Again there has been just a heap of stuff arrive this week.
First we have:
By David C. Kibbe
What would you call health care software that:
- Is Web-based and networkable, therefore highly scalable and inexpensive to purchase and use;
- Provides a 'unified view' of a patient from multiple sources of data and information;
- Is designed to be used interactively - by providers and patients alike - to coordinate care and create continuity;
- Offers evidence-based guidance and coaching, personalized by access to a person's health data as it changes;
- Collects, for analysis and reporting, quality and performance measures as the routine by-product of its normal daily use;
- Aims to provide patients and their providers with a collaborative workflow platform for decision support; and
- Creates a care plan for each individual and then monitors the progress of each patient and provider in meeting the goals of that plan?
I call this Clinical Groupware. The term captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.
Clinical Groupware is a departure from the client-server and physician-centric EHR technology of the past 25 years, a fixed database technology that never really became popular. It is a substantially new and disruptive technology that offers lower price of purchase and use, greater convenience, and is capable of being used by less skilled customers across a broader range of settings than the technology it replaces.
As the name indicates, Clinical Groupware is intended for use by groups of people and not just independent practitioners or individuals. It is not the same thing as an electronic health record, but may share a number of features in common with EHRs, such as e-Prescribing, decision support, and charting of individual visits or encounters, both face-to-face and virtual. Neither is Clinical Groupware bloated with extra features and functions that most providers and patients don't need and, with good reason, don't want to pay for.
Some Clinical Groupware may look and feel like a web-based "EHR lite." But Clinical Groupware aims to create a unified view of the patient, assembling health data and information that may be stored in many different places and in several different organizations - including HealthVault or Google Health -- which most EHRs cannot do.
Clinical Groupware is an evolutionary approach to a shifting health economy in which doing more is not always equated with better care, and the physician or provider role is transforming from autonomous expert to advisor, partner, and guide. It is also an organic response to the reality that most health care data in electronic format is dispersed across numerous organizations and companies - e.g. hospitals, labs, pharmacies, and devices - and provides a means of accommodating patient demands for a more participatory practice of medicine.
A huge amount more here:
http://www.thehealthcareblog.com/the_health_care_blog/2009/02/why-clinical-groupware-may-be-the-next-big-thing-in-health-it.html
This is a fascinating blog post that has triggered a great deal of discussion – well worth a careful browse.
Second we have:
by Farzad Mostashari and Micky Tripathi
Widespread use of interoperable electronic health records is necessary for transforming how health care is delivered and will be a key enabler of health care reform.
The Health IT provisions of the American Recovery and Reinvestment Act seek to promote nearly universal EHR adoption over the next 10 years, largely through incentive payments to be paid following meaningful use of EHRs for improvements in health quality, efficiency, prevention and safety.
However, successful implementation of EHRs is challenging, especially among small practices where most primary care is delivered.
These practices generally lack expertise and resources to purchase, install and use information technology to work better and more efficiently. Furthermore, despite the requirements for standards and certification, uncoordinated EHR implementations are unlikely to result in functional interoperability between systems.
More here:
http://www.ihealthbeat.org/Perspectives/2009/Achieving-Meaningful-EHR-Use-Leveraging-Community-Structures.aspx
The article provides two references and some useful links.
[1] Blumenthal D, The Federal Role in Promoting Health Information Technology, The Commonwealth Fund, January 2009
2. Mostashari F, Tripathi M, Kendall M. Lessons Learned From Two Large Community Electronic Health Record (EHR) Extension Projects. Health Affairs 28(2). March 2009 Forthcoming
MORE ON THE WEB
A useful article and a valuable perspective on major Health IT projects. This one will be a real ‘biggie’.
Third we have:
Prescribing errors are the most common medication errors in primary care practices
Most of the medication errors in primary care practices are prescribing errors, and more than half of these errors reach patients, concludes a new study. Electronic tools are necessary to reduce the rate of errors and subsequent harm (adverse drug events or ADEs) to patients, suggest the study authors. Studies of medication errors have typically been conducted in hospitals, rather than in primary care settings. To understand the nature of medication errors in primary care settings, the American Academy of Family Physicians (AAFP) Research Network and the AAFP Robert Graham Policy Center looked at medication error reports from two studies conducted in the network.
The researchers combined reports of medication errors from a 20-week medical error study involving 42 family physicians at 42 practices with those from a 10-week study involving 401 clinicians and staff from 10 diverse family medicine offices. Of a total of 1,265 medical errors reported, 194 reports concerned errors in medication. Seventy percent of the medication error reports involved prescribing errors, 10 percent each involved medication administration or documentation errors, 7 percent involved errors in dispensing drugs, and 3 percent involved medication monitoring errors. In 41 percent of the reports, the errors were prevented and did not reach the patients, while 59 percent reached the patient 35 percent did not require monitoring. Monitoring was required in 8 percent of the reports, intervention in 13 percent, and hospitalization of affected patients in 3 percent). Although 16 percent of the medication errors were ADEs, none of the errors resulted in permanent harm or a patient's death.
Pharmacists were most likely to prevent the errors from reaching the patients (40 percent of intercepted medication errors), while physicians and patients were almost equally likely to intercept the medication error (19 percent and 17 percent of intercepted errors, respectively). The researchers determined that more widespread use of heath care information technology, such as electronic medical records or computer physician order entry systems, could have prevented as many as 57 percent of the medication errors. The study was funded in part by the Agency for Healthcare Research and Quality (HS11584 and HS14552).
More details are in "Medication errors reported by US family physicians and their office staff," by Grace M. Kuo, Pharm.D., M.P.H., Robert L. Phillips, M.D., M.S.P.H., Deborah Graham, M.S.P.H., and John M. Hickner, M.D., M.Sc., in Quality and Safety in Health Care 17, pp. 286-290, 2008.
Site is here:
http://www.ahrq.gov/research/feb09/0209RA5.htm
This is another brick in the wall of the evidence for CPOE being of value in preventing error.
Fourth we have:
February 9, 2009 (Victoria, BC) – Some heart failure patients who live in the Greater Victoria area are now able to manage their health care in just a few minutes a day, from the comfort of their own homes, with the help of Telehomecare – an in-home monitoring system being launched by the Vancouver Island Health Authority (VIHA).
"Telehomecare enables rapid detection of problems, allows patients to self-manage their care and saves travel time for both patients and caregivers," said Health Services Minister George Abbott. "It is one way we are breaking down barriers to quality health care for British Columbians regardless of where people live."
Every day at a set time, an in-home monitoring device will greet the patient with a pre-recorded message to remind them to take their vital signs: blood pressure, pulse, oxygen saturation level and weight. This information is then automatically transmitted over the phone to a computer in VIHA’s Home and Community Care office where the data is reviewed.
Christine Gotzman, VIHA’s Home and Community Care’s Heart Failure Nurse, recognizes the impact that this new service will have on patients who live with heart failure. "Until now, my only communication with my patients has been in person or over the phone," she says. "This new Telehomecare service gives me the ability to remotely ‘see’ how my patients are doing on a daily basis and deliver care proactively. Once the data is sent to my computer, I can quickly assess their condition and, if necessary, provide a targeted response to their changing health status."
The first phase of the Telehomecare program will measure the progress of approximately 100 patients living with heart failure chosen through VIHA’s Seniors At Risk Integrated Network, currently operating in the Greater Victoria area. The long-term goal is to provide Telehomecare services throughout Vancouver Island.
"This innovative program offers many direct benefits to our patients," said VIHA’s Board Chair Jac Kreut, "including improved access to care, a reduction in emergency room visits, shorter hospital stays and fewer hospital admissions."
The Telehomecare program is being delivered as part of a larger provincial Telehealth strategy that includes VIHA and Interior Health, with a combined budget of $836,000. Interior Health initially launched its Telehomecare program in 2006, and recently expanded its program last fall to include patients in the East Kootenays.
More here:
http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/392-at-home-monitoring-helps-seniors-living-with-heart-failure
Another interesting study in the area of remote monitoring.
Fifth we have:
Younger physicians are more likely to gravitate to automated systems
Lucas Mearian
February 9, 2009 (Computerworld) Before the rollout an all-electronic health records (EHR) system about a year ago, only about half of the doctors and nurses in West Virginia's state hospitals were familiar with medical computer systems. So when technology rolled in, staffers pushed back.
"We actually had some nurses who were completely computer-illiterate. They didn't use a computer at work, and they had no use for it at home," said Jerry Luck, director of facilities systems administration at the West Virginia Department of Health and Human Resources.
West Virginia is not alone. Hospitals across the country are feeling pressure to implement more efficient IT systems in light of President Barack Obama's plan to establish a nationwide EHR system in the next five years. Under the Health Information Technology for Economic and Clinical Health Act (HITECH), physicians would be eligible for between $40,000 and $65,000 if they show they are using IT to improve the quality of care.
EHR systems are expected to streamline health care workflow, improve the quality of care and cut costs, according to experts. But medical facilities could also find themselves at loggerheads with some of their own staffers, which are far more familiar with pen and paper than a keyboard or tablet PC. Adding to the problem: the bulk of HITECH money will be awarded beginning in 2011, according to current legislation pending in the House. That doesn't give hospitals much time to prepare, and organizations that aren't ready won't receive funds.
West Virginia is a rarity: Its state government health care system has an all-electronic record-keeping system spread across seven medical facilities.
Lots more here:
http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=knowledge_center&articleId=9127549&taxonomyId=1&intsrc=kc_top
This is a useful summary of the issues encountered in an EHR roll-out and how they were addressed – a good read.
Sixth we have:
by Ginger Rough - Feb. 9, 2009 12:00 AM
The Arizona Republic
Have you taken the painkillers OxyContin or Vicodin in the past 10 months? How about the sleep aid Ambien or the stimulant Ritalin?
If you have and you obtained the drug legally, your prescription information is likely being stored in a centralized, state-managed database that can be accessed by doctors and pharmacists around Arizona.
The program, which debuted in December and is overseen by the Arizona State Board of Pharmacy, is designed to cut down on the persistent problem of prescription-drug abuse. But it also has raised concerns among privacy-rights groups that fear computer hackers or unscrupulous health workers will access patients' personal information. State health officials who pushed for the program say they know of no breach of any similar database in another state.
The system, they say, allows physicians and pharmacists to more easily identify "doctor shoppers," people who visit various doctors to obtain drugs that are potentially addictive.
Doctors and pharmacists who learn of a patient's overuse through the system can stop providing him or her the drug, alert other doctors and pharmacists treating the patient, counsel the patient or even contact law-enforcement agencies.
"I am so excited that we are finally getting this for our state," said Dr. Stephen Borowsky, an anesthesiologist and pain-management specialist.
"It's absolutely necessary. . . . These medicines have such great potential for addiction."
The first prescription-monitoring database in the country was set up 13 years ago in Nevada. Now, more than 30 states have authorized or created such lists after deciding that the potential benefits outweigh privacy concerns.
More here:
http://www.azcentral.com/news/articles/2009/02/09/20090209pharmacydrugs0209.html
Clearly this is a useful initiative. The description of how the system works makes interesting reading and deserves consideration as one model of controlling prescription drug abuse.
Seventh we have:
New Devices Track Patients Who Wander
When an autistic child or an adult with dementia wanders off and gets lost, finding them quickly sometimes can make a difference between life and death.
As the market for search-and-rescue technology expands, LoJack Corp., the maker of wireless devices that allow cops to find stolen cars, is announcing Tuesday the launch of a radio-based product designed to locate people.
Several companies already offer devices that use wristband radio transmitters to help police locate people quickly. But advocates for the elderly and disabled say there's a large and unmet need for more such services.
An estimated 18,000 people are already using wristband radio-tracking devices made either by Care Trak International, a LoJack competitor, or by Locator Systems, a Canadian company acquired by LoJack last year. Some of them are distributed by police departments. On average, they cost about $25 to $30 a month to use, though in cases of need, they may be provided free.
There are an estimated 5.2 million Americans with Alzheimer's, and more than half of those affected sometimes go on random and dangerous walks, according to the National Alzheimer's Association. Wandering is considered among the most life-threatening behaviors associated with the illness.
More here:
http://online.wsj.com/article/SB123423274308166263.html
This seems like a useful innovation that has now been brought to market.
Eighth we have:
http://www.e-health-insider.com/news/4564/cerner_gets_green_light_in_london
11 Feb 2009
NHS London and the NHS London Programme for IT have given the green light to further Cerner deployments in the capital.
The decision comes despite a the fact a programme of work to fix 22 known problems is running late and has yet to be completed. Royal Free reports that although good progress has been made it will not be possible to judge until March whether the fixes require work.
All further implementations of Cerner were shelved in October and an emergency ‘recovery plan’ instituted by LPfIT, BT and Cerner after serious problems with the Cerner Millennium software came to light at Barts and the London and Royal Free.
In January board papers, Andrew Way, chief executive of Royal Free Hampstead NHS Trust, reported good progress had been made, though the 90 day rescue project had been extended by agreement. The trust’s project board will monitor progress and “test the views of clinical and administrative staff in early March to assess the degree of improvement”.
EHI understands that a decision to restart Cerner implementations in London was taken at the beginning of February.
In December, NHS chief executive David Nicholson told the Commons health Select Committee that no more Cerner implementations would occur until known problems were resolved: “We’ve got some serious issues around the Cerner system, particularly in London at the Royal Free, and what we’ve said to Cerner and BT is that they’ve got to solve that problem at the Royal Free before we think about rolling it out across the rest of the NHS.”
At least one London trust reports having been told in the last few days that it should now “re-engage with Cerner”.
More here:
Cerner must be breathing more easily now the roll-out is progressing. One fears it still may be a bit of a poison chalice.
Ninth we have:
February 06, 2009 | Eric Wicklund, Managing Editor
SAN DIEGO – SafeMed is venturing into new territory, with a new name and some new products designed to push the company's healthcare footprint into new areas.
The San Diego-based healthcare analytics company - it provided the analytics engine for Google Health - announced this week that it will now be known as Anvita Health. In addition, the company launched a new mobile viewer for Google Health that allows users to gain access to their personal health records at any time and from any place.
"We see Google Health as a vital tool in allowing consumers to take a more active role in their own healthcare and the care of their families," said Ahmed Ghouri, Anvita Health's co-founder and chief medical officer, in a press release. "The Anvita Mobile Viewer builds a bridge between the home and the doctor's office and allows Google Health users to realize the full worth of their PHR data by taking it to where critical medical decisions are made."
Full article here:
http://www.healthcareitnews.com/news/safemed-changes-name-anvita-health-debuts-google-application-mobile-viewing
This is an interesting evolutionary direction for access to one’s PHR.
Tenth we have:
ScienceDaily (Feb. 9, 2009) — For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease.
In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study recentlly appeared online in the British Medical Journal.
“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper — this can work.”
More here:
http://www.sciencedaily.com/releases/2009/02/090206135313.htm
This is really interesting and important stuff – and adds another arm to the value proposition for EHRs. (See abstract in the report post for the week).
Eleventh we have:
09 Feb 2009
A new version of the QRISK software which identifies patients most at risk of developing cardiovascular disease (CVD) has been released for clinical use.
QRISK2 uses a new CVD equation to estimate an individual’s risk of developing heart disease over the next ten years, drawing on analysis of primary care data from practices using the EMIS GP computer system.
Its creators argue that it provides an accurate and fairer assessment of CVD risk than the widely-used Framingham risk equation, taking into account the higher risk of developing CVD to patients from deprived areas and from certain ethnic groups. It also considers other risk factors including whether the patient already suffers from a pre-existing condition such as diabetes.
Last year the National Institute for Health and Clinical Excellence (NICE) made a draft recommendation that the QRISK formula should replace the Framingham risk score currently used but later reversed its decision.
More here:
http://www.ehiprimarycare.com/news/4553/new_qrisk2_for_heart_disease_launched
This is very important work as it will assist in identifying – before the event – those who need preventive cardiovascular treatment and hopefully avoid both suffering and cost!
Twelfth for the week we have:
Posted: February 12, 2009 - 5:59 am EDT
In response to Jean DerGurahian's “HIPAA privacy rule not enough to protect info: IOM":
The current debate over the security and privacy of health records has generated many hardened “black vs. white” positions. As I read them, most of these positions are based on the fear of the writer that something important to them will be impeded by whatever rules they imagine coming out of the debate. There is a simple solution to the problem, one which can address every need, if we accept a few principles.
- We must agree that the patient must be able to control the use of their personally identifiable health information, or PHI. The HIPAA regulations got this right! This first principle has a social benefit policy corollary: Information derived from my record, but which cannot be used to identify me, is not under my control. Rather it is under the control of any provider I have granted access, and they can authorize its use for research and public health purposes under appropriate safeguards.
- We need to acknowledge that no medical provider can properly care for a patient unless they have access to the full health records of the patient.
- We need to recognize that a person who seeks care from a provider must allow that provider to access their complete health record.
- We need to acknowledge that designated emergency providers, when presented with a patient that they can identify, must have access to that patient's records. This situation is equivalent to a self-referral since we presume that a patient unable to give consent for treatment gives it implicitly unless they have explicitly denied permission.
- When a patient allows a provider currently caring for them to consult with, or to refer them to, another provider, they also grant that provider access to their records, and grant the referring provider the right to pass on the access rights they hold. This the central principle that makes the solution work.
- Finally, we must provide, on behalf of the patient, assurance that no other person, provider or not, can see their PHI.
More here:
http://www.modernhealthcare.com/article/20090212/REG/302129988/1031/FREE
This article strikes me as a nice succinct statement of principles.
Second last for the week we have:
By Joseph Conn / HITS staff writer
Posted: February 11, 2009 - 5:59 am EDT
If, as C. Peter Waegemann has said, last week's Towards an Electronic Patient Record conference and exhibition was to be the last TEPR, it’s an appropriate time to salute Waegemann and the folks at his Medical Records Institute, who have produced the show for a quarter of a century.
Trade shows are what you make of them. The time and effort you spend plotting and sailing your course through the schedule of keynote speeches, presentations and vendor exhibition hall visits and the attitude you bring to those encounters has a direct bearing on the benefit you derive from the experience.
The show Feb. 1-5 in Palm Springs, Calif., this year was something on the order of my eighth TEPR, and I’ve enjoyed every one of them.
What I’d always found about TEPR, in comparison to its major competitor, the Healthcare Information and Management Systems Society show, was that TEPR was on a more human scale, more approachable. If TEPR was vaudeville, HIMSS was the Greatest Show on Earth.
During a TEPR session, you could always get a question asked and answered as it came up, and afterward, grab a word or two with a speaker or panelist and swap business cards without waiting in line behind two dozen other people.
I remember one of the great thrills of the TEPR shows of yesteryear was the notorious TEPR Challenge.
Electronic health-record system vendors, often fretful and sweating, would demonstrate their software on stage during documentations of a mock patient encounter. The vendors had 10 minutes to complete the patient record. Live shots of their systems were projected onto huge screens for viewing by an audience of many hundreds of potential customers and competitors.
More here:
http://www.modernhealthcare.com/article/20090211/REG/302119960/1029/FREE
This is a sad announcement with TEPR shutting up shop after so many years. The discussion of ‘foilware’ that was so prevalent in this space a few years I found especially amusing. Live demonstrations are certainly a valuable way to sort the wheat from the chaff.
Last for this week we have:
Certification of consumer health platforms now available
February 12, 2009 (Toronto, ON) - Health information technology vendors entering the Canadian consumer health solution market can now apply for pre-implementation certification for their consumer health platforms from Canada Health Infoway (Infoway).
The e-Health Certification Services, launched today, will be broadened in the coming months to include consumer health applications.
“Infoway’s new certification service will help health information technology vendors develop solutions that leverage the considerable progress Canada is making in setting standards and deploying interoperable electronic health records throughout the health care system,” said Richard Alvarez, President and CEO, Canada Health Infoway. “Interest in consumer health solutions is growing, and ensuring these solutions are interoperable with the technologies clinicians are using to store Canadians’ health data is central to maximizing their potential.”
Certification will ensure consumer health solutions comply with Infoway’s privacy, security, interoperability and management standards and complement and leverage Canada’s investments in electronic health records. It will also provide vendors with an opportunity to demonstrate compliance with pan-Canadian standards.
Organizations investing in certified solutions can expect a higher degree of confidence that the products they purchase are reliable, interoperable, private and secure.
Vendors whose solutions achieve certification will be authorized to apply the “Infoway Certified” certification mark to their product and related marketing materials.
More here:
Again OZ is behind the US and Canada. I hope NEHTA’s plans in this area see the light of day soon so the painful process of catching up can begin.
There is an amazing amount happening (lots of stuff left out). Enjoy!
David.
