Quote Of The Year

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

Friday, November 30, 2012

It Seems Health Information Exchange Throws Up Similar Problems All Over.

The following appeared last week.
Monday, November 19, 2012

Patient Consent for Information Exchange Comes Into Focus

by Ken Terry, iHealthBeat Contributing Reporter
Federal and state laws require that patients give permission or be allowed to withhold consent for health information exchanges to use their individually identifiable health information (IIHI) for purposes other than direct patient care. Consequently, as health care providers start to adopt new care delivery models that necessitate clinical data exchange, patient consent is becoming a hot issue.
Despite the existing regulations -- or because of them, in some cases -- patient consent involves legal, technical and practical issues that are far from being resolved. Which circumstances require patient consent, which parties can be allowed to access particular information and whether patients must opt in to health information exchange or should be allowed to opt out are all open questions.
One reason for the lack of clarity is varying state requirements. According to the Office of the National Coordinator for Health IT, for example, slightly more than half of states are planning to deploy an opt-out model in their statewide HIEs. The rest are using or plan to use various kinds of opt-in approaches.
While the federal HIPAA law allows treating providers to exchange patient information directly without a patient's consent, some states place restrictions on those direct exchanges, according to Micky Tripathi, CEO of the Massachusetts eHealth Collaborative. There also are differences among states in whether they require prior consent for the aggregation of data by an HIE, he pointed out.
But moves are afoot to introduce some national uniformity in this area. Last March, ONC issued a program information notice to its state HIE grantees that includes guidance on patient consent. The key concept in this guidance is "meaningful choice," described as follows:
"Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. This type of exchange will likely occur in a query/response model or where information is aggregated for analytics or reporting purposes."
ONC and the Health IT Policy Committee, a federal advisory body, say that states can use opt-in or opt-out models as long as they offer patients meaningful choice, which requires advance notice, "full transparency and education" and revocability, among other things. Simply providing a "boilerplate form" in a physician's office or directing patients to read material posted on a website is not enough, Kathryn Marchesini, senior analyst and adviser to ONC's chief privacy officer, said.
"We're focusing on engaging the patient in an interactive manner so they understand the options that they have," she said.
Lots more here:
Here are some useful links from the article.

MORE ON THE WEB

The article provides a really useful summary of the consent issues that can be faced - including by the NEHRS / PCEHR which is (after all) at core just a Health Information Exchange on a rather grand level.
It is interesting that among the US States about ½ have gone for an opt-out approach and the other half an opt-in.
The full article is well worth a read for all the wrinkles experienced.
David.

Thursday, November 29, 2012

The US ‘Fiscal Cliff’ Might Make A Mess Of E-Health In The US. Could Be Ugly.

This appeared a few days ago.

The Fiscal Cliff and Meaningful Use: Be Very Afraid

NOV 16, 2012 8:11pm ET
During the congressional tax/budget debate coming very soon, someone in the Republican Party is going to demand another $20 billion or so cut from an entitlement program or another government program that is near and dear to the Democratic Party. Someone in the Republican Party will mention that boondoggle health information technology initiative in the hated stimulus bill, and someone in the Democratic Party will decide that’s where another $20 billion in savings can come from. Whatever federal funds are left to support electronic health records meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.
Don’t believe all the talk of how health I.T. has bi-partisan support. Nothing but the most sacred cows will be considered sacred in the upcoming budget battle. Since health I.T. doesn’t pass the sacred test, the spigot is in danger of running dry unless the nation’s physicians and hospitals rise up en masse and scare the hell out of their congressional representatives and senators.
Yes, AMA, you have to stop whining about ICD-10 and focus elsewhere on the real here and now. Yes, AHA, all of your hospitals are spending millions of dollars on EHRs and soon won’t be getting those rebate checks, unless you also turn them loose to fight for what they were promised. Yes, insurers and employers, if you want to have any government funding for information systems that will support bending the cost curve and moving to payment models better than fee-for-service, you also have a lot of work to do. And you all need to do it now.
More here:
The US ‘fiscal cliff’ is a series of taxation measures and spending cuts which have already been legislated and which begin to bite come January 1, 2013. The net effect on US GDP will be a contraction of the order of 4% of GDP next year - and given the fact US growth is only about 2% presently, this - if unchanged - may turf the US back into recession according to the non-partisan Congressional Budget Office.
There is going to have to be some serious ‘horse trading’ to avoid this cliff given the political divide we have in the US. At present the President rather has the upper hand in getting some concessions as he has a veto over any legislation that might prevent tax rises.
As the article points out there is a very large Health IT incentive program and you can bet those who want some spending cuts will want to wind that back big time.
We live in pretty interesting  times as, if the US does not sort this out - as most expect - we will also be hit down under.
I am reminded of Winston Churchill’s comment on the Americans - ‘They will always do the right thing - after having exhausted all other possibilities’ We can but just wait and watch.
David.

Wednesday, November 28, 2012

The Commonwealth Funds Provides A Primary Care And Health IT Report. Useful Stuff.

This report has had a lot of coverage in the last week. For example:

UK GPs top for use of EMRs

15 November 2012   Rebecca Todd
More than two thirds of UK GPs use electronic medical records and can also order tests or prescriptions online, manage patients lists or generate patient information electronically, a new survey reveals.
The 2012 Commonwealth Fund International Health Policy Survey of 8,500 primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, the United Kingdom and the United States, places the UK at the top of the table in their use of electronic records.
The report, published today, shows that more than two thirds (68%) of GPs in the UK said they have ‘multi-functional HIT capacity.’
Lots more here:
and here:

Aussie GPs lag behind on e-record use

21st Nov 2012
AUSTRALIA’S high rate of GPs keeping electronic patient records has declined since 2009 and Australia lags behind other countries in terms of electronic exchange of patient summaries with doctors in other practices, new research shows.
A survey by the Commonwealth Fund of 10 countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US – found progress in the use of health information technology in healthcare practices, particularly in the US.
Yet a high percentage of primary care physicians in all 10 countries reported they did not routinely receive timely information from specialists or hospitals.
Of the 500 Australian GPs surveyed, the use of electronic medical records was high but fell from 95% to 92% from 2009 to 2012 while the other nations mainly recorded increases.
Australia also had one of the lowest rates of GPs reporting they could electronically exchange patient summaries and test results with doctors outside their practice, at 27% – third last when compared to the other nine countries, with only Canada and Germany trailing.
More here:
Here is the link to the original report:
The key part worth quoting is the summary of findings:

Key Findings

  • Two-thirds (69%) of U.S. primary care physicians reported using EMRs in 2012, up from less than half (46%) in 2009. Both U.S. and Canadian doctors expanded their use of health information technology (HIT), though the two countries lag the U.K., New Zealand, and Australia in EMRs and use of HIT to perform a range of functions, like generating patient information or ordering diagnostic tests.
  • In the U.S.—the only country in the survey without universal health coverage—59 percent of physicians said their patients often have trouble paying for care. Far fewer physicians in Norway (4%), the U.K. (13%), Switzerland (16%), Germany (21%), and Australia (25%) reported affordability was a concern for their patients.
  • More than half (52%) of U.S. doctors said they or their staff spend too much time dealing with insurers’ restrictions on covered treatments or medications—by far the highest rate in the survey.
  • In each country, only a minority of primary care doctors reported always receiving timely information from specialists to whom they have referred patients, while less than half said they always know about changes to their patients’ medications or care plans.
  • U.S. physicians were the most negative about their country’s health system, with only 15 percent saying the system needs only minor change.
The full article and associated downloads are well worth a download and read. The report clearly identifies some gaps that Australian GPdom could do well to work on - as well as some areas that are going pretty well.
A part of the report I found interesting regarding GPs was the apparent drop in use of EMRs by a few per cent since the last survey in 2009 and the ongoing low level of connectivity and patient focussed services offered in Australia for patients electronically. There is a market opportunity for someone there I believe.
It is also of interest how few Australian GPs presently use secure messaging exclusively to transmit prescriptions rather than transmit the prescription and also print out a copy for the patient to present to pharmacist - to scan the barcode to download the prescription. Just a system difference I guess.
David.

Tuesday, November 27, 2012

It Looks To Me Like Those Operating The NEHRS Are Not Very Good At Their Job. Additionally No One Is Using It.

This very revealing article popped up today in The Australian.

More bumps in e-health road

THE Gillard government's personally controlled e-health record system is facing more bumps in its rollout following frequent disruption to its software vendor testing environment.
In the past seven months, only five vendors have passed the requirements for their software to be connected to the live e-health production platform. There are more than 250 software vendors who need their 300-400 products certified for the PCEHR.
The PCEHR is intended to be a secure electronic summary of people's medical history that is stored and shared in a "network of connected systems".
Software used by hospitals, GPs, allied health professionals, dentists and radiologists is often custom-made and needs to be compliant with the web-based national PCEHR system.
The longer it takes to test the systems, the longer it will take to roll out the software to hospitals, GPs and others who need to use it.
Sources close to the e-health project told The Australian the test environment had been going offline two to three times a week. This included planned and unplanned outages. The Department of Health and Ageing declined to comment on the outage frequency.
However, a spokeswoman said: "Obviously the test environment exists so things can be trialled before going live in the main system. That's the normal way IT systems like this operate the world over."
As recently as last Tuesday, the test system was offline for nine hours, but the spokeswoman said the test environment was stable.
She declined to provide reasons for unplanned outages.
The test environment had been available to software vendors since April this year, she said, adding that unavailability of the test environment had no impact on the live system.
"Software vendors are not permitted to connect to the (live) production system without passing testing in the software vendor test environment," the spokeswoman said.
"The test environment has absolutely no impact on the access to or functionality of the main system -- that is, patient and doctor use of the main system is not affected at all."
She declined to say how many times the test platform had been offline since it became available.
Meanwhile, 19,617 people had registered for an e-health record, the spokeswoman said.
The full article is here:
Looks like the system is unstable and no one much is using it. Worse those who have to use the test environment are being messed about.
As for clinical use this paragraph says it all.
“As of last Thursday there were 16 shared health summaries and one discharge summary uploaded into the PCEHR, the spokeswoman confirmed.”
Amusingly in a separate article we discover the geniuses who are running the program are so worried people might be alarmed about how things are being done that they have blocked the management minutes from FOI. This really shows they have something to hide! See here for article:
All in all this just seems to be going from bad to worse...At this stage it seems to be costing $20,000 per summary. The Return on Investment on all this is a bit dubious to say the least.
David.

Monday, November 26, 2012

Weekly Australian Health IT Links – 26th November, 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

Again a very quiet week. We have seen some interesting comparative work on IT use in General Practice and a number of (rather small) telehealth initiatives.
My weekly visit to the NEHRS revealed that the performance is still pretty dreadful - 5-10 seconds from click to complete page being painted (on a fast internet link).
At least my name remained stable over the week!
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Aussie GPs lag behind on e-record use

21st Nov 2012
AUSTRALIA’S high rate of GPs keeping electronic patient records has declined since 2009 and Australia lags behind other countries in terms of electronic exchange of patient summaries with doctors in other practices, new research shows.
A survey by the Commonwealth Fund of 10 countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US – found progress in the use of health information technology in healthcare practices, particularly in the US.
Yet a high percentage of primary care physicians in all 10 countries reported they did not routinely receive timely information from specialists or hospitals.
Of the 500 Australian GPs surveyed, the use of electronic medical records was high but fell from 95% to 92% from 2009 to 2012 while the other nations mainly recorded increases.
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Australian GPs drag the chain on e-mail

20 November, 2012 Julie Robotham
Australia’s general practices lag the world in communicating electronically with patients even though more than 90% store patient records electronically.
In an international survey of primary care doctors, only 20% of the 500 polled in Australia said they accepted patients’ questions or concerns by e-mail.
Even fewer – 7% - allowed patients to go online to book appointments or request referrals, and just 6% accepted electronic requests for script refills, according to the study from US health policy foundation The Commonwealth Fund.
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GPs see specialists as poor communicators

21 November, 2012 Paddy Wood
GPs think specialists are poor communicators who rarely provide timely information about patients and often alter medications without notice.
In a survey of 500 Australian GPs, just 13% said specialists made information about patients available when it was needed.
Less than a third agreed they were always advised of changes that specialists made to their patients’ medications or care plans, and 32% said they always received a report from specialists with “all relevant health information.”
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Script exchanges together

FRED IT’s eRx Script Exchange is set to become linked to rival MediSecure, with the government providing almost $10 million in funding to make the systems interoperable. According to an application revealed by the Australian Competition and Consumer Commission, the so-called ‘Electronic Transfer of Prescription (ETP) Prescription Exchange Service Interoperability Initiative’ aims to “significantly improve the uptake and use of electronic prescriptions”. E-prescribing is a significant policy component of the Fifth Community Pharmacy Agreement, and according to early analysis there are large numbers of electronic prescriptions being lodged by prescribers “ but the number being downloaded by dispensers is quite low” - due to patients presenting to a pharmacy which is not connected to the prescription exchange containing the e-script.
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Invitation to Participate in the SMD-POD Project

20 November 2012.  NEHTA is pleased to invite Secure Messaging Vendors to participate in the Secure Message Delivery – Proof of Inter-connectivity and Deployment (SMD-POD) project.  The purpose of the project is to provide financial assistance to Secure Messaging Vendors to "provide proof that standards-based secure messaging can be deployed in a scalable way, utilising National Infrastructure Services, and to also demonstrate that different conformant Secure Messaging Vendor products are capable of interconnecting within the Australian Primary Care sector and with other healthcare providers".
General Practice is a key sector; the inter-connectivity to other healthcare providers is vital because GPs communicate with each other and also to others, such as Medical Specialists and Allied Health Professionals. In addition, hospitals with gateways can also introduce Secure Messaging to the customers of all participating Secure Messaging Vendors. This activity will allow more healthcare providers to participate and use technology (eHealth).
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Projects to Better Connect Health and Aged Care

Applications have been opened by Minister for Mental Health and Ageing Mark Butler, for more than $17 million in projects to better connect Australia’s aged care system with the health and hospitals systems.
16 November 2012
Applications were opened today by Minister for Mental Health and Ageing Mark Butler, for more than $17 million in projects to better connect Australia’s aged care system with the health and hospitals systems.
“Successful applicants will carry out innovative projects that will see aged care providers work intensively with healthcare providers and medical insurers,” Mr Butler said.
“This will help give older people better access to complex health care, including palliative and psycho-geriatric care.”
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New Telehealth Centre officially opened at Princess Alexandra Hospital

The Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, and the Queensland Minister for Health, Mr Lawrence Springborg today officially opened a new telehealth centre at Princess Alexandra hospital, which is making healthcare more accessible to people living in regional and remote Queensland.
The centre is part of the $5.1 million Princess Alexandra Hospital Online Outreach Services project (PAH Online), which is jointly funded by the Australian and Queensland governments through the Digital Regions Initiative program.
"This centre is a glimpse into the future of healthcare delivery right across Australia," Senator Conroy said.
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Feds announce $3.3m aged care telehealth program

Virtual access to general practitioners will be trialled under a $3.3 million five year telehealth pilot at residential aged care facilities (RACF) announced by the federal government.
Commencing in February 2013, the program will involve up to 30 RACFs and is intended to develop a business case for video consultations as a means of delivering better GP access to residents.
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Better access to specialist neurological care for regional NSW

9 November 2012
People in regional NSW will have remote access to multiple sclerosis clinics in Sydney thanks to a new telemedicine facility in Dubbo.
The facility will improve the quality of life for people with multiple sclerosis (MS) and other neurological diseases, who often find travel to be physically and mentally exhausting and, for some, unaffordable.
"It is logistically impossible for many patients with multiple sclerosis to travel to our clinic on a regular basis, potentially compromising their medical care," said Dr Michael Barnett, leading MS neurologist and researcher at the University of Sydney's Brain and Mind Research Institute (BMRI).
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The state of broadband 2012: achieving digital inclusion for all

Read the full text

30 September 2012With this Report, the Broadband Commission expands awareness and understanding of the importance of broadband networks, services, and applications for generating economic growth and achieving social progress. High-speed affordable broadband connectivity to the Internet is essential to modern society, offering widely recognized economic and social benefits (Annex 1). The Broadband Commission for Digital Development promotes the adoption of broadband-friendly practices and policies for all, so everyone can take advantage of the benefits offered by broadband.
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The dilemmas behind creating a better you

Date November 22, 2012

David Ewing Duncan

Cutting-edge therapies are under way that may lead to a host of physical enhancements.
If a brain implant were safe and available and allowed you to operate your iPad or car using only thought, would you want one? What about an embedded device that gently bathed your brain in electrons and boosted memory and attention? Would you order one for your children?
In a future election, would you vote for a candidate who had neural implants that helped optimise his or her alertness and functionality during a crisis, or in a candidates' debate? Would you vote for a commander in chief who wasn't equipped with such a device?
If these seem like tinfoil-on-the-head questions, consider the case of Cathy Hutchinson. Paralysed by a stroke, she recently drank a canister of coffee by using a prosthetic arm controlled by thought. She was helped by a device called Braingate, a tiny bed of electrons surgically implanted on her motor cortex and connected by a wire to a computer.
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Martin Delatycki: Genetic explosion

THE announcement in 2003 that the human genome had been sequenced brought much excitement to both the scientific and the general community. Almost 10 years on, what has changed as a result?
We can now diagnose many disorders, allowing individuals and families options in terms of medical care and preventive treatments. Discovery of new genetic causes of disease is a daily event. Discovering genes took many years in the 1990s but can now take a matter of weeks.
We are now on the cusp of a quantum leap in what can be done. Next-generation DNA sequencing, which is also called massive parallel sequencing, allows the exome or genome to be sequenced in hours.
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UXC wins $40m contract for Gold Coast hospital

UXC will supply all ICT infrastructure for the hospital.
UXC has won contract with Lend Lease worth more than $40 million to provide and install ICT equipment at the new Gold Coast University Hospital at Southport.
UXC will supply all ICT infrastructure for the hospital.
The contract includes a data centre, wired network and wireless LAN, unified communications, IP telephony and firewalls and security.
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Sydney hospital ditches PCs, chooses zero clients on wheels

Summary: How do you deploy an additional 200 to 300 desktops in a hospital that just doesn't have the room? The answer is: you don't — not physically, anyway.
By Michael Lee | November 19, 2012 -- 05:40 GMT (16:40 AEST)
Speaking at VMware's vForum 2012 event in Sydney last week, Sydney Adventist Hospital (SAH) solutions architect for Information Services John Hoang led the audience through the way in which the private hospital uses virtualised and mobile workstations in a bid to move toward a paperless, digital hospital.
Hoang said that SAH had been "dreaming of what we would consider a healthcare nirvana — a complete paperless, digital hospital. One where we're able to capture all patient data electronically, deliver information to clinicians in a digestible matter, and do so in a manner that is synergistic to the way clinicians work."
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Privacy commissioners seek greater power as breaches increase

Regulators lack "clear mandate," said New Zealand privacy commissioner Maria Shroff
Privacy commissioners of Australia and New Zealand said they need more enforcement authority to combat data breaches and other privacy concerns.
Regulators “have to be responsive” to increasing privacy incidents, New Zealand privacy commissioner Maria Shroff said in a speech this morning at the International Association of Privacy Professionals (IAPP) Privacy Summit. If breaches continue to occur, “people will lose trust.”
The Office of the Australian Information Commissioner (OAIC) received 1357 privacy complaints in the 2011-2012 fiscal year, Australian Privacy Commissioner Timothy Pilgrim told the Privacy Summit in a separate speech.
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NSW Information Commissioner sends email to wrong list

Do as I say, not do as I do
The Information Commissioner in the Australian state of New South Wales, an officer whose job it is to offer and enforce best information management practice for the State, has apologised after sending an email to the wrong list.
The email in question advised of a conference at which the Commissioner, Deirdre O’Donnell, is due to speak.
But the mail, intended for members of the NSW Public Sector Right to Information/Privacy Practitioners Network, ended up elsewhere.
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e-med Medical Dictionary

By Wednesday Digital | November 23, 2012
The e-med Medical Dictionary is a searchable database of medical information that can be used as a starting point for medical enquiries. The app can also be used by anybody to initiate free consultations with the e-med nurse and contains extra functionality for current e-med members.
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Government cracks down on identity fraud

Date November 22, 2012

Jane Lee

PEOPLE who use the internet or a phone to use other people's identities to commit a crime could be sentenced to five years in jail under a new law.
The law, passed on Wednesday, expands the crime of identity fraud to include a number of activities such as flying interstate or booking domestic flights online using a fake identity.
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Big future for ehealth in USA and UK

Barack Obama’s reelection is being seen as a major step forward for ehealth in the USA, while the UK government has committed to 100 percent patient access to ehealth records by 2015.
The main reason put forward by health IT experts why Obama’s victory is a win for ehealth is the secure future of the Affordable Care Act, which was the president’s major health reform in danger of repeal by Republican contender Mitt Romney.
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Windows 8 PC orders weak, says analyst

Sales at Asian firms that assemble PCs for HP, Dell and others show lower expectations for Windows 8 pop
Computer sellers have scaled back their expectations of the sales pop they'll get from Windows 8 this year, according to an analyst.
Brian White, of Topeka Capital Markets, said that his checks of Asian computer manufacturers -- the relatively unknown firms that build desktop and notebook PCs to specifications issued by the likes of Hewlett-Packard and Dell -- found that orders last month climbed by less than half the average of the last seven years.
"With all of the sales numbers out for our ODM Barometer, October sales rose by 2 per cent month-over-month and below the average performance of up 5 per cent over the past seven years," White said in a note to clients earlier this month. "This is weaker than our preliminary estimate of up 5 per cent month-over-month in October and speaks to the continued challenges in the PC market."
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Enjoy!
David.

Does Anyone Know Who Else Is On This Group? Any e-Health Experts?

I was asked this and have no idea.
They are meant to make the NEHRS safe.

Clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR)

The Commission has established an independent Clinical Governance Advisory Group (CGAG) and a clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR).
This national clinical governance function complements and strengthens the work being performed by the National E-Health Transition Authority in assuring the safety and quality of the standards and specifications supporting the PCEHR and will provide external assurance on PCEHR clinical safety issues.
The CGAG meets quarterly to consider the clinical safety audits of the PCEHR and other clinical safety issues relating to the PCEHR and provide advice to the Department of Health and Ageing. The CGAG comprises experts from across Australia, and is chaired by the Chief Medical Officer Professor Chris Baggoley.
Page is here:
Google - asked for “Clinical Governance Advisory Group” - finds the UK entity but not much from Australia.
Any clues?
David.

AusHealthIT Poll Number 146 – Results – 26th November, 2012.

The question was:

How Do You Rate The Design Of The User Interface Of The NEHRS / PCEHR?

Excellent 5% (2)

Pretty Good 3% (1)

Neutral 0% (0)

Not Good 21% (8)

Plain Incompetent 64% (25)

I Have No Idea 8% (3)

Total votes: 39

Very interesting. It would seem the vast majority (85%) feel NEHTA has failed to deliver a decent design for the NEHRS / PCEHR.

Again, many thanks to those that voted!

David.

Sunday, November 25, 2012

Standards Australia Lets The Side Down Badly. What On Earth Gives?

In researching one of the other blogs this weekend I had occasion to visit the Standards Australia e-Health Site.

You two can visit it at:

http://www.e-health.standards.org.au/Home.aspx

There was only one glaring problem. The site is just unusable with Firefox 17. Just awful!

Interestingly the site looks just fine on both IE 9 and Safari (via an iPad).

What this means to me is that the web site has not been developed to appropriate international standards.

One question - just why would that be from Standards Australia?

Amazing!

David.

It Looks Like There Has Been Some Serious Movement on E-Prescribing and Script Exchange.

The following article appeared last week.

Script exchanges together

FRED IT’s eRx Script Exchange is set to become linked to rival MediSecure, with the government providing almost $10 million in funding to make the systems interoperable. According to an application revealed by the Australian Competition and Consumer Commission, the so-called ‘Electronic Transfer of Prescription (ETP) Prescription Exchange Service Interoperability Initiative’ aims to “significantly improve the uptake and use of electronic prescriptions”. E-prescribing is a significant policy component of the Fifth Community Pharmacy Agreement, and according to early analysis there are large numbers of electronic prescriptions being lodged by prescribers “ but the number being downloaded by dispensers is quite low” - due to patients presenting to a pharmacy which is not connected to the prescription exchange containing the e-script.
The project aims to allow electronic prescriptions to be accessed by all pharmacies, regardless of which exchange the script was lodged with. eRx and MediSecure are now tasked with working together and sharing all information necessary to create interoperability between their systems, with a deadline in the document of 24 Dec 2012 for the work to be completed.
The companies will each receive $660,000 (a total of $1.32m) as a capital contribution to undertake the work, which will also include the standardisation of the format and positioning of the barcodes on the original prescriptions.
Here is the information from the ACCC

eRx Script Exchange Pty Ltd - Authorisation - A91348

Applicant(s)
  • eRx Script Exchange Pty Ltd
Authorisation number(s)/Date lodged
  • A91348, 13th November 2012
Summary
eRx proposes to enter into a contract which has the purpose of enabling it to make its electronic pharmaceutical prescription exchange system (PES) interoperable with MediSecure's (MDS) PES and vice versa. Clause 14 of the proposed contract, which is the subject of this application, provides that following the introduction of interoperability, eRx and MDS will share equally in the fee which is charged to a pharmacy user and the Commonwealth by the PES to which the pharmacy is connected in respect of each prescription that has originated on the PES of the other party.
Documents
Here is the direct link to the application document:
The application is dated 9 November, 2012 but the funding arrangements (from the Commonwealth Department of Health and Ageing) were agreed months earlier.
It is interesting just how quickly approval was given.
It seems the two companies are going to have to get moving given the work to create the interoperability must be done by Christmas.
The Government is paying each of the Prescription Exchanges $660,000 as capital and then there is an amount of $8.3M available to be claimed as prescriptions are retrieved.
It is presently planned all the money will be claimed by June 30, 2013 via Medicare.
Pages 42-44 show the project timetable.
Pages 52 on describe the funded project. Here is the core of what is going on.

“C. The Commonwealth’s PES interoperability Project

The purpose of the Commonwealth’s PES Interoperability Project is to allow electronic prescriptions to be accessed by all pharmacies, no matter which PES the electronic prescription was originally lodged with. To achieve this outcome, the PESs must work together and share all information necessary to create interoperability between their systems to achieve interim interoperability4 by no later than 24 December 2012 in advance of conformance with Australian Technical Specifications for the Electronic Transfer of Prescriptions (ETP).
Full PES interoperability, conforming with Australian Technical Specifications for the Electronic Transfer of Prescriptions, and subsequent Australian Standards, will follow the completion of the Project.”
Obviously I am not very smart but I can’t find “Australian Technical Specifications for the Electronic Transfer of Prescriptions” on either the NEHTA or Standards Australia e-Health Web sites. Maybe they have a different name - but is it clear Standards Australia has still to approve the tech specs.
I have to say this all looks like a little of a mad rush to have something that will work available to satisfy ePIP requirements which are meant to be in place by February next year.
Oh well a little move forward!
David.

Saturday, November 24, 2012

Weekly Overseas Health IT Links - 24th November, 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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Survey: HIEs maturing, sharing more data

November 15, 2012 | By Marla Durben Hirsch
Health information exchanges are making progress in their quests to share electronic data among providers, with more data being exchanged and more HIEs becoming operational, according to the latest survey released by the eHealth Initiative.
Of the 161 HIE respondents, more than half, 88, are in the advanced stages of operational maturity, up from just 15 last year, reported Jason Goldwater, Vice President of Research and Programs for the eHealth Initiative, speaking on a webinar explaining the results of the survey.
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Increase in private HIEs raises concerns about compatibility

By Diana Manos, Senior Editor
Created 11/15/2012
WASHINGTON – Public health information exchanges (HIEs) have expressed concerns about compatibility and sustainability as the number of private HIEs continues to rise, according to eHealth Initiative's 12th Annual HIE Survey.
The survey of 161 HIEs nationwide indicates that if public and private HIEs are operating on different systems within a state or region, it will become increasingly difficult to exchange and leverage useful data to improve the quality and coordination of care in the United States, researchers said.
According to eHealth Initiative (eHI), there should be a level playing field between public and private HIEs.
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CIOs more optimistic about health IT than docs

November 16, 2012 | By Susan D. Hall
Healthcare executives, physicians and consumers hold disparate views of the changes taking place in healthcare delivery and information technology, according to a new report from Greenway Medical Technologies.
The study involved focus groups with C-level healthcare executives and surveys of more than 1,000 physicians, CIOs, health IT professionals and consumers, according to an announcement
Among the discrepancies: Physicians see themselves as those most responsible for creating a successful healthcare system, yet only 2 percent said they're actively taking steps to fix the current model. They're also unclear on who the other stakeholders should be. More than half of consumers, meanwhile, said government should take the lead on healthcare.
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Epocrates finally launches native iPad app

By: Jonah Comstock | Nov 15, 2012
Epocrates has finally launched a native iPad version of it’s landmark drug information app, up until now a conspicuous and much-discussed omission. The release is part of a larger strategy by CEO Andy Hurd to turn around the struggling company, which posts its second annual loss this year on revenue estimates of about $110 million.
In an October 30 quarterly investor’s call, Hurd mentioned data from Manhattan that suggested Epocrates was the most downloaded iPad app by physicians, despite Epocrates not having a native iPad app. Doctors have been using the iPhone version of the app, viewing it at two times the size on their iPad screens.
The app, released for iPad and iPad mini, is essentially an adapted version of the existing Epocrates iPhone app, but Hurd told MobiHealthNews that the larger screen size allows for new kinds of functionality.
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Mobile health starting to come of age

By Ki Mae Heussner | GigaOM.com, Published: November 10

Mobile health is starting to come of age.  In 2010, the Pew Internet and American Life Project reported that just 17 percent of cell phone owners used their devices to look up health information. But in a study released Thursday, the organization said that figure has climbed to 31 percent.
Mobile health is unsurprisingly even more popular among smartphone users, with 52 percent saying they have consulted their gadgets with medical questions.
The study, which is based on a national survey of more than 3,000 U.S. adults, also revealed that young adults and minorities are more likely to use their phones for health information. Caregivers and those who recently went through a medical crisis or significant change in their health status are other groups more likely to jump on the mobile health bandwagon.
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Many health apps are based on flimsy science at best, and they often do not work

By Rochelle Sharpe | New England Center for Investigative Reporting, Published: November 13

When the iTunes store began offering apps that used cellphone light to cure acne, federal investigators knew that hucksters had found a new spot in cyberspace.
“We realized this could be a medium for mischief,” said James Prunty, a Federal Trade Commission attorney who helped pursue the government’s only cases against health-app developers last year, shutting down two acne apps.
Since then, the Food and Drug Administration has been mired in a debate over how to oversee these high-tech products, and government officials have not pursued any other app developers for making medically dubious claims. Now, both the iTunes store and the Google Play store are riddled with health apps that experts say do not work and in some cases could even endanger people.
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Better IT needed to monitor medication doses, researchers say

November 15, 2012 | By Susan D. Hall
Hospital patients--even those with liver disease--often are given too much acetaminophen, which commonly is sold as Tylenol, but also is an ingredient in stronger narcotics such as Percocet and Vicodin, according to a study published in the Archives of Internal Medicine.
The researchers, from Partners HealthCare System in Wellesley, Mass., say better health IT systems are needed to monitor aggregate doses of ingredients such as acetaminophen when patients are given multiple medications, a Reuters story reports.
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Study: EHRs provide good ROI for hospitals in low-income settings

November 12, 2012 | By Marla Durben Hirsch
Implementing an electronic health record system provides a good return on investment for hospitals in low-income areas, according to a case study recently published in the Journal of the American Medical Information Association. The researchers studied the implementation of a hospital-wide EHR in a tertiary facility in Malawi, a nation in southeast Africa.
They noted that it was especially important to evaluate EHRs in low-income settings, because such hospitals suffer from additional problems, such as staff and supply shortages, which affect how fully the benefits of an EHR are realized They evaluated only three areas of impact: the length of stay, transcription times and lab use.
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Interoperability, costs among top concerns for health IT professionals

By Erin McCann, Associate Editor
Created 11/15/2012
CARROLLTON, GA – A new survey released Thursday sheds light on health IT trends currently affecting the industry, with data showing that interoperability and costs are chief concerns for healthcare providers.
Conducted by Greenway Medical Technologies, the survey sought insight from more than 1,000 physicians, industry professionals and consumers.
More than a quarter of respondents (26 percent) indicated that interoperability was a primary concern when it came to utilizing technology in their healthcare system, with overall costs closely following at 22 percent. Medical staff alignment and adapting to industry changes also were among the top concerns for providers.
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Congressional Health Chair Asks HHS Again for an I.T. Safety Plan

NOV 15, 2012 11:40am ET
Rep. Renee Ellmers (R-NC), chair of the House Committee on Small Business’ subcommittee on healthcare and technology, has sent a second letter to HHS Secretary Kathleen Sebelius asking for a study on the benefits, costs and safety of health information technology systems. Ellmers, a registered nurse with more than two decades of nursing and administrative experience in medical practices, says she received no reply from HHS for a letter sent this past summer. Following is text of the second letter to Sebelius, sent on Nov. 14:
“I am writing today to express my concern that the Department of Health and Human Services (Department) has failed to respond to my letter of June 12, 2012, requesting information on the Department’s actions following up on the Institute of Medicine’s November 8, 2011 report calling for greater oversight of health information technology (health IT).  My office confirmed with the Department’s Office of Legislative Affairs that the letter was indeed received.  I have included a copy of it for your review.
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How the Indiana Health Information Exchange is charting a course toward profit

November 15, 2012 | By John Morrissey
The following is an excerpt from an article published in the FierceHealthIT eBook "Key Lessons in Health Information Exchange." Download the eBook here to read more.
As health information exchanges spring up all over in response to regulations such as Meaningful Use and shifting payment models, the Indiana Health Information Exchange (IHIE) recommends healthcare leaders take a breath, top fixating on the technology and instead figure out what pays.
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Thursday, November 15, 2012

The 2012 Elections and the Future of Health Information Technology

by Dave Roberts
It happened. The campaign season we thought would never end did, and after billions of dollars spent on thousands of inescapable TV ads, we now have ... the same leaders we had before Election Day.
After all the speculation and prognostication, come January 2013, Barack Obama will still be President, John Boehner will still be speaker of the House and Harry Reid will still be Senate majority leader.
So what does this mean for health IT?
It means that doctors and hospitals can move forward with implementing electronic health records, as well as Obamacare, which included many health IT-related provisions. It means that more patients will have the ability to view, print or download their health records through online patient portals. It means that accountable care organizations sharing information electronically among providers will be better able to coordinate patient care. It means HHS will collect data on quality to measure where we can do better.  
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Ten-Country Survey of Primary Care Physicians Shows Progress in Use of Health Information Technology, Less in Other Areas

Bethesda, MD -- Redesigning primary care is an integral part of health reforms in the United States and elsewhere. A new study, being released today as a Web First by Health Affairs, surveyed primary care doctors in the United States and nine other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom.
The survey, conducted between March and July 2012, found US and German physicians the most negative about their health care systems: only 15 percent of US and 22 percent of German practitioners thought their systems worked well. On the brighter side, the survey found that 69 percent of US doctors report the use of electronic health records, bringing use in the United States closer to the Netherlands, New Zealand, the United Kingdom, and Norway, all with near-universal capacity.
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Despite rising health IT adoption, care coordination lags

November 15, 2012 | By Susan D. Hall
A survey of primary care providers in 10 countries finds health IT can help improve care, but a large percent of physicians in all countries complained about the time it took to receive information from specialists and hospitals.
U.S. doctors were the most likely to report spending substantial time dealing with insurance restrictions and that their patients often went without care because of costs. As in previous surveys, U.S. physicians were more likely to be dissatisfied with the practice of medicine and to say U.S. healthcare needs to be overhauled.
The survey report by the non-profit Commonwealth Fund appears in Health Affairs.
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More hospitals looking to optimize patient flow

By Erin McCann, Associate Editor
Created 11/14/2012
BURLINGTON, VT – Optimizing patient flow throughout various healthcare settings continues to be a critical objective for hospitals, with nearly a third of industry officials planning to invest in patient flow solutions.
According to CapSite's "2012 U.S. Patient Flow Study" released Tuesday, some 31 percent of U.S. hospitals indicated their intentions to purchase patient flow solutions to address the current patient crowding bottleneck effect seen in hospital departments nationwide.
The study represents unique voice of customer insight from more than 420 hospitals on market adoption, market share, market opportunity and vendor mind share across the U.S. hospital market.
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AHRQ offers tips on consumer health IT design

By Mike Miliard, Managing Editor
Created 11/14/2012
More and more, health IT is expanding from the clinical into the commercial realm. With patient engagement so crucial to the transformation of care delivery, that's a good thing. But some consumer technologies are better than others.
The Agency for Healthcare Research and Quality (AHRQ), looking to improve the usefulness and efficaciousness of those ever-evolving technologies, has published a report listing 10 tips for building IT that consumers will use and find useful.
With "Designing Consumer Health IT: A Guide for Developers and Systems Designers," the agency seeks to help speed the development of "effective consumer health information technology applications so people can better use their personal health information to manage their health," officials say.
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November 10, 2012

When a Palm Reader Knows More Than Your Life Line

By NATASHA SINGER
“PLEASE put your hand on the scanner,” a receptionist at a doctor’s office at New York University Langone Medical Center said to me recently, pointing to a small plastic device on the counter between us. “I need to take a palm scan for your file.”
I balked.
As a reporter who has been covering the growing business of data collection, I know the potential drawbacks — like customer profiling — of giving out my personal details. But the idea of submitting to an infrared scan at a medical center that would take a copy of the unique vein patterns in my palm seemed fraught.
The receptionist said it was for my own good. The medical center, she said, had recently instituted a biometric patient identification system to protect against identity theft.
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8 IT Healthcare Trends for Tech Job Seekers in 2013

– Rich Hein, CIO
November 13, 2012 
For more than two years Healthcare IT (HIT) has followed on a steady growth track, according to U.S. Bureau of Labor Statistics and that is likely to continue in the next few years, according to Bill Spooner, senior vice president and CIO at Sharp Healthcare. "HIT will continue to be a hot job market for the next two-three years," Spooner says.
The healthcare sector of IT walks a tightrope consisting of privacy, data security and the need to grow and update the infrastructure. HIT faces more challenges with HIPPA laws and privacy concerns then most other areas and with the convergence of mobile technologies, cloud computing, virtualization, clinical analytics and the upcoming IDC-10 (International Statistical Classification of Diseases and Related Health Problems), HIT could be the most active area within the IT sector next year. To help you hone in on where the career opportunities lie, here are eight HIT trends for 2013.
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Beware Social Media’s Pitfalls

Scott Mace, for HealthLeaders Media , November 13, 2012

Lest anyone get the wrong idea, social media can do harm as well as good. Social media's power is awesome, but as the brilliant superhero Spiderman says, with great power comes great responsibility.
If you read my column last week, you know that clinicians and patients, speaking in their authentic voices, can trump formulaic marketing materials. But the need to employ a metric ton of common sense and discretion is greater than ever.
The challenge for health leaders is to instill that common sense and discretion into every employee, since social media is nonhierarchical by its nature, and tweets, blogs and Facebook posts don't work if they need to be preapproved (and they won't scale either).
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NIH showcases informatics researchers as new open source ventures launch

By Anthony Brino, Associate Editor
After the National Institutes of Health grew interested in bioinformatics, following breakthroughts in the 1990s, the National Centers for Biomedical Computing were created with the goal of advancing the field by a few leaps and bounds, because IT systems hadn’t quite caught up to molecular biology. 
The nine centers were founded through the 2000s, and with the advent of new data processing and visualization tools, there's been "an explosion of knowledge" in biomedical research, said Brian Athey, from the University of Michigan Medical School’s National Center for Integrative Bio Informatics (NCIBI). 
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Docs lack guidance for disclosing conflicts of interest on social media

November 13, 2012 | By Susan D. Hall
Lack of guidance for physicians on disclosing conflicts of interest on social media sites such as Twitter is "an unacceptably gray area," Johns Hopkins postdoctoral fellow Matthew DeCamp writes in a commentary recently published in the Journal of General Internal Medicine.
"As physicians and patients increasingly interact online, the standards of appropriate behavior become really unclear," says DeCamp, a fellow in the School of Medicine's Division of General Internal Medicine. "In light of norms of disclosure accepted throughout medicine, it's surprising that major medical guidelines fail to adequately address this issue."
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CDS rule-authoring tools fall short

November 13, 2012 | By Susan D. Hall
A study of the array of rule-authoring tools used to convert medical knowledge into machine-executable clinical decision support rules across Partners Healthcare in Boston found many limitations--and frustrations. 
Most limit the ability to create CDS interventions that are standardized, sharable, interoperable and extensible, the authors found. None was deemed ideal.
The study, published at BMC Medical Informatics and Decision Making, reviewed through meetings with users of the clinical rule-authoring environments at Partners, who manage more than 7,000 CDS rules. It included an ad hoc collection of tools, some implemented enterprise-wide, some for ambulatory care only and others for specific systems. It focused on the process for creating and using reminder and medication rules.
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5 reasons to delay migrating to the public cloud

By Benjamin Harris, New Media Producer
Created 11/09/2012
With all the talk about switching from data centers to cloud-based computing, it seems like the cloud is an etherial magic bullet for every problem that healthcare IT might face, from reduced costs to improved flexibility. Not so fast, says Steve Jacobs, president of Velocity Data Centers, a firm that provides private cloud solutions.
While "there are some definite business advantages to operating in a cloud IT environment, the risks are very real and concerning," says Jacobs. For all of the pros of cloud-based solutions floating around, he points out that some of the cons can be big nails in the coffin for any organization that relies as much on data as healthcare does.
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Decisions doctors must make to avoid Medicare penalties

2013 will be a crucial year for physicians to avoid possible pay reductions under quality reporting and health information technology programs.

By Charles Fiegl, amednews staff. Posted Nov. 12, 2012.
A physician’s decision not to report Medicare quality measures or participate in paperless prescribing and health record programs in 2013 will be a costly one in the long run.
The programs have been voluntary for the past several years. However, federal laws require Medicare rates eventually to be reduced for physicians who do not participate in the physician quality reporting system as well as the electronic health records and e-prescribing incentive programs. The reason why 2013 is such a critical year for doctors is that Medicare officials are using it as a benchmark for future penalties in all of these programs.
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Picking the Right Partner for an HIT Adventure

NOV 1, 2012
Health care provider organizations buying an information system go through a long process to select the right vendor, but oftentimes a single incident can make a difference in sealing the deal-or killing it.
For Kerry Noble, CEO at Pemiscot Memorial Health Systems in Hayti, Mo., his confidence in a particular electronic health records vendor went way up when Ramsey Evans, CEO of Prognosis Health Information Systems, wrote in the contract that he'd refund the cost of the software if the hospital did not attest to EHR meaningful use within 120 days of go-live. Noble then went to a local bank and got financing to cover the costs of implementation through attestation-with Prognosis' guarantee as collateral. The first meaningful use incentive payment exceeded the cost of the EHR by about $500,000, Noble says.
At 48-bed Sabine Medical Center in Many, La., the willingness of one vendor to make promises-and put them in writing-helped close the deal when the center purchased its first emergency department information system, says Karen Ford, R.N., chief nursing officer. Cost is-and always will be-a big part in the vendor selection process Ford says. But in this case, veEDIS Clinical Systems of Plantation, Fla., promised specific levels of 24x7 on-site, peer-to-peer support by nurses, physicians, and technicians for the first two weeks after go-live. "That is a big deal when you're trying to transition an emergency room," Ford says.
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Feds look to mine social media for outbreak info

Posted: November 8, 2012 - 3:00 pm ET
Facebook may become a tool in containing the next disease outbreak under a pilot program to mine social networks for real-time public health data.
Accenture Federal Services, Arlington, Va., a wholly owned subsidiary of Accenture LLP, was awarded a one-year, $3 million contract by the U.S. Homeland Security Department to help boost the biosurveillence capabilities of the Office of Health Affairs, according to a news release. The office is responsible for providing health and medical expertise to prepare for, respond to and recover from any hazard impacting the nation's health security, including biological threats.
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Tulsa supercomputer holds potential for health improvements

November 12, 2012 | By Susan D. Hall
A roughly $3 million "community supercomputer" being built in Tulsa offers an array of massive-number-crunching possibilities, including predictive modeling to improve the health of residents there.
Bruce Benjamin,  associate dean for biomedical sciences at Oklahoma State University Center for Health Sciences said the supercomputer could identify patterns related to risk for heart disease from 15 measurements taken over eight hours from dozens of sleeping volunteers, according to a Tulsa World story.
Gerard Clancy, president of the University of Oklahoma-Tulsa, says the supercomputer could predict a person's conditions in 20 years--or could do so for the city as a whole, the World previously reported.
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EHR problem lists: Docs say more info is better

November 12, 2012 | By Susan D. Hall
Physicians are more likely to want more conditions on the patient problem list in electronic health records even though that information might be duplicated elsewhere in the record, according to a study published at BMC Medical Informatics and Decision Making.
Problem lists are subjective, involve multiple providers and lack overall standards or policy as information is shared among healthcare organizations, the authors note. 
"When problems are left out or hidden within a long and cluttered list, the problem lists' effectiveness is compromised. …To improve patient care and reap further benefit from the problem list as a data resource, the medical community needs to create clear, consistent, complete, and accurate problem lists. Unfortunately, the medical community's current approach to the problem list makes inconsistency and error the standard," they wrote.
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Monday, November 12, 2012

Despite ONC's Effort, Comparing PHR Privacy Policies Still Challenging

by Kate Ackerman, iHealthBeat Managing Editor
To date, personal health record adoption has been somewhat limited, but the market is expected to get a big boost from Stage 2 of the meaningful use incentive program.
Deven McGraw -- director of the Health Privacy Project at the Center for Democracy & Technology -- said, "The market for those tools has been a little soft I think because people have really had to hand enter in the data or scan [them] in, as opposed to being able to feed [the information] directly from a provider's electronic health record, unless they happen to be a patient at Kaiser or part of a system that already offers them that tool." However, she said, "That's going to change in 2014 when a lot of the early adopters in the HITECH incentive program begin Stage 2 and start actively encouraging patients to view and potentially download and transmit their data."
But is the industry ready when it comes to privacy and security regulations?
Survey data show that consumers routinely cite privacy and security as top barriers to personal health record adoption. A 2010 survey from the California HealthCare Foundation found that 75% of U.S. adults without a PHR cited concerns about the privacy of their information as the top barrier to using a PHR. CHCF publishes iHealthBeat.
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Enjoy!
David.