Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, August 10, 2013

Weekly Overseas Health IT Links - 11th August, 2013.

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.

Patient portal mandate triggers anxiety

Posted on Aug 02, 2013
By Zack McCartney, Contributing Writer
Stage 2 of the government’s Meaningful Use Program requires that at least 5 percent of patients view, download, and transmit their health information and send a secure electronic message to their provider. The CMS lowered this objective from 10 percent to 5 percent when it published its Stage 2 final rule.   
With the transition to Stage 2 starting in 2014, even the lowered objective spurred anxiety in the healthcare community over whether achieving the goal of patient engagement is even possible. 
 “I think it’s going to be a rocky transition,” said Zachary Landman, MD, and CMO at DoctorBase, “There really aren’t too many people that are doing effective patient engagement”

Glassomics eyes Google Glass for health

Posted on Aug 02, 2013
By Eric Wicklund, Editor, mHealthNews
The possibilities for Google Glass in healthcare are, to borrow an overused phrase, endless. A new collaboration in San Diego is looking to explore those opportunities in more detail.
Palomar Health and Qualcomm Life have launched a new incubator specifically focused on Google's computerized eyeglasses, which aren't expected to become commercially available until sometime next year. The incubator, called Glassomics, aims to bring in healthcare experts, developers, clinicians, venture capital interests, universities and others to look beyond the "Wow" factor.
"There's been a lot of interest among various people in healthcare," said Orlando Portale, Palomar Health's chief innovation officer, who created and trademarked Glassomics earlier this month. "There's quite a bit to learn because the user interface paradigm is quite a bit different from" the mobile platform that Palomar has explored in the past.

HIE 2.0 will be 'clinical network management'

By Anthony Brino, Associate Editor
The future of health information exchanges will be “clinical network management,” according to a 2013 HIE market report by Chilmark Research.
As the market for HIE services slows its growth — now growing in the high single digits — and consolidates, 2013 is set to be the year when most HIEs realize they need to focus on supporting care coordination, or clinical network management, Chilmark said.
Clinical network management could also be thought of as HIE 2.0, according to Chilmark researchers, with HIEs having robust use of query-based exchange; cross-venue medication reconciliation; automated clinical quality reporting to public agencies, Medicare and other insurers; virtually-managed care plans; and population health analytics.

Study: EMR Risk Stratification Can Reduce Readmissions

August 1, 2013
An electronic medical record (EMR)-enabled strategy that targets scarce care transition resources to high risk heart failure (HF) patients can reduce hospital readmissions, according to a new study in the British Medical Journal Quality & Safety.  
The study, conducted by investigators from PCCI, a non-profit research and development corporation, evaluated 1,747 adult inpatients admitted with HF, acute myocardial infarction, and pneumonia over two years at Parkland Memorial Hospital, a 780-bed teaching hospital in Dallas, Texas. The software sits above the EMR and stratifies patients admitted with HF on a daily basis by 30-day readmission risk, as defined by a published HF readmission reduction electronic model.

ONC's Blair says public-private HIE 'incredibly disruptive'

By Anthony Brino, Associate Editor
“This is a big experiment we’re conducting,” the ONC’s principal advisor for state HIT-enabled care transformation Hunt Blair said at the CMS eHealth Summit, talking about the confluence of public-private investments in EHR adoption and health information exchange.
“And we’re going to get negative results," Blair added, "that’s what happens in an experiment.”
Blair, who joined the ONC in January after working as deputy commissioner of health reform at the Vermont Department of Health Access, did not mention any negative impacts of health IT or medicine specifically. His point was that meaningful use, health information exchange, value-based payments and care delivery redesign — all part of the federal government’s health reform endeavor — are challenging, with varying results so far across the states and localities.

ONC contract guidance attempts to level the EHR playing field

August 1, 2013 | By Marla Durben Hirsch
Regular readers of FierceEMR know that I tend to be cynical about new developments. I don't take them at face value and delve deeper to see if there's anything in addition going on behind the scenes.
And so it is with the Office of the National Coordinator for Health IT's new "legal" guidance on EHR contract terms.
I love this new guidebook, called "EHR Contracts: Key Contract Terms for Users to Understand." It identifies seven provisions commonly found in vendor contracts, explains what they mean, what electronic health record purchasers need to know, and other related issues.
It's a very good tool, written in plain English.

7 steps for developing an effective eHealth strategy

August 1, 2013 | By Dan Bowman
Very few health organizations or geographic regions have a proper strategy for the implementation of eHealth, despite evidence that technology's role in healthcare continues to grow, according to research published this week in the Journal of Internet Medical Research. To that end, a pair of researchers from South Africa and Canada outlined seven steps necessary to the development of an effective eHealth strategy.
"Entities will often emulate or adapt practice from elsewhere," the study's authors said. "While emulation or adaptation is common, these approaches are inappropriate: 'emulation' because solutions and approaches must be context-specific, and 'adaptation' because, although a compromise, it remains suboptimal."

Mobilizing Health Information Technology

by Patricia Flatley Brennan Thursday, August 1, 2013
We've all heard that electronic health record adoption has tripled since 2010, which is especially noteworthy considering that the field of health information technology is still in its relative infancy. But while EHRs are top of mind in most health IT discussions, they're only one facet of a rapidly growing and evolving industry.
It's time to start expanding our health IT focus to encompass devices and applications that are much more accessible to patients, who are increasingly using smartphones and tablets to capture their health data. These data paint a more complete picture of their health and have significant potential to positively change our health care delivery system.
This new kind of data is termed "observations of daily living," or "ODLs." They're the bits of information that are defined and recorded by people during the course of their daily lives, based on health information that is personally relevant and meaningful to them.

An EMR downtime then and now

Source: John Halamka, MD Date: Aug 1, 2013
On November 13, 2002, the network core at Beth Israel Deaconess failed due to a complex series of events and the hospital lost access to all applications. Clinicians had no email, no lab results, no PACS images, and no order entry. All centrally stored files were unavailable. The revenue cycle could not flow. For two days, the hospital of 2002 became the hospital of 1972.
On July 25, 2013, a storage virtualization appliance at BIDMC failed in a manner which gave us Hobson's choice — do nothing and risk potential data loss; or intervene and create slowness/downtime. Since data loss was not an option, we chose slowness. Here's the email I sent to all staff on the morning of July 25.
"Last evening, the vendor of the storage components that support Home directories (H:) and Shared drives (S:) recommended that we run a re-indexing maintenance task in order avoid potential data corruption. They anticipated this task could be run in the middle of the night and would not impact our users. They were mistaken.

OHSU: Three Big Breaches in a Year

JUL 29, 2013 6:06pm ET
Unauthorized use of cloud computing storage services in two departments of Oregon Health & Science University has resulted in the organization notifying more than 3,000 patients that protected health information may have been compromised. The incident is the third major breach for OHSU in the past year. The previous breaches on the HHS Office for Civil Rights’ public Web site included an unspecified theft on July 4, 2012, affecting 702 patients, and the theft of a laptop on Feb. 22, 2013, affecting 1,114.
Here is the statement on the latest breach from the university:
Oregon Health & Science University is notifying 3,044 patients that their OHSU health information was stored on an Internet-based email and/or document storage service, also known as a “cloud” computing system.

Epic holdout questions install craze

Posted on Jul 31, 2013
By Bernie Monegain, Editor
In a recent blog post, John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center in Boston, offers his views on why the Epic EHR has gained unprecedented momentum in the market among providers nationwide -- not least among an elite group of hospitals in Boston.
So far, though, BIDMC, which is among that exclusive Boston-based group, is sticking with its in-house built EHR.
An Epic system – or other client-server technology – might relieve some demands on Halamka and his IT team, but it would not likely be as flexible.

Go-live gone wrong

Posted on Jul 31, 2013
By Bernie Monegain, Editor
Though it seems that much of the healthcare industry is finally on board with making the transition from paper to digital records, the transformation comes with a high price. Much anticipated, and sometimes hyped, electronic health record system rollouts cost millions of dollars and often end up causing chaos, frustration, even firings at hospitals across the country.
Case in point: Maine Medical Center in Portland, Maine, a 600-bed hospital that is home to the celebrated Barbara Bush Children’s Hospital, and a part of the MaineHealth network.
Maine Med’s go-live last December of its estimated $160 million Epic EHR system seemed at first to go off without a hitch. But four months later, the hospital network’s CIO, Barry Blumenfeld, MD, (pictured at right) was out of a job, and, in an April 24 letter to employees, Maine Medical Center President and CEO Richard W. Petersen announced a hiring freeze, a travel freeze – and a delay in the further rollout of the EHR throughout the rest of MaineHealth.

4 tips for hospitals moving to cloud-based storage

July 31, 2013 | By Ashley Gold
Boston-based Beth Israel Deaconess Medical Center recently moved to cloud data storage, due in large part to their volume of medical records, according to CIO of the Beth Israel Deaconess Care Organization Bill Gillis. Speaking to Becker's Hospital Review, Gillis and Bob Dupuis, practice director at Arcadia Solutions--which built BIDMC's custom network storage system--explained why they think it will work.
"We got space at a cloud storage facility and were able to build our own cloud that we now manage and maintain," Gillis said. "In 2007, not a lot of organizations were using cloud-based storage, but we were just going with something we thought would work--and it did."

VA: 80,000 vets used telehealth in 2012

July 31, 2013 | By Dan Bowman
Roughly 80,000 veterans took advantage of telehealth tools in more than 200,000 remote consultations in 2012, the U.S. Department of Veterans Affairs announced this week.
The figures were touted Tuesday at the VA's first Connected Health Showcase in Washington, D.C., according to a story published at Military.com. In addition, the VA said that its telehealth program has reduced bed days for veterans by 58 percent and hospital admissions by 38 percent.

Health data breaches usually aren’t accidents anymore

Personal medical information is being targeted because of the value it holds and the relative ease thieves have getting their hands on it.

By Pamela Lewis Dolan amednews staff — Posted July 29, 2013
During the past decade, the health care industry has adopted new practices and technology to protect against patient data breaches. But as protection of data becomes more sophisticated, so have the ways in which the data are exposed.
Data security firm ID Experts examined some of the biggest breach cases from the past decade and talked with data security experts to understand how the trends have changed during the past 10 years. The report identifies future threats to data security and gives advice on how organizations can respond to those threats.
One of the biggest changes during the past decade is the data being targeted. Ten years ago, it was personal identifiable information. Now, said Rick Kam, president and co-founder of ID Experts in Portland, Ore., personal health information is being targeted, mainly because of the value it holds and the relative ease thieves have getting their hands on it.

EPRs essential for HES expansion plans

22 July 2013   Rebecca Todd
Hospitals will need electronic patient record systems to meet NHS England’s “ambitious” plans for extracting a hugely expanded hospital dataset from April 2014.
A consultation starts today on the commissioning board’s proposal to require a much larger dataset be electronically provided by hospitals from the start of the next financial year.
NHS England proposes to extract data including all tests and results, investigations performed and medications prescribed, as well as nursing observations.

Despite EHR, Patient ID Problems Persist

Scott Mace, for HealthLeaders Media , July 31, 2013

If you think that moving to electronic health records will eliminate mistaken identity in healthcare, you are mistaken.
This article appears in the June issue of HealthLeaders magazine.
The change from fee-for-service to coordinated care is challenging providers to solve a longstanding need to identify patients more precisely to avoid waste, fraud, and substandard care.  
For years, the healthcare industry has recognized the problem of errors related to improper patient identification. If you were to think that moving to electronic health records would eliminate mistaken identity in medicine, you would be, well, mistaken, according to a variety of healthcare executives interviewed for this story.

Report: Building blocks for a health sector digital ecosystem are falling into place, slowly

Even advanced economies are a long way short of delivering a digital ecosystem for the healthcare sector, but a report finds progress is being made, and some cause for optimism.
That’s our interpretation of Accenture’s latest cross cultural study of digitised health care service delivery called "The Digital Doctor is in" which found that across eight advanced economies, in only two – England and Spain – are doctors routinely accessing digital clinical data about patients.

Tool Lets Employers Calculate Their Cost for Hospital Errors

JUL 29, 2013 3:29pm ET
The Leapfrog Group, a coalition of employers seeking improved quality of care at lower prices, has introduced software to enable health care purchasers to see how much they spend unnecessarily because of medical errors in hospitals.
Also available with the Hidden Surcharge Calculator is a white paper from Leapfrog. The organization estimates that a patient admitted to a hospital with a safety grade of “C” or lower generates $7,780 in hidden surcharges because of errors.

Cloud storage debacle marks hospital's third privacy incident in a year

July 30, 2013 | By Dan Bowman
Information for more than 3,000 patients at Oregon Health & Science University was put at risk when medical residents stored the data on a password protected cloud computing system, the institution announced this week. The potential data breach is the third such reported incident to occur at the university in less than a year, and the fifth since 2008.
In May, a faculty member at the university's school of medicine found that residents in the Division of Plastic and Reconstructive Surgery were using Google Drive and Google Mail to maintain a spreadsheet of patients that was accessible among department members in real time. A subsequent investigation determined that similar practices had taken place in the hospital's Department of Urology and in Kidney Transplant Services. Those patients impacted--3,044 in all--were admitted to the hospital between Jan. 1, 2011 and July 3 of this year.

Docs rarely 'game' CDS systems to reduce alerts

July 30, 2013 | By Susan D. Hall
A vast majority of physicians entered accurate data into an imaging clinical decision support system, according to a new study that found little evidence of attempts to "game" such systems to avoid intrusive computer alerts.
The study, conducted by researchers at Brigham and Women's Hospital and Harvard Medical School, compared data entered in the emergency department for the use of CT angiography (CTA) for the evaluation of patients with suspected pulmonary embolus (PE). They chose this data because the orders can be compared directly with lab results to determine whether the tests ordered are appropriate. They also looked at downstream effects of erroneously entered information in an article recently published online in the Journal of the American Medical Informatics Association.

Emis-TPP data sharing called off

26 July 2013   Rebecca Todd
An agreement to work on direct sharing of information between TPP and Emis users has collapsed.
EHI reported in March that the GP IT system suppliers were working on a “groundbreaking” data-sharing agreement.
The companies said they were looking for sites to pilot the technology, which would allow clinicians using one system to view patient records from the other system.
However, talks have broken down.

5 ways health IT impacts consolidation

Posted on Jul 29, 2013
By Jeff Rowe, Contributing Writer
Most health IT professionals are probably more focused on implementing or maintaining systems than they are tracking larger healthcare trends, such as the pace at which hospitals and practices are being bought and sold.
The fact is, however, that information technology – even if it's not a direct driver of healthcare consolidation – can certainly be a significant factor in the decision-making of healthcare administrators, affecting both the choice to consolidate and how successfully a consolidation is carried out.

Political Heat Scorches Meaningful Use Timetable

Scott Mace, for HealthLeaders Media , July 30, 2013

Until recently, MU has had a bipartisan aura about it. But now the desire for a delayed deadline for Stage 2 is growing among healthcare providers and technology vendors. Could this be the moment that MU becomes another partisan issue in Washington?
July has been full of FUD—fear, uncertainty, and doubt—for electronic health record technology.
Committees in both the House of Representatives and the Senate have heard officials make the case for providers to get more time to comply with Stage 2, beyond the current September 30, 2014 deadline.
The AHA and AMA joined the call for delay. And CHIME renewed its call for a delay of Stage 2.

CMS Clarifies Meaningful Use Clinical Quality Measure Specs

JUL 26, 2013 1:57pm ET
The Centers for Medicare and Medicaid Services has added three new Frequently Asked Questions relating to clinical quality measure specifications under the electronic health records meaningful use program:
QUESTION: When new versions of clinical quality measure (CQM) specifications are released by the Centers for Medicare and Medicaid Services (CMS), do developers of Electronic Health Records (EHR) technology need to seek retesting/recertification of their certified complete EHR or certified EHR module in order to keep its certification valid?
ANSWER: No. The minimum version required for 2014 Edition certification is the version of CQM specifications released by CMS in December 2012.  EHR technology that has been issued a certification based on the December 2012 version will remain certified even when CMS releases new versions of CQM specifications.

Analytics means we 'roll up our sleeves'

Posted on Jul 29, 2013
By Mike Miliard, Managing Editor
UPMC has invested more than $1.6 billion in its IT infrastructure over the past five years, according to Pamela Peele, chief analytics officer of UPMC Health Plan. That's more money, she points out, than its home city has spent on three pro sports stadiums combined – "and we take sports seriously in Pittsburgh."
Those massive investments have paid big dividends, said Peele, speaking July 24 at the The Institute for Health Technology Transformation's Denver Health IT Summit, and showed how UPMC's strategies could be useful even for smaller organizations without that sort of financial muscle.

4 reasons DICOM needs an upgrade

July 28, 2013 | By Mike Bassett
The Digital Imaging and Communications in Medicine (DICOM) standard for distributing and viewing any kind of medical image may not be the best method for Internet-based multi-organization exchange, according to testimony heard at a recent hearing of the Clinical Operations Workgroup of the Health IT Standards Committee.
According to a recent blog post from FierceHealthIT Advisory Board member John Halamka (pictured), co-chair of the committee and  chief information office at Beth Israel Deaconess Medical Center in Boston, two officials of LifeImage--CEO Hami Tabatabaie and CTO Michael Baglio--testified that image exchange should be divided into two categories: local and long distance.

Message matters: The persuasive impact of health blogs

July 29, 2013 | By Ashley Gold
Health-focused blogs and journals can have a positive impact on patients, but they're much more effective when written in non-narrative form by authors to whom readers can relate, according to a new study in the Journal of Medical Internet Research.
Author Amy Shirong Lu, Ph.D., of Northwestern University, set out to examine how message type and source similarity--the number of shared characteristics between writer and readers--persuade readers to adopt a specific health behavior, such as running for exercise.

Axial Exchange raises $5M, adds enhancements to hospital app platform

By: Aditi Pai | Jul 26, 2013
Raleigh, North Carolina-based Axial Exchange, a mobile app developer, raised just under $5 million from undisclosed investors, according to an SEC filing. Axial Exchange is backed by a syndicate of venture capital firms, led by Canaan Partners.
The company recently announced a series of enhancements to its mobile patient engagement app which include prioritizing elements related to day-to-day health management including medication adherence, access to all health system resources available to patients, and a new design approach that focuses users on the health information, instead of the design elements of the app.

ONC Unveils Final Health IT Safety Plan

by Helen R. Pfister and Susan Ingargiola, Manatt Health Solutions Monday, July 29, 2013
On July 2, the Office of the National Coordinator for Health IT released a final version of its Health IT Patient Safety Action and Surveillance Plan. ONC had released a draft of the plan for public comment in December 2012. The plan is a significant piece of the federal government's efforts to ensure the safety of electronic health records and other health IT tools. In addition to the Health IT Safety Plan, the government is considering whether:
  • A comprehensive risk-based regulatory framework is appropriate for health IT; and
  • Regulatory guidance relating to mobile health apps, in particular, is necessary.


The Health IT Safety Plan, which was a joint effort between ONC and the Agency for Healthcare Research and Quality, addresses recommendations made by the Institute of Medicine in its 2011 report, titled, "Health IT Patient Safety: Building Safer Systems for Better Care." In the report, IOM acknowledged that EHRs have the potential to reduce medical errors but also have the potential to cause them. Thus, the report called on the government and the private sector to maximize the safety of health IT-assisted care.

Berwick Names 11 Monsters Facing Hospital Industry

Cheryl Clark, for HealthLeaders Media , July 29, 2013

Former acting head of the Centers for Medicare & Medicaid Services, Don Berwick, MD, acknowledges healthcare providers have come a long way in the last few decades, but it's "by no means enough."
"And the wild things roared their terrible roars and gnashed their terrible teeth and rolled their terrible eyes and showed their terrible claws."
Where the Wild Things Are by Maurice Sendak
Like this line from Maurice Sendak's celebrated children's book, America's hospitals face some terrible monsters, 11 of them to be exact, said Don Berwick, MD, former acting administrator of the Centers for Medicare & Medicaid Services.
"We're scared of the truth, the next wave of what we have to do to transform healthcare. And it crosses some scary landscape. It's stuff we don't want to think about and don't want to talk about," he told some 1,400 executives assembled for the American Hospital Association's Leadership Summit in San Diego last week.

4 Strategies for Securing HIT Leadership Talent

Chelsea Rice, for HealthLeaders Media , July 29, 2013

Competition among healthcare recruiters to place well-qualified and experienced health information technology executives is fierce.These strategic tips can help.
With ICD-10, health insurance exchanges, and Meaningful Use deadlines bearing down on them, hospitals and health systems are in a bind to recruit and retain the right health IT executives to implement and manage increasingly complex health information systems.
More than half (52%) of hospitals and health system executives say "inadequate staff with expertise" is their top HIT challenges over the next three years, according to the HealthLeaders Media Intelligence Report, Healthcare IT: Tackling Regulatory, Clinical, and Business Needs.
Unfortunately, competition among hospital recruiters to place effective and experienced HIT executives is fierce.

The high cost of health care

Searching for a diagnosis

Jul 24th 2013, 18:24 by C.H. | NEW YORK
AMERICA spends more on health care than any other country in the world. What is more, spending within America varies dramatically from one region to the next. This is well known. Less understood is how best to change it. The health system is enormously complex. Differing views on reform inspire rowdy protests and send pundits into frothy-mouthed rants. To lower health spending, it would help to know what drives it up. A huge new report from America’s Institute of Medicine (IOM) helps provide an answer.
In the study, commissioned by Congress, the IOM looked at the geographic variation in spending within Medicare, the health programme for the old, and within the commercially insured population. It is the biggest ever analysis of why some regions spend more than others. Crucially, the factors driving the variation in Medicare spending are different from those affecting private coverage.


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