Again there has been just a heap of stuff arrive this week.
First we have:
Electronic Medical Record Mandates to Increase Jobs in IT
By: Don E. Sears
2009-08-28
With a $20 billion infusion from the Health Information Technology Act, the EMR market is expected to grow in major ways. Expect jobs to expand in systems integration, programming, project management and training.
Where are IT jobs going to be over the next two years? There are a number of expectations, including a whole lot more in Web application development, including social media, enterprise software and a host of mobile applications for Internet-enabled devices such as the iPhone and competitors.
Another area expected to have growth is in health care, specifically in electronic medical records (EMRs).
With a large economic stimulus package behind it, the EMR market is expected to grow in major ways with a $20 billion infusion from the Health Information Technology Act. As detailed in an article at NWjobs.com (affiliated with the Seattle Times), the EMR market for job growth will run the spectrum from technical sales to training to programming. From the article:
The Bureau of Labor Statistics says employment for medical records and health information technicians is expected to grow faster than average for all occupations, with an 18 percent increase through 2016. Within the field there are 125 job titles in more than 40 settings, says Gretchen Murphy, director of University of Washington programs in health information management.
The companies that make and sell EMR software are a good starting point for employment. Jobs can run the gamut from sales to training to project management.
EMR sales careers can range from entry-level telemarketers with base pay in the $30,000s to the six-figure field sales positions.
Much more here:
This is a positive aspect of a move to e-Health that is often forgotten.
A detailed follow-up article is also found here:
Second we have:
New gadgets prod people to remember their meds
By Scott Kirsner, Globe Columnist | August 30, 2009
About 35 years ago, Boston University psychology professor Andrew Dibner had the sort of flash of inspiration that can propel an entrepreneur for years: When an elderly or disabled person falls and needs help, what if there was technology in their home that could summon an ambulance for them - even if they couldn’t get to a phone?
No one was sure the world needed Dibner’s technology - including the senior citizens he wanted to help - and no one wanted to finance his idea, either.
Despite the obstacles, Dibner’s company, Lifeline Systems Inc., created an entire business category - personal emergency response systems, often worn by seniors as a pendant around the neck - and dominated that category for decades before being acquired in 2006 for $750 million. (It was one of Lifeline’s rivals, no longer around, that gave us the unforgettable phrase, “I’ve fallen and I can’t get up!’’)
Dibner, now retired and living amid the golf courses of Sun City, Ariz., is helping to launch another technology start-up targeting seniors. He is an investor and adviser. MedMinder Systems Inc., a Newton start-up, is one of several local companies developing technologies to remind people to take medicine.
But is the world ready for the wirelessly connected pill organizer that flashes, beeps, e-mails, and calls you on the phone?
Amazingly, while the cost of prescription drugs represents a significant chunk of our health care spending, both as individuals and as a country, the cost of not taking the drugs that have been prescribed to us has major economic repercussions.
A study released this month by the New England Healthcare Institute, a Cambridge think tank, found that anywhere from a third to a half of all Americans don’t take their meds, or don’t take them at the right time or at the right dosage. The institute estimated that the result - which can include extra doctors visits and even hospitalization - costs $290 billion annually.
MedMinder has designed an intelligent pill organizer called Maya that’s about the size and shape of a large textbook.
More here:
Sounds like a great idea to me. Getting my Mum to remember to take her medicine was the bane of the last 10 years of her very long life!
Third we have:
Assessing Demand for EHRs
HDM Breaking News, August 28, 2009
The Medicare and Medicaid incentives for adopting electronic health records will lead to a gradual build in demand for the software, rather than a surge, one investment analyst says. “That’s because some portion of the market will want to wait to see the final rules,” says Raymond Falci, managing director of Cain Brothers & Co., New York, who tracks public health care I.T. firms.
On Aug. 20, David Blumenthal, M.D., national coordinator for health information technology, predicted that the final definition of the “meaningful use” of electronic health records that will be used to determine eligibility for incentive payments under the economic stimulus program will not be available until the middle or end of spring 2010. The preliminary definition of meaningful use requirements will be issued by the end of this year, followed by a 60-day comment period, Blumenthal said.
This timing for defining meaningful use, which is later than many expected, may mean demand for EHRs will ramp up more gradually than if the details were known sooner, Falci says. Regardless, health care organizations are dividing into two camps: Those that are moving forward with plans to qualify for federal electronic health records incentive payments and those that are waiting for the final regulations on incentives, he says.
“A lot of hospital CIOs and group practice administrators have told me that they need to get started now” to ensure they qualify for maximum incentives by having a qualifying EHR in place by 2011, the analyst says.
Falci speculates that the federal government might wind up pushing back all the deadlines called for under the American Recovery and Reinvestment Act, much as it did when creating the rules to carry out HIPAA. “My guess is, in the big picture of what the government is trying to accomplish, they’re going to have to modify the timeline.”
Regardless, the Wall Street analyst predicts that most clinical software companies “will be pretty busy next year just serving those who want to get a jump start. So I’m not too concerned about the impact on their financial performance.”
Reporting continues here:
http://www.healthdatamanagement.com/news/ARRA-38893-1.html
Given the scale of the program I guess some slippage is inevitable – we shall see!
Fourth we have:
FTC final rule requires quick PHR breach notification
By Joseph Conn / HITS staff writer
Posted: August 31, 2009 - 11:00 am EDT
The Federal Trade Commission weighed in last week with new rules to protect the privacy and security of personally identifiable healthcare information stored on personal health-record systems offered by companies not covered by federal privacy rules under the Health Insurance Portability and Accountability Act of 1996.
The FTC rulemaking on breach notification by vendors of PHRs comes under the authority of the American Recovery and Reinvestment Act of 2009.
Broadly, the new FTC rule calls for customer notification in the event of a breach of identifiable health information. Notification must occur “without unreasonable delay” but no later than 60 days after the breach is discovered.
The FTC estimates that about 200 PHR vendors, 500 “PHR-related entities” and 200 service providers will be covered by the rule. Of these, the FTC estimated there will be 11 breaches a year that will require notification to an estimated 232,000 PHR customers, with a total cost of compliance at $795,000.
The FTC interim final rule said the stimulus law “recognizes there are new types of Web-based entities that collect consumer's health information,” including “vendors of personal health records and online applications that interact with such” PHRs that additionally “are not subject to the existing privacy and security requirements” of HIPAA.
More here (registration required):
http://www.modernhealthcare.com/article/20090831/REG/308319912
I have to say it is good our Privacy Commissioner is also suggesting we have such breach notification.
Fifth we have:
HealthPartners saves money with e-records
Minneapolis / St. Paul Business Journal - by Chris Newmarker Staff writer
HealthPartners is providing some proof for health reform advocates who say that electronic medical records can save health providers money.
The Bloomington-based health provider and insurer says it’s saved $430,000 over the past year by including electronic X-rays, MRIs, CT scans and radiology reports in patients’ electronic health records. Savings included $130,000 that no longer had to be spent on transcribing radiologist reports, and $300,000 that was no longer needed for film storage costs.
That doesn’t include the savings that came from reducing radiology report turnaround times from two days to about four hours.
“The benefits of being paperless include increased efficiency because images can be available quickly at multiple locations and they cannot be lost,” said Kim LaReau, vice president and chief information officer at HealthParters’ Regions Hospital in St. Paul.
More here:
http://www.bizjournals.com/twincities/stories/2009/08/24/daily55.html?s=industry&i=health_care
The evidence on both saving and service improvement continues to build.
Sixth we have:
Standard e-health records a way off yet
Published Monday August 31st, 2009
Digital Technology is not main issue for national file sharing system
SAINT JOHN - Electronic health records won't be standardized country-wide anytime soon, nor should they be, says Norm Archer, professor emeritus at McMaster University.
As all jurisdictions in Canada move towards making digital health records available to any authorized health professional the idea of a national patient file sharing system is seen as the ultimate goal.
But Archer, who spoke on a panel about e-health at a technology conference in Saint John last week, doesn't believe it is possible within five to 10 years, the speculated timeline for country-wide electronic file sharing.
Other panelists, including Jean-Marie Godin of FacilicorpNB, the provincial Crown corporation that manages IT services for provincial health care, say expanding electronic health records across Canada is an achievable goal.
But standardizing is more difficult he says. Godin, who used to work for the former Acadie-Bathurst Health Authority, says it took three months for the gynecologists in Bathurst to standardize ways of recording the 11 different results for a pap test.
"Standards is the issue here, not technology," Godin says.
Archer says standardization should be left to relatively small geographic areas that most people would normally go to receive health care. For New Brunswick this may be the whole province, but for Ontario he says there would have to be multiple regions.
For the rare occasions that someone needs medical attention outside their home region Archer says the doctor can still pick up the phone. He sees country-wide standardization as a much longer-term goal.
More here:
http://nbbusinessjournal.canadaeast.com/front/article/776661
Some interesting views expressed here. Not sure I agree with all of them.
Seventh we have:
InformationWeek Healthcare Launches to Address Changing Needs of Healthcare Technology Professionals Amid Mandate for Improved Patient Care and Lower Costs
New Editorial Portfolio Provides Critical Information, Unique Insights and Tools for Healthcare Technology Professionals in an Industry on the Cusp of Major Transformation
SAN FRANCISCO, Sept. 1 /PRNewswire/ -- InformationWeek, the leading multimedia business technology brand, announced today the launch of InformationWeek Healthcare (www.informationweek.com/healthcare). The new Web site, newsletter (http://www.informationweek.com/newsletters/subscribe.jhtml) and InformationWeek Analytics Reports (http://www.informationweekanalytics.com/), coupled with expanded coverage in InformationWeek magazine and live Web events, helps healthcare technology professionals understand how to apply new technologies for more effective patient care and more efficient operations.
The federal government has set aside close to $20 billion to encourage hospitals, doctors' offices, and other healthcare providers to start digitizing their medical records and processes. The goal: to get at least half of U.S. hospitals and doctors' offices to adopt e-health record systems by 2014, up from less than 10% today.
InformationWeek has covered the IT strategies, issues, and implementations defining the healthcare industry for years. With federal funding and mandates on the table, the pressure is on healthcare technology professionals to get going now. InformationWeek Healthcare is timed to serve healthcare technology professionals tasked with analyzing IT products, services, policies, and vendor strategies aimed at the sector.
More here:
http://sev.prnewswire.com/computer-electronics/20090901/NY6865701092009-1.html
This looks like good news – another source of Health IT coverage.
Eighth we have:
Cerner Client Recognized for Deepest Use of Electronic Health Records Among U.S. Pediatric Hospitals
Children's Hospital of Pittsburgh of UPMC Recognized by KLAS as the Leader in Use of Healthcare Information Technology Among Pediatric Hospitals in the United States
KANSAS CITY, Mo. and PITTSBURGH, Sep 1, 2009 (GlobeNewswire via COMTEX) -- Children's Hospital of Pittsburgh of UPMC, which has used Cerner(r) solutions for 10 years, was recently recognized by KLAS as the leader in its use of healthcare information technology among pediatric hospitals in the United States. Children's Hospital uses Cerner solutions to enable a paperless workflow in every patient care setting in the hospital as well as the health information management department.
(Tweet this: Cerner client, Children's Hospital of Pittsburgh, named leading pediatric hospital in U.S. for HIT use http://bit.ly/cernPR)
"Throughout its journey of automation, the leadership at Children's Hospital of Pittsburgh had a true vision to use healthcare IT to improve patient safety and clinical outcomes," said Trace Devanny, Cerner president. "Cerner is proud to have worked with Children's Hospital to make this vision a reality. We commend the leadership, IT teams, clinicians, and staff at Children's Hospital for the dedication that makes them the leader in use of healthcare information technology among pediatric hospitals in the United States."
Children's Hospital began using Cerner solutions in 1999 when it implemented solutions to automate processes in its pharmacy department. Since then, the hospital has implemented an additional 19 solutions and upgraded to the Cerner Millennium(r) healthcare computing platform.
"This recognition is a real tribute to the hard work and ingenuity of the physicians and employees of Children's Hospital as well as our strategic partnership with Cerner," said Christopher Gessner, Children's Hospital president. "The automation of clinical information across the continuum of care is a highly complex and challenging undertaking that can only be accomplished through outstanding teamwork. Cerner has truly shared our vision of using technology as an enabler for our clinicians to provide better, safer care for our patients. We look forward to our continued work together as we analyze the data available to us and work continuously to improve the care of our patients and workflow of our staff."
Children's Hospital has realized numerous benefits from using Cerner solutions including:
* Reductions in medication errors that cause harm; * Elimination of transcription errors; * Improvements in documentation and compliance; and * Improvements in turnaround times for radiology and lab reports. Children's Hospital implemented computerized physician order entry (CPOE) in 2002 to improve patient safety, and has seen a reduction in medication safety events since that time. The rate of medication safety events that reached the patient has decreased since CPOE from 0.091/1,000 doses to 0.036/1,000 doses, a 60 percent reduction. Improvements have been seen in each major step of the medication process: ordering, dispensing, and administration.
Full article here:
This is a useful report showing that in the complex paediatric environment Health IT can work and make a difference.
Love the instructions on how to Tweet the news in the press release!
Note just how long it has taken!
Ninth we have:
Hospital Uses EMRs to Avoid Drug Errors
Sarah Kearns, for HealthLeaders Media, August 31, 2009
In 2008, Linda Severson, RN, was called into her superintendent's office after the facility had experienced a near miss pertaining to look-alike/sound-alike drugs. He asked her if there was anything she could do to prevent this kind of problem from happening again.
In response, Severson, who works at Cherokee Mental Health Institute (CMHI), in Cherokee, IA, took matters into her own hands and changed the CMHI computer system settings for all look-alike/sound-alike drugs so that they show up differently than the rest by default. This change brings additional attention to look-alike/sound-alike drugs to the person entering the record.
Since implementing the new process, CMHI has seen and is now tracking a noticeable reduction in errors associated with look-alike/sound-alike drugs.
Electronic medical records
The facility's original medical record system was used as an order entry form. For example, if the practitioner filling out the form worked in pharmacy, he or she would identify pharmacy in the order type. Then the order code would be brought up, which in pharmacy's case, would be the particular type of drug.
When it came time for the pharmacy practitioner to choose the type of drug, this was where CMHI experienced problems.
One particular case was distinguishing between the drug hydroxyzine, an antihistamine used to treat insomnia, and hydralazine, an anti-hypertensive drug used to treat high blood pressure.
"When you chose the drug, you would only have to put a portion of the drug name in," says Severson. "When you typed in [the letters] 'HYDR,' you would get every drug with those four letters in it."
More here:
Note how it is both having the systems – and setting them up intelligently that makes a difference!
Tenth we have:
Survey of Spanish docs online
02 Sep 2009
A third of Spanish doctors say that patient’s looking up details of their condition online can complicate their relationship with patients and even undermine their credibility.
The results come in a study that examines how health information on the Internet is changing the relationship between doctors and patients.
"Although the e-patient is a new phenomenon that is growing exponentially, very few studies analyse it from a doctor's point of view," said José Joaquín Mira, the main author of the working paper published recently in the journal ‘Atención Primaria’ (primary health care).
The researchers analysed the opinions of 660 doctors who all work for the Spanish National Health System - 330 in primary health care and 330 in hospitals - in the provinces of Alicante, Madrid, Zaragoza and Huesca.
Results show that 96% of the doctors surveyed have been questioned by their patients about information they have read on the Internet. In addition, almost three out of every 10 professionals recommend websites to their patients.
More here:
http://www.ehealtheurope.net/news/5167/survey_of_spanish_docs_online
Sounds like the concepts of ‘patient empowerment’ have not made it to Spain yet!
Eleventh for the week we have:
Speech Recognition May Speed EMR Adoption
| 2009-08-28 |
With a five-year adoption mandate of electronic health records hanging over health organizations, they are faced with many hurdles—but speech recognition may very well be the critical enablement technology they have been looking for.
As health care organizations strive to improve the way they handle patient records in the digital realm, many are struggling with the ultimate electronic medical records bugaboo. That is, how the heck do they get the doctors to actually use EMRs?
“The big challenge is getting the doctors to use the electronic health records,” says Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center, who cites American Hospital Association numbers that show only about 17 percent of physicians in the United States currently use EMRs.
A study by the New England Journal of Medicine of 3,000 hospitals in April shows even worse adoption rates—only 1.5 percent of all non-federal U.S. health care facilities use a comprehensive EMR system, and just 8 percent have EMRs installed in at least one unit.
Federal lawmakers are trying to promote better adoption of EMRs in order to develop the infrastructure necessary to reap the benefits of pervasive EMR use. With the passage of American Recovery and Reinvestment Act (ARRA) of 2009, the government plans to disperse $36 billion in aid to promote EMR investments nationwide.
But even though the average 500-bed hospital will expect to rake in about $6 million of those funds if they implement EMRs by 2011, that will hardly cover the expense of a full deployment, according to PriceWaterhouseCoopers consultants.
More here (registration required):
Sensible suggestion – we need so good studies with quality systems to see how well it can work.
Fourth last we have:
Summary and Comment
Computerized Alerts Can Influence Drug Prescribing
After computer prodding, physicians ordered fewer prescriptions for potentially inappropriate drugs and heavily advertised drugs.
Computerized decision support is one way to influence drug prescribing. In two new studies, researchers addressed this topic.
One study was conducted in an Indianapolis emergency department (ED) with a computerized order-entry system for all prescriptions. Researchers tracked prescribing patterns for older patients (age, 65) after 63 ED physicians were randomized to a decision-support prescribing intervention or to a control group. In the intervention group, orders for nine drugs that were deemed to be potentially inappropriate for older adults (e.g., promethazine, diazepam, propoxyphene, diphenhydramine) generated computerized alerts that suggested alternatives. During the 2-year study, the proportion of older ED patients who received prescriptions for potentially inappropriate medications was significantly lower in the intervention group than in the control group (2.6% vs. 3.9%).
.....
Comment: These studies indicate that computerized alerts can influence drug prescribing. In the hypnotic drug study, the goal clearly was to limit prescribing of expensive branded drugs. The ED study, however, raises interesting conceptual questions about what should be considered "inappropriate" in geriatric prescribing. That question is addressed in another recently published study (JW Gen Med Sep 3 2009).— Allan S. Brett, MD
Published in Journal Watch General Medicine September 3, 2009
Citation(s):
Terrell KM et al. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial. J Am Geriatr Soc 2009 Aug; 57:1388.
- Medline abstract (Free)
Fortuna RJ et al. Reducing the prescribing of heavily marketed medications: A randomized controlled trial. J Gen Intern Med 2009 Aug; 24:897.
- Medline abstract (Free)
More here (free) :
http://general-medicine.jwatch.org/cgi/content/full/2009/903/1
Useful summary of a couple of papers from the excellent Journal Watch.
Third last we have:
Vendors Launch HIE Platform
HDM Breaking News, September 1, 2009
Orion Health Inc. and Cisco Systems Inc. have combined some of their technologies to create a data exchange platform for providers to report data to public health agencies. The platform also enables providers to receive public health notifications from the agencies.
More here:
http://www.healthdatamanagement.com/news/public_health-38912-1.html
More information is available at cisco.com/go/axp and orionhealth.com.
These are some big players getting together.
Second last we have:
5 decisions that will determine the fate of e-health records
Experts say success hinges on the outcomes of these decisions
- By Alice Lipowicz
- Sep 02, 2009
Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.
The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.
1. Follow the rules or be innovative?
Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance of rigidity and flexibility.
“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.
More here:
http://fcw.com/articles/2009/09/07/fedlist-5-steps-to-ehr-success.aspx
See the other 4 critical success factors by following the link.
Last, and very usefully, we have:
Will the HITECH Act be Effective or a Bust?
Carrie Vaughan, for HealthLeaders Media, September 1, 2009
When it comes to implementing electronic health record systems and exchanging health information electronically, healthcare providers are being incentivized, nudged, or hit with a stick. As everyone reading this probably already knows, healthcare providers have until 2015 to be deemed "meaningful users" of certified EHRs before they are penalized under the regulations outlined in the HITECH Act.
The big question is will we spend this stimulus money in a way that truly makes healthcare more cost effective and improves the quality of care for patients. Almost every one that I talk to makes a point to say that the HIT Policy committee is approaching this the right way—although they may grumble about recommended guidelines being too aggressive or not aggressive enough.
A lot of questions still remain and the final definition of meaningful use and the certification criteria for vendors likely won't be finalized until the first quarter of 2010. So will the HITECH Act—based on where we are headed and the work that has already been done—achieve its goals? I know. It's a tough question to answer and no one has that crystal ball to glimpse into the future. But if we are getting off track, the time to correct the situation is now or we could end up wasting a lot of tax payer money for naught.
"We have a fragmented healthcare system where patient data is not available, so we want informational integration at least," J. Marc Overhage, MD, PhD, director of medical informatics and research scientist at Regenstrief Institute, Inc. and president and CEO of the Indiana Health Information Exchange, told me during an interview for HealthLeaders magazine's August cover story, "Hang On."
Much more here:
Continuing commentary and discussion about how all this is going to work.
There is an amazing amount happening. Enjoy!
David.
