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"

or

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

Saturday, November 02, 2013

Weekly Overseas Health IT Links - 03rd November, 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.
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Halamka offers lessons on Healthcare.gov's rough go-live

Posted on Oct 24, 2013
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
CIOs face many pressures: increased scope, reduced timelines, trimmed budgets. After nearly 20 years as a CIO, I've learned a great deal about project success factors.
When faced with go live pressures, I tell my staff the following:
"If you go live months late when you're ready, no one will ever remember.
If you go live on time, when you're not ready, no one will ever forget."
I have hundreds of live clinical applications. Does anyone remember their go live date? Nope.
Were there delays in go live dates? Many.
With even the best people, best planning, and appropriate budgets, large, complex projects encounter issues imposed by external factors (new regulations, competing unplanned events, requirements changes) that cannot be predicted during initial project scheduling.
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mHealth enters consumer Golden Age

Posted on Oct 25, 2013
By Erin McCann, Associate Editor
The mobile health market is making a mark -- and it's a big one, as this year saw a record number of U.S. consumers now using mobile phones for health information, according to new industry research. 
Some 95 million Americans are currently using mHealth technologies, up 27 percent from 75 million just in 2012, according to the Manhattan Research Cybercitizen Health study. And these numbers have big implications for pharma marketers. 
Of the more than 8,600 adults surveyed, some 38 percent of smartphone users deemed them "essential" for finding health and medical information, according to the report, which underscores the opportunities for pharma marketers and found that consumers access health information on mobile phones at home, not just on the go.
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'Smart' cane among the robotic projects landing federal grants

October 25, 2013 | By Susan D. Hall
Development of a "smart" cane that can send navigation information to the user is just one of the projects funded through $38 million in federal grants awarded as part of the National Robotics Initiative.
It's the second round of funding doled out by the National Science Foundation (NSF), the National Institutes of Health (NIH), U.S. Department of Agriculture (USDA) and NASA since the initiative began two years ago, according to an NSF release.
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8 ways to manage change, not just HIT implementation

October 25, 2013 | By Julie Bird
There's a way to manage change associated with health IT, healthcare consultant Frank Speidel, M.D., says--eight ways, to be more precise.
Writing at HITConsultant.net, Speidel, chief medical officer for the Health IT staffing firm Healthcare IT Leaders, identifies what he calls eight "ates" for managing that change (check out the full post for more detail):
·         Contemplate the changes IT implementation brings to the health system and its operations by convening a diverse group representing different elements of the organization.
·         Communicate to understand "the why, where and what of the change" and where the change is taking the organization.
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NIH and CDC launch registry for sudden death in the young

By Diana Manos, Healthcare IT News
The National Institutes of Health and the Centers for Disease Control and Prevention have announced they are collaborating to create the Sudden Death in the Young Registry to help researchers work on preventing these type of deaths in the future.
According to NIH officials, data will be entered into a centralized database managed by a data coordinating center at the Michigan Public Health Institute and will not contain personally identifiable information. 
The resulting registry will become a resource for scientists to learn more about the causes of sudden death in the young and ultimately to develop better diagnostic and prevention approaches.
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Study: EHR input can be improved to better assess quality of care

October 22, 2013 | By Marla Durben Hirsch
The quality of data in an EHR shows promise for assessing the quality of primary care, but clinical reporting first needs to be improved, according to a new study published in the Journal of the American Medical Information Association.  
The researchers, from the Radboud University Nijmegen Medical Centre in the Netherlands, noted that quality indicators for diabetes treatment are often retrieved from chronic disease registries. They evaluated the quality of primary care physicians' recording in their EHRs compared to the quality of recordings in a simple chronic disease registry.
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Health IT takes hold around the world

Posted on Oct 24, 2013
By Zack McCartney, Contributing Writer
Every country, every government, every population is a participant in a global trial and error. Each one faces different circumstances and, therefore, approaches healthcare differently.  But, as world health leaders see it, everyone can learn from others' struggles and successes to improve and simplify their respective strategies. Health information technology is at the core.
Finding the global lessons from local healthcare strategies facilitates progress toward Universal Health Coverage, or UHC, a public health concept championed notably by the World Health Organization and it’s director, Margaret Chan. According to Najeeb Al-Shorbaji, director of knowledge, management, and sharing at the WHO, in a statement released to Healthcare IT News, WHO defines UHC as “all people receiving quality health services that meet their needs without exposing them to financial hardship in paying for them.”  
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SCR opt-out does not apply to care.data

22 October 2013   Rebecca Todd
Care.data information leaflets being sent to households in January will tell patients that an opt-out of the Summary Care Record scheme will not carry over to a new montly GP data extract.
Patients can opt out of both schemes if they wish, but must do so separately.
The care.data programme involves taking a large dataset from all GP practices covering patient demographics, events, referrals and prescriptions.
This will be linked with Hospital Episode Statistics and other data-sets to create new Care Episode Statistics, giving a more holistic view of patient journeys in the NHS.
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Obamacare woes prove the need for essential IT health

By Richard Waters
Leaving technology to backroom people is no longer an option
Complex IT projects fail. Websites get overwhelmed with too many visitors and seize up. Integrations involving a number of legacy systems lead to a scramble of incompatible technology.
Stuff happens. If this were the extent of the problems facing President Barack Obama’s new online healthcare exchanges – a centrepiece of his healthcare reform – then it would be just another cautionary tale about a mismanaged IT project.
But the shambles in Washington represents something altogether more ominous. IT has been a submerged risk in the business world for a long time, hard to assess and therefore often ignored by investors and senior managers.
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Privacy guru knocks patient ID as ploy

Posted on Oct 23, 2013
By Neil Versel, Contributing Writer
In calling for a national patient identification system, Bill Spooner, senior vice president and CIO of Sharp HealthCare in San Diego, said at the CHIME Fall CIO Forum earlier this month, "The real opponents [to a unique patient ID] are the privacy advocates." He was right.
Adrian Gropper, MD, Watertown, Mass.-based CTO of the Patient Privacy Rights Foundation in Austin, Texas, called the renewed push for a national patient ID an intentional ploy by healthcare providers, insurance companies and health IT vendors to protect revenue streams and avoid investing in patient-matching technology.
"If you wanted to exchange medical information, let the patient specify how they want to be identified," Gropper said. "You don't need [a unique] ID, you need information transparency."
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5 ways to fail a Meaningful Use audit

October 23, 2013 | By Marla Durben Hirsch
Many hospitals are making mistakes that are tripping them up during Meaningful Use audits, according to Meaningful Use audit expert Jim Tate in a new article on HITECHanswers.net.
"There is a lot of money on the table, not to mention careers, and the audit process should not be taken lightly. There is simply too much at stake and a wrong move during the audit or appeal process would take a hospital's staff to a place where it should never have to go," he writes.
Tate identifies some of the "worst practices" he's seen hospitals engage in. In contrast to last week's FierceHealthIT feature, Five ways to survive a Meaningful Use audit, here are five ways to fail a Meaningful Use audit.
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North American health IT market to hit $31.3B by 2017

October 23, 2013 | By Julie Bird
The health IT market in North America is forecasted to hit $31.3 billion by 2017, up 7.4 percent per year from $21.9 billion in 2012, according to a market report from Dallas-based MarketsandMarkets.
Although U.S. providers represent 72.6 percent of the market, the market is growing more quickly in Canada with a compounded annual growth rate of 7.7 percent, according to an announcement describing the research. The Canadian market is expected to leap from $15.9 billion in 2012 to $22.6 billion in 2012, driven in part by a publicly funded health structure.
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RWJF Launches Tool: Comparing Healthcare Quality-A National Directory

Written by Ellie Rizzo (Twitter | Google+)  | October 22, 2013
The Robert Wood Johnson Foundation has launched a tool, Comparing Healthcare Quality: A National Directory, allowing consumers to peruse reports and information on hospitals through a centralized database.
The RWJF's purpose in creating the tool is to allow the public to have easy access to reliable information on quality of care in their communities, according to the news release.
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10 Myths about HIPAA’s Required Security Risk Analysis

OCT 21, 2013 3:40pm ET
With revamped HIPAA privacy and security rules now in effect that include higher emphasis on conducting a security risk analysis, the federal HealthIT.gov Web site dispels 10 pieces of misinformation about what the rules really require:
1. The security risk analysis is optional for small providers. False. All providers who are “covered entities” under HIPAA are required to perform a risk analysis. In addition, all providers who want to receive EHR incentive payments must conduct a risk analysis.
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PHR progress still hangs in limbo

Posted on Oct 22, 2013
By Erin McCann, Associate Editor
Mobile personal health records may be on the uptick in the near future. But before consumers are able to access PHRs at their fingertips from virtually any location, there are some big barriers standing in the way, according to new research by Frost and Sullivan.
One of the biggest challenges, as researchers point out, is interoperability -- or, more accurately put, lack thereof. Traditionally, data collectors, such as providers, hospitals, physician specialty groups, labs, payers, government entities and imaging centers, have operated independently of each other, deploying unique IT infrastructures and fragmented patient record systems. 
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Five realities of healthcare's digital transformation

October 22, 2013 | By Susan D. Hall
The digital transformation in healthcare involves an array of stakeholders as well as regulatory and cultural change. Five "realities" emerge for discussion in a post from David Lee Scher, MD, at Healthcare Talent Transformation.
Among them:
"Build it and they will come" doesn't necessarily work.   Process and workflow changes must accompany the adoption of new technology, as physicians are painfully finding out with the adoption of EHRs, Scher writes. Technology also requires cultural change, with providers and patients both buying into disease-management plans.
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Parents: Email communication with docs should be free

October 22, 2013 | By Ashley Gold
Emailing doctors like you'd email a co-worker or a friend about a concern seems to be the modern way of communicating--but would you be willing to pay for it?
Parents polled by the University of Michigan C.S. Mott Children's Hospital said no. While they said they'd love to get an email response from their child's healthcare provider about a minor visit rather than making a visit, roughly half of all respondents said such a process should come at no cost.
"Most parents know it can be inconvenient to schedule and get to an office visit for a sick child," Sarah Clark, associate director of the National Poll on Children's Health and an associate research scientist in the University of Michigan Department of Pediatrics, said in an announcement. "An email consultation would prevent the hassles of scheduling and allow sick children to remain at home. Email also could be available after hours when their caregiver's office is closed."
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Why Doctors Hate EHR Software

Have meaningful use incentives merely propelled sales for a lot of lousy software?

Maybe this will be a "no duh" observation for those who work in healthcare or health IT, but a lot of doctors really hate the electronic health records (EHR) software they're compelled to use.
As an InformationWeek staffer recently assigned to this beat after only occasionally covering health IT in the past, I was surprised how unanimously and passionately dissatisfied most doctors are with the usability of this software, which they see as draining rather than enhancing their productivity. I'm sure there are exceptions where doctors are more enthusiastic about technology, the software they are using is higher quality, or a little of both. But if you open the door to a conversation about how horrible medical records software is, you'll get an earful.
Here's what I'm basing this on. Having spent the past few months writing about massive open online courses (MOOCs) for the education beat, I was happy to discover a Coursera course on Health Informatics in the Cloud starting at just about the time that I needed to come up to speed on my new beat. I'm happy to say the instructor, Georgia Tech's Mark L. Braunstein, MD, will be contributing to InformationWeek as a columnist, so watch for that. Braunstein has spent most of his career in healthcare IT, so I think it's fair to say he's a true believer in the potential and the necessity of digitizing medical information. However, when I turned to the course discussion forums I found a message thread titled "Health IT Doesn't Fix Problems -- Good Health IT Does."
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How Telemedicine Drives Volume, Revenue

Scott Mace, for HealthLeaders Media , October 22, 2013

Not only is health information technology helping to control costs, it's also creating new opportunities for revenue.

This article appears in the October issue of HealthLeaders magazine.
Healthcare systems find that telemedicine can help grow their volume and drive out inefficiencies, but new methods of care delivery require thoughtful planning to avoid hiccups.
The UC Davis Health System now offers access to 30 specialty care services ranging from behavioral health and dermatology to audiology and ophthalmology for both children and adults.
Recently, the system reported it was able to grow its pediatric medicine practice through telemedicine. In a study published in the July 2013 issue of Telemedicine and e-Health, authors from the UC Davis Health System reported 2,029 children transferred to the hospital from 16 surrounding hospitals connected via telemedicine between July 2003 and December 2010.
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Structured Data Leads to Better Analysis, Outcomes

Scott Mace, for HealthLeaders Media , October 22, 2013

Software that can create structured tables of data from clinicians' notes and then incorporate them into any standard electronic medical record, is easing concerns that structured EHRs are killing the clinical narrative.

At CHIME earlier this month, I heard many CIOs complain that electronic health record systems do a poor job of summarizing clinicians' notes and integrating them with the structured data which forms the backbone for much of the population health analytics which can bend the cost curve of care.
I've been writing for a long time about concerns that structured EHRs are abandoning the clinical narrative. I've even written about the potential for natural language processing (NLP) technology to extract actionable information from that narrative.
Now there is evidence that NLP is starting to make a difference, and more importantly, may not require providers to be locked into a new set of such technologies. Instead, providers might be able to shop around for best-of-breed tools to get the job done.
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Why Copying and Pasting Must Stop Now

OCT 17, 2013 11:21am ET
Copying and pasting documentation within the electronic health record is a practice whose time to stop has come as industry forces demand better documentation. “I think everyone in the industry recognizes it is an issue,” says Michelle Mitcheff, physician services auditor at Indiana University Health’s Southern Indiana Physicians practice in Bloomington, IN.
But awareness isn’t yet significantly translating into action and that action soon may be forced. While putting together its 2013 work plan, the HHS Office of Inspector General took the stand that EHRs being used to copy and paste are making fraudulent activity easier, although it is yet unknown what action the office will take.
During a session at the AHIMA Conference in Atlanta, Mitcheff will walk through why copy and paste has to become history. “I recently sat in on training by a big-name vendor teaching providers how to copy and paste,” Mitcheff says. “But they weren’t telling providers they can be penalized for that.”
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Google Glass delivers patient data

17 October 2013   Kim Thomas
A proof-of-concept that uses Google Glass to deliver patient data to doctors has been announced by Philips and Accenture.
The Google Glass head-mounted display, which is connected to Philips IntelliVue Solutions, is designed to improve the effectiveness of surgical procedures by providing doctors with hands-free access to critical clinical information.
A demonstration of the technology shows how a doctor wearing the display could simultaneously monitor a patient’s vital signs and react to surgical procedural developments without having to turn away from the patient. The display also enables the doctor to monitor a patient’s vital signs remotely or enlist assistance from doctors in other locations.
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HITRUST issues draft privacy controls

October 21, 2013 | By Susan D. Hall
The Health Information Trust Alliance (HITRUST) has issued proposed changes to its Common Security Framework (CSF) to better protect patient data.
Developed by a group of larger healthcare companies, HITRUST aims to create a unified security standard specifically tailored for the healthcare industry. Its draft privacy controls, an effort to keep the framework up to date, include 125 specific changes affecting 35 controls in the CSF. The controls are based on the HIPAA Privacy Rule and recommendations from the National Institute of Standards and Technology (NIST) and some other standards bodies.
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Tech ‘surge’ to repair Obamacare websites

By JASON MILLMAN | 10/20/13 1:38 PM EDT Updated: 10/21/13 11:21 AM EDT
The Obama administration Sunday said it’s called on “the best and brightest” tech experts from both government and the private sector to help fix the troubled website at the root of the Obamacare enrollment problems.
The unusual Sunday 600-word blog post from the Department of Health and Human Services was the first update in more than a week on the many failings of an expensive website that HHS itself described as “frustrating for many Americans.” But it didn’t specify whom the administration had called in, or when the American people would see clear-cut results on HealthCare.gov.
 “We’re kind of thinking of it as a tech ‘surge,’” an HHS official told POLITICO.
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Q3 2013 Federal Health IT Activity

by Helen R. Pfister, Susan R. Ingargiola, and Erica L. Cali, Manatt Health Solutions Monday, October 21, 2013
The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the third quarter of 2013. Below is a summary of key developments and milestones achieved between July 1 and September 30.

Highlights

The third quarter of 2013 saw a number of important developments:
  • National Coordinator Submits Resignation. On Aug. 6, Farzad Mostashari announced his resignation as National Coordinator for Health IT, effective Oct. 4. Principal Deputy National Coordinator David Muntz also announced his resignation in September. Jacob Reider is serving as acting national coordinator, and Lisa Lewis is serving as acting principal deputy national coordinator until permanent replacements are announced. 
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A New Map of How We Think: Top Brain/Bottom Brain

Forget dated ideas about the left and right hemispheres. New research provides a more nuanced view of the brain

By
Stephen M. Kosslyn and  G. Wayne Miller
Oct. 20, 2013 8:31 a.m. ET
Who hasn't heard that people are either left-brained or right-brained—either analytical and logical or artistic and intuitive, based on the relative "strengths" of the brain's two hemispheres? How often do we hear someone remark about thinking with one side or the other?
A flourishing industry of books, videos and self-help programs has been built on this dichotomy. You can purportedly "diagnose" your brain, "motivate" one or both sides, indulge in "essence therapy" to "restore balance" and much more. Everyone from babies to elders supposedly can benefit. The left brain/right brain difference seems to be a natural law.
Except that it isn't. The popular left/right story has no solid basis in science. The brain doesn't work one part at a time, but rather as a single interactive system, with all parts contributing in concert, as neuroscientists have long known. The left brain/right brain story may be the mother of all urban legends: It sounds good and seems to make sense—but just isn't true.
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Enjoy!
David.

Friday, November 01, 2013

A Very Interesting Review Of A Number Of Approaches To e-Health From Around The World.

This appeared a little while ago.

Health IT takes hold around the world

Posted on Oct 24, 2013
By Zack McCartney, Contributing Writer
Every country, every government, every population is a participant in a global trial and error. Each one faces different circumstances and, therefore, approaches healthcare differently.  But, as world health leaders see it, everyone can learn from others' struggles and successes to improve and simplify their respective strategies. Health information technology is at the core.
Finding the global lessons from local healthcare strategies facilitates progress toward Universal Health Coverage, or UHC, a public health concept championed notably by the World Health Organization and it’s director, Margaret Chan. According to Najeeb Al-Shorbaji, director of knowledge, management, and sharing at the WHO, in a statement released to Healthcare IT News, WHO defines UHC as “all people receiving quality health services that meet their needs without exposing them to financial hardship in paying for them.”  
A video on the WHO’s website, “The many paths to universal health coverage,” documents the various  efforts in Thailand, Rwanda, Oman, China, Mexico, and Turkey to achieve this lofty goal. As the video notes, “Their experience can provide lessons to countries just beginning the journey” toward UHC. This means, ideally, more time and money spent repeating past successes and avoiding past errors – and also innovating.
In December 2012, the UN passed a resolution on UHC that urges member states to develop health systems capable of providing high-quality care while avoiding direct payments at the point of delivery.
Healthcare IT plays a central role in modern healthcare strategies.
As a relatively new component of healthcare, there is still much to learn about how best to integrate digital health systems. Keeping an eye out for successes and innovations -- learning opportunities around the world -- should be a priority for all countries, world health leaders say.
“Similar to UHC, an eHealth strategy is unique to the situation in the country,” said Al-Shorbaji, “But there are still common elements, methodologies and best practices that can help countries to avoid mistakes, for example, investing large amounts of money without a proper plan, roadmap or a strategy – this leads to fragmentation, wasting resources, disconnection with people and ‘solutions looking for problems,’”
Al-Shorbaji detailed several points on how information and communications technology is important to universal healthcare along with the challenges WHO has encountered when working with member states to integrate newer technologies into their healthcare systems. Simply put, “Data collection for public health surveillance or for personal use is a prerequisite for successful health intervention. Absence of timely and quality health data simply means hasty decision-making, non-evidence based planning, low and delayed care delivery, opinion driven management and so on.”
If UHC means targeting everyone with high-quality, affordable services, healthcare systems need to be able to record data on all of its patients, as in a national electronic health record that can allow physicians and patients to share data. Practitioners need to monitor quality of care. The health needs of the population need to be defined and monitored.  
The five main challenges for developing an IT infrastructure, says Al-Shorbaji, are issues of standardization and interoperability, lack of national planning, lack of solid evidence, sustainability (as insufficient funding has limited the success of many eHealth projects), and lack of human resources. ICT, therefore, is a central component to any UHC strategy, as there needs to be a system in place that can collect and share data in the healthcare system. Finding the best route to a meaningful HIT system, though, is still being worked out around the world.    
Here are glimpses at several healthcare IT projects around the world. Some have already proved successful.  Others are in the works, but are exciting prospects for the use of information technology in healthcare.
The officials we talked with say the projects have the potential to contribute to the world’s growing body of knowledge on how the world can best use health IT to provide more comprehensive, more accessible healthcare.
Lots more here including coverage of Australia and Denmark.
It is very interesting to see an international perspective of what is happening here and what others are doing.
Enjoy the read.
David.

Thursday, October 31, 2013

This Might Help NEHTA Avoid Being Sued by MMRGlobal. Seems Progress Is Being Made.

This appeared a few days ago.

US Congress to consider law against 'patent trolls'

Date October 24, 2013 - 4:32PM
The US Congress to soon review the behaviour of "patent trolls", a widespread practice some say is crippling innovation in the US and overseas.
A US congressman, who has led the charge against frivolous patent infringement lawsuits, introduced a bill on Wednesday to curb the behaviour of so-called trolls but faced criticism that some of the proposals go too far.
The bill from Representative Bob Goodlatte, chairman of the House Judiciary Committee, requires companies to provide specific details on what patent is infringed and how it is used when they file a lawsuit.
It also requires judges hearing patent cases to award fees to the winner in an infringement lawsuit, unless the judge decides that the loser's position was "substantially justified" or some other circumstances exist.
Goodlatte, a Virginia Republican, is working on the bill with his counterpart on the Senate Judiciary Committee, Vermont Democrat Patrick Leahy. Leahy indicated his legislation would be ready soon.
The White House urged Congress to take steps to curb abusive patent lawsuits in June. Other proposals are circulating on Capitol Hill, as well as a proposed study of "patent assertion entities" (PAEs) by the Federal Trade Commission.
PAEs or 'patent trolls' are companies that typically do not invent or manufacture products. Their business model is to buy the intellectual property of others and seek money from firms that may infringe those patents.
Last year, trolls accounted for the majority of patent lawsuits in the US according to Colleen Chien, a law professor at Santa Clara University.
Lots more here:
I last mentioned MMRGlobal in a recent blog found here:
We can only hope that having the law change in the US will mean the tiny MMRGlobal will simply go out of business and we can all just get on with life!
Seems the change will probably happening pretty soon.
David.

Wednesday, October 30, 2013

Does This Remind You Of Anything That Has Happened In Australia Recently. Great Article.

This fantastic blog appeared a few days ago.

Halamka offers lessons on Healthcare.gov's rough go-live

Posted on Oct 24, 2013
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
CIOs face many pressures: increased scope, reduced timelines, trimmed budgets. After nearly 20 years as a CIO, I've learned a great deal about project success factors.
When faced with go live pressures, I tell my staff the following:
"If you go live months late when you're ready, no one will ever remember.
If you go live on time, when you're not ready, no one will ever forget."
I have hundreds of live clinical applications. Does anyone remember their go live date? Nope.
Were there delays in go live dates? Many.
With even the best people, best planning, and appropriate budgets, large, complex projects encounter issues imposed by external factors (new regulations, competing unplanned events, requirements changes) that cannot be predicted during initial project scheduling.
It helps no one -- the users, the business owners, or the IT department -- to slavishly adhere to a deadline when the project is not ready to go live.
I work on federal advisory committees in the Obama administration and truly believe in the goals of many administration programs: Meaningful Use, HIPAA Omnibus rule, and Affordable Care Act.
However, we've seen that in the interest of accelerating change, deadlines have been imposed that do not allow for sufficient testing, piloting and cultural change. The result is that haste makes waste.
As I've written in my blog many times, ICD-10 will become a crisis for the Obama administration. Payers and providers will not be ready by October 1, 2014. Documentation systems and clinician billing process changes will not be mature enough to support a successful go live. More time is needed. My experience with IT crises is that you can survive one at a time, but a succession of problems creates a pattern that users and oversight bodies will no longer tolerate. I hope the premature go live of the Health Insurance Exchange results in a review of ICD-10 go live dates.
Meaningful Use Stage 2 attestation criteria are good. The certification scripts need very significant revision. How did this happen? They were created in a rush to adhere to an artificial deadline, not reviewed by the federal advisory committees, and not piloted tested/revised. New regulation is needed fix them and that will take time. Again, the lessons of the Health Insurance Exchange should cause us to extend Meaningful Use Stage 2 deadlines by a year, deferring future stages of Meaningful Use until we have consolidated our gains and understood our successes/failures with current stages.
Lots more here:
Would it not be wonderful if there had been someone with the experience of Dr. John Halamka around a year or so ago when we had the mad rush to bring the PCEHR live in July, 2012.
As a result of that rush we are still trying to get it fixed up to the stage when it will be really useful a year + later.
The advice in the first few paragraphs is so right it hurts and must never be forgotten.
On a related topic this also appealed to me this week.

8 ways to manage change, not just HIT implementation

October 25, 2013 | By Julie Bird
There's a way to manage change associated with health IT, healthcare consultant Frank Speidel, M.D., says--eight ways, to be more precise.
Writing at HITConsultant.net, Speidel, chief medical officer for the Health IT staffing firm Healthcare IT Leaders, identifies what he calls eight "ates" for managing that change (check out the full post for more detail):
·         Contemplate the changes IT implementation brings to the health system and its operations by convening a diverse group representing different elements of the organization.
·         Communicate to understand "the why, where and what of the change" and where the change is taking the organization.
Lots more here:
Well worth a read for those involved in implementation.
David.

Tuesday, October 29, 2013

It Seems The NEHTA Chairman Is In Line To Be Chairman Of ANZ Bank.

Only one comment.

I hope someone in ANZ makes sure they are comfortable with what has happened with NEHTA during his Chairmanship. I wonder is he planning to stay?

I can't say I have seen evidence of the level of oversight, scrutiny and management control of NEHTA I would have liked to have seen, and would have expected, from an excellent independent chairman.

What do others think?

Yes I have a personal interest as I have a few ANZ shares!

David.



Does This Article Indicate Some Real Hope For The PCEHR Or A Last Gasp?

The following appeared a little while ago.

AMA puts flawed PCEHR on the mend

22/10/2013
When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be.
“I asked the treating doctor how often do you get a patient’s medical history, including the medications they are on, their allergies and diagnoses, and he said ‘Never’,” Dr Moy recalled.
At the time, he was heavily involved with HealthConnect SA in developing an electronic care planning system for elderly patients.
“A by-product of that was that we were developing a prototype of the electronic health record,” he said.
The project was killed off prematurely when the global financial crisis hit in late 2008, bringing an abrupt end to the funding.
But it left an indelible impression on Dr Moy, who saw the potential for e-health to vastly improve health care and potentially save thousands of lives a year, by ensuring practitioners at the point of service had access to vital patient information such as medications, allergies and previous diagnoses.
So it was with mounting frustration and dismay that he, along with much of medical profession, watched as the Federal Government made basic blunders in building and introducing the Personally Controlled Electronic Health Record (PCEHR).
When he was approached by AMA officials last year to become involved in efforts to address problems with the PCEHR and turn it into something useful for clinicians and patients, Dr Moy was initially reluctant.
But the chance to help realise the potential of e-health to save lives and improve care convinced him to make the commitment.
A little more than 12 months later, he believes the AMA has achieved real progress toward turning the PCEHR from an IT-driven system with little appeal or usefulness for practitioners into something with real and practical benefits for both doctors and patients.
But it hasn’t been easy.
“The whole project had gone off track,” Dr Moy said. “It was being driven by IT people and programmers, and I could see that they were ballsing it up.”
He said they had developed the system with no understanding of how clinicians worked – a huge oversight given that it was doctors (mostly GPs) who would be creating the health records and bearing any risks arising from incomplete or incorrect information.
“I am not an IT person, I am a work flow person, and the program managers and IT people did not understand workflow.
“They did not understand that the way that doctors are going to interact with the PCEHR is through the GP desktop system.”
Through his work on the Department of Health and Ageing PCEHR Independent Advisory Council, combined with the efforts of other AMA officials – not least President Dr Steve Hambleton – progress is being made to turn the PCEHR into a practical and useful system.
This has included urging the development of a one-button navigation system for the PCEHR on GP desktop systems; trying to ensure the desktop PCEHR software packages each have a similar look, feel and work flow; promoting the development of demonstration PCEHR models to help doctors familiarise themselves with how it would look and work; and institute a moratorium on the addition of new features until the basics of a practical and usable system for doctors and patients are established.
“We don’t need to start again, but we need to make it useable, and our goal is to make sure that clinicians get to develop the workflow of it,” Dr Moy said.
He admitted that there was a considerable way to go, but said progress was being made, and urged sceptics to withhold judgement.
More here:
I found this a very interesting article. What it seems to be suggesting that all sorts of things are being done to try and make the PCEHR a little more clinician friendly at the behest of an Independent Advisory Council of the then DoHA.
Here is the link to the Council.
It seems to meet 4 times a year but does not seem to produce any minutes of its meetings that are publically available.
Only with dramatically improved transparency on just what these Councils are actually doing will we have any idea what is going on. On the face of it some of these changes seem reasonably sensible so why the secrecy?
This is certainly something the Deloittes Refresh of the National E-Health Strategy as well as the new Minister need to take an acute interest in.
David.

Monday, October 28, 2013

Weekly Australian Health IT Links – 28th October, 2013.

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

Another week goes by and we still hear almost nothing from the new (now slightly less new) Federal Health Minister. The silence is really deafening!
Other than that interesting to see the US is looking at laws around patent trolls and that thought controlled computers are progressing to more and more reality.
I checked out my PCEHR record today. The system is still slow, had drug information that is 3 months out of date and is just as user unfriendly as ever. Just so you know!
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E-health records in need of urgent help: GPs

21/10/2013
The nation’s peak general practice organisations have called for urgent action to address serious shortcomings in the troubled electronic health records system.
At a summit held earlier this month at AMA House, United General Practice Australia (UGPA) identified major problems with the Personally Controlled Electronic Health Record (PCEHR) system that severely undermined its usefulness to both practitioners and patients.
“Currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement in patient health outcomes,” UGPA, which includes the AMA, the Royal Australian College of General Practitioners, the Australian Medicare Local Alliance and the Australian College of Rural and Remote Medicine, said.
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Does the PCEHR meet the GP Data Governance Council criteria?

The General Practice Data Governance Council is “committed to profession-led governance regarding the issues of data collection activities in general practice,” in particular secondary use of patient data generated through clinical care delivery to patients.
GPs and consumers have voiced concerns with regards to secondary use of data uploaded to the PCEHR, so I thought it would be interesting to have a look at the PCEHR and see if it meets the goals of the Data Governance Council.
As outlined in an earlier post, it appears PCEHR data can be used by the government for:
  • Law enforcement purposes
  • Health provider indemnity insurance cover purposes
  • Research
  • Public health purposes
  • Other purposes authorised by law
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AMA puts flawed PCEHR on the mend

22/10/2013
When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be.
“I asked the treating doctor how often do you get a patient’s medical history, including the medications they are on, their allergies and diagnoses, and he said ‘Never’,” Dr Moy recalled.
At the time, he was heavily involved with HealthConnect SA in developing an electronic care planning system for elderly patients.
“A by-product of that was that we were developing a prototype of the electronic health record,” he said.
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Clock ticking for scanning incentive confirmation

23 October, 2013 Nick O'Donoghue
Pharmacy owners are being encouraged to ensure they are meeting the criteria to receive the Electronic Prescription Scanning Incentive, even through the Government had yet to confirm it will be paid next month.
The first payment of the $2000 incentive is due to be made next month, however the Pharmacy Guild of Australia is waiting to hear if the recently elected Coalition Government will sign-off on it.
While the profession has yet to get confirmation that the incentive will go ahead as announced in August, a Guild spokesperson said the organisation was continuing to plan for its rollout, and urged pharmacy owners to take a similar approach.
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Tasmania looks for core eHealth infrastructure replacement

Summary: Tasmania's eHealth infrastructure is beginning to show its age and needs to be replaced with an open standards system.
By Michael Lee | October 21, 2013 -- 06:29 GMT (17:29 AEST)
Tasmania's Department of Health and Human Services (DHHS) is looking for a contractor to replace the core systems behind its current eHealth integration infrastructure since the existing software is nearing its end of life.
The existing system runs on the Java Composite Application Platform Suite (Java CAPS), which was originally developed by Sun Microsystems and folded into Oracle when purchased in 2010. Oracle subsequently released Java CAPS 6.3 in 2011, but the tender documents show that DHHS wishes to transition from the suite.
Oracle itself is rolling features from Java CAPS into its Service Oriented Architecture (SOA) suite, and encouraging users to migrate to its new systems.
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Review launched into e-health record scheme

07/10/2013
The Abbott Government has ordered a review of the troubled shared electronic health record program amid concerns about poor take-up, cost overruns and implementation problems.
Health Minister Peter Dutton has ordered the review – the details of which are yet to be released – citing concerns that the Commonwealth so far has little to show for its $1 billion investment in the Personally Controlled Electronic Health Record scheme.
“We all support an electronic health record,” a spokeswoman for Mr Dutton told The Australian late last month. “However, we have grave concerns about the amount of money the previous Government spent on e-health for very little outcome to date.
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Digitising data will reduce errors in patient care

Joshua Gliddon
With approximately 9.3 per cent of Australia’s gross domestic product spent on healthcare, there is significant scope for improvement in productivity to drive better health outcomes and better care per dollar spent.
One of the biggest challenges facing the health system in Australia is its highly fragmented nature. Funding is decoupled from the provision of care, and outcomes are not always matched with healthcare inputs, notes David Dembo, general manager for GE’s healthcare business.
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Weaving a web of world eHealth strategies

Digital strategist Rachel de Sain is fascinated by the intersection of health and social media, so she jumped at the opportunity to present some of her own research at the recent Medicine 2.0 conference in London, adding a side trip to a US conference before returning to Sydney.
De Sain says that her own consulting agency, Flaxworks, reflects her indigenous New Zealand heritage.
“Technology doesn’t work effectively unless you really sit there with the community and understand what the problems are that you are trying to solve, and then look at all the various pieces of the organisation, the various sides of a challenge, the various stakeholders and weave them together into a solution,” she says.
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eRx launches script app

24 October, 2013 Nick O'Donoghue
Pharmacy IT group, Fred Health, launched its eRx Express app which will enable consumers to order their prescriptions from smartphones, today.
Using the app, patients are now able to scan a QR code on their prescription, which is sent to a pharmacy of their choice where they can pick it up at their preferred time.
Paul Naismith, a pharmacist and CEO of Fred Health, said the app was vital to advancing e-health for pharmacy, health professionals and the wider community.
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Approaching 19,000 hospitals across APAC region to adopt cloud solutions by 2018

Posted on Oct 09, 2013
By Dillan Yogendra
Globally, healthcare is embracing cloud technologies and the Asia-Pacific (APAC) region is in a hurry to explore innovative solutions that support patient-centric care through efficient capture and dissemination of medical and health information. Research by Frost & Sullivan: Analysis of Healthcare Cloud in APAC, recently reported the market for cloud technologies, which included software-as-a-service (SaaS) and infrastructure-as-a-service (IaaS) offerings, was valued at US$194.4 million in 2012 – and the market is expected to expand at a compound annual growth rate (CAGR) of 22.3% between 2012 and 2018.
"Healthcare providers are cognisant of the long term cost benefits of cloud solutions. What they are looking for now, are reliable technology partners who can address their concerns over data privacy and security," said Natasha Gulati, Connected Health Industry Analyst, Frost & Sullivan Asia-Pacific. Although many healthcare IT vendors emphasise the enhanced security and back-up support provided by cloud technologies, the message has yet to reach hospital CIOs. This is why healthcare continues to invest in private clouds while other industries are rapidly moving to public or hybrid cloud models. In addition, given the current pressures of rising costs and diminishing margins, healthcare CIOs are unable to justify the significant investment required for transitioning to a cloud environment.
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New Zealand is the leading force in shared EMR implementation

Posted on Sep 26, 2013
By Dillan Yogendra
Canterbury in particular offers an ideal example to corroborate the claim that healthcare IT integration works best if accompanied by an integrated overall approach to medical care, as reported in HIMSS Insights.
Plans were already in place to install a centralized shared medical record that could be accessed from information systems of care providers, hospitals, and the community nursing agency but progress was slow. Then came February 2011 and New Zealand experienced one of the worst earthquakes in generations – many general practitioner (GP) paper-based archives were either lost or temporarily unavailable but Canterbury hospital’s electronic documentation remained accessible all the way through.
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ULTRA pathology laboratory software back in the game and planning a new release

Australian-developed laboratory information system ULTRA will have a new lease of life thanks to a buy-out by Irish firm Cirdan Imaging, which has taken over the US-based Centricity Laboratory Division from GE Healthcare.
A Cirdan subsidiary, Cirdan Ultra, has been set up as a joint venture with software developer Kainos and there are plans to issue a new version of the product in January 2015, says Dave Crockett, who is Vice President of Sales and Marketing for Cirdan Ultra.
Crockett is currently in Australia visiting key clients and establishing a local office in Ballarat.
It’s full-circle for ULTRA, which pathology systems consultant Yvonne Sherlock says has been used by at least half of the laboratory staff in Australia at one time or another.
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US Congress to consider law against 'patent trolls'

Date October 24, 2013 - 4:32PM
The US Congress to soon review the behaviour of "patent trolls", a widespread practice some say is crippling innovation in the US and overseas.
A US congressman, who has led the charge against frivolous patent infringement lawsuits, introduced a bill on Wednesday to curb the behaviour of so-called trolls but faced criticism that some of the proposals go too far.
The bill from Representative Bob Goodlatte, chairman of the House Judiciary Committee, requires companies to provide specific details on what patent is infringed and how it is used when they file a lawsuit.
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Unniversal Device Identifiers in FHIR

Posted on October 25, 2013 by Grahame Grieve
The FDA and partners around the world are in the process of introducing a new identification framework for medical devices called the “Universal Device Identifier” (UDI). They asked for FHIR to “support” UDI. But what does that mean?
First, some background on what a UDI is, and then some analysis of the use cases for UDI in the scope of FHIR.
What a UDI is
A UDI is a barcode (or series of barcodes, or even an RFID) on a medical device that carries the following information:
  • Device Identifier (Mandatory)
  • Lot Number
  • Serial Number
  • Manufacture date
  • Expiry Date
The first element is the key piece of data – it represents the key that can be used to look up information about the device in the public device registry (GUDID or equivalent). It is referred to as the DI (Device Identifier). There’s also the other fields, which are called the PI (Production Information).
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Telstra shuffles leadership deck, steers toward Asia

Telco has no option but to pursue Asian market, says Thodey
Telstra CEO David Thodey has announced a realignment of its senior executives and an increased focus on Asia.
Among the leadership changes, which are effective Monday next week, Brendon Riley has been appointed group executive of global enterprise and services. The $5 billion revenue business unit will include network application services, global applications and platforms, a new cloud division, ventures, enterprise and government and defence.
Kate McKenzie has taken Riley’s previous role as chief operations officer, which now includes the chief technology and innovation portofolios. She was previously managing director of the products and marketing group.
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Healthcare.gov website 'didn't have a chance in hell'

The failure rate for software development projects is high generally, particularly large ones like Healthcare.gov, says Standish Group data
WASHINGTON -- A majority of large IT projects fail to meet deadlines, are over budget and don't make their users happy. Such is the case with Healthcare.gov.
The U.S. is now racing to fix Healthcare.gov, the Affordability Care Act (ACA) website that launched Oct 1, by bringing in new expertise to fix it.
Healthcare.gov's problems include site availability due to excessive loads, incorrect data recording among other things.
President Barack Obama said Monday that there is "no excuse" for the problems at the site.
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Casualty death rate higher on weekends

Date October 26, 2013

Lucy Carroll

Reporter

Patients are more likely to die in hospital at weekends than on weekdays, according to ground-breaking Australian research that experts say shows hospital staffing levels must change.
They say continuing to operate on a five-day week business model will put lives at risk.
"Illness occurs 24/7, not just in normal business hours,'' said lead author Enrico Coiera, the director of the Centre for Health Informatics at the University of NSW. ''The idea that we can offer reduced levels of care at the weekend needs to be re-evaluated.''
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Thought-controlled computers closer than we think

Date October 21, 2013 - 3:18PM

Drew Turney

We've gone from the mouse to Kinect-style gesture control in some 30 years. Might the next frontier in computer interfaces be controlling machines just by thinking about them?
A recent breakthrough from the University of Washington shows that when technology lets the brain control a device such as a robotic arm, the brain is behaving in the same way as if it was commanding the relevant muscles to carry out the act in reality. In other words, by thinking about kicking a ball, the area of the brain active in doing so behaves in the same way as if you were really kicking a ball.
That means that in brain/machine interaction, just thinking about an action might prompt a machine to do it for you. Mind-controlled technology itself isn't new. Last year American quadriplegic Cathy Hutchinson used a robotic arm to sip coffee from a bottle thanks to a sensor array connected to her brain that relayed commands to the arm via a computer.
Gains are also being made in computers responding to signals from elsewhere in the body. In September The Wall Street Journal reported on an amputee controlling an artificial leg using sensors that received nerve and muscle impulses to move the knee and ankle with much more precision than traditional artificial limbs offer.
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Next supercomputer will be fuelled by electronic blood

  • Hannah Devlin
  • The Times
  • October 18, 2013 11:42AM
THE SUPERCOMPUTER of the future will be close to the efficiency of the human brain and fuelled by "electronic blood", the director of IBM research has predicted.
The company has unveiled an experimental version of its biologically inspired computer, which it claims could lead to a 10,000-fold increase in the efficiency of computers.
Speaking in Zurich, Matthias Keiserwerth said that the energy requirements of the world's most powerful computers were now so great that they were limiting advances in computational performance and artificial intelligence.
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Enjoy!
David.

A Useful Update On the Status Of The PCEHR


The Week in Brief - With AIIA CEO Suzanne Campbell

 25th October, 2013
Personally Controlled Electronic Health Record (PCEHR) – this week a status update has been provided to the PCEHR Independent Advisory Council (IAC) confirming:
  • 3,500 new consumer registrations per day, with over 1 million people now registered
  • 5,582 healthcare provider organisations and 8,016 individual healthcare providers are now registered
  • 9,300 shared health summaries and over 2,000 discharge summaries are now recorded
  • 27,500 consumer entered health summaries, approximately 8,600 consumer entered notes and approximately 3,900 advance care directive custodian notices are now held
Found here:
http://us2.campaign-archive1.com/?u=659039b8ef8b09830b577068f&id=7704efe403&e=749e2f3613

For Information - It is important to note that 16 months after go live we have only 0.04% of the population  with a record for a cost of roughly $100 each. Hardly a raving or cheap success just yet.
The really telling statistic is that only 27,000 of the 1 million who have registered have actually added their own summary. The fact is the system is a hardly used white elephant.

David