Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, January 31, 2012

There Is A Very Important Point Contained In This Article. There Is A Need To Sort Fact From Fiction and Hope!

The following commentary appeared a little while ago.

Research data everywhere and not a drop to drink

By gshaw
Created Jan 25 2012 - 1:48pm
Physicians like numbers. Data, double-blind studies, peer-reviewed journal articles, evidence. And they clamor for scientific proof whether the issue is prescribing statins [1] to patients at risk for heart disease or whether the debate at hand is the value of e [2]lectronic health records systems [2], the pros and cons of email communication [3] between docs and patients, the benefits of e-prescribing [4], or the impact of m-health technologies on patient outcomes.
Show me any IT initiative that will affect a physician's workflow, schedule, paycheck, or liability risk and I'll show you a doctor who's calling for evidence that the rewards outweigh the risks.
And since m-health, e-health, connected health, telehealth and data-driven health (et al) are pretty much dead in the water without physician support, researchers are scrambling to deliver it.
The Journal of the American Medical Informatics Association recently published a flurry of such studies, including one that found using an automatic alert system in providers' EHR systems significantly increases the documentation of previously unknown patient problems [5]. Another found that poor EHR implementation can skew quality measures. A third found that some EHRs are lacking in adverse drug event detection [6]. And yet another said they're a good tool for identifying preventative services in order to avoid unnecessary procedures.  
But wait, there's more: On any given day you can find a new study that proves this or that about EHRs and other health IT tools. Web-based tools aren't effective for diabetes management [7]. EHRs improve hospital nursing care [8]. EHRs reduce racial disparities [9]. It goes on and on.
You see the problem, here, right? There are thousands--if not hundreds of thousands--of questions about electronic health data and the various tools physicians can use to harness it. By the time researchers finish slicing and dicing data in incremental studies such as these, the EHRs of today will be sitting on a shelf in the Smithsonian ... and we still probably won't be any closer to reaching a consensus about their overall benefits or efficacy.
Lots more here:
There are two threads here that I think we need to tease out. The first regards the need for evidence based practice and the second is the need for real clarity as to just what a particular piece of evidence means and just how far the findings of even a very conclusive and well conducted study can be extrapolated into drawing more general conclusions.
On the first issue we need first to accept that common sense and evidence are not the same thing! We also need to acknowledge that with the costs and risks of health care services rising we need not to be adopting and doing things that just seem right and make apparent sense. We need to devote increasingly scarce resources to those activities that can be shown to really make a difference to health outcomes.
If ever there was an example of the sort of woolly thinking that leads to bad decisions in action it is the thought bubble that has led us to the PCEHR. Never been tried, never been tested but off we go! What nonsense!
On the same point we also cannot go on pretending that e-Health is harm and risk free. There is now a lot of evidence that says that is simply not the case!
On the second issue I would be the first to admit that right now the evidence base for sweeping generalisations in Health IT looks very shaky indeed. There are all sorts of questions around whether an apparently conclusive study conducted at a major referral centre means much for the larger world of more normal facilities and whether what is found in premium implementations is actually seen to be generalizable. It is all too easy to say well it worked there, it makes sense that it does so the outcome will always be true in all situations. This is just not so - as the drug makers will testify. In careful clinical trials a particular therapy is excellent - but put into the hands of the ordinary clinician and a less motivated patient and the outcome can be very different!
I believe this is fundamentally important material that deserves more thought and reflection. It is just not good enough to hope something will work - as I keep being told elsewhere ‘hope is not a strategy’. We need evidence and proof!
David.

p.s.

As a coincidence - just as I finished this blog article this appeared:

http://blogs.crikey.com.au/croakey/2012/01/31/mental-health-funding-well-targeted-or-just-well-meant/

Guess what? The same problem of Government health policy being implemented in an evidence free way!

Monday, January 30, 2012

There Are Some Interesting Rumours Regarding NEHTA Doing The Rounds Tonight!

I don't have any details at this point - other than to say that apparently 'urgent reports' are being sought and assessments of the impact of the NEHTA 'product recall' on the PCEHR program are being requested.

Hardly a surprise - in fact I am surprised action did not come sooner!

It will be fun to keep an eye on www.health.gov.au and www.nehta.gov.au for any announcements / releases.

Please note this is all unconfirmed but I need readers to keep an eye out and let me know what happens and when!

David.

Weekly Australian Health IT Links – 30th January, 2012.

Here are a few I have come across the last week or so.
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

There was really only one bit of news this week that had been the source of rumours late last week and which then broke with the first article in the round up at the Australian on Tuesday morning.
It is amusing to see that the spin machine was still pumping out material even as briefings for the Wave sites were being organised (See items 2 and 3).
We now know at least some of what was reported is not quite ‘on the money’!
Other than that we see more submissions appearing for the Senate Community Affairs enquiry into the PCEHR and related matters.
You can be sure the lobbying pro and con is going on furiously behind the scenes at this point.
Sadly Queensland Health is also in the news again for all the wrong reasons!
All this bad news sadly made some reasonably good news on Telehealth from a large assemblage of publicity seeking ministers (nothing new in that!).
Have a good week - we should soon hear when the Senate Committee hearings will be. They will be interesting to watch!
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E-health key trial halted by specifications glitch

MOST of the trial sites for the federal government's electronic health record project have been taken offline after it was discovered they were working to different specifications than the planned national model.
The National E-Health Transition Authority (NEHTA) halted the rollout of primary care desktop software at 10 trial sites on Friday blaming incompatibility with the national specifications.
It is the latest blow for the Personally Controlled Electronic Health Record (PCEHR) project, which has attracted $466 million in federal funding over two years and is considered vital to efforts to combat preventable and chronic disease.
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Hunter e-health to go live

BY JACQUI JONES
23 Jan, 2012 04:00 AM
The Hunter will launch personally controlled electronic health records in the coming weeks, ahead of a national rollout on July 1.
Hunter Urban Medicare Local has spent the past year doing preparatory work.
The Medicare Local’s primary care, IT and e-health director John Baillie said the Hunter system would go live in the next few weeks.
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Electronic records create healthier system

BY PETER JEAN, HEALTH REPORTER
24 Jan, 2012 04:00 AM
Lost and forgotten referral letters have led to countless Australians being turned away from specialist doctor appointments or forced to wait while administrative staff request faxed copies from GPs.
But when Sydney GP Raymond Seidler sends a patient to a specialist or the emergency department at the nearby St Vincent's Hospital, he knows his referral letter won't be forgotten.
That's because as an eHealth early adopter, Dr Seidler's Kings Cross practice is electronically connected to hospitals. ''The hospital receives up-to-the-minute information including pathology tests performed by the GP and has all the demographic information required clearly legible,'' he said. ''The GP no longer has to print page after page of referral letters and ensure that the patient actually takes the letter with them to the hospital often some weeks later to their appointment.''
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Specification issue halts health software

By Suzanne Tindal, ZDNet.com.au on January 24th, 2012
The National E-Health Transition Authority (NEHTA) has confirmed that it has had to halt the planned implementation of primary-care desktop software at e-health pilot sites, due to an issue with specifications.
"This pause will impact work currently being undertaken by the primary-care e-health network sites: Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local and Accoras (Brisbane South). Greater Western Sydney, St Vincent's, Calvary, Cradle Coast, NT and Mater will be impacted on the primary care elements of their projects," the authority said in a statement, confirming a report by The Australian.
Only three projects will not be affected: two pilot sites run by Medibank and FredIT; and the Department of Defence's e-health program JEHDI.
NEHTA said that "internal checks" detected problems with a recent release of specifications, which was pushed out in November 2011.
"Our specifications are subject to rigorous assessment processes. These processes highlighted some technical incompatibilities across versions," the authority said.
It stressed that the software hadn't gone live, and that the decision to halt work is a quality-control call in order to reduce risk. It will work with the sites and the software vendors on what to do, given the delay.
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March the target for NEHTA specification fix

Written by Kate McDonald on 25 January 2012.
The National E-Health Transition Authority (NEHTA) is hoping to finalise changes to its specifications for GP desktop software by mid to late March.
Problems have been discovered in the specifications for GP software development released in November last year.
NEHTA has put a hold on further implementation of the software, affecting most of the Wave 1 and 2 sites for implementation of the PCEHR.
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E-health records moving ahead: NEHTA

25 January, 2012 Sarah Colyer
The clinician leading the government's drive for e-health records is meeting medical colleges on Wednesday and will reasssure them that the program is moving ahead, despite newly discovered technical glitches that could render some software systems uselsss.
The National E-Health Transition Authority (NEHTA) confirmed on Tuesday that it had told GP software vendors to pause work on projects aimed at allowing GPs to send patients’ health information electronically, due to “technical incompatibilities”.
A spokeswoman for NEHTA would not elaborate on the problems. But sources within the organisation are worried that the rush to meet an unrealistic political deadline of July 1 for the start of the national scheme will lead to a system riddled with errors.
Speaking ahead of a meeting with the RACGP and other groups in Melbourne, NEHTA clinical advisor and former AMA president, Dr Mukesh Haikerwal, told Australian Doctor: “We have to be upfront about the fact that ‘things have been discovered’.”
Two separates sets of specifications for writing software have been circulated by NEHTA which are not compatible, Dr Haikerwal said.
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Oz stalls e-health trials

Pilot catches bugs in specs
Australia’s e-health implementation has stalled because of cross-version software incompatibilities, it emerged yesterday.
The agency responsible for the rollout, the National E-Health Transition Authority, made the announcement on January 24, stating that an assessment of the Primary Care desktop software “highlighted some technical incompatibilities across versions”.
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NEHTA halts PCEHR pilot sites

The National E-Health Transition Authority has provoked fresh doubts about the $467 million PCEHR project after it formally halted most of its pilot ehealth sites today.
NEHTA chief executive Peter Fleming announced it had temporarily paused implementation of Primary Care desktop development due to a range of software incompatibilities.
Affected pilots include the Primary Care eHealth Network sites of Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local and Accoras (Brisbane South). Also affected are the primary care aspects of projects at Greater Western Sydney, St Vincent's, Calvary, Cradle Coast, NT and Mater. According to NEHTA, Medibank, FredIT and JEHDI will progress as planned.
The move comes after the government-funded organisation in November confirmed the deployment of “tiger teams” to drive the development and implementation of standards for the PCEHR. It also issued a new round of specifications in November.
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NEHTA presses pause on e-health records

The implementation was stopped after internal checks detected issues in the specifications
The National e-Heath Transition Authority (NeHTA) has halted the implementation of primary care desktop software development at a number of lead implementation sites for the $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.
A spokesperson for the authority told Computerworld Australia the decision to “pause” the implementation came after internal checks detected issues in the latest release of its specifications in November 2011.
“Our specifications are subject to rigorous assessment processes,” the spokesperson said.
 “These processes highlighted some technical incompatibilities across versions. We have identified problems with the specifications and have made the decision in order to avoid any risks.”
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Computer glitch stymies NEHTA trial

24th Jan 2012
THE federal government's e-health trial has suffered an embarrassing setback after the National E-Health Transition Authority (NEHTA) discovered incompatibilities between the software used on its pilot websites and the main planned network.
NEHTA said it was "pausing" development of its primary care desktop software being tested at the Metro North Brisbane, Inner East Melbourne and Hunter Urban Medicare Locals.
The glitch would also affect other e-health sites, including those of Greater Western Sydney, St Vincent’s and Mater Health Sydney, Calvary Health Care ACT, Cradle Coast Electronic Health Information Exchange in Tasmania, the NT Health Department and Brisbane's Mater Misericordiae Health Services, NEHTA said in a statement.
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Government struggling to meet e-health deadline

NEHTA halts preliminary site work.

The Federal Government is unlikely to meet its promised July 1 deadline for completion of the $466.7 million e-health records project after the body overseeing implementation of the system halted preliminary work in lead implementation sites this week.
A spokesperson for the National E-Health Transition Authority (NEHTA) said "work on primary care desktop software development" at ten of 12 lead implementation sites around the nation had stalled due to "technical incompatibilities across versions" of the specifications provided to the sites.
None of the software affected by the issue had been pushed live to patients, but one report suggested NEHTA told heads of the implementation sites affected last week that there was a "potential clinical risk" if work went ahead using the specifications supplied.
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Long road ahead for e-health records

  • by: Karen Dearne
  • From: Australian IT
  • January 26, 2012 7:37AM
The Health department spent $142 million on e-health activities in the last financial year – around one-third of a total $424m spent on health IT projects over the past 10 years.
Spending more than doubled during 2010-11, up from $60m a year earlier, reflecting a ramping up of work on the Gillard government’s $500m personally controlled e-health record program to meet its July 1 launch.
But documents released today show that while individuals may be able to register for a PCEHR from that date, national usage of the system is not planned in the foreseeable future.
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"Limited" PCEHR set to flop says consumer group

19 January, 2012 Michael Woodhead
Patients are unlikely to participate in the PCEHR program because it will offers few benefits initially and will deny patients control over who has access to their records, the Consumers Health Forum says.
In a submission (link) to a Senate inquiry into the PCEHR bill, the CHF also calls for the personal  electronic health records system to be “opt-out “ by default rather than “opt-in”, which it says will lead to a lack of critical mass for the system.
The consumers’ group says a major  drawback with the “opt in” model is that patients may rely on their GP for registration, and thus may not feel personally  involved or engaged with the new system.
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'Opt-in' will undermine e-health records: AMA

Government must issue data to support the "opt-in" model
The Australian Medical Association (AMA) has continued to lobby the government to change its $466.7 million e-health record system to an “opt-out” model, arguing that the current “opt-in” model will undermine the system’s health improvement objectives.
In its submission (PDF) to the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body’s president, Steve Hambleton, maintained the current “opt-in” design will undermine the goals of the system, “to reduce the occurrence of adverse medical events and duplication of treatment”.
“In the early days we are concerned that if medical practitioners search for a PCEHR they will often not find one for their patient,” the submission reads. “This may deter future attempts by medical practitioners and consequently lead to a very low uptake of the proposed PCEHR by medical professionals.
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E-health funding boost required for x-rays

By Josh Taylor, ZDNet.com.au on January 23rd, 2012
Extra funding for the personally controlled e-health records (PCEHR) will be required in order to support sharing and storage of diagnostic images, according to the Australian Diagnostic Imaging Association (ADIA).
The government has laid out $466.7 million in funding for the implementation of its e-health agenda, with PCEHRs scheduled to be made available to the public by 1 July.
While these records will allow sharing of basic medical information, more funding will be required to ensure that x-ray images and other medical diagnostic images are able to be shared between healthcare providers, the association noted in a submission to a parliament inquiry.
"This will involve some level of investment in e-health applications over and above that which has already been made," the association said. "We anticipate that a number of funding issues will need to be worked through with government to provide an incentive for practices to participate in PCEHR."
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Insurer wants access to PCEHR data

24 January, 2012
The nation’s largest private health insurer, Medibank is lobbying for access to patients’ PCEHR data so that it can identify fund members who may benefit from preventive health programs.
In a submission (link) to a Senate inquiry into the e-health record system, Medibank says that it is barred from using PCEHR data under current legislation, even if the patient consents.
Targeting of preventive health programs is also hampered because patients are unable to authorise insurers to access their records, Medibank says.
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Queensland Health accused of bias towards IT supplier Cerner Corporation

QUEENSLAND Health is again facing accusations it favoured an IT supplier that became the frontrunner for a multimillion-dollar government contract.
Confidential papers show a Health boss already was in talks with software company Cerner Corporation at least a year before consultants were hired to conduct an external investigation into potential suppliers.
The electronic medical records project was even given the codename "Project Mango" to avoid constantly naming Cerner in official correspondence, the papers said.
Queensland Health chief information officer Ray Brown rejected suggestions of favouritism by Queensland Health as "ridiculous", saying an independent probity adviser had reviewed the process and found no reason to believe Cerner was treated with undue bias.
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Payroll debacle Mk 2 - Qld Health staff not paid today

ANOTHER Queensland Health pay bungle is unfolding this morning as employees take to social saying they have not been paid.
Dozens of Health workers have contacted The Courier Mail to say they their pay has not appeared in the bank accounts.
 It is understood doctors, nurses, and administrative staff are affected.
Workers who have contacted the Courier Mail claim Queensland Health has made no effort to contact employees to alert them, and have instead told workers to "keep checking in,'' themselves with the payroll department.
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Seeing the doctor online is new reality

·         AAP
·         January 22, 2012 1:01PM
A NEW telehealth program will enable cancer patients to regularly consult their doctor even if they are hundreds of kilometres away.
The $20.6 million pilot program starting in July will use the national broadband network to deliver health services to older Australians with cancer and those in palliative care.
Health Minister Tanya Plibersek and Broadband Minister Stephen Conroy said patients in the first NBN rollout areas would find the high-speed broadband network more reliable in delivering e-health services.
They said the network would ultimately transform the way health care was delivered in Australia, particularly for rural and remote areas.
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Online doctors a new reality

A $20.6 million pilot program starting in July will use the National Broadband Network to deliver telehealth services to older Australians
  • AAP (AAP)
  • 23 January, 2012 08:20
Cancer patients and the elderly will be able to see their specialist or GP with the click of a mouse, even if they are hundreds of kilometres away.
A $20.6 million pilot program starting in July will use the National Broadband Network to deliver telehealth services to older Australians, cancer patients and those in palliative care.
Groups can apply for grants, typically of between $1 million and $3 million, to conduct two-year trials in telehealth services for patients, particularly in regional and rural areas.
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NBN to further boost Telehealth Takeup

A new $20.6 million telehealth program utilising the National Broadband Network (NBN) will provide new and innovative in-home telehealth services to older Australians, people living with cancer and those requiring palliative care.
22 January 2012
Health Minister, Tanya Plibersek, and Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, said the NBN Telehealth Pilot Program would deliver services to patients in NBN rollout areas and provide feedback on how this program and other health care measures can be delivered nationwide.
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iPhone app scans for skin cancer

MICHELLE ROBINSON
January 23, 2012
A mobile phone app that allows people to analyse their moles for cancer risk is a good tool, but should not be relied on in isolation, the Cancer Society of New Zealand warns.
Skin Scan, an application for iPhones, allows users to take photos of their moles and find out whether they are likely to be cancerous.
Released by Romanian company Cronian Labs, the technology can be downloaded for $5.49.
The Cancer Society of New Zealand has applauded the technology as a way of reminding people to look after their skin and seek medical help for any changes to the appearance of moles.
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Phone images capture a moral minefield

Geesche Jacobsen
January 28, 2012
How far should citizen journalists go? Geesche Jacobsen investigates.
When amateur footage of a police officer allegedly punching a spectator at the SCG was released a week ago, police promptly announced an internal review.
Shortly before Christmas, a worried passenger filmed a bus driver texting while he was driving the bus on the M2; he was suspended from duty soon after the footage became public.
In the Middle East, authorities have come under greater scrutiny after the world-wide spread of mobile phone videos of the crackdown on demonstrators during the Arab Spring.
But while more and more images from citizen journalists around the globe have been disseminated to millions of viewers, thanks to the internet and the wide availability of mobile phone cameras, this technology also opens up legal and moral minefields
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Enjoy!
David.

AusHealthIT Poll Number 106 – Results – 30th January, 2012.

The question was:
Do You Believe The Various Wave Sites Will Eventually Coalesce To Form A Coherent National PCEHR System?
For Sure
-  8 (16%)
Probably
-  6 (12%)
Probably Not
-  8 (16%)
No Way
-  27 (55%)
I Have No Idea
-  0 (0%)
Votes 49
That seems pretty clear - around 70% of readers are not confident we will actually see a real working national system.
Again, many thanks to those that voted!
David.

Sunday, January 29, 2012

What Does The Next Year or So Hold For E-Health in Australia? It Might Be Quite A Ride!

(The follow is a draft article for a magazine I do a column for - comments welcome)
I first have to point out that this short article is being written in late January and while, as we slipped off into the ‘silly season’ last year, we might have been forgiven for thinking the e-Health path for 2012 has been clearly marked, it seems, somehow that six short weeks have changed everything.
To go back to 2011 we had all watched the announcement of the Personally Controlled Electronic Health Record (PCEHR) by the then Health Minister, Nicola Roxon, the announcement of contractors and the selection of some pilot implementation (Wave) sites around the country. Funds has been allocated, a Concept of Operations document, explaining at a high level, what was planned had been released and, after some perfunctory consultation some enabling legislation had been introduced into Parliament.
We were assured that behind the scenes there was frenetic activity and that when we arrived at July, 1 2012 we would all be able to register at a web portal for our very own PCEHR, if we wanted one, and having your own PCEHR would be transformative for your patient care, the delivery of that care and the way the whole Health System worked.
Sceptics were pretty quiet by and large and there was also a sense that while it all looked very rushed the alternative of total inactivity was  obviously less desirable. This sense was doubtless heightened by the money that was on offer to those involved to get involved and make it happen.
I think was can pretty accurately date the moment when all the external gloss and smoothness started to erode and real concerns began to emerge about just how practical and realistic what was being proposed actually was.
I suggest the date was when this report was released by the Federal Parliamentary Library. The report was RESEARCH PAPER NO. 3, 2011–12 17 November 2011. The e health revolution—easier said than done. Author: Dr Rhonda Jolly.  In the broadest terms the report pointed out that there were more than a few issues that needed work and that the present plans might be a little over optimistic.
The report can be downloaded from this link:
With the introduction of the Bills to enable the PCEHR the next shoe fell and the Senate Community Affairs Committee decided on an enquiry into the legislation and a range of related matters. Submissions closed in mid-January, 2012 and to date over 40 submissions have been published on the Senate web site. Without in any way pre-empting the Committee’s findings it would have to be fair to day a good number of concerns and issues get a pretty substantial airing in these written submissions and it is hard to see how the whole program can continue unchanged at this point.
The enquiry will oral take evidence in early February, 2012 and a report is due by the 29th February - a date that it is hard to see will actually be met given the complexity of the matters raised in the submissions.
All of a sudden we now have all sorts of uncertainty about the timing of delivery of the PCEHR, the continuation for funding for National E-Health Transition Authority (NEHTA) and the PCEHR program and a host of other questions which have now been thrown up in the air.
The haste to meet the July 1, 2012 political deadline has had the effect of causing some ‘innovative’ approaches being adopted to specification development by NEHTA (the so-called Tiger Team process) and in the last week of January, 2012 it was announced that work on most of the pilot sites was being suspended for six to eight weeks while some erroneously issued specifications were corrected and re-issued to the affected technical teams. The impact on the time lines and budget are unknown at the time of writing.
With all this going on it would be fair to say the crystal ball was becoming pretty cloudy, but it has now become really opaque with the replacement of Nicola Roxon by Tanya Plibersek as Federal Health Minister as a result of a Cabinet reshuffle late last year.
From any sensible perspective it has to be concluded that the future for E-Health in Australia has become very uncertain for at least the next 2-3 months.
It is more than possible the new Health Minister will want to call a ‘pause’ and come to grips with just what is happening, what is doable and what the next steps should be. It is also possible the Senate Enquiry will make a series of important recommendations that change the landscape.
I do not recall a time when the forward direction of e-Health in Australia has been so unclear and indeed - on the basis of the submissions to the Senate Enquiry - so contested.
There is no doubt we need to make serious progress in the e-Health domain but it also seems that - on the basis of issues seen a many international programs - that progress is by no means as easy as it might seem at first glance!
I would suggest you drop back to the column in three months’ time to find out how all these possible options have actually played out and what the impact will be on your health service and those who are working there.
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David.

Saturday, January 28, 2012

Weekly Overseas Health IT Links - 28th January, 2012.

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.
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Medicine Jim, but not as we know it

12 January 2012   Shanna Crispin
Developers worldwide have been challenged to create their version of Star Trek’s medical tricorder in the hope that it will spark more innovation in health technology.
Three different versions of the tricorder featured on the show, but they all enabled doctors to diagnose diseases and collect bodily information about a patient by simply scanning them with a detachable hand-held scanner.
The Qualcomm Tricorder X Prize is offering $10m (£6.5m) to any developer that can create a similar device.
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Digital Health Revolution Long Awaited, Much Misunderstood

Jim Molpus, for HealthLeaders Media , January 17, 2012

First let's dispel one thing about revolutions: no one reading this column who works in healthcare is going to start one, except maybe in your respective capacities as consumers of healthcare. Revolutions come when a critical mass of people—18th-century French serfs or overtaxed colonists—decide there is a better way.
So if anything, the work being done by hospitals, health systems, physicians, and IT companies in creating electronic health records and smart devices is mere road-paving for a new way of practicing medicine that is hopefully not too far off—just in time to save healthcare from collapsing in its own inefficiency.
Eric Topol, MD, cardiologist and chief academic officer at Scripps Health, hopes that his new book, The Creative Destruction of Medicine, will help nudge consumers and a few other constituencies into seeing the true potential of digital health to flip the paradigm, as suggested by the book's subtitle, "How the Digital Revolution Will Create Better Health Care."
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Break down all barriers to health information exchange

January 17, 2012 — 12:05pm ET | By Ken Terry
Farzad Mostashari, National Coordinator for Health IT, discussed the obstacles to the interoperability of health information systems in a recent interview with HealthLeaders Media. To overcome these barriers, he said, the cost of HIEs must be reduced, their value must be increased, and the "preconditions for trust" among providers must be created.
The Office of the National Coordinator for Health IT (ONC), he noted, is developing standards that will lower the cost by making interfaces easier to build. At the same time, ONC is working with the states to ensure that all healthcare providers have access to HIEs, he said.
As for the value of HIE, Mostashari pointed out that public and private payers "are putting out new models for paying for care that rewards coordination [so] we're seeing the value proposition start to emerge for information exchange." He added that while trust among providers develops slowly, he believes it will begin in local networks and gradually spread.
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Despite $3.2B HIT spend in Europe, clinical IT investment lacking

January 17, 2012 — 2:40pm ET | By Dan Bowman
Health professionals in Europe are embracing integrated technology, but only to an extent, according to a recent report by the European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry (COCIR). The report found that hospitals in western Europe--the UK, Germany, France, Italy and Spain--spent roughly $3.2 billion on health IT in 2010, according to an article in Health Imaging, but most of that spend went toward administrative IT.
Additionally, the level of equipment utilized "varie[d] greatly" between different countries, the authors noted.
"More investment in clinical information is needed to move today's healthcare delivery models to the next level of efficiency and quality," the report's authors wrote. "Industry calls for more investment in order to move to integrated, more efficient, safer and patient-centered healthcare systems."
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5 keys to getting your HIE capabilities up and running

January 18, 2012 | Michelle McNickle, Web Content Producer
Health information exchange is an integral part of many HIT initiatives, including the meaningful use of health IT and healthcare reform. While still a relatively new capability, the idea of transferring sensitive information securely is enough to make organizations nationwide take note.
Sonal Patel, vice president of client services at Corepoint Health, suggests five keys to getting your HIE up and running.
1. Have a strategy in place. According to Patel, HIEs have become the center of attention these days, and she suggests organizations take baby steps in this arena while developing a strategy that’s their own.  Whether it’s an acute care facility, a larger ambulatory care organization, or standalone centers that submit results to an HIE, all are in a situation where, “they need to ask themselves about the surrounding market, their environments, and what approach they want to take to the market,” she said. “Do they want to use this connection as a differentiating factor, or a capability to move forward? It’s a decision that’s made at a higher level as to where integration occurs.”
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Patient-specific, eye catching alerts less likely to be ignored

By mdhirsch
Created Jan 19 2012 - 9:29am
Want doctors to read the alerts they receive in their electronic health records systems? Then make them more patient-specific and interesting to read.
That's the skinny from a recent study published in the Journal of the American Medical Informatics Association. The study focused on the use of computerized drug alerts for psychotropic drugs prescribed to 5,628 senior citizens by 81 physicians. The researchers expected computerized alerts to reduce the number of falls by these seniors, which is a leading cause of injuries. However, physicians overrode most drug alerts because they believed that the benefit of the drugs outweigh the risks involved. Physicians also expressed a concern that too many drug alerts were "nuisance alerts" of little clinical value.
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Electronic alerting system improves documentation of patient problems

By mdhirsch
Created Jan 19 2012 - 9:23am
Using an automatic alert system in providers' EHR systems "significantly" increases the documentation of previously unknown patient problems, which could potentially facilitate quality improvement.
That's the conclusion of a recent study published by the Journal of the American Medical Informatics Association. According to the study, which involved 28 clinics affiliated with a large academic medical center, patient problems were about three times more likely to be documented when providers received an alert. "This increase is clinically important, since many of these problems are used for quality improvement and clinical decision support," the study's authors reported.
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American Docs Question Health IT's Benefits

U.S. physicians are more skeptical about the benefits of electronic health records and health information exchanges than their international counterparts, according to an Accenture study.
By Nicole Lewis,  InformationWeek
January 18, 2012
U.S. physicians are less likely than doctors in other countries to think that healthcare IT can improve diagnostic decisions, according to a survey of 3,700 doctors in eight countries. Additionally, only 47% of U.S. doctors report that healthcare technology has helped improve the quality of treatment decisions, compared to 61% of the other physicians interviewed. Only 45% think that technology leads to improved health outcomes for patients, against a survey average of 59%.
"The survey of doctors shows that more needs to be done to bridge the disconnect in perception and impact of health IT benefits," Kaveh Safavi, Accenture's health practice lead in North America, told InformationWeek Healthcare. "However, despite the high-level skepticism of technology, U.S. physicians have made progress in implementing healthcare IT for practices relating to disease management."
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New Apps Let Facebook Record Your Personal History

The site can now provide summaries and stats that offer a window on your life months or years in the past.
Facebook won the loyalty of more than 800 million users largely by getting them into the habit of visiting again and again to see the latest updates, comments, and photos posted by friends. Now the site will also let outside apps provide even more content, and it will encourage people to spend time looking back over activity from months or even years ago. New features introduced at an event in San Francisco last night will enable users to automatically record their eating, reading, exercise, and other habits over time, share them with friends, and review their previous actions.
The key to the new features is an update to the Timeline page that Facebook founder Mark Zuckerberg introduced at his company's F8 event last September. Now, with a user's permission, third-party websites and mobile apps can record details of what the person is doing and automatically feed that information to the person's Timeline page through a "Timeline app" that sends the data to Facebook and provides the necessary permission and privacy settings.
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Report highlights promises, perils of social media for healthcare

Posted: January 19, 2012 - 6:00 pm ET
A report from the not-for-profit ECRI Institute, a patient-safety and quality-improvement organization, details social media's potential as a public-engagement tool for healthcare organizations but warns that risk management is necessary.
The 20-page report "Social Media in Healthcare" from the Plymouth Meeting, Pa.-based organization cites a 2011 National Research Corp. survey that found that 41% of roughly 23,000 respondents reported using social media to research healthcare decisions. Facebook and YouTube dominated their social-media selections.
So far, most hospitals use social media "as an extension of their existing marketing and public relations plans"; physicians use the sites also to market themselves and their practices while often mixing in personal information.
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SATURDAY JANUARY 21, 2012 Last modified: Wednesday, January 18, 2012 11:23 AM CST

Nurse terminated for unauthorized viewing of TRMC patient records

A privacy breach by a “curious” nurse at Titus Regional Medial Center has resulted in letters to 108 former patients warning of a slight risk of identity theft.
Hospital Administrator Ron Davis relayed Tuesday that internal auditing procedures uncovered the misconduct.
“The nurse said she was just ‘curious’ and looked at records she was not authorized to view,” Davis said. “She has sworn that she did not do anything with that information.”
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5 ways to make your EMR more user-friendly

January 19, 2012 | Michelle McNickle, Web Content Producer
By Michelle McNickle, Web Content Producer
Created 01/19/2012
One of the biggest objections to the adoption of an EMR is its usability (or lack thereof), which is no surprise considering the ease of its predecessor: paper. Thankfully, there are a few ways to make your system not only more bearable, but significantly easier to use.
“There are several guidelines that have been published, [and each] cover particular OS, whether it be Mac, Unix, or Windows,” said Bob Hunchberger, a clinical informaticist for a 500-bed hospital. “If your application will be deployed in the PC world, it’s important that you adhere to the standards that are implemented in the Windows world. Why? Because Microsoft has ‘trained’ its users for more than a decade what behaviors to expect from applications that run in that environment.”
Hunchberger suggests five practical ways to make your EMR more user friendly. 
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5 Legal Issues Surrounding Electronic Medical Records

Written by Molly Gamble | January 19, 2012
Though the technology has been around for roughly 30 years, physicians making the move from paper to electronic medical records may still face some challenges — particularly when it comes to understanding the legal implications of EMRs. In Nov. 2011, the Centers for Disease Control and Prevention reported that the percentage of physicians who've adopted basic EMRs in their practice doubled from 17 to 34 percent from 2008-2011. The percent of primary care physicians using EMRs grew even more, roughly doubling from 20 to 39 percent in that same time frame.
A large portion of EMR implementation revolves around a seamless transition for physicians, nurses and other caregivers, so as to not disrupt workflow or take excessive time out of their day. These systems, however, pose certain legal risks for physicians and healthcare systems that should not go unnoticed.
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Tuesday, January 17, 2012

The Role of the CMIO

Although my business cards and my CV list the title Chief Information Officer, I was given the title Chief Medical Information Officer (CMIO) when I was hired at BIDMC in 1998.   Today, I serve three kinds of roles:
CIO - Responsible for strategy, structure, staffing, and processes for a 300 person IT organization
CTO - Responsible for the architecture of our applications and infrastructure, ensuring reliability, security, and affordability
CMIO - Responsible for the adoption of the applications by clinicians, optimizing quality, safety, and efficiency in their workflows
Although I've been able to balance these three roles because of the extraordinary IS staff at BIDMC, good governance, and a supportive CEO, it's challenging for one person to perform all these tasks.  Many hospitals and health systems are expanding their management team to include a CMIO.
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Friday, January 20, 2012

Q4 2011 Saw Surge of Federal Health IT Activity

During the last quarter of 2011, the federal government continued to implement the HITECH Act, enacted as part of the American Recovery and Reinvestment Act. Below is a summary of key developments and milestones achieved between Oct. 1, 2011, and Dec. 31, 2011. 
Q4 2011 Health IT Highlights
The fourth quarter of 2011 saw a number of important developments, including the following.
  • IOM Publishes Report on Patient Safety and Health IT.
    On Nov. 8, 2011, the Institute of Medicine released a series of recommendations related to the effect of health IT on patient safety in a report titled, "Health IT and Patient Safety: Building Safer Systems for Better Care." The Office of the National Coordinator for Health IT commissioned the report and will use it to inform its development of health IT-related patient safety policies. 
  • HHS Revises Meaningful Use Timeline.
    On Nov. 30, 2011, HHS announced changes to the Medicare and Medicaid electronic health record incentive programs' meaningful use timeline. Under the changes, health care providers who meet Stage 1 meaningful use requirements in 2011 would not need to meet Stage 2 meaningful use requirements until 2014. 
  • ONC Announces Plans for Dashboard To Assess Progress of Health IT Grants.
    On Dec. 22, 2011, ONC published a notice in the Federal Register announcing plans to establish an "ONC Health IT Dashboard" to measure the effectiveness of grants awarded for a variety of health IT purposes. The Dashboard will include information from community college-based health IT training programs; individual physicians and hospitals; regional extension centers; state health information exchanges; and vendors that track health IT adoption and trends. ONC will use the Dashboard to compare the performance of grant recipients; develop a tool to evaluate the Medicare and Medicaid EHR incentive programs; and estimate state and national levels of health IT adoption. Researchers and the public will have access to the Dashboard. ONC will de-identify and aggregate any publicly accessible information.
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CfH issues tablets safety warning

13 January 2012   Shanna Crispin
NHS Connecting for Health has warned trusts about the risks of using tablet devices - saying they are much more likely to be stolen and to be used to inadvertently share patient information than other technology.
The ‘good practice guidelines’ say the use of tablets in commercial organisations is increasing and there is “pressure for NHS organisations to follow suit.”
But it warns: “These devices present a number of issues that are not necessarily found in more traditional technology solutions.”
The document states tablet devices are “inherently less secure” than traditional IT equipment and that this means they are not necessarily suitable for accessing sensitive and patient identifiable data.
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How to turn a tablet into a security tool

January 12, 2012 | Marcus Ranum, CSO, Tenable Network Security
It seems like it was just the other day that I was being asked whether laptop computing was going to have a big impact on security. Of course, it did, but mostly on the unprepared - the organizations that didn't ask, or even think about the question, ‘why would making computing more portable, more personal, and easier to steal/lose present a problem?’
By the mid-1990s I was simply answering the question with a sound-bite: "Distributed data is distributed vulnerability." Indeed, the last decade has treated us to an endless litany of breach disclosures along the lines of "laptop with customer database stolen from contractor's car," or "customer database found on USB stick in airport." Sobering news, always.
Twenty years later, portable devices have 10,000 times as much storage space, are smaller and shinier, and may be in an easier-to-lose form factor, such as a telephone-oid or tablet. Equally as important – there are more of them, and simple probability across your device population means that more will go astray, and do so with more data on them.
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Texas doctors lead open-notes movement

By Todd Ackerman, HOUSTON CHRONICLE
Published 10:01 p.m., Monday, January 16, 2012
Texas doctors are at the vanguard of what U.S. researchers say is an inevitable revolution to make consultation notes and other records easily accessible to patients.
The idea, at odds with the decades-old attitude that medical records belong to doctors because they're the only ones trained to interpret them, is being tested in an ongoing national study that has already confirmed that patients want to read their notes but most doctors are still resistant.
"Many doctors aren't there yet, but this is going to happen, this can't be stopped," said Jan Walker, a nurse at Harvard Medical School's Beth Israel Deaconess Medical Center in Boston and the study's lead author. "In today's more transparent society, patients want this - and it should be to everyone's benefit."

3 ways social media is transforming the doctor-patient relationship

January 17, 2012 | Chris Foster, Principal, Booz Allen Hamilton
Much like other advances in health information technology (HIT) such as electronic health records and telemedicine, social media is changing how doctors and patients interact. Social media empowers patients to seek out information, make more informed decisions, and partner with their health care providers on managing their care.
Historically, medical care has been primarily physician-centric — “take the doctor’s orders”; however, more recently, patients are playing an increasingly more active role in their treatment. At its very core, social media is a driver of a patient-centered model, promoting two-way continuous communication between supportive community networks, health care providers and patients through the most current, transparent, and immediate information available.
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Sculley: Health Tech Needs Usability, Not Flash

IT companies need to better understand the healthcare industry before they can change it, former Apple CEO tells CES audience.
By Neil Versel,  InformationWeek
January 13, 2012
Former Apple and PepsiCo CEO John Sculley, now an investor in several healthcare companies, believes in the power of consumer-facing IT to transform parts of healthcare. But this cannot happen unless technology developers understand this complex industry and the vendors engage the people who actually pay for health services, he said.
"The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services," Sculley said Thursday in Las Vegas at the Digital Healthcare Summit adjunct to 2012 International CES.
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11 healthcare data trends in 2012

By Michelle McNickle, Web Content Producer
Created 01/06/2012
Mobile devices, data breaches and patient privacy rights were some of the most talked-about topics in health IT in 2011, and according to expert opinions complied by ID Experts, 2012 won’t be any different. 
In fact, experts continue to predict an upswing in mobile and social media usage, response plans, and even reputation fallout. Eleven industry experts outlined healthcare data trends to look for in 2012.
1. Mobile devices could mean trouble. Healthcare organizations won’t be immune to data breach risks caused by the increased use of mobile devices in the work place, said Larry Ponemon, chairman and founder of the Ponemon Institute. A recent study confirms that 81 percent of healthcare providers use mobile devices to collect, store, and/or transmit some form of personal health information (PHI). But, 49 percent of those admit they’re not taking steps to secure their devices. 
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  • JANUARY 19, 2012

Health Care Is Next Frontier for Big Data

·         By BEN ROONEY

Big Data—the ability to collect, process and interpret massive amounts of information—is one of today's most important technological drivers. While companies see it as a way of detecting weak market signals, one of the biggest potential areas of application for society is health care.
Historically, health care has been delivered by one doctor looking at one patient with only the information the doctor has at that time. But how much better if the doctor had access to information about thousands, or even tens of thousands, of people?
Acquiring medical data has, historically, been problematic. It is wrapped in layers of regulations and stringent safeguards and is expensive to collect.
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PACS market to hit $5.4B by 2017

January 18, 2012 — 2:45pm ET | By Dan Bowman
The worldwide market for picture archiving and communications systems (PACS), which continue to grow in popularity, is expected to reach $5.4 billion by 2017, up from $2.8 billion in 2010, according to a new report from GlobalData.
A combination of government initiatives to adopt IT in healthcare and advancements in technology as a whole will be two of the major factors contributing to such growth, the report's authors said. Specifically, as hospitals look to save money with regard to storing images, PACS adoption will continue to thrive, they said.
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Bacon calls for halt on Millennium

19 January 2012  
Conservative MP Richard Bacon has called for a halt to all Cerner Millennium deployments following appointment problems and delays at the latest trusts to go-live with the system - North Bristol and Oxford.
Bacon, who has followed the progress of the National Programme for IT in the NHS for many years, said the two hospitals had been “brought to their knees” by the implementation of the new electronic patient record system.
“These deployments need to be stopped until we are sure that they can be managed safely,” he said; adding that the system should be "switched off" if it was not working for patients.
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Hack Attacks Now Leading Cause Of Data Breaches

Exclusive: Identity Theft Resource Center identifies hacking, followed by data lost in transit and insider attacks, as the leading data breach culprits in 2011.
By Mathew J. Schwartz,  InformationWeek
January 12, 2012
The majority of data breaches stem from hack attacks, followed by data that's lost while physically in transit. That's according to a forthcoming study from the Identity Theft Resource Center (ITRC), which assessed all known information relating to the 419 breaches that were publicly disclosed in the United States in 2011. A copy of the report was provided to InformationWeek in advance of its release.
Last year, data breaches triggered by hacking--defined by the ITRC as "a targeted intrusion into a data network," including card-skimming attacks--were at an all-time high, and responsible for 26% of all known data breach incidents. The next leading cause of breaches was data on the move (18%)--meaning electronic storage devices, laptops, or paper reports that were lost in transit--followed by insider theft (13%).
Overall, malicious attacks--counting not just hack attacks but also insider attacks--accounted for 40% of publicly disclosed breaches, while 20% of breaches were the result of accidental data exposure.
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Tuesday, January 17, 2012

Meaningful Use Incentives Increasing, but Disparities Persist

Despite a sluggish start, federal incentive payments to hospitals have been rising significantly in recent months.
Data from CMS show that the nation's hospitals received nearly $741 million in incentive payments during October and November 2011 for implementing electronic health records. That figure for those two months is about $70 million more than what hospitals received during the first full fiscal year of the program, from its launch in October 2010 through September 2011.
But aggregate data on the incentive program obscure wide variations in how individual states are performing under the incentive program. Closer analysis of the CMS data shows that some states' hospitals have done well in accessing incentive payments, while hospitals in other states have received little or no funding. The analysis of the EHR incentive program payments to hospitals was prompted by results from quarterly surveys on meaningful use conducted by the College of Healthcare Information Management Executives.
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Vendors on a Buying Spree

Four more health information technology vendors have announced acquisitions, bringing the total during the first 12 days of 2012 to at least 10 deals.
Payer vendor The TriZetto Group has acquired Kocsis Consulting Group of Hudsonville, Mich., for an undisclosed sum. Kocsis offers training, compliance and change management software to bridge the gap between implementing new information systems and using them to their potential. Software modules cover user training, business/change readiness, process improvements, policy and procedure documentation, and compliance readiness such as HIPAA 5010 and ICD-10.
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By Joseph Conn

The IT VistA gets larger

Here are a few quick bits of news from last week about federal electronic health-record system incentive payments.
The 24th meeting of the WorldVistA community wrapped up a three-day run Sunday at University of California Davis. WorldVistA is a not-for-profit organization founded in 2002 to promote the use of an open-source version of the VistA system outside the Veterans Affairs Department, where the VA has been developing the EHR for more than 30 years.
Open-source maven Roger Maduro reported from the meeting that Oroville Hospital donated $150,000 to WorldVistA. Its members contributed or contracted for the production of code modifications needed to certify WorldVistA EHR software as capable of meeting federal meaningful-use criteria and to help IT staffers at 133-bed Oroville configure the system to their needs.
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A systematic approach to quality improvement

A look at successes, strategies behind some of the Thomson Reuters 15 Top Health Systems
By Rebecca Vesely
Posted: January 14, 2012 - 12:01 am ET
About a decade ago, the board of directors of Tanner Health System in Carrollton, Ga., decided to make an absolute commitment to patient satisfaction and quality.
That commitment has gotten results, with the three-hospital system for the first time being named among Thomson Reuters' 15 Top Health Systems in the nation.
“We've been getting some confirmation that this long journey toward excellence is paying off,” says Loy Howard, Tanner's president and CEO. “In the journey of quality improvement, it's hard work. It really has to be, in my opinion, the focus of the whole organization.”
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Digitizing Health Records, Before It Was Cool

By MILT FREUDENHEIM
Published: January 14, 2012
VERONA, Wis.
THE push to move the nation from paper to electronic health records is serious business. That’s why a first look at the campus of Epic Systems comes as something of a jolt.
A treehouse for meetings? A two-story spiral slide just for fun? What’s that big statue of the Cat in the Hat doing here?
Don’t let these elements of whimsy fool you. Operating on 800 acres of former farmland near Madison, Wis., Epic Systems supplies electronic records for large health care providers like the Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, and Johns Hopkins Medicine in Baltimore, as well as health plans like Kaiser Permanente and medical groups like the Weill Cornell Physicians Organization in New York. In fact, Epic’s reputation as a fun-filled, creative place to work helps draw programmers who might otherwise take jobs at Google, Microsoft or Facebook.
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How to sell mobile health devices even when hospitals fear theft

Thefts of portable digital health devices, like smartphones and tablets, accounted for half of data breaches in 2011. That kind of mobility is hurting the adoption of mobile health products.
Russell Dollinger has been working on strategies around the problem. Dollinger’s California startup Ingenuitor, which produces books and digital devices to overcome language barriers in hospital settings and medical situations, had a customer back off a mobile purchase over fears of device theft.
 “We present our software to hospitals on carts and portable units,”Dollinger said. “One COO wanted portable devices. The next time we presented to the same hospital, the previous COO had left and the new one said, ‘We have to have a cart-based device.’ It was the same place, but the attitude changed because they were concerned about theft.”
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Enjoy!
David.