Useful and Interesting Health IT News from the Last Week – 23/08/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

$1.8b program puts patients at risk

Louise Hall Health Reporter

August 20, 2009

HOSPITAL patients' lives could be put at risk from overdoses or wrong medication, experts warn, if the ambitious timetable for the Government's e-Health plans mean computer-generated prescriptions are introduced without adequate training and support for staff.

Their comments come after a Federal Government commission found electronic prescribing had doubled the rate of medication errors at a large hospital because of poorly designed software that automatically filled out scripts to the maximum dose and ordered unnecessary repeat courses.

The findings fly in the face of the widely espoused benefits of electronic prescribing - that it would cut errors by alerting doctors to possible side-effects and allergies and reduce reliance on handwriting.

''There's no doubt that introducing electronic prescribing can introduce new errors,'' said Ric Day, a clinical pharmacologist at St Vincent's Hospital, which is one of two hospitals to have introduced electronic medicine management.

''You can't just buy the software and turn it on - training staff in how to use it appropriately is absolutely critical.''

Yesterday the Health Minister, Nicola Roxon, told an e-Health conference in Canberra the Government was committed to overhauling a system where ''paper is still king''.

She said the estimated $1.8 billion cost of introducing individual electronic health records may be funded from savings derived from the Government's proposed cuts to private health insurance rebates.

.....

The review, published in the journal Australia and New Zealand Health Policy, also reported that the introduction of electronic medicine management in select acute wards in Queensland had been discontinued after six weeks in a rural hospital and eight weeks in a metropolitan hospital because it was dangerous.

.....

More here:

http://www.smh.com.au/national/18b-program-puts-patients-at-risk-20090819-eql1.html

Now we need to go to the source here:

Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008

Elizabeth E Roughead and Susan J Semple

Australia and New Zealand Health Policy 2009, 6:18doi:10.1186/1743-8462-6-18

Published: 11 August 2009

Abstract (provisional)

Background

This paper presents Part 1 of a two-part literature review examining medication safety in the Australian acute care setting. This review was undertaken for the Australian Commission on Safety and Quality in Health Care to update a previous national report on medication safety conducted in 2002. This first part of the review examines the extent and causes of medication incidents and adverse drug events in acute care.

Methods

A literature search was conducted to identify Australian studies, published from 2002 to 2008, on the extent and causes of medication incidents and adverse drug events in acute care.

Results

Studies published since 2002 continue to suggest approximately 2%-3% of Australian hospital admissions are medication-related. Results of incident reporting from hospitals show that incidents associated with medication remain the second most common type of incident after falls. Omission or overdose of medication is the most frequent type of medication incident reported. Studies conducted on prescribing of renally excreted medications suggest that there are high rates of prescribing errors in patients requiring monitoring and medication dose adjustment. Research published since 2002 provides a much stronger Australian research base about the factors contributing to medication errors. Team, task, environmental, individual and patient factors have all been found to contribute to error.

Conclusions

Medication-related hospital admissions remain a significant problem in the Australian healthcare system. It can be estimated that 190,000 medication-related hospital admissions occur per year in Australia, with estimated costs of $660 million. Medication incidents remain the second most common type of incident reported in Australian hospitals. A number of different systems factors contribute to the occurrence of medication errors in the Australian setting.

Full article in .pdf found here:

http://www.anzhealthpolicy.com/content/6/1/18

The relevant citations to e-prescribing are found on pages 13 and 20 (which compared computer printed and hand written discharge prescriptions without decision support.)

The article referred to is found here:

http://www.mja.com.au/public/issues/180_03_020204/letters_020204_fm-4.html

The key comment is here.

“This uncontrolled observational audit demonstrated that electronic prescribing without decision support in busy medical wards can significantly increase the risk of patient harm when compared with the handwritten system. The discharge prescription component of this system was withdrawn on the basis of this audit, and the paper-based system reinstituted until a safer alternative becomes available.”

Guess what! It is not talking about e-prescribing – its talking about discharge summary data extraction. What we have is an article based on this study which bases its comments on a non-peer reviewed letter from 5 years ago. Worse the review only looks at acute care in Australia and ignores what happens in General Practice and in the rest of the world – where it has been show e-prescribing really works.

Utter nonsense and pathetic inaccurate, selectively quoting, journalism. Final straw it that the journal where the review was published is so poor it is closing down in December, 2009 and not taking any more papers!

Second we have:

US grants $1.4bn for e-health records

Debra Sherman in Chicago | August 21, 2009

THE US government announced grants of almost $US1.2 billion ($1.44bn) to help hospitals and health care providers establish and use electronic health records.

The grants include $US598m to set up some 70 health information technology centres to help health care institutions acquire electronic health record systems and $US564m to develop a nationwide system of health information networks, vice president Joe Biden's office said.

The funds are aimed at helping physicians and hospitals adopt electronic medical records and at building an exchange to move health information among various healthcare agencies, Health and Human Services Secretary Kathleen Sebelius said on a conference call.

"This is just the first wave of resources invested in health technology aimed at transforming our paper-driven system to an electronic system over the next several years," said Ms Sebelius, who was in Chicago to unveil the grants with Mr Biden.

She said that expanding the use of electronic medical records would be "fundamental to reforming" the system and that broad adoption could help reduce medical errors, improve quality and make the entire system more efficient.

National Coordinator for Health IT David Blumenthal said the funds will likely be granted in three cycles over the course of 2010.

More here:

http://www.australianit.news.com.au/story/0,24897,25960401-15319,00.html

It seems the US has found a little money to get seriously started – and there is another 30+ billion to come!

Third we have:

Orion Health™ eReferrals Enable Better Communication Between GPs and Hospital

Posted August 18th, 2009 by Orion Health

SYDNEY, NSW. – August 17, 2009 –ACT Health is the first region in the country to go live with a comprehensive, electronic referral management solution (eReferrals) from leading healthcare technology providers Orion Health Pty Ltd and HealthLink.

The eReferrals project has created significant interest amongst the clinical community because it provides General Practitioners (GP) across the Australian Capital Territories (ACT) with visibility of the referrals process in The Canberra Hospital (TCH) and creates efficiencies that benefit patients and health care providers.

Some of the most common problems with paper-based referrals in hospitals occur as a result of legibility, duplication or data entry errors, or inadequate updates on the status of a referral. In some instances this can lead to problems with patient care and adverse patient outcomes. eReferrals helps to eliminate the risks associated with manual processes and also allows staff at TCH to prioritise case loads to better serve patients.

When a patient is in need of specialist care, a GP refers a patient to a specialist or other provider at TCH for treatment. Using the eReferrals system, the GP can electronically submit and manage the referral through to completion. The system enables GPs to track referral progress to ensure an appointment is booked in a timely manner and that the patient attended their appointment. It also provides automatic notifications of any change in the state of the referral.

Initial reactions to the new system are overwhelmingly positive. The pilot went live in early June, and more than 30 GPs across the ACT region are using the system to refer to more than 60 Specialists in Outpatient Services. Plans are already underway to expand to additional services at TCH, and several hundred General Practices within the ACT and nearby regions.

Eventually, ACT Health expects the eReferrals solution, which tracks the transfer of care of a patient, to enable any healthcare provider within ACT and nearby regions to refer a patient to another healthcare provider. “We envisage this solution will enable electronic referrals throughout the ACT Health system. With the go live of this eReferrals solution, we’re on the way to making our vision of an eHealth future a reality”, said ACT Health CEO Mr Mark Cormack.

The joint eReferrals solution was implemented by ACT Health, Orion Health, HealthLink and piloted with a group of General Practices. According to Orion Health’s Regional Manager Chris Stephens, when a similar system was implemented in Hutt Valley DHB in New Zealand, urgent and semi-urgent referrals were processed faster (by 3 days) and productivity improved by 40%.

“By replacing paper based systems we are able to improve patient access to care, ensure accurate and secure information transfer and increase productivity in handling and use of patient information. A trusted partner of ACT Health, HealthLink assists patients in their care as they move through the different parts of the healthcare system” says Geoffrey Sayer, General Manager for HealthLink Australia.

The full release is here:

http://www.pressreleasepoint.com/orion-health%E2%84%A2-ereferrals-enable-better-communication-between-gps-and-hospital

This is another example of how people are getting on with it while Government and NEHTA fiddles. The worry, as has been mentioned here before, is now we get is all interoperable and nationally integrated at the end of the day.

Fourth we have:

iSOFT expects higher profits in 2010

August 18, 2009 - 10:49AM

Health information technology company iSOFT Group Ltd expects to generate higher sales and profits in 2009/10.

ISOFT, formerly IBA Health, builds software applications to enable healthcare providers such as hospitals to manage information on patients.

On Tuesday, iSOFT booked a net profit for the 2008/09 financial year of $35.09 million, up 143 per cent on the prior year as the company expanded globally.

Revenue for the 12 months to June 30, 2009 was up 50 per cent at $540.12 million.

The company declared an unfranked dividend of one cent per share.

"ISOFT expects sales growth of 10 per cent, almost five times the forecast industry average in the 2010 full year, with margins at 2009 full year levels," iSOFT said in a statement.

More here:

http://news.smh.com.au/breaking-news-business/isoft-expects-higher-profits-in-2010-20090818-eo8p.html

This looks like a so far so good result that justifies some optimism that we (Australia) can have a global player in the Health IT space. The next 2-3 years will tell us one way or another I suspect.

There is more detailed coverage here (free registration required):

http://www.businessspectator.com.au/bs.nsf/Article/iSoft-shrugs-of-the-downturn-as-net-profit-surges--pd20090818-UZT4H?OpenDocument

iSoft shrugs off the downturn as net profit surges 137% to $34.7m

and here:

http://www.australianit.news.com.au/story/0,24897,25947058-15306,00.html

iSoft net profit up 137pc

Karen Dearne | August 18, 2009

I am not sure, however, that the NBN will produce the scale benefits iSoft suggest in their recent Senate submission – although I very much agree that broadband is a key and necessary enabler of e-Health. I am just not sure how much of the benefit can at attributed to the NBN and how much to other aspects of e-Health. That said, this is a useful contribution to the discussion.

The submission is found here:

http://www.aph.gov.au/senate/committee/broadband_ctte/submissions_from_april_2009/sub91.pdf

(The usual disclaimer about having a few iSoft shares applies)

Fifth we have:

Repaired reactor ready for isotopes

Leigh Dayton | August 22, 2009

Article from: The Australian

WITHIN weeks Australia's nuclear facility will begin production of a key medical isotope, nearly two years after its new $400million research reactor was shut down for repairs.

"It's very important for Australia to have indigenous supplies of these radiopharmaceuticals," Australian Nuclear Science and Technology Organisation scientist Ron Cameron says.

Previously, the isotope was produced using ANSTO's 49-year-old HIFAR nuclear reactor at Lucas Heights, near Sydney. During the shutdown of the Argentinian-designed OPAL reactor, ANSTO had to import the isotope molybdenum-99 (Mo-99), at a cost of $100,000 a week.

Once production is up and running, Cameron says, not only will Australia have a predictable and secure supply of the isotope, it will gain a toehold into a lucrative international market valued at about $US260 million ($313m) a year.

Mo-99 is a radioisotope used to derive Technetium-99m (Tc-99m), a radiopharmaceutical utilised in roughly 80 per cent of all nuclear medicine procedures.

"Once we're in full production we'll look into the international market," Cameron says, adding that ANSTO is already considering how to increase production beyond national needs.

Full article here:

http://www.theaustralian.news.com.au/story/0,25197,25958952-23289,00.html

This really has been a great example of just how poor Governments are in managing technical implementations. The lessons for e-Health are clear.

I suspect this commentator may not agree however.

Roxon E-Health Comments Welcomed By PSA

21 Aug 2009

Comments by the Minister for Health and Ageing, Nicola Roxon, committing to e-health reforms and electronic patient records have been welcomed by the Pharmaceutical Society of Australia.

Addressing the 'Health e Nation Conference' in Canberra during the week, Ms Roxon said she wanted Australia's future health system to be connected, secure and efficient. "It is frustrating that in a sector where technology and research drive continual innovation in patient care, paper is still king. After a decade of doing our banking - and almost everything else - online, we're still carrying our x-rays under our arm, a script to the pharmacy, and the hospital can't send a discharge summary to the family GP," Ms Roxon said.

The President of the PSA, Warwick Plunkett, said pharmacists endorsed Ms Roxon's comments and called on the Government to fast-track the implementation of e-health. "The National E-Health Strategy has pointed to a 10-year implementation phase for the introduction of e-health in Australia which the PSA believes is just far too long and has the potential to endanger patient care," Mr Plunkett said.

More here:

http://www.medicalnewstoday.com/articles/161409.php

This paragraph is interesting:

“Mr Plunkett said the implementation of projects such as Medicare and the GST, which included privacy provisions and major IT capability, showed that with Government commitment major undertakings could be introduced in as little as two years.

"There is no reason that e-health should be any different." The PSA also calls on the Government to introduce robust standards for e-health capability and processes which includes the inter-operability of commercial solutions in the market place. "The development of these commercial solutions is getting ahead of Government. It is important that the health professionals who will drive the system and the public who use the system have confidence and choice in it from the outset," Mr Plunkett said. Mr Plunkett said the PSA and its members would do everything possible to assist the Government in speeding up the process of implementation of e-health and its various components”

Sixth we have:

Paperless prescribing a step closer as vendors strike deals

Elizabeth McIntosh - Friday, 21 August 2009

THE leading GP practice software provider has jumped on board with the Pharmacy Guild-backed e-prescribing system, leaving the RACGP-backed product out in the cold for now.

Widely touted as a significant step in reducing medication errors, the e-prescribing systems will allow GPs to send electronic scripts directly to pharmacists – provided they both use the same system.

Last week, Health Communication Network (HCN) – which produces Medical Director – announced a partnership with eRx Script Exchange, an e-prescribing system in which the Pharmacy Guild holds a 50% stake.

In the same week, rival e-prescribing system MediSecure – which won the college’s backing by establishing a GP advisory board – announced an alliance with Zedmed, a smaller practice software vendor.

Best Practice has agreements with both e-prescribing providers, and Genie is now in discussions with the two groups.

More here (registration required):

http://www.medicalobserver.com.au/News/0,1734,5118,21200908.aspx

This seems to be just rolling on!

Seventh we have:

Broadband won't come cheap

Matthew Denholm | August 17, 2009

Article from: The Australian

THE first national broadband network rollout, in Tasmania, will cost an estimated $20,000 for each premises that takes up the superfast internet connection -- and business leaders say its impact may be minimal.

The Rudd and Bartlett governments, which are jointly undertaking the rollout, refuse to reveal the taxpayer-funded plan's cost, business plan or an estimate of the take-up.

However industry sources told The Australian that the take-up rate had been estimated at 17 per cent of the 200,000 target premises -- homes and businesses.

Aurora Energy, the state-owned power company undertaking the rollout via overhead cabling, would not confirm or deny this estimate, claiming it was "commercial in confidence".

A trial of high-speed internet in Tasmania had a take-up rate of 14-15 per cent, which other industry sources said was more realistic a target for the NBN.

With the rollout in Tasmania expected to cost $700 million, a 17per cent take-up (34,000 premises) would mean a unit cost of $20,588.

Tasmania's peak body for information and communication technology industry, TASICT, said without a take-up rate of 80-90 per cent, NBN would lack the "critical mass" needed to become the focus of service and information delivery.

TASICT president Peter Gartlan said even a take-up rate of 20-40 per cent would not "make a big enough difference".

"It needs a very good percentage of take-up to make sure you have the benefits of a high-speed connection and for government and industry to leverage it effectively," Mr Gartlan said.

"For critical mass it has to be pretty high: up to 80 to 90 per cent. If it is not the focus of delivery, it is just another communications means."

He said government might need to step in to offer incentives to increase the take-up, potentially adding to the already unprecedented cost of the project.

Tasmanian Chamber of Commerce and Industry managing director Andrew Scobie said he was "challenged" to see how the plan would deliver greater, justifiable benefits than wireless options.

More here:

http://www.theaustralian.news.com.au/business/story/0,28124,25938987-5018020,00.html

There certainly does seem to be some scepticism about the business case for all this.

Eight we have:

http://www.australianit.news.com.au/story/0,24897,25939922-15306,00.html

$43bn NBN figure plucked from air

Jennifer Hewett | August 15, 2009

WHEN Kevin Rudd proudly announced the government's plan for a national broadband rollout in April, it was a political triumph. The headline figure of $43billion instantly captured the national imagination.

But the $43bn estimate always owed more to political artifice than any detailed financial analysis. Its usefulness was primarily as a shiny big number that would prove to voters -- and to Telstra -- the government was serious.

Cost? Priceless.

In reality, the federal government couldn't know what its grand scheme to provide a high-speed fibre network to the home would cost. There were far too many variables. That's also why there was no business plan -- something the government-appointed Infrastructure Australia was insisting on before it would consider public funding for any infrastructure projects put forward by state governments.

Instead, the $43bn number was the product of a dazzling political manoeuvre, backed by just enough financial assumptions and figurings to allow key departments such as Finance and Treasury to give it their imprimatur.

Initial departmental estimates had varied wildly, from $50bn to about half of that. But the final negotiated agreement on costs allowed the government to announce an estimated cost of $38bn to $43bn for the project.

Even the relatively specific numbers had the political advantage of sounding more credible than round numbers would have -- although any of these could have been regarded as equally valid. So much depends on just what is built and who builds it and what prices are paid for existing network assets that can be sold into the new NBN Company.

Those types of negotiations are only just beginning.

But picking a larger number at the beginning reduced the chances of the government being accused of a cost blowout in years to come while reassuring voters Canberra knew what it was doing.

It fitted neatly into the story of a government committed to "nation building''.

Its sheer size also obliterated the failure of the original much more modest plan of a fibre-to-the-node scheme whose viability had just been shot down by the government's previous expert panel.
Public attention switched immediately to the promise of a much bigger, better scheme delivered to every home.

At the same time, the government's insistence it could get a commercial return on the investment also meant Labor could avoid adding such a massive commitment on to an already overladen budget bottom line.

The strategy worked brilliantly. Telstra folded almost straight away, promising to co-operate and negotiate constructively with government on the national broadband network. The voters were impressed with all the possibilities of the digital future.

Much more here:

If this is even ½ true we might have a small problem. It is a huge amount of money to be committed without a decent and realistic plan. May be the plan it to be able to announce later – we now have a plan and look how cheap it is!

Lastly the slightly more technical article for the week:

HTML 5: Could it kill Flash and Silverlight?

The budding Web spec just might remove the need for proprietary rich Internet app add-ins

Paul Krill (InfoWorld) 17 June, 2009 08:09

HTML 5, a groundbreaking upgrade to the prominent Web presentation specification, could become a game-changer in Web application development, one that might even make obsolete such plug-in-based rich Internet application (RIA) technologies as Adobe Flash, Microsoft Silverlight, and Sun JavaFX.

The World Wide Web Consortium's (W3C) HTML 5 proposal is geared toward Web applications, something not adequately addressed in previous incarnations of HTML, the W3C acknowledges. In other words, HTML 5 tackles the gap that Flash, Silverlight, and JavaFX are trying to fill.

The rich promise of HTML 5

"HTML 5 is really the second coming of this Web stuff -- of the Web," says Dion Almaer, co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. The specification boasts capabilities covering video and graphics on the Web, as well as a slew of APIs, Almaer notes.

HTML 5 technologies such as Canvas, for 2-D drawing on a Web page, are being promoted by heavyweights in the Internet space such as Apple, Google, and Mozilla. (Although Microsoft itself has given a thumbs-up to certain aspects of HTML 5, it has not backed Canvas.)

"HTML 5 features like Canvas, local storage, and Web Workers let us do more in the browser than ever before," says Ben Galbraith, also co-founder of the Ajaxian Web site and co-director of developer tools at Mozilla. Local storage enables users to work in a browser when a connection drops and Web Workers makes "next generation" applications incredibly responsive by pushing long-running tasks to the background, he says.

Web applications will become more fun, says Ian Fette, project manager at Google for the Chrome browser: "They're going to be faster and they're just going to provide overall a better user experience and make the distinction between online apps and desktop apps blurred."

More here:

http://www.computerworld.com.au/article/307687/html_5_could_it_kill_flash_silverlight?fp=4&fpid=611908207

I wonder how this will influence things over time? It is clear what is going to be done in the browser is going to get more complicated and interesting over time.

More next week.

David.

Report and Resource Watch – Week of 17, August, 2009

Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.

First we have:

Five Lessons From Seattle On Adopting Electronic Medical Records

Topics: Health IT

By Julie Appleby

Aug 10, 2009

Third of an occasional series on health information technology.

SEATTLE — Atop a hill here, three of Washington state’s pre-eminent hospital systems sit within blocks of each other, equipped with state-of-the-art electronic medical record systems that track test results, send warnings about dangerous drug interactions and provide medical histories.

But a patient crossing the street from one hospital to another would be wise to bring paper records: The systems, made by different manufacturers, can’t talk to each other.

For much of the country, linking the electronic records of doctors, hospitals and clinics remains an elusive goal. Even in this tech-savvy city, “no one is quite there yet,” says Jim Bender, medical director for health information at Seattle’s Virginia Mason Medical Center.

Among the reasons: cost, computer systems that aren’t compatible with rival systems, resistance among physicians and privacy concerns. Overcoming the obstacles, Bender says, “will take federal will and money.”

Money is on the way. Under the federal-stimulus legislation, the government plans to spend $32 billion on health-information technology over the next 10 years, and projects $13 billion in savings by doing so. Most of the money will go to doctors and hospitals.

But there are risks. Unless the money is doled out carefully, the money “may go down a rathole,” says Janice Newell, chief information officer for Swedish Medical Center, another major hospital here.

That’s one of the lessons of Seattle’s experience, here are more:

More here with a list of key points:

http://www.kaiserhealthnews.org/Stories/2009/August/10/seattle-health-info-tech.aspx

A useful list of lessons to consider.

Second we have:

Electronic Reminders Keep Hearts Healthy

Study Shows Health Advantage for Patients Who Use Electronic Medical Records

By Salynn Boyles

WebMD Health News

Reviewed by Elizabeth Klodas, MD, FACC

Aug. 7, 2009 -- Electronic reminders can help heart patients stay healthy and on their medications even though they are no longer being closely monitored, new research shows.

The study is among the first in the U.S. to show that electronically maintained health records can improve outcomes among heart patients and possibly even lower health care costs.

Researchers followed 421 patients with coronary artery disease enrolled in the Kaiser Permanente Colorado managed care health plan. Medical records for the patients, including physician visits and laboratory and pharmacy data, were kept electronically.

The patients were participants in an intensive pilot intervention program designed to keep them on cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes.

The program -- which linked patients to teams of cardiologists, pharmacists, nurses, and primary care doctors through electronic health records and direct counseling -- resulted in high rates of patient drug compliance and attainment of goals for blood pressure and cholesterol levels.

More here:

http://www.webmd.com/heart-disease/news/20090807/electronic-reminders-keep-hearts-healthy

This is another brick in the wall showing how EHR technologies can assist.

More details are here:

http://www.medindia.net/news/view_main_print_new.asp

Electronic Health Record Links Care Givers And Cardiac Patients

The report is found here:

http://www.ajmc.com/issue/managed-care/2009/2009-08-vol15-n8/AJMC_09aug_Olson_497to503

Third we have:

P4P helps safety net hospitals boost care in just three years

August 07, 2009 | Bernie Monegain, Editor

WASHINGTON – New analysis shows that safety net hospitals have improved patient care through a nationwide pay-for-performance demonstration project, even without the help of information technology.

The Premier healthcare alliance released the results of its research on Thursday. Premier Senior Vice President of Public Affairs Blair Childs said the study included 250 hospitals of all types. The intent was to gauge whether certain types of hospitals performed differently.

Officials at two of the hospitals say the work of gathering the required information will be made much easier and faster once they role out an electronic health record.

"We do not have a fully integrated health information system," said Cathy Robinson, the corporate compliance officer and vice president of medical staff and support services at Rush Health Systems in Meridian, Miss.

Although hospitals like those in the Rush system and the Sinai Health System in Chicago, which serve a disproportionate share of indigent patients, performed below others at the outset, the research revealed that differences in quality lessened after three years in the clinical areas of heart attack, heart failure and hip/knee replacement.

Also after three years the under-representation of safety net hospitals dissipated for hospitals receiving awards that recognize facilities for performance in the top 20 percent of all participants.

The HQID project, or Hospital Quality Incentive Demonstration, is the basis for CMS' proposal to Congress for a national value-based purchasing (VBP) or pay-for-performance (P4P) program.

More here:

http://www.healthcareitnews.com/news/p4p-helps-safety-net-hospitals-boost-care-just-three-years

There is a press release and links to the detailed data found here:

http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp

CMS/Premier Hospital Quality Incentive Demonstration (HQID)

What is interesting is that this organisation is doing well and is wanting to do better with better IT.

Fourth we have:

Making the ‘Big Switch' to cloud computing

By Joseph Conn / HITS staff writer

Posted: August 10, 2009 - 11:00 am EDT

Part one of a two-part series:

It is an odd way to start a magazine story, by recommending that readers rush out and read books. And yet, that is precisely what Newsweek suggested a couple of weeks ago in its article, “Fifty books for our time.”

It is a recommendation repeated here for book No. 4 on that list, The Big Switch: Rewiring the World, From Edison to Google, by Nicholas Carr, first published last year. Newsweek said all of the books on its list “open a window on the times we live in.” In the case of The Big Switch, at least for healthcare information technology, it is more of a window on the times we are only now just beginning to live in, but that's likely to change significantly as time goes by, according to healthcare and IT industry experts contacted for this story.

The switch in question is what Carr, a former executive editor of the Harvard Business Review, sees as the inevitable conversion of most computing from the mainframe, client/server and local network technologies, overwhelmingly the dominant models in clinical healthcare computing today, to the next generation of off-site, remotely hosted and managed services via the “World Wide Computer.” That's a Carr coinage interchangeable with a more commonly used term: cloud computing.

Carr argues that we are on the cusp of a change in business and society as profound as at the end of the 19th century. Back then, industrialists made the big switch of that era, converting their factories from the motive forces of the water wheels and steam plants they owned to a vastly larger-scale, electrical power grid they did not own but used as customers of a utility. Computing, he argues, is being commoditized just as electricity was a century or so ago.

Lots more here:

http://www.modernhealthcare.com/article/20090810/REG/308049977

Second part of the article is here:

http://www.modernhealthcare.com/article/20090811/REG/308119991

These two part provide a good discussion of the place of Cloud Computing in Health IT.

Fifth we have:

States urged to start now on health exchanges

• By Alice Lipowicz
• Aug 10, 2009

State governments should start planning now to foster health information exchanges and adoption of electronic health records in their states, according to new guidance released by the State Alliance for eHealth, which the National Governors Association sponsors.

The Health Information Technology for Economic and Clinical Health (HITECH) Act contained in the economic stimulus law provides at least $2 billion for health information exchanges and up to $45 billion in incentive payments to doctors and hospitals for digitizing their patient records. The law sets a goal of 2014 to dramatically increase the number of providers who are using electronic patient records and participating in health exchanges.

“States must immediately begin planning how they will support this new direction and lead the way for broad deployment and use of Health Information Exchange,” the guidance states. “The role of states in modernizing the health care system was already substantial, but it will dramatically expand as the HITECH Act is implemented.”

Much more here:

http://fcw.com/articles/2009/08/10/states-should-begin-work-now-on-hies.aspx

For a copy of the 32-page guidance, "Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange," click here.

Given the scale of the funding it is worth reading what is being suggested.

Sixth we have:

11 August 2009

eHealth Worldwide

:: Africa: East Africa: Sea Cable Ushers in New Internet Era (23 July 2009 - AllAfrica)
A privately-funded consortium, Seacom, commissioned its Sh59 billion ($760m) undersea cable in Kenya, Tanzania, Mozambique, Uganda and South Africa with Rwanda set to be linked up in the next two weeks. This effectively means that Kenya is now part of the global information superhighway and will be able to compete on a more level platform with more established economies.

More detail here:

http://www.who.int/goe/ehir/2009/11_august_2009/en/index.html

There is a full report with 20+ links found at the URL above.

Second last we have:

Electronic Health Records: Facing the Issues

Richard Raysman and Peter Brown

New York Law Journal

August 12, 2009

Over the past decade, electronic transactions have slowly supplanted paper-based systems in many industries. For example, individuals and Wall Street brokerage firms employ electronic trading; federal and state taxpayers increasingly e-file their returns; and attorneys e-file pleadings and federal court documents. However, a physician jotting notes on a paper chart, which will then be stored in a large filing cabinet, remains the norm.

In February, President Barack Obama signed a $787 billion economic stimulus bill, the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-005, 123 Stat. 115 (2009), which contains the Health Information Technology for Economic and Clinical Health Act encouraging health care providers to adopt electronic medical records. With billions of dollars allocated toward the digitalization of health care, the era of electronic medical records has begun in earnest.

Much more here:

http://www.law.com/jsp/legaltechnology/pubArticleLT.jsp?id=1202432957427&Electronic_Health_Records_Facing_the_Issues

A useful run through the issues from a US legal perspective.

Lastly we have:

EHRs among top concerns for group practices

By Andis Robeznieks / HITS staff writer

Posted: August 12, 2009 - 11:00 am EDT

The top concerns among medical group practices this year were operating costs rising faster than revenue, maintaining physician compensation while reimbursement declines, and choosing and implementing an electronic health record, according to a study released by the Medical Group Management Association.

Those were the same top concerns listed in last year's survey. In this year's survey, the fourth-highest concern was collecting from self-pay patients and those with high-deductible health plans and health saving accounts. For the second year in a row, practices ranked managing finances in the face of uncertain Medicare rates as the fifth-highest concern. Recruiting physicians was the sixth-ranked concern, down from fourth last year.

More here :

http://www.modernhealthcare.com/article/20090812/REG/308129988

The link to the report is in the text. Interesting that moving to EHRs is on the list of major concerns.

Enough goodies for one week!

Enjoy!

David.

International News Extras For the Week (17/08/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Tories to let patients amend medical records online

Conservatives' plan to give the public easier access to their own NHS notes wins backing of GPs

By Jane Merrick and Nina Lakhani

Sunday, 9 August 2009

Patients could amend their own medical records and leave comments on symptoms, medication and treatment, under radical plans unveiled by the Conservatives today.

In a move which could be dubbed "Wiki-health", a Tory government under David Cameron will allow people to access online health records, which are currently restricted. Patients would be prevented from changing key details, but could amend personal medical information.

In a move that could prompt fears of invasion of privacy, patients could also share their data with third parties, such as gyms, private clinics or weight-loss groups, and join online "communities" of people with the same condition or illness to swap experiences and receive support.

The Tories have vowed to scrap the controversial NHS IT system, which has already cost more than £12bn and whose completion is years behind schedule. Instead, electronic medical records would be handled by a private internet giant such as Microsoft or Google, which has links to one of Mr Cameron's closest aides, Steve Hilton.

Some senior Tories, including the former shadow home secretary David Davis, expressed concern that Google would control private data. However, doctors' leaders last night welcomed any move to empower patients and make records more interactive.

The plans are in a review of the way medical records are handled, commissioned by the shadow health minister Stephen O'Brien. He said: "Giving patients greater control over their health records is crucial if we are to make the NHS more patient-centred. Labour's attitude to personal data is misguided. They seem to think they own it and, all too often, they have been appallingly careless in looking after it.

Much more here:

http://www.independent.co.uk/news/uk/politics/tories-to-let-patients-amend-medical-records-online-1769694.html

With an election due next year we are going to hear a lot more about all this. One really hopes we don’t wind up with a ‘baby and bathwater’ situation. There is some pretty good stuff that has been done!

Second we have:

Electronic health cards face resistance in Germany

Sindya Bhanoo, The Industry Standard

08.10.2009

In Germany, many in the medical field think that the government's push to roll out nationwide e-health cards may mean too much technology too fast.

Germany has already partially transitioned to electronic health records, and many hospitals are currently in the midst of a major transition to electronic records, said Martin Peuker, the deputy CIO of Charite Hospital in Berlin. He said that the electronic health cards would be interoperable with EHR programs in hospitals and store, as well as retrieve, patient medical history, insurance information and prescriptions on a microchip.

Beta versions of the the cards, which are currently being tested in northwest Germany, recently met national security and privacy regulations required for a national rollout, according to Gematik, a private company involved in the design of the card.

Still, some health IT experts expressed concern.

"It's a typically German project -- very complicated," Peuker said.

Peuker and his IT team are interested in the e-health card, but warn that convincing doctors to use technology can be a difficult task. According to Peuker, even before the card technology was tested, there were problems with the older EHR implementation. For several years, he said, Charite Hospital has been refining its EHR system. Doctors often protest having to use it. "Every day, we have this discussion," Peuker said. "They say, it would be so much faster to do it all on paper."

In April, German insurance companies announced they were ready to deploy e-health cards throughout the country, but faced resistance from doctors and pharmacists who refused to purchase the necessary card reading equipment.

More here:

http://www.thestandard.com/news/2009/08/10/electronic-health-cards-face-resistance-germany

It seems major international projects are having trouble all over!

Third we have:

Monday, August 10, 2009

Mobile Phones Drive Health IT Innovation in Developing Countries

by Paula Fortner, iHealthBeat Senior Staff Writer

Although the U.S. health care system has dominated the media spotlight in recent months, innovative mobile technologies are helping to fundamentally transform health care in many developing countries.

Last month, the Rockefeller Foundation announced a $100 million initiative to strengthen health systems in Africa and Asia by building capacity, supporting policy interventions and promoting health IT applications.

As part of its health IT strategy, the foundation intends to leverage mobile phone-based technologies to improve health care access, quality and efficiency.

Karl Brown, Rockefeller's associate director of applied technology, explained that the foundation sees mobile health technologies "as sort of the front lines of e-health." He said that although servers, databases and Web sites will be necessary to support the mobile phone applications, health workers can use the devices to extend their reach to regions that lack adequate health care infrastructure.

An Environment Ripe for Mobile Health

According to Brown, mobile health tools are particularly suited to meet the needs of developing countries. "The thing that is very compelling about the mobile phone is that it's an infrastructure that is growing very fast of its own accord, and it exists for the most part in a lot of these countries," Brown said. He added, "The mobile phone is much more suited to a lot of these environments in some cases than a computer or a laptop or an Internet connection because it doesn't use a lot of power."

At the AED Satellife Center for Health Information and Technology, staff members work with local and international nongovernmental organizations to develop mobile data collection and dissemination tools. Andrew Sideman, Satellife's associate center director, says many regions of developing countries do not have reliable access to the Internet or even electricity.

"One of the reasons that we were interested in using PDAs, and now mobile phones is that they are very stingy with power," Sideman said. "Because the batteries can last for seven or eight hours between charges, and then they charge very quickly from a solar charger, we can circumvent the issues of not having a strong electric grid infrastructure."

Despite limitations in Internet and electricity access, most developing countries have some degree of mobile phone coverage. According to the U.N. Foundation, about 80% of the world's population lives in a region with mobile phone coverage and about 64% of all mobile phone users live in the developing world.

Brown explained that many people in developing countries already possess mobile phones and are familiar with basic functions such as making phone calls and sending text messages. Therefore, he said, it doesn't take long to train people to use new mobile phone applications such as Internet browsers or information systems.

Reporting continues here (with links):

http://www.ihealthbeat.org/Features/2009/Mobile-Phones-Driving-Health-IT-Innovation-in-Developing-Countries.aspx

Interesting material indeed.

Fourth we have:

Hospitals slow to use technology to halt errors

Don Finley, Hearst Newspapers

Monday, August 10, 2009

(08-10) 04:00 PDT San Antonio -- At a nurses station at busy Metropolitan Methodist Hospital, Dr. Randy Panther pauses to check the Caller ID on his incessantly ringing cell phone. Then he uses a high-tech device called an electronic prescription pad to order antibiotics for a patient's infection.

On the screen, a pop-up window warns that the patient has a drug allergy. The computer suggests a safer choice.

Down the hall, nurse Esther Garcia is distributing medication from a cart topped with a laptop computer and a hand-held bar code scanner - the kind used by supermarket clerks on bulky items like 20-pound bags of dog food.

First she scans the bar code label on a dose of medicine prepackaged by the hospital pharmacy. Then she scans the bar code on a patient's hospital bracelet. The laptop informs her she's giving the patient the prescribed dose.

These systems were designed to prevent errors where they commonly occur in a hospital - on the doctor's prescription pad and during the nurse's medication rounds. Some research suggests that hospitals using both systems could eliminate most medication errors, innocent mistakes that can cause grievous injury to some patients and kill others outright.

But few hospitals use the new technology. A recent survey suggests that only 17 percent of U.S. hospitals use the electronic prescription pad, more formally known as the computerized provider order entry system, or CPOE. Other surveys have found even fewer hospitals use bar coding.

Cost is a major factor - a computerized entry system can cost a major hospital upward of $11 million, according to published estimates. But experts say hospitals have had other reasons to drag their feet.

Steep adoption curve

The Hospital Corporation of America, the nation's largest private health care chain, uses bar coding in all of its 163 hospitals. CPOE, the more expensive technology, is used in about 20, including Metropolitan Methodist. But that system is still voluntary for physicians, and only a handful of the hospital's doctors use it. The rest continue to scribble on paper, putting patients at risk of misread prescriptions.

"We're looking at a very steep curve of adoption of CPOE," said Dr. Jonathan Perlin, chief medical officer of the chain.

Doctors are slow to embrace computer innovations because some recent medical software technologies "really weren't built with a professional friendliness," Perlin said.

In addition, there's debate in the profession about whether the new systems do more harm than good. When Children's Hospital of Pittsburgh launched its computerized provider order entry system in 2001, the death rate actually rose for five months. Critics blamed poorly designed software.

Nevertheless, Dr. Robert Wachter, professor of hospital medicine at UCSF and an expert on medical errors, sees promise in new systems, especially bar coding. He says it might eliminate egregious errors like the overdose of blood thinner that almost killed the newborn twins of actor Dennis Quaid in 2007.

Much more here:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/09/MNN9191UJC.DTL

This is a good summary of the adoption issues of best practice in error prevention – including Health IT!

Fifth we have:

Surescripts looks to cash in on push for e-prescribing

Posted: August 10, 2009 - 5:59 am EDT

A little over a year after the merger of the two largest electronic prescribing exchanges, SureScripts and RxHub, the merged for-profit company is in line to benefit from the federal government's financial push for physicians to e-prescribe.

The privately held company, which now goes by Surescripts, already is growing quickly as a result of recent uptick in e-prescribing and from the economies of scale that resulted from the merger of the two competitors.

“E-prescribing volume has just skyrocketed, and we've handled that without adding a lot of new people,” says Surescripts President and CEO Harry Totonis. “We're processing twice as many transactions with relatively the same number of people. The efficiency we get is benefiting everyone.” Surescripts declined to provide financial data on the company.

The merger pooled the resources of two companies whose sponsors are either directly or indirectly still battling for market share in prescription drug sales. Both SureScripts and RxHub were formed in the aftermath of the 2000 bursting of the dot-com bubble that wiped out several e-prescribing startups.

In February 2001, the then three largest pharmacy benefit manager companies, AdvancePCS (later acquired by CareMark Rx, now CVS Caremark), Express Scripts and Medco Health Solutions formed RxHub to serve as their e-prescribing gateway.

Much more here (registration required):

http://www.modernhealthcare.com/article/20090810/MODERNPHYSICIAN/308109997

This is a useful discussion of the state of e-Prescribing in the US.

Sixth we have:

NZ e-records bill could be US$300m

The Dominion Post

Last updated 05:00 10/08/2009

A nationwide electronic health records system will cost at least US$300 million (NZ$447m), according to one of the world's largest health software providers.

Such a system would hold a record of a person's health history, and could be accessed by all health providers and patients themselves.

The projection comes as seven district health boards gear up to buy such a system, which could be introduced throughout the country.

ISoft chief executive Gary Cohen says given the United States with a population of about 300 million has allocated US$19 billion towards the development of electronic health records, New Zealand would have to pay at least US$300m to establish a nationwide system.

"I don't believe a proper system across the country can be done for less than that."

More here:

http://www.stuff.co.nz/technology/2734004/NZ-e-records-bill-could-be-US-300m

I am not sure why this discussion is being had. Seems to me it is a ‘how long is a piece of string’ sort of discussion. It will cost what is needed to put in place what is needed.

Seventh we have:

Health IT will be critical for data-rich decisions

By Mary Mosquera

Friday, August 07, 2009

The adoption of health information technology is aimed at improving the quality of healthcare. It will also be critical to handling the volume of patient data that will rapidly multiply as healthcare becomes more personalized, according to Dr. John Glaser, an advisor to the Office of the National Coordinator for Health IT as well as chief information officer of Partners Healthcare in Boston.

Glaser, together with ONC head Dr. David Blumenthal and Obama administration chief technology officer Aneesh Chopra, spoke at an Aug. 6 meeting of the President’s Council of Advisors on Science and Technology.

“When we look into the future, one of the things we see is the sheer volume of data that has to be sorted through,” Glaser said. “I might have hundreds of notes to go through for a patient, and I don’t have time to do that. Which are the notes most relevant to my hypothesis about the patient?”

Clinicians need business intelligence and analysis for that to occur, Glazer told the group. Similarly, physicians need to determine the true set of medications that a patient who gets care from multiple physicians across multiple organizations, is using.

More here:

http://govhealthit.com/newsitem.aspx?nid=71956

Eighth we have:

SSA to expand electronic health record project

By Mary Mosquera

Monday, August 10, 2009

The Social Security Administration announced Friday it has $24 million available for contracts with hospital networks and health information exchanges willing to electronically share the health records of patients seeking disability benefits from the agency.

SSA posted a request for proposals Aug. 7 to expand the number of healthcare organizations that will participate in the project, which links providers electronically to SSA via local HIEs and the nationwide health information network (NHIN). Responses are due Sept. 18. Contracts, which are funded through the stimulus law, will be fixed price and last 12 months.

The RFP can be found at:

https://www.fbo.gov/?s=opportunity&mode=form&id=df343db1bf298ef9336bb8da0e723863&tab=core&_cview=0

SSA in February began electronically collecting medical data from MedVirginia, a central Virginia health information exchange that links several hospitals. SSA is linked to MedVirginia via the federal CONNECT gateway, a tool that enables agencies to access the NHIN. With the new RFP, SSA wants to build on its successes with MedVirginia.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from providers who have treated them. The use of health IT will vastly improve the efficiency of this still largely paper-based process, said Michael Astrue, Social Security commissioner.

“With these competitive contracts, Social Security continues to be a leader in the use of health IT to improve service to the American public,” he said.

Full article here:

http://govhealthit.com/newsitem.aspx?nid=71959

This is important standards based progress. Really quite exciting given the scale of the problem.

Ninth we have:

Big Loss for Eclipsys

HDM Breaking News, August 7, 2009

Hospital software vendor Eclipsys Corp. had a large loss during the second quarter of 2009 as revenue slightly dipped.

The Atlanta-based company recorded a net loss of $4.1 million, or seven cents per share, compared with net income of $8.5 million during second quarter of 2008. Investment analysts expected earnings per share of 12 cents. Quarterly revenue fell 1.7% to $129.8 million.

For the first six months of 2009, Eclipsys lost nearly $5 million compared with profit of $8.7 million a year ago. Half-year revenue rose 1.4% to $260 million.

Much more here:

http://www.healthdatamanagement.com/news/financial_performance-38784-1.html?ET=healthdatamanagement:e966:100325a:&st=email

Surprising a major Health IT provider is not doing better.

This report is just above water also.

http://www.healthdatamanagement.com/news/financial_performance-38785-1.html?ET=healthdatamanagement:e966:100325a:&st=email

Earnings, Revenue Down for QuadraMed

Tenth we have:

Doctors Get Better Decision Support Tools

Christus Health, a large hospital operator, deploys five clinical support offerings from Elsevier.

By Marianne Kolbasuk McGee

InformationWeek

August 11, 2009 08:00 AM

Christus Health, which operates about 40 U.S. healthcare facilities, is rolling out clinical decision support software from Elsevier to about two dozen of its Texas hospitals.

The non-profit, Catholic health system is based in Dallas but has hospitals, physician offices, and clinics in 70 cities in Texas, Arkansas, Louisiana, Oklahoma, Utah, and Mexico.

Christus is rolling out five Elsevier online clinical support offerings, including Clinical Pharmacology, which provides drug information. It's also using Elsevier's ToxED 2.0, which helps treat drug overdoses; First Consult, which offers point-of-care, evidence-based decision support; MD Consult, which integrates several medical resources in an online service; and Mosby's Nursing Consult, which helps nurses quickly find answers to clinical questions.

More here:

http://www.informationweek.com/news/healthcare/clinical-systems/showArticle.jhtml?articleID=219100660

It would be good to roll something like this out in Australia – for all clinicians - as recommended by Deloittes.

Eleventh for the week we have:

Online Treatment May Help Insomniacs

By AMANDA SCHAFFER

You can do almost anything on the Internet these days. What about getting a good night’s sleep?

It might be possible, some researchers say. Web-based programs to treat insomnia are proliferating, and two small but rigorous studies suggest that online applications based on cognitive behavioral therapy can be effective.

“Fifteen years ago, people would have thought it was crazy to get therapy remotely,” said Bruce Wampold, a professor of counseling psychology at the University of Wisconsin. “But as we do more and more things electronically, including have social relationships, more therapists have come to believe that this can be an effective way to deliver services to some people.”

The first controlled study of an online program for insomnia was published in 2004. But the results were hard to interpret, because they showed similar benefits for those who used the program and those in the control group. The two new studies, from researchers in Virginia and in Canada, advance the evidence that such programs can work.

In the Virginia study, called SHUTi, patients enter several weeks of sleep diaries, and the program calculates a window of time during which they are allowed to sleep. Patients limit the time they spend in bed to roughly the hours that they have actually been sleeping.

The goal is to consolidate sleep, then gradually expand its duration — the same technique that would be used in face-to-face therapy, said Lee Ritterband, a psychologist at the University of Virginia, who developed the program.

Stella Parolisi, 65, a registered nurse in Virginia and a patient in the study, said sticking to the restricted sleep schedule was hard, “but toward the end, it started to pay off.”

“Before, if I was exhausted, I would try to get to bed earlier and earlier, which was the wrong thing,” she said. “It just gave me more time to toss and turn.”

But after using the program, she began to sleep for at least one four-hour stretch a night.

Much, much, more here:

http://www.nytimes.com/2009/08/11/health/11slee.html?_r=2&ref=health

Interesting approach to getting to sleep – browsing a web site!

Twelfth we have:

AAFP subsidiary unveils networking site for docs

By Andis Robeznieks / HITS staff writer

Posted: August 11, 2009 - 11:00 am EDT

TransforMED, a wholly owned, for-profit subsidiary of the American Academy of Family Physicians, has developed a networking Web site for helping primary-care practices implement the medical home model of care.

Called Delta-Exchange, the site will provide case studies, how-to articles and other resources that provide information on topics such as developing team-based care, maximizing office space and managing change, a news release said.

Users will be charged a $30 monthly fee and will be able to post documents, share images and videos and create wiki pages. The functions of Delta-Exchange are said to be based on the findings of a two-year, medical-home national demonstration project.

More here (registration required):

http://www.modernhealthcare.com/article/20090811/REG/308119989

This is a good idea to expand Health IT use in the US GP world.

Thirteenth we have:

Elsevier launches online tool to help nurses avoid 'never events'

August 11, 2009 | Diana Manos, Senior Editor

PHILADELPHIA – Elsevier has launched an online tool to help nurses prevent the 10 "never events" identified by the Centers for Medicare and Medicaid Services.

According to officials of the Philadelphia-based healthcare information services provider, the tool empowers nurses to prevent "never events," or hospital-acquired conditions (HAC), in the quest to improve care quality and maximize hospital reimbursement.

Elsevier will make the tool available on its Mosby's Nursing Consult Web site in the CMS never events section.

"CMS Never Events supports nurses in proactively preventing avoidable incidents and ensuring that patients receive the safe, high quality and efficient care they expect from hospitals," said Eileen Robinson, director of nursing continuing education for Elsevier. "Professional nurses have a responsibility to prevent adverse events as part of a broader effort to improve quality, enhance the patient care experience and increase the hospital's financial stability."

Nursing Consult's contributors developed CMS Never Events in response to CMS' 2008 decision that it would no longer pay for adverse events that could be prevented through the application of specific evidence-based protocols. In addition, CMS does not permit patients to be billed for the cost of these events.

More here:

http://www.healthcareitnews.com/news/elsevier-launches-online-tool-help-nurses-avoid-never-events

Sounds like a good initiative.

Fourteenth we have:

Certification Recommendations OK'd

HDM Breaking News, August 14, 2009

Multiple entities could provide certification services that attest an electronic health records system meets meaningful use requirements under the American Recovery and Reinvestment Act, according to recommendations adopted today by the HIT Policy Committee.

The recommendations now go to the Department of Health and Human Services for consideration as federal officials write the rules that will implement the Medicare/Medicaid incentive programs for meaningful use of EHRs.

The recommendations also mean that the Certification Commission for Healthcare Information Technology soon could have competition. The workgroup recommends that multiple organizations be accredited to perform "HHS Certification" testing and provide certification. HHS Certification means a certifying process that is limited to the minimum set of criteria necessary to meet functional requirements of ARRA and achieve the law's meaningful use objectives.

Much more here:

http://www.healthdatamanagement.com/news/stimulus-38815-1.html?ET=healthdatamanagement:e975:100325a:&st=email

I hope having multiple groups doing this work – actually improves things.

Fifteenth we have:

AGENCY'S FORMER CEO SPEAKS OUT

Here is the statement by former eHealth Ontario CEO Sarah Kramer:

Since leaving eHealth Ontario in June, I have refrained from public comment about my time as CEO, or the controversy that prompted my departure from the organization.

However, in the last few days, a number of media reports have appeared, filled with new and misleading allegations. In these circumstances, I now feel compelled to make the following comments.

The Auditor General of Ontario is currently conducting a review of the consultant fees and all other financial matters relating to my time at eHealth Ontario – and the period that preceded me at Smart Systems for Health Agency (SSHA).

These latest media stories are an attempt to pre-empt that report and its findings.

The simple fact is that when I took over as CEO at eHealth Ontario last year, I was charged with turning around a failing behemoth – SSHA – which had already run through more than $600 million dollars with hardly anything to show for it in terms of moving Ontario closer to the goal of eHealth, and modernizing and improving the quality and safety of health care for Ontarians.

With the clear direction and full support of the Board and the government, I worked hard to jumpstart what, as SSHA, had been a moribund and deeply troubled and dysfunctional organization.

An essential part of this was shedding an internal culture that prized process above results. This had two important consequences: ruffling the feathers of an entrenched and ineffective bureaucracy, and bringing on outside consultants – among the most respected eHealth experts not just in Canada, but the world.

As with any major change, our efforts were met with strong, intractable resistance and outright hostility in some quarters, including within the Ministry of Health and among a few other vested interests in the health care sector.

Indeed, much of the sensationalized media coverage over the last several months has been based on the unchallenged accounts of those interests who opposed and sought to forestall these essential reforms which the government had mandated me to implement.

The immense opposition which confronted us made the work of outside health care and eHealth experts even more essential. The sums involved in recruiting this expertise were not negligible.

But I – with the full support of the Board of Directors – believed that was an essential investment in turning around what was a badly drifting organization.

Given the many hundreds of millions that were squandered under the auspices of SSHA, it is ironic that the much smaller amounts spent on these consultants have garnered so much attention.

These are the facts.

Rather than a continuation of these misleading and destructive news stories, I look forward to the Auditor General’s report.

Source:

http://www.thestar.com/news/ontario/article/681162

Since Ms Kramer has spoken out – it seemed fair to let people judge if her comments balance the other reports we have carried. Some of this has the ring of truth to me.

Fifth last we have:

AHRQ plans $48 million in grants for patient registries

By Mary Mosquera
Wednesday, August 12, 2009

The Agency for Healthcare Research and Quality plans to make available in the fall details of grant opportunities worth $48 million for developing national patient registries for researching the long-term effects of treatment strategies and collecting data on under-represented populations.

Beside the patient registries, AHRQ plans grants and contracts amounting to $300 million in total for comparative effectiveness projects funded by the economic stimulus. Among the projects, the agency of the Health and Human Services Department will provide grants for a coordinated national effort to study and measure the treatment benefits in routine clinical practice. AHRQ will initially concentrate on 14 common conditions, including diabetes, obesity, and heart and blood vessel conditions.

More here:

http://www.govhealthit.com/newsitem.aspx?nid=71963

First get the data and then you can make the changes!

Fourth last we have:

No, Don't Buy an EMR Now! Yes, Buy an EMR Now!

Gregory A. Hood, MD; Joseph E. Scherger, MD, MPH

Published: 08/05/2009

Introduction

Electronic medical records (EMRs) evoke strong reactions, from anger to enthusiasm. The US Government considers EMRs vital to controlling healthcare costs and improving patient care, but adoption is lagging. Doctors cite cost, work slowdown, potential problems and difficulties, and other issues as reasons to avoid an EMR. Medscape invited 2 experts to present their points of view on whether doctors should buy an EMR now.

On "point," we welcome Gregory A. Hood, MD, internist with Drs. Borders and Associates, PSC, in Lexington, Kentucky, and Governor-Elect of the American College of Physicians, Kentucky chapter. On "counterpoint," we have Joseph E. Scherger, MD, MPH, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine California, and Medical Director of Quality and Informatics at Lumetra in San Francisco, California.

Debate here (registration required):

http://www.medscape.com/viewarticle/706725?src=mp&spon=18&uac=17738FT

Good debate – issue is timing – not whether to proceed!

Third last we have:

A Virtual Repository for Patient Records
AVPR enables health care providers to extend the reach of limited EHR systems.

By Libby Bucsi

As a health care provider, you face challenges similar to those in industries such as manufacturing, telecommunications, retail and others -- "stovepiped," non-integrated systems that store only part of the information your organization creates. Virtually all functional areas of a hospital or clinic may have their own systems, each organized around the function they support -- such as admissions, surgery, radiology, laboratory, pharmacy, HR, anesthesiology, and others -- rather than around the patient they serve.

Electronic health record (EHR) systems (which for the purposes of this article include EHRs, EMRs and EPRs) -- used by most health care organizations and designed to help manage some of this information -- often contain only 30 to 50 percent of a patient's information, either clinical or financial. The rest of this data exists in multiple locations and in varied forms, often paper. A substantial amount of patient data resides in proprietary information silos of electronic systems such as surgery, radiology, pharmacy, or even e-mail, to which EHR systems do not have access.

The volume of patient data is great and the variety of the data makes the situation even more complex. Patient data can include:

· contracts, claims and invoices;

· physical referrals, admissions questionnaires and patient-consent forms;

· test results, incident reports and consultation summaries;

· Web pages, e-mail and instant messages;

· audio, video, and picture archiving and computer systems (PACS) images; and

· enterprise application data, corporate records and procedure manuals.

The result of all this complexity? Siloed, hard-to-access digital information and scattered, poorly managed physical information, ultimately resulting in reduced quality of patient care, inefficiencies and non-compliance.

Virtual repository for patient records

To address these issues, health care providers are turning to virtual repositories for patient records (VPRs). A VPR is a central repository for all unstructured content. A VPR is not a replacement to EHR systems, but a vital adjunct. It is an adapter-based solution that complements and enhances industry-standard medical information systems such as McKesson, Epic, Picis, GE, PeopleSoft, and others that often have limited interoperability.

A VPR provides a single, consolidated, patient-centric view of information -- clinical and non-clinical -- delivered by a platform that bridges the gap between disparate systems, enables regulatory information to be managed via automated business rules, streamlines clinical and administrative processes, and effectively deals with paper. Rather than further complicating an already complicated information infrastructure, a VPR is accessed through the familiar interface of an EHR system.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=204619

This is an interesting idea. Worth a read. It seems EMC have one for sale if you are interested!

Second last we have:

Getting It Right the First Time
Testing and validation are crucial steps to take before going live with electronic health records.

By Robin Tardif

Paper-based medical charts are quickly being replaced by electronic health records (EHRs), and for good reason. EHRs allow patient records to flow seamlessly and securely across hospitals, labs and physician practices. This decreases redundant entries and clerical errors while enabling facilities to add to the existing patient record. In turn, complete and accurate information is delivered expediently, improving the delivery of health care. Additionally, since the American Recovery and Reinvestment Act of 2009 (ARRA) provides incentives for health care organizations to make meaningful use of EHRs, there is even more reason to do it quickly, and to do it right.

EHRs are still big-ticket items. Depending on the number of physicians and patients, desired interfaces, required hardware, hired consultants, and myriad options and variables, EHRs can cost hundreds of thousands of dollars, if not more. To justify that sort of expense, the return on investment (ROI) needs to be as large as possible.

EHRs bring with them a new set of rules, including access protocols, and processes/policies for the sharing and securing of patient information (not to mention expanded HIPAA regulations under ARRA). As organizations become reliant on this technology, it is crucial that it works correctly and accurately.

One of the most important methods for ensuring that your new EHR holds accurate data, works properly and will maximize your investment is to perform thorough, exhaustive testing and validation prior to implementation. Implementing an efficient system with high user retention and short transition times will help ensure that your organization's EHR meets expectations and optimizes your ROI.

Much more here:

http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=204616

Amen to that – sensible read indeed!

Last, and very usefully, we have:

Can digital health protect your privacy?

As hospitals begin to more widely adopt electronic health records, it will take more than technology to secure your privacy.

By David Goldman, CNNMoney.com staff writer

Last Updated: August 11, 2009: 3:27 PM ET

NEW YORK (CNNMoney.com) -- Digitizing health records. A good idea say most experts, but it will take a feat of policy, technology and education to ensure your records don't get into the wrong hands.

It all starts with one basic question: Who actually owns your health records?

"Right now, hospitals assume the liability, but the model has to shift to one where the patient controls the data and whether it is put online," said Dr. David Brailer, chairman of Health Evolution Partners and former health tech czar under President Bush. "The people who hold your data control your data."

Controlling the dissemination of patient data is becoming more of a hot-button issue as the push to go digital heats up. The Obama administration is spending $20 billion on incentives to hospitals and physician offices to ensure that a national digital health network is formed by 2014.

Much more here:

http://money.cnn.com/2009/08/11/technology/electronic_health_records_privacy/?postversion=2009081115

Just a reminder that it will be both technology and people that get this done! The people need to be sure their private information will stay just that – private!

There is an amazing amount happening. Enjoy!

David.