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How Electronic Health Records Can Lead to Care Coordination
August 13, 2013
Inadequate care coordination is a major problem in health care delivery, but information technology (IT) is emerging as an important tool for enhancing coordination and, ultimately, improving the delivery of care.
Most chronic conditions require multiple clinicians to coordinate care, and most patients who have these conditions visit providers from many different medical groups. This creates obvious logistical challenges, such as making sure all providers are up to date on the current care plan, as well as their respective roles and responsibilities for keeping track of the patient. Additionally, patients with more than one chronic condition — who incurred roughly 93 percent of Medicare spending in 2011 — require coordination among an even greater number of providers.
Experts have proposed IT as a key tool for improving coordination among patients and their providers — an especially important goal for provider organizations as they move toward accountable care. However, evidence shows that today's electronic health records (EHRs) and health information exchanges do not include adequate functionality to improve care coordination or facilitate caregiver collaboration.
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Mobile Technology Could Put Health In Hands of Patients
A growing number of companies are seeking to help people better manage their chronic illnesses with home monitoring devices. According to the CDC, nearly 1 in 2 adults live with chronic disease. (Photo: Imec)
If health care is the new gold rush, then it’s no surprise Silicon Valley’s high-tech companies, entrepreneurs and recent MBAs hope to strike it rich on the heels of U.S. health care reform.
A growing number of today’s technological gold-seekers want to help patients manage chronic disease. Specifically, they are interested in home monitoring devices – wireless trackers that can send thousands of electrocardiogram (EKG) tracings, blood sugar levels or other bodily statistics directly to health care professionals.
While home monitoring devices may have a glittering future, some of today’s tech companies are chasing fool’s gold.
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Leadership: Focus on the Fundamentals
AUG 21, 2013 3:52pm ET
Whether you are a first-time leader, an experienced professional taking over a new team or a senior leader who can use a little leadership pick-me-up, focusing on these five fundamentals will serve you and your teams well:
1. It starts with showing respect. Respect is the leader’s currency, and you cannot earn it unless you give it. A title doesn’t command personal respect, it’s your words and actions that help you bankroll this critical capital. Speak kindly. Pay attention. Slow down and strive to understand. Don’t let your devices distract you in mid-conversation or meeting. Show that you care and offer help where you can. Paying attention to someone is a high form of displaying respect.
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Kaiser Opens Colorado-based IT Center
August 22, 2013 by Gabriel Perna
Kaiser Permanente, the nationwide integrated healthcare provider and payer based out of Oakland, has officially opened a new healthcare information technology center in Greenwood Village, Colo.
The five-story building will eventually house 700 IT employees for the provider, by the year 2015, with half of that already having started working at the new location. Kaiser is recruiting solutions architects, managers/directors, software developers, project/program managers, and programmers for 95 positions.
"As healthcare evolves, there is an increased demand for IT solutions and support to deliver quality patient care," Phil Fasano, executive vice president and chief information officer, Kaiser Permanente, said in a statement. "This new IT location is a center of excellence where best in class employees use technology to ensure the delivery of high-quality, affordable health care to Kaiser Permanente members living in Colorado and across the country."
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Providers: Don't be penny wise, pound foolish when it comes to cyber insurance
August 22, 2013 | By Marla Durben Hirsch
I find it ironic to read this week in American Medical News that while interest in cyber insurance has grown, many physicians are reluctant to buy it to protect their businesses in the event of a security breach of their electronic patient data because they are "overwhelmed" with installing EHRs and complying with the Meaningful Use incentive program and HITECH Act.
The article also reports that 52 percent of healthcare organizations, not just physicians, say they wouldn't buy cyber insurance because premiums are too expensive.
While the article doesn't list cyber insurance carriers or compare premiums from insurer to insurer, it does note that cyber insurance costs about $2,500 a year.
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Hospital IT spending jumps high
Posted on Aug 22, 2013
By Paul Cerrato, Contributing Writer
Hospital executives have never been frivolous when it comes to investing in technology, but as reimbursements shrink, the need to carefully analyze each purchasing decision has never been more urgent.
Given all the worthwhile – and not so worthwhile – options, what choices are hospital administrators currently making?
Since IT spending is largely taken up by meeting meaningful use and ICD-10 requirements, said Chantal Worzala, director of policy at the American Hospital Association, hospitals don’t have much left over for investments in other things.
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Health IT preparing for 'omics'
Source: Mike Milliard Date: Aug 21, 2013
Data systems in healthcare are lacking when it comes to the storage and handling of increasingly complex medical information, according to a new study published in the Journal of the American Medical Association.
Physicians are moving en masse to electronic health records, but existing data systems aren't sophisticated enough to make optimal use of ever-expanding patient information, according to one of the report's authors, Justin Starren, chief of the division of health and biomedical informatics in the department of preventive medicine at Northwestern University Feinberg School of Medicine.
This problem that will only be exacerbated as data grows apace – fueled by innovations such as next-generation genomic sequencing – and becomes cheaper and more available to health care providers.
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An Epic test
Cambridge University Hospitals NHS Foundation Trust’s is getting ready for the go-live of its Epic electronic patient record system. As part of the preparations, the company is making trust staff take exams; and they are not making it easy, eHospital programme director Carrie Armitage tells Lis Evenstad.
21 August 2013
Carrie Armitage, director of the eHospital programme that Cambridge University Hospitals NHS Foundation Trust is running with its neighbour Papworth Hospital, expects the scheduled go-live of its electronic patient record system to be, well, ‘epic.’
Next October, the programme is planning a trust-wide, simultaneous explosion of the Epic system, including a full patient administration system, specialist modules, nursing and clinical observations and documentation, order communications, a specialist theatre system, pathology, radiology and e-prescribing.
To name just some of the planned features. It all seems very ambitious, and Armitage acknowledges that it might seem radical to do everything at once.
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NPfIT to cost £10 billion
22 August 2013 Rebecca Todd
The final cost of the National Programme for IT in the NHS is expected to be more than £10 billion.
Around £2.6 billion of actual benefits had been identified as of March 2011, but the Department of Health is predicting a final benefit figure of £10.1 billion.
An NPfIT benefits statement, released to EHI under the Freedom of Information Act, reveals that as of 2012, the total cost of the programme in 2004-05 prices was forecast as £10 billion with around £7.3 billion spent already.
The programme was set up in 2002 and originally slated to cost £12.7 billion, however it was officially axed in September 2010 and again in 2011, without delivering its original vision of electronic patient records across the health service.
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2012 laptop breach helped Beth Israel's security during Boston Marathon bombing
August 22, 2013 | By Susan D. Hall
In one sense, a stolen laptop that cost Beth Israel Deaconess Medical Center more than $500,000 in lawyers and crisis experts paid off in helping the hospital deal with security issues in the aftermath of the Boston Marathon bombing in April.
Following the breach, which occurred in May 2012, the hospital brought in consulting firm Deloitte to help evaluate its privacy practices, an audit that CIO John Halamka described as a "public colonoscopy"--evaluating every aspect of how hospital employees use computers, according to an article published this week in Fast Company.
Deloitte's recommendations led to 26 new hires focused on data security and millions in costs to the hospital, plus external security audits for all its vendors.
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3 quality, coordination lessons from the Beacons
By Anthony Brino, Associate Editor
Being able to digitally submit clinical quality measures (CQMs) to Medicare is one of the big promises of health IT for physicians and providers — and it’s still coming, along with other administrative simplifications.
But digital CQMs have been put to good use on the ground by some of the 17 Beacon Communities, the Office of the National Coordinator for Health IT argues in an issue brief. As the ONC and the Centers for Medicare & Medicaid Services finalize novel eCQMs for Medicare, in the areas of clinical care, care coordination and outcomes, here are three lessons from the Beacons on using quality measurements.
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EHNAC Accreditation Firm Finalizes New Criteria for 15 Programs
AUG 21, 2013 3:57pm ET
The Electronic Healthcare Network Accreditation Commission, which certifies entities that process transactions or exchange health information for meeting best practices, has finalized new criteria for 12 existing programs and three new programs covering use of the Direct Project secure messaging protocols.
Among other changes, the criteria were updated to reflect use of cloud computing and to align with provisions of the omnibus HIPAA rule that made changes to the privacy, security, breach notification and enforcement rules, as well as the Genetic Information Non-Discrimination Act. The compliance data for the rule, finalized in early 2013, is September 23, 2013.
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Reaction to ONC's Recently Released Health IT Safety Plan Mostly Positive
Thursday, August 22, 2013
Given the broad reach and potential implementation complexity of the Office of the National Coordinator for Health IT's new health IT safety plan, and the health care sector's typical response to anything that calls for or even hints at more regulation ahead, one might expect a fair bit of grousing to ensue. After all, the plan calls for significantly stepped-up surveillance in health IT, a requirement for transparency in provider/user reporting of health IT-associated safety hazards and adverse events, and public posting of results of summative testing of health IT, particularly electronic health records' usability and error rates.
In the six weeks since the ONC issued the plan, however, it's been mostly quiet on the reaction front, according to Jacob Reider, ONC's chief medical officer. "Honestly, I have not seen any substantive negative feedback. There's been the occasional blog or Twitter post suggesting that we're doing too much or too little, but, for the most part, response on both the provider and vendor side has been fairly positive.
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How physicians can ensure context in the medical record
■ Data alone can show only so much. A doctor’s narrative is important in picking up the nuances of a patient’s story.
The digitization of medical records has given physicians opportunities to do much more with their patients’ records than they were able to do with them in paper form. But have electronic health records lessened the opportunity for the record to be viewed in the appropriate context?
Experts say the most useful patient record will strike a good balance between structured data (data readable by a computer) and a physician’s narrative. This balance is sometimes hard to strike, however, as many electronic health records focus on creating templates meant to capture the structured data.
While templates can speed up the documentation process, they do not provide room for nuance. As patient records become more portable and the number of people involved with a patient’s care increases, it’s increasingly important for the record to tell a patient’s story accurately and thoroughly.
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Intermountain innovation lab to focus on making care more patient-centric
August 21, 2013 | By Ashley Gold
A patient room of the future with 3-D printing, handwashing sensors and "life detectors" aren't tools out of some futuristic movie--they're all part of Intermountain Healthcare's new Healthcare Transformation Lab, which launched this week, the 22-hospital health system announced.
Salt Lake City-based Intermountain teamed with technology companies Dell, CenturyLink, NetApp and Sotera Wellness to create the lab, located at its flagship 208-bed hospital in Murray, Utah. The purpose of the lab is to enable joint research that will lead to development of new ideas "to improve and optimize patient care."
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Intermountain looks to the future, again
Posted on Aug 21, 2013
By Mike Miliard, Managing Editor
Intermountain Healthcare has joined with a group of IT companies including Intel and Dell to launch its new Healthcare Transformation Lab, which will work to bring envelope-pushing technologies to the bedside faster and more efficiently.
Having pioneered the use of electronic medical records, informatics and evidence-based care as far back as the 1970s, Intermountain has always been a forward-looking organization. Chief Information Officer Marc Probst says this new project is just the latest example of that.
"Innovators look past walls, and say, 'We can do it better,'" says Probst in a video interview. "I think we have a lot of that thinking here in the Transformation Lab."
At a time in healthcare that's "incredibly unique," with "so much happening so quickly," Probst says the lab is a way to capitalize on that momentum, pushing forward to "extend the use of future – or not-yet-proven – technologies into Intermountain Healthcare, and bring forth innovative or transformational technologies into our operations."
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Inmarsat, Cisco partner for satellite-based telemedicine
The deal will bring telemedicine to remote regions
Satellite operator Inmarsat on Tuesday announced a partnership with Cisco to provide connectivity for a mobile telemedicine system operating in the world’s most remote and underserved communities.
Under the deal the Cisco TelePresence VX Clinical Assistant will make use of Inmarsat’s global 3G-level satellite network in areas with little or no terrestrial telecommunications infrastructure.
The VX Clinical Assistant gives healthcare facilities, including hospitals and clinics, the ability to interface and collaborate with medical professionals anywhere in the world using Cisco TelePresence to share content and ultimately deliver medical care through high definition videoconferencing and real-time transmission of key diagnostics ranging from ultrasounds to blood pressure readings.
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Sensitivity of e-health data not used in care a low concern for patients
August 20, 2013 | By Dan Bowman
Patients whose electronic health data is used for secondary purposes aside from their own care aren't terribly concerned with the sensitivity of such information, but are interested in why the information is used, according to research published this week in JAMA Internal Medicine.
For the study, researchers from the University of Pennsylvania Perelman School of Medicine and the University of Texas Southwestern Medical Center surveyed more than 3,300 adults about their preferences about how such information is used (whether for research, quality improvement or commercial marketing); who is using it (hospitals, businesses or public health departments); and the data's sensitivity. The participants ranked their willingness to share such data in various scenarios on a scale of 1 to 10, with 1 representing a low willingness to share).
Respondents were less willing to share such information in scenarios involving marketing and quality improvement uses, and drug company and public health department users, the researchers found.
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The Trouble with Image Sharing, and the Opportunity
Scott Mace, for HealthLeaders Media , August 20, 2013
Hoarding medical imaging data is one of the most highly profitable, and strategic, tactics of hospitals competing in a fee-for-service market. It also represents a huge opportunity to reduce the high cost of healthcare as reform comes online.
One of the lesser-talked about menu objectives in Meaningful Use Stage 2 is a requirement to use EHRs to receive more than 10 percent of imaging results. Given the current crunch regarding core objectives of Meaningful Use Stage 2, it is understandable that not much is being said about this requirement.
Nevertheless, sharing images goes to the heart of what is possible with healthcare IT. The generation of medical images costs a fortune. Under a fee-for-service model, generating the maximum possible images out of the various departments of a hospital is a huge source of revenue.
As we know, the fee-for-service system is hanging on for the foreseeable future. I'm guessing that if you strip away the generation of duplicative, unneeded medical images, you are probably talking about the difference between many a profitable hospital and those same hospitals running at a loss.
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HIEs maintain a more accurate medication list than ED records
August 19, 2013 | By Susan D. Hall
Health information exchanges offer the potential to offer doctors in the emergency department a more accurate list of medications that a patient is taking than the drug list recorded by the triage nurse and ED staff, according to a new study.
Research conducted in Montreal compared patients' community pharmacy-dispensed medications--those purchases are all recorded in a database called the Régie de l'Assurance Maladie du Quebec (RAMQ)--with the drug list the ED staff compiled. Pharmacy records identified 41.5 percent more prescribed medications than were noted in the ED chart, according to the study published at the Journal of the American Informatics Association.
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Health organizations not prepared to use e-health tools to combat epidemics
August 19, 2013 | By Dan Bowman
Despite a plethora of claims that IT tools like information exchanges and geographic information systems could help to combat health epidemics, research published this week out of Australia concludes that organizations worldwide would not be adequately prepared to use e-health systems in the event of a massive pandemic disease.
The study's authors, who published in the International Journal of Biomedical Engineering and Technology, said that despite the promise of such tools, organizational preparedness is essential, yet lacking. To that end, the adoption of those tools would be too disruptive to current protocols, they said.
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The cost-benefit calculation of electronic health records systems
August 19, 2013 | By Gienna Shaw
It's discouraging to read that more than half of physicians say the costs of electronic health records systems outweigh the financial benefits. But it's also heartening to see that, in the survey of 1,200 employed and independent physicians, most agree the benefits to patient care do justify the investment.
Reminds me of the much-spoofed MasterCard commercial: Electronic health records system: $15,000 to $70,000. Patient safety and quality: Priceless.
And, oh, if only an EHR system really was a mere $70K. There's more to the cost than the initial investment in hardware and software--a lot more. There's training costs, loss of productivity as clinicians and other staff learn new systems. There's IT staff to hire. And don't forget ongoing maintenance and the inevitable updates to buy and install.
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The Data Stops Here
Monday, August 19, 2013
Editor's Note: The California HealthCare Foundation publishes iHealthBeat.
In California, a county supervisor is considering budget cuts to a local public hospital that could affect thousands of residents. Where can she turn for data?
In an ideal world, that supervisor would have ready access to local breakdowns on poverty, insurance status, hospital finances and the prevalence of chronic conditions, among other measures. Some of this information exists at a local level, but it requires searching across an assortment of government sources, from the local health department to state agencies to the federal government. Accessing such a disorganized array is tough to do with limited staff resources.
The reality is that too few local officials can readily tap the data needed to make decisions about health care in their communities.
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08/01/2013 | 8:00 AM
You’ve got mail: Someone else’s medical test results
The first e-mail came at the end of June. It was from a doctor’s office in another state—a large cardiology group. The note listed the name of a test. It listed the full name of the patient. It listed the full name of the doctor who treated that patient. It said the test was normal and provided a number that I could call for more information. Presumably, this was supposed to be good news. But it was someone else’s test result.
I’ve written before about the accidental voyeurism that can happen when you have a common e-mail address, and misaddressed notes to other people begin to stack up. I have both a common name and a common e-mail, and receiving and deleting notes from another Carolyn Johnson’s boyfriends, church groups, real estate clients, neighborhood watch groups, potential future employers, financial aid officers, and students has pretty much become a part of my daily routine. Recently, though, I’ve noticed a new kind of misrouted e-mails that seem less trivial than some of the other unwelcome missives that show up in my inbox. These are notes or test results from other people’s doctor’s offices.
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Jeremy Hunt plans sale of confidential patient medical records to private firms
Confidential medical records may be offered to private companies for as little as £1, according to plans drawn up by officials.
2:20PM BST 18 Aug 2013
The new General Practice Extraction Service will consolidate NHS patient records sent to a central database by GPs around the country.
The project has been described by campaigners as an "unprecedented threat" to medical confidentiality, and doctors do not have to inform patients that their records are being passed on.
The records will include details of medical conditions and patient identifiable information including a patient's NHS number, postcode and date of birth, reports the Daily Mail.
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Enjoy!
David.