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, December 10, 2011

Weekly Overseas Health IT Links - 10th December, 2011.

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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ATandT, Accenture Collaborate on Cloud Medical Imaging

By: Brian T. Horowitz
2011-11-29

AT&T will host the Accenture Medical Imaging Solution to allow doctors and radiologists to share and store medical images.

AT&T and Accenture have launched Accenture Medical Imaging Solution, a cloud database that will allow hospitals to centrally manage access to medical images and enable doctors and radiologists to collaborate on care.
Accenture is an IT consulting and services firm as well as a systems integrator. The two companies announced the new platform at the annual Radiological Society of North America (RSNA) conference in Chicago on Nov. 28. The agreement with Accenture is part of AT&T's previously announced plans to commercialize Medical Imaging and Information Management (MIMM) in late 2011.
The Accenture Medical Imaging platform incorporates AT&T's MIMM cloud service, which the telecom launched on June 22. MIMM is a vendor-neutral pilot cloud project that allows doctors to store, view and share medical images such as CAT scans, MRIs and X-rays. Baptist Health System in Alabama and Henry Ford Health System in Detroit are also deploying MIMM.
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Study Compares Physical and Cloud Exchange of Images

HDM Breaking News, November 29, 2011
As providers move to tightly coordinate patient care, they have to find ways to efficiently share patient information. That includes scrapping use of physical media such as CDs for sharing medical images, and exchanging images and reports on cloud-based platforms, according to a new study from consulting firm Chilmark Research.
"As the health care system moves from a reimbursement model based on fee-for-service to one based on outcomes, health care organizations of all sizes will not only need to continue to optimize operations to remain competitive, but will also need to develop more collaborative care processes to manage transitions in care more effectively," according to the study. "To reach these goals, HCOs are beginning to take a close look at all departments, including radiology, for optimization in support of new collaboration processes across care settings."
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Government announces new Open Data plans

29 November 2011   Rebecca Todd
The government has pledged that everybody in England will have online access to their GP records by “the end of this parliament” in 2015.
The announcement was made as part of Chancellor George Osborne’s Autumn Statement, which painted a generally bleak picture of the UK economy, while including some measures to try and stimulate growth.
Among these are a Plan for Growth that includes a number of Open Data measures aimed at stimulating industry and jobs. These were developed in collaboration with a number of companies including GlaxoSmithKline.
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EHR adoption for office docs at 57%: survey

Posted: December 1, 2011 - 10:45 am ET
Rates of electronic health-record system adoption among office-based physicians grew significantly in 2011, according to a national report card on EHR adoption.
In a survey conducted by the National Center for Health Statistics between February and June, 56.9% of physician respondents said their practice uses electronic health records in some capacity other than for billing. That's up from the 50.7% of respondents who replied the same in 2010 (PDF). In addition, 52% of respondents this year said their practice was planning to apply for federal EHR incentive payments, up from 41% who said the same in 2010.
The NCHS, an arm of the Centers for Disease Control and Prevention, has been measuring EHR adoption since 2008 as part of its National Ambulatory Medical Care Survey program. The latest numbers are based on mail surveys conducted with a sample of 10,301 physicians.
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3 steps to minimize 'data breach epidemic'

December 01, 2011 | Chris Anderson, Senior Editor, Healthcare Payer News
The frequency of data breaches in healthcare have increased 32 percent in the past year and cost the industry an estimated $6.5 billion annually according to the second annual benchmarking study conducted by the Ponemon Institute.
Among the chief culprits responsible for data security breaches were sloppy employee handling of data and the ever-increasing use of mobile devices in the healthcare setting. Forty-one percent of healthcare executive surveyed attributed data breaches related to protected health information (PHI) to employee mistakes, while half of the respondents said their organization does nothing to protect the information contained on mobile devices. In all, 80 percent of healthcare organizations use mobile devices that collect, store and/or transmit some form of PHI.
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Wi-Fi Platform Sends Lifesaving Data Between Ambulances, Hospitals

November 29, 2011 By Sarah Rich
Seconds can save lives — especially when a patient is being rushed to a hospital. And Wi-Fi platforms that transmit a patient’s medical information from the ambulance to the hospital are helping to save time.
By installing this technology in its ambulances, Rowan County, N.C., is sending vital information to hospitals before a patient arrives, thus enabling better preparation and health-care response.
Rowan County installed wireless communication platforms in its 11 ambulances within the county’s Emergency Medical Services Division so responders taking an individual to a hospital can transmit a patient care report to the facility prior to the ambulance’s arrival at the hospital, said Frank Thomason, the county’s chief of emergency services. The communication platform provides a Wi-Fi access point in the ambulances, making them function as mobile hotspots. Using laptops inside the ambulances, emergency responders fill out a patient care report and with the assistance of the communication platform, the information is transmitted wirelessly to the hospital.
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Health Information Exchanges: Get Everyone Onboard

The ultimate goal is a universally accepted national health information exchange. What's the holdup?
By Paul Cerrato,  InformationWeek
November 29, 2011
Why have health information exchanges turned into such a debacle in the U.S.? At first blush, it's easy to jump to the conclusion that HIEs--organizations that let healthcare providers easily share information--are just a large sandbox with a lot of big egos not willing to play well together.
One player in the sandbox, of course, is the Centers for Medicare and Medicaid Services, which mandates that hospitals and medical practices participate in an HIE in order to obtain Meaningful Use incentive checks. Ignore the mandate and you'll eventually be penalized.
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10 Ways ICD-10 Will Improve Quality of Care

Cheryl Clark, for HealthLeaders Media , December 1, 2011

The popular approach to writing anything about ICD-10 conversion these days is to describe the disastrous impact providers say it will have­—or is already having—on healthcare, nearly two years ahead of its launch. 
From the sound of it, everyone from physicians to nurses to CFOs and CIOs must be preparing for hell itself, or at least stocking up on awesome quantities of Pepcid.
Peter Carmel, MD, president of the American Medical Association, and flocks of physician groups speak of its "onerous" burden, costing each physician $28,000, on top of the reimbursement cuts and other changes they already face.
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Physicians must learn how to put patients in the center

December 02, 2011 | Mary Mosquera, Government Health IT
WHITE OAK, MD – Physicians need to learn "patient-centeredness" as one of their core medical skills so they can incorporate it into their daily practice. But many clinicians are unfamiliar with what is involved in practicing with the patient at the center of his or her care, despite it being a foundation for improved quality and new delivery models.
Some physician professional organizations are stepping up to offer teaching aids about patient-centered care. 
Patient-centeredness should be a part of education in medical schools, training for residency and included within competencies for certification and re-certification, according to physician executives of professional organizations.
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Report: Telehealth Industry Will See Uptick in Competition

(11/30/2011) With a global revenue forecast of $990 million by 2015, the Telehealth market is already attracting a host of suppliers and innovators at various points in the value chain according to a new report from research firm InMedica. In a new whitepaper, “Competitive Dynamics in the World Telehealth Market – 2011 to 2020”, InMedica assesses the current telehealth ecosystem and forecasts how it will change over the next ten years.
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In 2012, a Mobile Security Minefield

– Taylor Armerding, CSO
November 28, 2011 
The mobile device, now the dominant technological tool in American enterprise, will become more dominant in 2012 and beyond. Industry analysts say mobile device shipments will top 1 billion in 2015, leaving PC shipments in the dust.
That will bring big benefits, but also big risks.
Its benefits for user convenience and productivity are obvious and irresistible -- a smart phone can handle everything from email to collaboration to video chat. It can serve as your GPS. It can scan product bar codes. It can find and store your favorite songs, help you take high-res photos and HD video and expand both your social and professional network.
But it is not very secure, which puts users and the enterprises that employ them at greater risk.
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African e-health 'moving in wrong direction'

Maina Waruru
2 December 2011 | EN
 [NAIROBI] Importing or copying the latest 'e-health' technology from developed countries may not be the best way forward for health services in Africa, a conference has heard.
A focus on high-tech healthcare solutions could come at the expense of basic prevention such as access to clean water and sanitation, good nutrition and hygiene, and health education, said experts at the AfriHealth conference in Kenya, this week (30 November–1 December).
In a continent where 80 per cent of illnesses stem from preventable infectious diseases, this is a move in the wrong direction, said Yunkap Kwankam, executive director of the International Society for Telemedicine and eHealth.
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Stage 2 of Meaningful Use Moved to 2014

HDM Breaking News, November 30, 2011
The Department of Health and Human Services has moved the start date for Stage 2 of the electronic health records meaningful use program from 2013 to 2014.
The initial HHS announcement did not make clear which providers were eligible to wait until 2014. The department clarified its position to Health Data Management.
Federal officials this summer had voiced support for a proposal to delay Stage 2 one year to 2014 for providers who attest to Stage 1 in 2011. The rationale was that Stage 1 pioneers who attest in 2011 should not be penalized by tight timeframes next summer for getting ready for Stage 2. Now, that proposal is adopted, and since providers who begin Stage 1 attestation in 2012 could wait until 2014 to start Stage 2, now everyone will start Stage 2 in 2014. Pioneer providers in 2011, however, can get three years of Stage 1 incentive payments.
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Cancer Researchers Call For EHR Standards

American Society of Clinical Oncology report says, with modifications, electronic health records could play a transformational role in targeting cancer treatments.
By Nicole Lewis,  InformationWeek
November 30, 2011
As cancer researchers better understand the "panomics" of cancer--the "combination of genes, proteins, molecular pathways and unique patient characteristics that together drive the disease," electronic health records (EHRs) can play a transformational role in cancer research. So concludes the American Society of Clinical Oncology (ASCO), which calls for EHR vendors to implement standards to facilitate capturing, storing, and sharing this panomics-related data, with the goal of increasing cancer survival.
ASCO's report--Accelerating Progress Against Cancer: ASCO's Blueprint for Transforming Clinical and Translational Cancer Research--summarizes recent breakthroughs in technology and cancer panomics. But the report also asserts that while an unprecedented opportunity exists to make more rapid advances in research for cancer treatments, the nation's research system is "unprepared to deliver on this promise."
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5 tips for speech recognition software from RSNA

December 01, 2011 | Mike Miliard, Managing Editor
CHICAGO – At RSNA 2011 earlier this week, David L. Weiss, MD, of Carilion Roanoke Memorial Hospital in Roanoke, Va., asked for a show of hands.
How many people in the audience were radiologists? Almost all of them were.
And how many of those people use speech recognition technology in the course of their work? More than half of them raised their hands.
Finally, how many of those people were completely happy with the technology? Just two or three of them were.
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Survey: Health Data Not Better Protected Than a Year Ago

HDM Breaking News, December 1, 2011
The second year of a benchmark survey to track progress in securing protected health information finds improved policies and staff training, but also increased frequency of breaches, rising incidents of identity theft, poor control over mobile devices, and two-thirds of organizations don't provide protection services for breach victims.
That mixed bag means protection isn't any better than a year ago, says Rick Kam, president of ID Experts, a Portland, Ore.-based data breach and remediation firm that sponsors the survey.
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CMS develops new EHR guide for docs

Posted: December 1, 2011 - 3:00 pm ET
The CMS has developed what it describes as a "comprehensive tool" to help guide physicians and other eligible professionals through all phases of the Medicare electronic health-record incentive payment program.
The Web-based interactive resource, called "An Introduction to the Medicare EHR Incentive Program for Eligible Professionals" (PDF) includes chapters on program basics, eligibility and registration. It also has a description of all of the Stage 1 meaningful-use criteria and advises practitioners on how to choose the optional measures they will use as part of the attestation phase of the program.
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Why Can't Patients See Their EHR Data?

Journal of the American Medical Informatics Association outlines arguments for and against expanding patient access to their health data.
By Ken Terry,  InformationWeek
November 29, 2011
Should healthcare providers give patients access to their electronic health records and if so, how do they make that happen? A new review in the Journal of the American Medical Informatics Association (JAMIA) examines the complexities of giving patient access to their records online.
Written by researchers at the University of Toronto but focused largely on the U.S. environment, the study notes that while EHR data is not typically being shared with patients, many consumers want access. And research suggests that data sharing with patients, coupled with communication and education, can help improve efficiency, quality of care, and patient satisfaction while also lowering costs.
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5 points of view from an EHR end user

November 29, 2011 | Michelle McNickle, Web Content Producer
Discussions surrounding EHRs and their adoption (or lack thereof) have grown into heated debates concerning their usability and effectiveness. And the most vocal folks, whose opinions could very well change the way EMRs work, are none other than the end users themselves: the clinicians.
That’s why we looked to David Hager, MD, to debunk some of the myths and explain some of the gripes he and his colleagues have with EHR systems. 
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November 28

Marino’s records bill contentious

Congressman’s electronic health care records proposal has supporters, detractors.

JONATHAN RISKIND Times Leader Washington Bureau
WASHINGTON – A report released this month helps make the case for a proposal by Rep. Tom Marino, R-Lycoming Township, to give health care providers who use money-saving electronic records more legal protections, proponents say.
But a critic of Marino’s bill says granting legal immunity for reporting medical errors caused by faulty electronic records deprives patients of the right to seek compensation and takes away incentives for records vendors and the health care community to make needed improvements.
When Marino introduced his Safeguarding Access for Every Medicare Patient Act in October, he said it would create a system for reporting potential errors in electronic records without the admission of the mistake being used as a legal admission of wrongdoing. The bill also applies to Medicaid patients, and since so many providers accept patients from the federal health care programs for seniors and the poor, Marino’s bill effectively would apply to most of the medical community.
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ICD-10: Mandate and Opportunity

Marianne Aiello, for HealthLeaders Media , November 28, 2011

This article appears in the November 2011 issue of HealthLeaders magazine.
As the clock continues to tick down toward October 2013, when ICD-10 takes effect, hospital leaders are hopeful that the coding changes will result in improved quality of care. Still, many remain wary of the inevitable learning curve that comes with the mandate.
In the long run, the increased specificity of the coding structure will enable physicians to better tailor patient care, says Greg Walton, CIO of El Camino Hospital in Mountain View, CA. But in the short term, it will cause problems and communication confusion, he says.
“The level of details required and the amount of change is laced with a massive learning curve,” he says. “Mistakes are always made during large change periods. Moreover, frustration rises with change and that, too, leads to confusion and errors.”
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Study Names 4 EHR Vendors That Are Good Bets

Robert Lowes
November 29, 2011 — Physicians shopping for an electronic health record (EHR) system increasingly discover that most products are look-alikes — at least when it comes to the functions they perform, such as e-prescribing.
Chalk up that uniformity to federal meaningful-use requirements as well as standards promulgated by the Certification Commission for Health Information Technology.
So on what basis, then, should a physician pick one EHR vendor from hundreds on the market? A new report from a research and consulting firm called IDC Health Insights lays out other selection criteria for EHR shoppers aside from software functionality and identifies 4 vendors that stand out from the pack. These companies — Cerner, eClinicalWorks, NextGen Healthcare, and the Sage Group — are well positioned to dominate the EHR scene in the years to come for practices with 20 physicians or more, according to report authors Judy Hanover and Sven Lohse.
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10 lessons learned from linking VLER to private health orgs

November 28, 2011 | Colin Barry, CEO, MEDfx
The research on coordinated care is clear: Patients experience better outcomes when medical teams operate within a connected healthcare ecosystem. Access to the patient’s complete medical history helps physicians make better decisions, reduces medical errors and eliminates duplicate diagnostic testing.
During the past several years, the US government has undertaken a number of initiatives to encourage healthcare practitioners to adopt and use electronic medical records (EMRs). One such project was the development of the Virtual Lifetime Electronic Record (VLER) program, a joint effort between the Departments of Defense (DoD) and Veterans Affairs (VA) to develop and implement an electronic health record system to allow secure sharing of data between civilian and military healthcare organizations.
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6 most in-demand skills for HIT professionals in 2012

November 28, 2011 | Michelle McNickle, Web Content Producer
The demand for capable IT specialists is growing, and according to Guillermo Moreno, vice president of recruiting firm Experis Healthcare, certain skills are bound to take the spotlight come 2012. 
“This is an area that’s of interest and concern, given what we’re seeing in the marketplace,” Moreno said. “With the continuation of the build of the information technology movement in healthcare, we are seeing some sizable fractures in the healthcare space around human capital and human talent.” 
With the New Year around the corner, we asked Moreno to look ahead and share with us the top six most in-demand skills for healthcare IT professionals in 2012. 
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At RSNA, 'a new age' of informatics

November 29, 2011 | Mike Miliard, Managing Editor
CHICAGO – At RSNA 2011 on Monday, radiologists and imaging professionals from across the country and around the world prepped themselves to make the most of a fast-changing healthcare landscape – one in which health IT will play an increasing and pivotal role.
In a session titled "Radiology Informatics: Fundamentals for the Future," Keith Dreyer, DO, vice chairman of radiology computing and information sciences at Massachusetts General Hospital, explained how quality mandates surrounding image interpretation, reporting and access mean that informatics and IT will be soon brought more to the fore than ever. In fact, they herald a "new age for radiology," he said.
Dreyer explained how radiology information systems (RIS) and picture archiving communication systems (PACS) as they exist today are adequate, but lacking.
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Image sharing could cut unnecessary tests: RSNA

Posted: November 29, 2011 - 12:15 pm ET
A new medical image-sharing network is being touted as tool that can help reduce unnecessary exams and cut patient radiation exposure.
The Radiological Society of North America is overseeing development of the network, which was founded in 2009 with a $4.7 million contract from the National Institute of Biomedical Imaging and Bioengineering, according to an RSNA news release. The RSNA is hosting its annual convention this week in Chicago. So far, Mt. Sinai Medical Center, a 1,039-bed hospital in New York; the UCSF Medical Center, a 660-bed hospital in San Francisco; and the University of Maryland Medical Center, a 702-bed hospital in Baltimore, have enrolled patients in the network. Mayo Clinic (Rochester, Minn.) and the University of Chicago Medical Center (Illinois) are expected to enroll patients.
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Patient records access standard urged

29 November 2011   Rebecca Todd
New research on patient records access recommends a set of national standards for implementation, training and promotion and a centralised IT support service.
Paul Fleming, the head of IM&T at NHS Stockport, researched four GP practices giving patients access to their records in Stockport, Tameside and Glossop for the final dissertation of his health informatics Masters degree.
Fleming delivered his findings for the first time at an IT conference held in Stockport earlier this month.
He found that each practice implemented patient records differently and recommended that there should be a set of national standards for the process.
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EHR Adoption To Reach 80% By 2016

Competitive marketplace means electronic health record vendors must work harder to meet clinicians' demands, says IDC.
By Nicole Lewis,  InformationWeek
November 28, 2011
By 2016, more than 80% of healthcare providers will put an electronic health record (EHR) in place, according to an IDC Health Insights report; right now the figure stands at less than 25%. That said, EHR vendors face a very competitive marketplace, and will have to do a better job of designing products that are more user-friendly, have broader functionality and features, and are compatible with mobile devices.
The report, "IDC MarketScape: U.S.A. Ambulatory EMR/EHR for Midsize and Large Practices 2011 Vendor Assessment," evaluates EHR systems that support practices comprised of 20 providers or more. The study also examines eight of the largest EHR vendors, each of which serve at least 15,000 providers, and relied on interviews with vendors as well as IT managers at healthcare delivery organizations.
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Berwick's resignation from CMS bad news for health IT

November 25, 2011 — 11:44am ET | By Ken Terry
The resignation of Don Berwick last week after 18 months as administrator of the Centers for Medicare & Medicaid Services (CMS) should be a cause of concern in the healthcare industry, as well as the health IT sector. Berwick was the Obama Administration's point man on healthcare reform, and his departure due to Republican opposition in the Senate likely will slow the industry's inevitable transition to accountable care.
When President Obama appointed Berwick during a Congressional recess in April 2010, industry groups widely supported the move--despite the fact that the pediatrician and Harvard professor was a leading proponent of change. In his role as founder and CEO of the Institute for Healthcare Improvement (IHI), Berwick had built a stellar reputation as an advocate of quality and safety improvement. IHI's safety campaigns, in particular, had enlisted thousands of hospitals; later, when Berwick became CMS administrator, many of those hospitals joined CMS' Partnership for Patients safety program partly out of respect for Berwick.
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Mersey Burns app for fluids developed

28 November 2011   Shanna Crispin
Mersey Regional Burns and Plastic Surgery Unit launches burns fluid calculator app
Doctors at the Mersey Regional Burns and Plastic Surgery Unit, part of St Helen's and Knowsley Teaching Teaching Hospitals NHS Trust, have developed a mobile application which could result in more patients surviving severe burns.
Doctors working in A&E currently have to go through laborious manual calculations to assess burns and work out how much fluid to give victims – taking into account the surface area of the burn and the patient’s physiological information.
In order to simplify and speed up the process, two doctors have developed an app for iPhones and iPads to automatically work through the calculations.
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healthsystemCIO.com Survey Shows CIOs Frustrated With State Of HIE

Posted by Anthony Guerra on November 23rd, 2011
Lack of ONC Leadership Contributing to HIE Morass
The vast majority (92 percent) of CIOs say local, state, regional and national HIE initiatives are duplicating efforts/work, according to the November healthsystemCIO.com SnapSurvey. As such, it’s not surprising more than 60 percent describe their state’s HIE situation as a “confused mess.”
A large portion of the blame for such a state of affairs falls on ONC, with none describing the organization’s leadership in this area as “very good” and only 3.8 percent finding it “good.” The largest response when answering this question (46 percent) termed ONC’s work “not so good.”
When asked about the technical side of HIE — referring specifically to standards — the CIO community is split, with 23 percent answering that the standards are ready, 38 percent prognosticating they will be ready within two years, and another 38 percent saying even two years isn’t enough time.
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Monday, November 28, 2011

New ONC Initiative Tackles Data Segmenting in HIE

by Helen Pfister and Susan Ingargiola, Manatt Health Solutions
One of the most challenging issues in electronic health information exchange (HIE) relates to tagging and separating certain pieces of health data from others in an electronic health record. There are myriad reasons why separating different types of health information is important to HIE, including enabling consumers to exert greater control over who sees their health information, but doing so can be difficult. 
To overcome existing obstacles, the Office of the National Coordinator for Health IT recently began a new Data Segmentation Initiative. The initiative will develop standards to electronically tag and separate sensitive health information.
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Enjoy!
David.

Friday, December 09, 2011

Decision Support That Seems To Really Make A Difference. Australia Should Subscribe!

The following appeared just a few days ago.
November 16, 2011, 4:14 PM ET

A Little Electronic Help for Doctors Helps Hospitals, Study Shows

Hospitals that use a computerized medical-information tool to help doctors make decisions at the point of care have better patient outcomes than those who don’t, according to a new study in the Journal of Hospital Medicine.
Researchers at Harvard University examined data for Medicare beneficiaries at 1,017 hospitals between 2004 and 2006 as the hospitals adopted a clinical-information system called, UptoDate. They compared that with data from 2,305 hospitals that don’t use the system and found that use of the system was an independent predictor of reduced mortality, shorter hospital length of stay, and better performance on widely used hospital quality metrics.
The study was funded by UpToDate, but the researchers say it had no role in the study design or results.
Lead author Thomas Isaac, a physician at Beth Israel Deaconess Medical Center in Boston and instructor at Harvard Medical School, says that the researchers weren’t sure they’d find any association between the information system and the three quality measures. But hospitals saved approximately 372,500 hospital days per year and 11,500 lives over the three-year period, the study found. The hospitals using the system had better quality performance for care provided to heart-attack, heart-failure and pneumonia patients.
More here:
Here is the abstract:

Use of UpToDate and outcomes in US hospitals

  1. Thomas Isaac MD, MBA, MPH1,
  2. Jie Zheng PhD2,
  3. Ashish Jha MD, MPH2,3,4,*,§

Abstract

BACKGROUND:

Computerized clinical knowledge management systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known.

OBJECTIVE:

To examine the impact of UpToDate on outcomes of care.

DESIGN:

Retrospective study.

SETTING:

National sample of US inpatient hospitals.

PATIENTS:

Fee-for-service Medicare beneficiaries.

INTERVENTION:

Adoption of UpToDate in US hospitals.

MEASUREMENT:

Risk-adjusted lengths of stay, mortality rates, and quality performance.

RESULTS:

We found that patients admitted to hospitals using UpToDate had shorter lengths of stay than patients admitted to non-UpToDate hospitals overall (5.6 days vs 5.7 days; P < 0.001) and among 6 prespecified conditions (range, −0.1 to −0.3 days; P < 0.001 for each). Further, patients admitted to UpToDate hospitals had lower risk-adjusted mortality rate for 3 of the 6 conditions (range, −0.1% to −0.6% mortality reduction; P < 0.05). Finally, hospitals with UpToDate had better quality performance for every condition on the Hospital Quality Alliance metrics. In subgroup analyses, we found that it was the smaller hospitals and the non-teaching hospitals where the benefits of the UpToDate seemed most pronounced, compared to the larger, teaching institutions where the benefits of UpToDate seemed small or nonexistent.

CONCLUSIONS:

We found a very small but consistent association between use of UpToDate and reduced length of stay, lower risk-adjusted mortality rates, and better quality performance, at least in the smaller, non-teaching institutions. These findings may suggest that computerized tools such as UpToDate could be helpful in improving care. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.
The abstract with access options for full text is here:
You can get an idea of what UpToDate does from the 2 minute demo.
Individual subscriptions are only about $500 per annum. It does not take more than one or two improved decisions a day to make this service worth its weight in gold!
The real world study that shows it really works in the real world makes it something the Government should be getting a national license for!
David.

Thursday, December 08, 2011

Here Is A Good Exposition Of How PHRs Can Be Made Relevant. The PCEHR Misses Most Of What Is Needed.

This very useful review appeared a few days ago.

How Providers Can Make PHRs Relevant

Greg Freeman for HealthLeaders Media , November 30, 2011

This article appears in the November 2011 issue of HealthLeaders magazine.
Personal health records have been a forward-thinking idea for some time now, but the rewards and requirements of achieving meaningful use are putting more pressure on providers to adopt a system that allows easy access for the patient but a reliable conduit of information from the health provider. Of the many models available, how does a provider know which way to go?
The key may be creating a PHR that is actually used by the patient and provider, not just offering a system that sounds good on paper but might not be what either party wants. In the past, healthcare providers have found that some PHRs aren’t user-friendly for the patient; the data is often incomplete or inaccurate, and many doctors don’t trust the accuracy of records created and maintained by patients. The result is that the PHR isn’t utilized to any significant extent.
One of the first decisions when considering a PHR is whether to have it tethered to the electronic medical record so that data can be linked automatically, or to have the PHR be a standalone system in which information must be entered. The tethered (or shared) option is winning favor among many providers, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at the University of Pittsburgh Medical Center. UPMC uses a PHR system called HealthTrak, a Web-based portal that allows patients at its 20 hospitals and 400 outpatient sites to feed data into the electronic record. More than 70,000 patients currently use the system.
UPMC explored both options originally, developing its tethered HealthTrak system but also partnering with Google and its untethered PHR called Google Health. Even before the recent demise of Google Health, UPMC was seeing better results with the tethered option, which saw higher participation and more positive feedback.
“Our research shows that patients like having a direct connection to their physician. A shared connection is what consumers really want,” Martich says. “They want to communicate directly with them, get their lab results in a timely fashion, and see their appointments. They like seeing what their doctor sees.”
UPMC’s HealthTrak system was developed in-house six years ago through a grant from the Department of Defense, because the health system treats many military patients. UPMC uses Epic’s EMR system, and the UPMC HealthTrak PHR was built on the framework of Epic’s MyChart PHR. When Epic developed its MyChart patient portal, the health system linked its PHR to MyChart and the EMR. The PHR allows patients to see their lab results, vital signs, appointments, and most other data in real time, as soon as it is available to the physician, with the exception of MRI, CT, and radiology results. In addition, patients can correspond directly with the doctor, who is expected to reply within one business day.
Another question involves who is going to pay for this access. There are fee-based models for PHRs, in which the patient pays for the right to access the system, but Martich says UPMC patients were not interested in paying—even though they are enthusiastic about the PHR when it is free to them. UPMC does charge $40 for e-visits, in which an established patient with a new condition fills out an online form for 21 possible diagnoses and submits it to the physician for evaluation.
Epic charges UPMC for each patient using the PHR linked to its EMR, but the health system does not pass that expense on to the user. The charge is approximately $2 per year per patient, Martich says. 
Once your PHR is in place, how do you engage both patients and physicians in using it? More than 1,100 physicians at UPMC use the Epic EMR, and they are encouraged to have their patients sign up for the PHR. The health system fosters participation by both patients and physicians by holding tutorials during staff meetings and having contests with a prize—such as a catered lunch for the staff—for the physician office that signs up the most participants.
The corporate communications department also helps market to patients by providing leaflets and screen savers for computers in the exam rooms that encourage patients to ask their doctors about HealthTrak. Sign-ups average about 700 per week, up from 500 last year, Martich says.
Patients with the most diagnoses—the sickest—are the most likely to use a PHR, says Holly Miller, MD, MBA, FHIMSS, chief medical officer with MedAllies, a company in Fishkill, NY, that provides PHR and other technical support for healthcare providers. She also is on the board of directors of HIMSS and is former CMIO for Cleveland-based University Hospitals and Health Systems.
Lots more here:
The point that struck me as most interesting was that there was useful evidence suggesting that the use of a ‘tethered’ approach was more popular than a standalone solution when offered head to head.
I believe this is because this approach provides better access to an individual’s key clinician and allows much better interaction between provider and consumer.
It is also interesting that consumers even seem to be prepared to pay a small amount to have access to a tethered PHR.
As I have said before the PCEHR needs a basic re-design to deliver this functionality and it needs to happen soon - before more waste on an essentially in-appropriate system.
It seems odd NEHTA and DoHA are unable to consider new evidence when it becomes available.
Who was the famous economist who said “I am prepared to change my mind when the facts change - what do you do?”.
David.