This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Quote Of The Year
Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
Saturday, September 03, 2011
Weekly Overseas Health IT Links - 03 September, 2011.
Friday, September 02, 2011
Natural Language Processing - A Method To Better Exploit the Information Content in EHRs?
While there is nothing new under the sun it does seem there have been some progress in utilising Natural Language Processing (NLP) for clinical and research purposes.
Natural language processing better for spotting quality lapses after surgery: study
By Joseph Conn
Posted: August 24, 2011 - 11:45 am ET
Are computer programs that read text-based medical records ready for prime-time use in quality improvement? Maybe so, according to research published in the latest issue of the Journal of the American Medical Association.
Quality-improvement researchers concluded that computerized natural language processing of free-text portions of patient medical records was more effective in identifying quality lapses in post-operative surgical patients than a computerized review of discrete data elements in those records. Natural language processing, or NLP, is the use of computers to read and process information expressed in human language.
The researchers looked at the randomly selected records of 2,974 hospitalized surgical patients at six U.S. Veterans Affairs Department medical centers from 1999 to 2006 that were reviewed through the Veterans Affairs Surgical Quality Improvement Program.
A report on their findings, "Automated Identification of Postoperative Complications Within an Electronic Medical Record Using Natural Language Processing," appears in the Aug. 24/31 issue of JAMA.
In conducting the study, researchers obtained from the VA's VistA electronic health-record system narrative clinical notes, such as discharge summaries, progress notes, operative notes, microbiology reports, imaging reports and outpatient visit notes.
The quality-improvement program records had been assessed for 20 "patient safety indicators" developed by the Agency for Healthcare Research and Quality that rely on structured administrative data, such as ICD-9 codes, from hospital discharge records to identify possible adverse events.
More here:
http://www.modernhealthcare.com/article/20110824/NEWS/308249988
We also have coverage here:
Wednesday, August 24, 2011
Reaping the Benefits of Electronic Medical Records
Researchers use natural language processing to flag postsurgical complications in physicians' notes.
By Emily Singer
Despite billions of dollars in incentives to support the adoption of electronic medical records, evidence that these systems improve the efficiency or quality of care has been scarce. But a new study shows that natural-language processing—a branch of computer science that employs linguistics to analyze regular speech—may greatly increase the utility of these records in improving care.
Researchers used this approach to sift through physicians' notes, the richest and most complicated aspect of electronic medical records, for postsurgical complications such as pneumonia and sepsis. The method proved considerably more accurate than other automated systems. They say similar approaches could be used for a variety of applications, including predicting which patients are at risk, and developing automated tools that help doctors choose treatments.
"You can finally see how clinical data can be used to measure patient safety more systematically, and that we will really be able to use these things to manage care," says Ashish Jha, a physician at Harvard Medical School who wrote an editorial accompanying the paper. The paper and editorial were published this week in Journal of the American Medical Association.
One of the most anticipated benefits of electronic medical records is computerized tracking of patients and institutions—to detect whether a particular patient is at risk for a specific complication, for example, or a specific department or hospital is performing more poorly than others.
Automated tracking is already in use in prescribing; for example, to detect when two medicines interact. Because prescription information is a highly structured part of the medical record, it has been fairly easy to analyze with software. However, harnessing the vast information available in less structured parts of the medical record, such as clinicians' notes—which contains free-form entries about the patient's history and status, including postsurgical complications—is much harder.
"If we can't access that information, we will have a hard time monitoring records to improve care," says Jha. "This paper is so powerful because it shows you can do this."
.....
Nuance, a leading maker of voice-recognition software, is already developing commercial systems that use natural-language processing to analyze medical information. The company is collaborating with the IBM team that developed Watson, the robot made famous by beating human contestants on the television game show Jeopardy, to apply the robot's natural-language processing tools to medicine.
More here:
http://www.technologyreview.com/biomedicine/38418/?nlid=nldly&nld=2011-08-24
The bottom line here is that we now have essentially proven technology which in the right circumstances can make a real difference to what we know about what is going on in the health system. Another tool seems to be becoming very much more useful.
David.
Thursday, September 01, 2011
Here Is A Key Reason For Privacy in EHRs to Be Taken Very Seriously. The Surrounding Security is Also Important!
This very useful report appeared a few days ago.
Workers staying silent on mental health, with bosses kept in the dark
- Stephen Lunn
- From: The Australian
- August 25, 2011 12:00AM
THE stigma surrounding mental illness remains strong enough for nearly four in 10 sufferers to not disclose the condition to their employers.
And even for those who do, understanding and support from employers and managers is severely lacking, a study by Sane Australia reveals.
The Working Life and Mental Illness study, to be published today, which surveyed 520 people with a mental illness, finds the majority don't believe their manager understands mental illness and its impact in the workplace.
"Fewer than half of managers (43 per cent) were said to understand how it affected people in the workplace," the report says, with only 30 per cent of sufferers offered flexible working arrangements.
"Many people with a mental illness do not disclose their condition to employers, fearful they will lose their jobs, thus making it harder to access support. This also applies to employees who are caring for a family member with a mental illness."
Geelong bookkeeper Nicci Wall, 45, was diagnosed with bipolar disorder and obsessive compulsive tendencies 10 years ago, having suffered depression since her 20s. Ms Wall says her current employer's understanding and acceptance of her illness and preparedness to work around it is a win-win, as the flexible work hours allow them to get the best out of her.
More here:
The research bulletin on which the report is found here.
http://www.sane.org/images/stories/information/research/1108_info_rb14work.pdf
What is clear here is that there are a large number of people who suffer, or have suffered, some mental illness (and that is a major segment of the population) who do not have understanding employers and who fear stigmatisation and persecution - like job loss - of the information does not remain confidential.
Add this large group to those that have other illnesses of clinical history that may disadvantage and stigmatise and you are talking a very large number of people.
The ill-informed who label all such patients and more especially those who advocate on their behalf ‘privacy Nazi’s’ really miss the point. Any systems that fail to recognise these issues and make sure there are minimal issues will just fail.
Just how tricky it will be is shown here:
New Data Spill Shows Risk of Online Health Records
By JORDAN ROBERTSON (AP) on August 22, 2011
SAN FRANCISCO (AP) -- Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.
There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.
At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.
Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.
But there are not-so-hidden costs with modernization.
"When things go wrong, they can really go wrong," says Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches. "Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link."
Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.
The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.
Titus says Hecht's company failed to use two basic techniques that could have protected the data - requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."
Large-scale medical data breaches have been on the rise in recent years.
In one of the biggest, government health data was at risk in 2006 when a laptop with data on 26.5 million veterans was stolen from a government employee's home. The computer equipment was recovered, and the FBI said the sensitive files weren't accessed.
.....
This year, hard drives containing health histories, financial information and Social Security numbers of 1.9 million Health Net insurance customers disappeared from an office. State regulators launched investigations into Health Net's security procedures.
The California company declined to comment, saying the incident was still under investigation.
The latest incident is "an eye-opener, and we're going to get eye-opener after eye-opener," says Jim Dempsey, a security and public policy expert at the Center for Democracy & Technology.
As instances of data mishandling become more commonplace, government officials may seek greater control over security policies of companies with access to health care records that aren't currently regulated.
"It should be yet another warning bell for companies: You've got your reputation on the line, and you're also facing enforcement action if you don't pay attention to the security of the data you collect and process," Dempsey says.
The full article is here:
http://techland.time.com/2011/08/22/new-data-spill-shows-risk-of-online-health-records/
There are also issues being raised in managing records in the cloud.
EHR Data In Cloud Needs Strong Security Trail
Presenters at a recent Legal EHR Summit warn healthcare providers to press their vendors for clear answers on security.
By Neil Versel, InformationWeek
August 22, 2011
With healthcare's unique information security requirements, the growth of cloud-based electronic health records (EHRs) is raising a number of new issues regarding data stewardship and organizational responsibility.
According to Gerard Nussbaum, director of technology services at management consultancy Kurt Salmon Associates, the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules do not specify whether a provider using a cloud-based EHR owns data in the medical records or if the information belongs to the service host. Speaking last week at the American Health Information Management Association (AHIMA) Legal EHR Summit in Chicago, Nussbaum recommended that healthcare providers explicitly negotiate data usage in contracts, particularly in case of a breach.
"Nothing is secure from breaches," noted Nussbaum, an attorney. Knowing this, he said it's best to "iron out up front" what each party's legal responsibility is in the event of a breach, such as who must notify individuals whose data may have been compromised.
Health information management consultant Sandra Nunn, who participated in a panel discussion on managing health information in the cloud, said she wants her clients to reach a clear understanding with their vendors about whether information will be sequestered in the cloud if there is a breach and whether there will be an easily accessible audit trail.
"Having multiple cloud vendors can complicate your situation," Nunn said. She surmised that it might be a good idea for providers to ask their vendors once or twice a year to create an audit log just to make sure it's possible.
Lots more here:
http://www.informationweek.com/news/healthcare/security-privacy/231500467
Additionally and quite surprisingly it seems some medical devices might also be at risk.
Hacked Medical Device Sparks Congressional Inquiry
Legislators demand answers after a security researcher remotely controlled his own insulin pump using a $20 radio frequency transmitter at Black Hat.
By Mathew J. Schwartz, InformationWeek
August 23, 2011
Two members of Congress have asked the Government Accountability Office (GAO) to review the Federal Communications Commission's approach to medical devices with wireless capabilities to ensure that the devices are "safe, reliable, and secure."
The letter to the GAO, from Reps. Anna G. Eshoo (D-Calif.) and Edward J. Markey (D-Mass.)--both members of the House communications and technology subcommittee--was sparked by a medical device hacking demonstration earlier this month at the Black Hat conference in Las Vegas.
While most Black Hat presentations typically detail exploits launched against others or more benign forms of hardware hacking, security researcher Jerome Radcliffe actually hacked--live and onstage--his own insulin pump, which he relies on to subcutaneously administer multiple doses of insulin per day. Radcliffe, 33, said he was diagnosed with diabetes at age 22.
Next came the medical device hardware hacking. Specifically, Radcliffe reverse-engineered the wireless commands sent from the small controller that ships with his pump, and which is used to tell the pump what dosage of insulin to administer. After decoding the communications protocol, Radcliffe was able to program a small radio frequency (RF) transmitter--easily available for $100 new, or $20 for a used one on eBay--to remotely control his insulin pump. In his demonstration, Radcliffe showed how he could use the remote transmitter both to administer arbitrary insulin doses, as well as to disable the pump.
Many more details here:
http://www.informationweek.com/news/security/vulnerabilities/231500548
There is no reason to be in any way alarmist about any of this but the messages are clear. First there are many consumers who will need a lot of reassurance about electronic health records. Second that, despite the best efforts, there will be occasional security leaks. These need to be anticipated and managed effectively to minimise possible damage to EHR use. Third we really do need to have a careful planned approach to EHR protection that is continually reviewed and updated.
As a last comment we do need to ensure there is proper disclosure of all significant breaches so that lessons are leant quickly and repeat leaks are prevented.
A large issue indeed!
David.
Looks Like There Is Being A Delay With the Release of the Revised Version of the PCEHR ConOps.
On NEHTA’s website - as of Sep 1 - the following Headline is displayed.
NEHTA - National E-Health Transition Authority
Personally controlled electronic health records (PCEHR) Concept of Operations
Following receipt of submissions, the final Concept of Operations document is scheduled for release in August 2011.
See www.nehta.gov.au
Also from the Government site we have:
PCEHR Draft Concept of Operations Consultation
The Draft Concept of Operations - Relating to the introduction of a PCEHR system (draft Concept of Operations) consultation process closed on 7 June 2011. All submissions received by the deadline were reviewed and will help inform the final personally controlled electronic health record (PCEHR) system Concept of Operations document - scheduled for release in August 2011.
The draft Concept of Operations provides details about how the PCEHR system might look, what information it might contain, and how it will function and connect with existing clinical systems. It also covers participation issues, information management, privacy and security, and matters of implementation, evaluation and consultation.
The content was shaped by a range of consultations which the Department of Health and Ageing and the National E-Health Transition Authority (NEHTA) held with stakeholders — consumer groups, health professionals, the Information and Communications Technology (ICT) industry and state and territory governments.
You can find out more about the draft Concept of Operations by reading the fact sheet and the PCEHR consumer booklet, e-health - have your say, which describes key elements of the proposed PCEHR system, and the impact it will have on health care in the future.
See here:
http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/pcehr
So the self-imposed deadline has already slipped. I guess we will just have to wait.
David.