9m surplus on total revenues of $123.6m.
The surplus was attributable to prepayments for elements of its Council of Australian Governments funded work program scheduled for the current year.
Nehta is holding $10m in revenue received but not yet earned, $5.8m in payments for vendors not yet made, and separate program funding of $1.2m received but not yet earned.
Other expenses and commitments not yet incurred include the National Authentication Service for Health (NASH) design and build at $6.5m, a Healthcare Identifier (HI) service cost of $4.8m plus a further $2.8m for HI implementations and advertising, and $10.7m in implementation support costs.

Seeking the e-health elixir

When the discussion turns to e-health Mukesh Haikerwal locks eyes – he rarely glances away but examines your reaction with diagnostic concentration. It’s no doubt a skill honed as a GP, but it is still slightly unnerving.
Government, its agencies, health departments and the IT sector may all on occasion try to stare him down but Haikerwal won’t blink in terms of what he wants from a national e-health programme. As the national clinical lead for Australia’s National E-health Transition Authority (Nehta) Haikerwal is determined that technology can completely reform Australia’s health sector and deliver improved, more sustainable services to Australians.
He has for years fought unsustainable status quos, ever since he was an uppity junior doctor in the UK railing against the long hours forced on young doctors. Today he’s 50 and a highly visible member of the establishment, a former president of the Australian Medical Association, an Officer of the Order of Australia, and was appointed chair of the World Medical Association in April.

Pay TV helps case for SA patient records

REVENUE from commercial pay TV and movie services will subsidise South Australia's new hospital digital patient record system unveiled today.
Launching the system, Health Minister John Hill said it was intended "to provide a clinical workstation for doctors and nurses and help standardise and improve clinical work practices across the whole health system".
Its establishment will see Telstra install about 3500 17-inch touchscreen bedside computers in 12 of the state's hospitals, through a joint investment with the South Australian government.
The state government has contributed $36.7 million to the system's roll-out, under an 8.5-year agreement with Telstra, following a tender process last year.

Victoria sets start-up costs for health catalogue

Auditor calls for development as soon as possible.

Health Purchasing Victoria expects to spend about $1.3 million to start building a common product catalogue for the state's public hospitals.
The start-up costs are laid out in a procurement report (pdf) by the Victorian Auditor-General.
"Initial software development and implementation is estimated at $600,000 with
$100,000 a year in licence fees," the agency told the auditor.
"Staffing costs for implementation and ongoing management are estimated at $600,000 in year one, rising to $950,000 per year from year three onwards.

Medibank Private's Health Solutions boosts revenue

MEDIBANK Private's new Health Solutions unit boosted its revenues to $258 million last year, up 53 per cent since its acquisition of software-based medical support online services provider, McKesson Asia Pacific, on July 1 last year.
The division helped the insurer attain a before-tax profit of $428m on total revenue of $4.7 billion.
Medibank managing director George Savvides said the purchase had enabled the expansion of its nurse and doctor triage services, preventive health programs and mental health services, delivered by phone or over the web.

Health secretary Jane Halton takes IBM Australia to task

  • by: Karen Dearne
  • From: Australian IT
  • October 26, 2011 4:01PM
THE federal Health department's reliance on IBM as its ICT outsourced technology services provider is causing frustrations, with system changes over the weekend resulting in "a catastrophic failure".
In an email to all staff yesterday, secretary Jane Halton said "As you are no doubt painfully aware, changes made by IBM to the department's IT storage environment" caused major system outages that had "significantly affected everyone".
"Our own IT staff worked very hard with IBM on resolving the issue yesterday, overnight and continue today to attempt to fix the problem and restore the system as soon as possible," Ms Halton said in the email, leaked to news website Crikey.

Doctors deplore changes to funding for PET scans

Julia Medew
October 24, 2011
ACCESS to potentially life-saving cancer scans has become a lottery, with thousands of patients denied government funding for the most accurate imaging test available for most cancers.
Doctors have told the Herald that changes to the Medicare Benefits Schedule in July have cut funding for thousands of people to have positron emission tomography scans, a highly valued test that detects cancer before it can be found with other medical imaging techniques. The scan, which creates two- and three-dimensional images, also helps doctors monitor treatment and check if cancer is becoming active again. In some cases, it can be the difference between life and death.
As of July, many patients with cervical cancer are no longer funded to receive the scan for restaging of their illness, while about half of all patients with lymphoma have been taken off the funding list. They are joined by patients with gastrointestinal stromal tumours who until July were funded to receive scans.

Martin Van Der Weyden: The robot invasion

24 October, 2011
THE ambiance of our hospitals is universally described as clinical, frequently impersonal and definitely dispiriting.
Inexorably caught up in the busyness of this medical microcosm, patients lose their identity in a form of reductionist verbal shorthand, becoming “the patient with CCF in bed 13 in Ward 3C”.
For the patients, even working out who is a doctor can be a complex exercise among a myriad of other health professionals. Couple this with the strict regimentation of ward activities and it is little wonder that hospitals, whose business is human welfare, are often accused of losing their humanity.

Super IT blunder risked $23m contract

Asher Moses
October 24, 2011 - 11:32AM
The federal government has been in daily contact with the company responsible for the First State Super security failure and has demanded immediate changes to its systems as the company revealed that three other superannuation funds it administers were also affected.
The security breach sparked panic in the government because Pillar Administration, which is responsible for the day-to-day operations of First State Super and other superannuation funds, is next month set to take over the super fund for federal politicians, police, ASIO spies, department heads and other federal public servants.
The federal government ordered an immediate independent IT review of Pillar's systems and says the $23 million contract won't begin until "remedial security enhancements" are implemented.

CTOs urge faster progress on e-health standards

By Jamie Yap , ZDNet Asia on October 27, 2011 
Technology leaders worldwide have called on the United Nations (U.N.) to step up progress on electronic health standards in order to achieve reliability and interoperability, which they said are crucial in enabling both patients and healthcare professionals to fully access and reap the benefits of e-health services and solutions.
The International Telecommunication Union (ITU), the U.N. agency for information and communication technology, said in a statement earlier this week it met with 21 CTOs from leading ICT companies, all of whom have urged it to accelerate technical standardization work in the field of e-health and cooperate with other standard bodies to create secure, reliable and interoperable e-health services and solutions.

NBN Co chief defends 'gag' on wireless

Clancy Yeates
October 25, 2011
NBN Co chief executive Mike Quigley has defended controversial agreements that stop Telstra and Optus pushing wireless services as alternatives to the network, saying the restrictions are in taxpayers' interests.
But Mr Quigley's support for what critics say are ''gag orders'' is at odds with comments from the competition watchdog, consumer groups, and the Productivity Commission.
As part of NBN Co's $11 billion deal with Telstra to shut down its fixed-wire network, Telstra is pledging not to promote wireless as an alternative to fixed-broadband for 20 years.
Optus, which is receiving $800 million to dismantle its cable network, has made a similar commitment for 15 years. The pledges have raised competition concerns, as wireless is likely to be the main competition with the NBN, a wholesale monopoly.

John McCarthy, one of the fathers of AI, dies at 84

McCarthy developed the LISP programming language and AI labs at MIT and Stanford
John McCarthy , one of the grandfathers of artificial intelligence, died Sunday. He was 84.
In 1958, while at MIT, McCarthy invented the programming language LISP, which has become the main language for artificial intelligence (AI) ( ) work. He also was one of the co-founders of the first artificial intelligence laboratory at MIT and the founder of the artificial intelligence laboratory at Stanford University.
Stanford University, where McCarthy was a professor emeritus of computer science, confirmed his death in a tweet Tuesday.

AusHealthIT Poll Number 94 – Results – 31st October, 2011.

The question was:
Will The DoHA/NEHTA Use of Rapid Delivery 'Tiger Teams' Lead to Stable, Implementable Standards for the PCEHR?
You Bet
-  3 (6%)
-  0 (0%)
Probably Not
- 11 (22%)
No Way
-  35 (71%)
Votes 49
A very, very  clear  vote. 93% do not think the Tiger Teams are a real goer!
Again, many thanks to those that voted!

Sunday, October 30, 2011

The Personally Controlled EHR (PCEHR). Are There Some Deeper Implications For the Consumer-Clinician Interactions?

The following article appeared a few days ago in the MJA Insight.

Sue Ieraci: Paternalism’s new practitioners

24 October 2011
WESTERN society’s view of doctors has changed substantially in the past few decades. What might previously have been regarded as special expertise and judgement is now seen as arrogance and paternalism.
As more of the general population has access to education about their health, it is only appropriate that orthodox medicine should adapt by providing more information, expressing uncertainty where it exists, and involving the patient in their care decisions. There is no doubt that this happens more than ever — and rightfully so.
Paradoxically, however, as orthodox medicine has become less paternalistic and increasingly based on evidence, more people are turning to practitioners who offer certainty in the guise of choice and empowerment.
At its worst, the outcomes of this “empowerment” can be devastating, as was the case in WA, when a woman was “influenced by misinformation and bad science” and refused orthodox medical treatment. The WA coroner was reported as saying that if the woman had not spent a year seeking the advice of a naturopath rather than seeing a doctor, she may have survived.
Maybe this case is an example of that fact that, while culturally we have turned away from “elitism” and moved towards the concepts of autonomy and choice, something in our humanity still seeks reassurance and certainty.
More here:
The two links cited point here:

Doctors and patients 'in parallel universes'

Hilda Bastian of the Consumers Health Forum claims most doctors don't treat patients as equal partners in medical decision making (Photo credit: British Medical Journal).
Despite the rhetoric of partnership, the reality is that most doctors don't treat patients as equal partners in medical decision making, according to an Australian health consumer advocate.
In this week's special issue of the British Medical Journal focusing on patient partnership, Ms Hilda Bastian, chairwoman of the Australian Consumers' Health Forum says that doctors need to work more equitably and effectively with patients.
"Many doctors retain the paternalistic view that they are the right people to speak and act for the people they care for," Ms Bastian says.
She says doctors often fail to acknowledge patients' own expertise in their condition and needs and feel threatened by those who are well informed. Patients, on the other hand find it difficult or frustrating when doctors appear not to have the information on offer.
Lots more here:
and to a report found here where an obviously intelligent women deferred treatment for her cancer for over a year from diagnosis (going with homeopathy) because she had concerns about the treatment.
See here:
What seems to be at issue in all this is how a patient is to navigate the health system, who they should trust for advice and who should be accountable when things go badly wrong.
In here article Dr Ieraci goes on to talk of the issue that faces a range of ‘holistic’ or ‘fringe’ practitioners who devote a lot of time to engaging the patient, empowering them and then really not providing, within that relationship, an honest assessment that there may be other more mainstream treatment choices. She then goes on to suggest this can be as ‘paternalistic’ as the no-discussion, my way or the highway, physician of old.
A core fear many clinicians have regarding the PCEHR is that having either patients or doctors with potentially only partial information there may be all sorts of unexpected issues arise. The risks to the quality of care this potentially poses are obvious.
My take on all this is that unless the consumer develops a fully trusting relationship with a mainstream and skilled clinician they put themselves at unnecessary risk. There is no doubt that there is much traditional medicine does not have all the answers for, and there is much comfort that can be found in adjunctive treatment but we need to get the basics as well done and as evidence based as we can before moving on to the other approaches.
Used properly it seems to me providing patients with access to the same electronic record the mainstream clinician is using to support their care provision may very well turn out to be a good thing in establishing the trust, openness and confidence between professional and patient we need. (Such models are working well in the US with Kaiser Permanente and are being actively worked on in the UK and elsewhere).
Creating parallel partial systems - as the PCEHR is - is just wrong headed in my view and is, in a way also just paternalistic and confrontational - saying to doctors we are going to set up a parallel system without the least level of prior consultation, discussion or review of other options, is hardly a way to get professional acceptance.
Despite all the denial our health system is actually quite amenable to, and architected for, the ‘tethered’ Personal Health Record  model given the inevitable ‘gatekeeper’ role the Medicare system imposes for access to care of many sorts. It is this sort of approach the Government should be pursing - in co-operation with the profession - not in confrontation with it as it now seems to be.
Personal control of a partial and ill-understood record (on the part of the patient who may or may not understand results reports and the like) may just turn out to be more dangerous than no shared record at all. Of course we have no idea about all that because no one has actually done a serious trial, at any scale, on the actual PCEHR proposal. There seems to be some idea that a whole range of Wave Sites are suddenly going to morph (on July 1, 2012) into a functioning national system! If you be believe that you would believe anything!
Before wrapping up, the issues of paternalism and autonomy are, I believe, best resolved on a one to one basis where the patient chooses how much guidance they want and also understand that with less guidance comes more personal accountability for ultimate outcome. With communication and trust this can work very well and each can have a satisfactory experience and hopefully good clinical outcomes. We all have to navigate relationships we are comfortable with, with lawyers, accountants and other professionals. We need to do the same with our doctors, while recognising that maybe your health is more important and needs more work than the tax return or the legal dispute!

Saturday, October 29, 2011

Weekly Overseas Health IT Links - 29 October, 2011.

Note: Each link is followed by a title and few paragraphs. 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.

Vocera updates mobile comms badge

17 October 2011   Shanna Crispin
Futuristic mobile communications company Vocera is looking to introduce an updated version of its communication badge to hospitals in the United Kingdom.
The wireless Vocera systems are activated by voice through the communication badges worn around the neck.
Royal Liverpool and Broadgreen University Hospitals NHS Trust has been using the system since 2008.
Vocera has redesigned the Star Treck-style badge following customer consultation and feedback from users.
October 15, 2011

Those Scan Results Are Just an App Away

EVEN in the vast world of apps, Dr. Patrick J. Gagnon has one with an unusual distinction: it had to be cleared for use by the Food and Drug Administration.
Dr. Gagnon, a radiation oncologist, uses the app when he sees patients in his Fairhaven, Mass., office. He pulls his iPhone out of his pocket, and then he and a patient, side by side, can view images on it and discuss treatment.
“It’s a nice way to go through a scan with a patient,” he said.
The app he uses, called Mobile MIM, made by MIM Software, can turn an iPhone or an iPad into a diagnostic medical instrument. It allows physicians to examine scans and to make diagnoses based on magnetic resonance imaging, computed tomography and other technologies if they are away from their workstations.

Better NHS IT could avoid 16,000 deaths

18 October 2011   Jon Hoeksma
Better use of advanced clinical information technology in England's hospitals could help prevent 16,000 deaths a year, according to figures cited in a new report.
University Hospitals Birmingham NHS Trust includes the figure, based on its own experience, in a new report submitted to the team investigating above-average death rates from 2005 to 2008 at Stafford Hospital.
The trust says that use of its’ locally developed PICS clinical system, now offered commercially with CSE Healthcare, has led to a 17% fall in deaths among emergency patients over 12 months, which would equate to 16,000 deaths prevented across England.

Talk about a revolution

Professor Michael Thick, the former clinical director NHS Connecting for Health, now McKesson’s VP clinical strategy and governance, explains why the success of the NHS reforms will not be ensured by technology alone.
19 October 2011
When plans for the vision of the future of healthcare in the UK were recently announced, one of its central aims would be to bring NHS resources and decision-making ‘as close to the patient as possible’.
The phrase “No decision about me, without me” not only provided a neat sound-bite to encapsulate the message, but it also casually condensed a multitude of major challenges into just six words. Moreover, it threw down the gauntlet to stakeholders across the marketplace that those responsible for designing and implementing health informatics systems needed to raise their game.
And though IT itself cannot lead change, its suppliers can show leadership and influence others to drive cultural change. The most effective suppliers will add true value to the dialogue. They will have an intrinsic understanding of the NHS and how it operates at senior levels – and will be able to contribute meaningfully to discussions around service design because of it. There are savvy suppliers out there already working with the NHS – and patients – to enable healthcare to be provided in new and innovative ways.

NHS rejects fears over roll out of medical database

Published on Saturday 22 October 2011 22:00
THE NHS in North Yorkshire has begun transferring medical records on to an electronic database to help boost life-saving treatment for hundreds of thousands of patients.
But health chiefs have maintained strict procedures will be in place to protect patients’ confidential records, which can be accessed by doctors anywhere in the country.
Angela Wood, NHS North Yorkshire and York’s assistant director of informatics, said: “Anything that can be done to save vital minutes in the treatment of patients can only be a good thing.
“When the new database starts to save lives, hopefully the concerns about the new procedures will diminish.

Leeds releases portal open source code

20 October 2011  
Leeds Teaching Hospital has released the open source code related to its Opensource clinical portal after a successful development phase.
The Opensource portal, developed with integration service provider ReStart Consulting, provides a single view of patient events and data from key departmental systems. The successful Phase 1 of its development saw integration from five systems to the portal via the trust’s integration engine using HL7 messaging.
The five systems are iSoft’s PatientCentre PAS; the trust’s own Patient Pathway Manager, which is used in the trust’s oncology department, and information from applications provided by Bluespier, Ascribe and EMIS.
Dr Tony Shannon, clinical lead for informatics at Leeds Teaching Hospital, said: “We are pleased that the first pilot phase of the Open Portal project has been a useful success. The feedback from clinical teams here at the Trust is very positive and the pilot project has proven to be both clinically and technically useful.”

Few HIEs financially self-sustaining, survey finds

Posted: October 20, 2011 - 11:00 am ET
Financial sustainability remains an unsolved mystery for the vast majority of health information exchanges, according to a synopsis of a new survey report by the eHealth Initiative, a not-for-profit organization promoting health information technology.
A small but growing number of HIEs, however, have found the secrets to financial success, and they should be studied and emulated, the survey summary said.
There were 196 health information exchange “initiatives” responding to the 2011 version of survey, and just 24—that’s 12%—reported they were financially self-sustaining, according to a news release about the report, “Health Information Exchange: Sustainable HIE in a Changing Landscape,” which the eHealth Initiative is selling for $250.

eHealth Initiative Releases 2011 Report on Health Information Exchange Sustainability

Trends show advancement with a small number of programs, but action is needed to support health information exchange sustainability now more than ever

WASHINGTON, Oct 18, 2011 (BUSINESS WIRE) -- Today, eHealth Initiative (eHI) released its 2011 Report on Sustainability entitled, Health Information Exchange: Sustainable HIE in a Changing Landscape, taking stock of community-based efforts designed to improve health and healthcare through the mobilization of health information electronically.
This report builds on the 2011 HIE survey results which indicate that at least 255 communities across the U.S. are continuing to bring together multiple stakeholders to focus on the secure exchange of health data to improve health and outcomes for patients. Such efforts bring all stakeholders within the health system, including clinicians, community health centers, consumers, employers, health plans, hospitals, laboratories, pharmacies, public health agencies and government together to streamline data delivery between patients and providers.

ONC reorganizes, adds deputy slot

Posted: October 20, 2011 - 11:30 am ET
The Office of the National Coordinator for Health Information Technology now has a No. 2, at least on the organization chart.
As part of a reorganization “to more effectively meet the mission” outlined by the Health Information Technology for Economic and Clinical Health Act, a section of the American Recovery and Reinvestment Act of 2009, the office will add the position of principal deputy, according to a notice by HHS Secretary Kathleen Sebelius.
According to the notice, to be published in the Federal Register, the principal deputy “works with and reports directly to” the national coordinator “and will be responsible for day-to-day operations, decision making and staff management of ONC.”
By Joseph Conn

For now, trust no one on Internet privacy

Trust, once lost, is hard to restore.
Earlier this month, Federal Communications Commission Chairman Jon Liebowitz talked about roping trust like a runaway horse and leading it back into the barn of fair Internet commerce.
Liebowitz was speaking at a half-day conference in Washington about online privacy.
At the same conference, Stanford University graduate student Jonathan Mayer presented his research report, “Tracking the Trackers: Where Everybody Knows Your Username” The “leakage” of personally identifiable information from one web site operator to another is ubiquitous, Mayer said.

Majority of consumers skeptical about EHR use

October 20, 2011 — 8:01am ET | By Marla Durben Hirsch - Contributing Editor
An estimated 56 million people have viewed their medical data on an electronic health record maintained by their doctor, and another 41 million are interested in doing so, according to a new survey released by Manhattan Research. Despite such growth, however, a majority of adult patients are skeptical about accessing their health information via a doctor's EHR.
More than half of American adults--140 million people--were estimated to have not accessed their medical records via their physicians' EHRs, and had no desire to do so. According to the survey, those who weren't interested were older, less educated and "significantly" less likely to use the Internet or electronic devices. 

Many Patients Love EHRs, Fear Storing Data Themselves

Consumer interest in accessing electronic health records is growing, but still below majority level, survey reports.
By Ken Terry,  InformationWeek
October 17, 2011
Nearly half of consumers have viewed or would be interested in seeing their electronic health records (EHRs), according to a new survey by Manhattan Research. But so far, that interest has not translated into a leap in the use of personal health record (PHR) applications to store that data.
Based on the survey's sample of 8,745 adults, Manhattan Research estimated that 56 million people, or 24% of the adult population, have already accessed data in their physician's EHR. Moreover, the New York-based firm said, 41 million (17%) more consumers would like to have this access.
In contrast, 140 million consumers--a 59% majority--report that they have not used and would not be interested in accessing their medical records in their doctor's EHR.

Physicians take a stand on reuse of health data

October 19, 2011 | Bernie Monegain, Editor
WASHINGTON – The American College of Physicians, which represents 132,000 internal medicine specialists, is proposing a privacy rule that says researchers should maximize appropriate uses of information to achieve scientific advances without compromising ethical obligations to protect individual welfare and privacy.
The ACP discusses its members fears about re-uses of personal data as well as re-uses of research data and samples a new document, which is an update of a paper produced by ACP two years ago.
The release of “Health Information Technology & Privacy” comes near the close of the comment period Oct. 26 for the Advance Notice of Proposed Rulemaking (ANPRM) of “Human Subjects Research Protections: Enhancing Protections for Research Subjects and Reducing Burden, Delay, and Ambiguity for Investigators." The proposed changes, which will be highlighted in ACP’s ANPRM comments, are designed to strengthen protections for human research subjects.

Health IT M&A activity down in 2011, value up

October 20, 2011 | Diana Manos, Senior Editor
NEW YORK – The first three quarters of 2011 mergers and acquisitions volume is down 6 percent compared with transactions in 2010, according to a report investment bank Berkery Noyes released Oct. 17.  The study also found transaction value increased by 245 percent in 2011 over 2010.
Berkery Noyes, specializing in information content and technology industries research, attributed the sharp increase in transaction value to the Blackstone Group’s announced third quarter acquisition of Emdeon for $3.03 billion, the largest transaction thus far in 2011.

Are Scribes the Missing Link Between Physicians and EHRs?

Written by Sabrina Rodak | October 17, 2011
Hospitals across the country are implementing electronic health records as they work towards meeting meaningful use requirements and receiving incentive payments. Physicians and other healthcare providers may need to alter their workflow as they transition from paper to electronic records. Physicians in the emergency department, however, may have more difficulty fitting EHRs in their workday due to the fast-paced environment.

"There are huge benefits [of EHRs] in terms of sharing information and data mining, for epidemiological reasons and billing reasons; but there's just that missing link," says Jason Ruben, MD, director of CEP America's Scribe Program. To integrate EHRs into the ED without disrupting physicians' time with patients, Dr. Ruben helps hospitals develop scribe programs, in which people, typically pre-med students, follow ED physicians and enter their data into the EHR for them. Dr. Ruben explains the benefits of scribes and why they might be used hospital-wide in the future.
Thursday, October 20, 2011

An IT-Driven Colonoscopy: What Hospitals Can Learn From Other Industries

When I went in for my first-ever screening colonoscopy, I was worried about complications or the doctor finding cancer. The procedure was routine, my results were good and I was back at work the next morning; however, the process was uncoordinated, inefficient and lacked a customer focus. The experience could have been improved with IT solutions common in other industries.
The GI Referral and Initial Office Visit
My first colonoscopy began with a routine visit to my primary care practitioner. When I mentioned that I had not had my recommended colonoscopy after turning 50, she referred me to a gastroenterologist. My PCP uses an electronic health record, but the gastroenterologist to whom she referred me does not. So when I visited the gastrointestinal (GI) practice for my pre-procedure exam, I had to complete all the same paperwork, including a detailed medical history, and I had the same physical exam I had just gone through with my PCP. I also received printed instructions about what I needed to do and what to expect the week of my colonoscopy.

Consent system puts patients in charge of their health data

A pilot program will show how records are used and shared and how choices are stored electronically.

By Pamela Lewis Dolan, amednews staff. Posted Oct. 19, 2011.
A few physician practices are scheduled to test a federally authorized system that would make it easier for patients to decide how, when and with whom to share their health data -- and easier for doctors to know their patients' choices.
The Health and Human Services Office of the National Coordinator for Health Information Technology has given a $1.2 million contract to a private company to develop and pilot a system for patients to learn their options for consenting to the use of their data and recording their choices electronically.
The system will be piloted at four physician offices that are part of western New York's health information exchange, HEALTHeLINK. It's not yet known how the system will be presented to patients or how physicians will be involved.

Use of IT can reduce disparities, study says

Posted: October 19, 2011 - 11:00 am ET
Effective use of health information technology can reduce racial and ethnic healthcare disparities, according to a newly published study in the Joint Commission Journal on Quality and Patient Safety.
The authors recommended a series of steps, including using health data to find and fix gaps in care, and developing clinical decision support tools that specifically address areas where disparities are common. Those strategies can help providers identify causes of healthcare inequities, such as language barriers and difficulty navigating a complex healthcare system, they said.
Written by Jeff Byers
October 18, 2011

Report: EHR market to hit $6.5B in 2012

The U.S. market earned revenues of $973.2 million in 2009 and total market revenues are expected to peak at $6.5 billion in 2012, primarily due to new licensing and upgrades as hospitals scramble to get certified EHR systems in place, according to a report from market researcher Frost & Sullivan.
“Revenues are expected to retrench some after 2013 due to increased market saturation and growing price competition,” the report, titled “U.S. Hospital EHR, 2009-2016: Charting the Course for Dramatic Change,” continued.
Since 2009, hospitals’ interest in EHRs has skyrocketed, primarily due to financial subsidies provided by the U.S. government’s HITECH Act, where the rate of hospital EHR adoption is expected to expand significantly over the next several years, particularly for advanced EHRs designed to meet meaningful use criteria, according to Frost & Sullivan.

Could ICD-10 have as big a financial impact as the mortgage crisis? Yes. Here's why.

October 17, 2011 | Michael F. Arrigo, Managing partner, healthcare practice, No World Borders
U.S. National Healthcare Expenditures (NHE) are $2.7 trillion in 20111 and are forecasted to grow 34% in five years. This multi-trillion dollar economy will shift its reimbursement paradigm to ICD-102 in under 24 months. ICD-10 will introduce opportunities and risks to hospitals and health plans that may be equivalent to the $148.2 billion to $500 billion in losses3 to the U.S. economy in the mortgage crisis. This is because ICD-10 introduces favorable and unfavorable reimbursement results.
Yet, ICD-10 was obscure outside the health care industry until just months ago. Only recently did mainstream business media start covering ICD-104, described by The Wall Street Journal as health care’s ‘Y2K5 problem’. It is ironic that Y2K, the mortgage crisis, and ICD-10 have similarities. Cynics criticized Y2K as an expensive non-event. As I’ll point out later, even if this were true, Y2K produced other important benefits. The mortgage crisis was about ethical failures in leadership, transparency, and poorly documented quality that led to higher than expected risk.

Mostashari: 'Our healthcare system is in trouble'

October 17, 2011 | Diana Manos, Healthcare IT News
Healthcare IT stakeholders gathered Oct. 14 in Washington for a work meeting, discussing ways IT could help improve transitions in care.
The invitation-only meeting was hosted by the Office of the National Coordinator for Health Information Technology (ONC), the John A. Hartford Foundation, the Gordon and Betty Moore Foundation, and Kaiser Permanente.
Attendees included federal officials, electronic health record vendors, entrepreneurs, grantees, leaders from ONC’s Beacon Communities and foundation funding organizations.
 “We basically have all the tribes together today,” said Aaron McKethan, director of ONC’s Beacon Program, as he kicked off the meeting.

Spotty IT adoption limits quality aims: report

Posted: October 18, 2011 - 11:30 am ET
A new report from the Commonwealth Fund says the nation's uneven adoption of health information technology has hindered quality improvement efforts. But the authors also said that recent changes, including those in the health reform law, could boost IT use.
“The Affordable Care Act and investments in information systems offer the potential for rapid programs in areas like adoption and use of health information technology, safer care and premature deaths from preventable complications,” said Dr. David Blumenthal, chair of the Commonwealth Fund's Commission on a High Performance Health System, which produced the report, and professor of medicine and healthcare policy at Massachusetts General Hospital, Boston, and Harvard Medical School.
Blumenthal is also the former head of HHS' Office of the National Coordinator for Health IT.

Interim care-transition standard near: ONC

Posted: October 17, 2011 - 11:00 am ET
A federal advisory group is expected to finalize a short-term implementation standard for transitions of care by year-end, according to officials from the Office of the National Coordinator for Health Information Technology.
The group of industry representatives, working as part of the S&I Framework in ONCHIT's Transitions of Care Initiative, aims for health IT vendors to begin using the interim implementation standard by the end of 2011, according to Dr. Douglas Fridsma, director of Standards and Interoperability for ONCHIT. The Transitions of Care Initiative aims to improve the electronic exchange of core clinical information among providers, patients and others as part of the federal EHR incentive program.

How HIT Can Make Care Transitions Safer

Gienna Shaw, for HealthLeaders Media , October 17, 2011

So much can go wrong during so-called transitions of care. Lack of communication and coordination with primary care physicians when a patient is discharged from the hospital, for example, can compromise patient safety, lead to ED visits and readmissions, and cause a host of other problems.
So how can health information technology make care transitions safer and more seamless?
That was the question posed at a working meeting of developers, healthcare providers, patient organizations, technology companies, health IT experts, and officials from government agencies in Washington, DC, on Friday. Kaiser Permanente sponsored the event along with the John A. Hartford Foundation and the Gordon and Betty Moore Foundation. Participants worked to identify immediate and short-term technology solutions to improve care transitions and brainstormed new ideas.

BT completes N3 internet speed boost

17 October 2011   Shanna Crispin
BT has completed a two-stage upgrade of the N3 network intended to speed up internet access across the NHS.
The service provider has announced it has more than doubled the capacity of the network’s internet gateway – the part of the broadband network which carries traffic to and from the internet.
During the spring BT increased capacity from 1.82Gbps to 3Gbps. It has now completed the second stage of the upgrade by expanding the capacity limit to 5Gbps.

Commentary: Why RECs and HIEs need each other

October 14, 2011 | Laura Kolkman
Regional Extension Centers (RECs) and health information exchange (HIE) initiatives share a common purpose: enabling the exchange of patient information to improve health outcomes and care quality. Their individual goals and objectives are also complementary. RECs support physicians in the selection, implementation and use of electronic health records (EHRs), while HIEs provide the infrastructure across which the information collected by those EHRs can be exchanged.
Yet in our work with RECs and HIEs nationwide, we have not seen consistent levels of meaningful coordination of efforts between the two. In fact, we’ve encountered areas where the REC and the HIE seem to be competing — a situation that is both confusing and counterproductive.

VA, DoD moving toward SOA as iEHR takes shape

October 13, 2011 | Mary Mosquera
ALEXANDRIA, VA – The Defense and Veterans Affairs Departments are much more alike in the healthcare services they deliver than they are different. That is critical as they build the components of their integrated electronic health record (iEHR), which will be based on common services applications instead of a large proprietary technology system, said Mark Goodge, chief technology officer of the Military Health System.
“We’ve done the mapping of what the VA and DOD do, and we’re so much alike, about 98 percent alike. There are some things that are different, like theater [battle operations] for us and long-term beneficiary care that VA does,” he said at an Oct. 12 conference sponsored by Defense Strategies Institute.

2-D bar codes help docs manage vaccines via EHRs

October 13, 2011 — 7:44pm ET | By Ken Terry
Cook Children's Health Care System in Fort Worth, Texas and athenahealth, a Watertown, Mass., electronic health records vendor, have demonstrated that a new 2-D bar coding system for vaccines can be used to help physician practices and the parents of pediatric patients manage vaccination data.
Besides athenahealth, Microsoft and drug manufacturers Sanofi Pasteur and Merck also collaborated on the pilot with Cook Children's, which includes a hospital and a group of 300 physicians. Clinicians administering shots to children use the bar codes to scan information about the vaccines into the cloud-based athenahealth EHR. Parents can use mobile devices to read the bar codes and upload them to personal health records on Microsoft HealthVault.

ACOs: A sustainable business model for HIEs?

October 14, 2011 — 4:47pm ET | By Ken Terry
Few regional and state health information exchanges have found a sustainable business model. John Tempesco, chief marketing officer at ICA, a Nashville-based HIE vendor, recently told attendees at a Massachusetts conference that accountable care organizations (ACO) might provide the solution.
Speaking at a meeting of the Massachusetts Health Data Consortium, Tempesco said that the key to HIE success will be "patient centered HIE technology" that enables true communication at critical hand offs, collaboration across the continuum of care and analytics to determine best practices to reduce costs while improving quality. These also are the goals that ACOs will have to achieve.
Monday, October 17, 2011

California Readies Medicaid EHR Incentive Program

California has taken one large step forward in its goal to make electronic health records a ubiquitous part of health care provider practices in the state.
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for inventive payments under Medicare and Medicaid.
The California Department of Health Care Services announced the application process for the Medicaid EHR incentive program is open for business. The state now is ready to distribute as much as $1.4 billion in federal incentive funding to hospitals and physician groups who treat beneficiaries of Medi-Cal, California's Medicaid program.
The application process will be staggered over three months: hospital registration opened on Oct. 3; physician groups are next in line, able to apply on Nov. 15; and individual physicians can file for the federal money beginning Dec. 15.