Again there has been just a heap of stuff arrive this week.
First we have:
Tuesday, September 08, 2009
A Lower Bar for Computerized Physician Order Entry Adoption -- Is It Worth It?
by Protima Advani
Ten years after the Institute of Medicine's landmark report "To Err Is Human," which placed a spotlight on hospital deaths attributable to medication errors, the problem persists, causing significant harm to patients and high costs to hospitals.
Computerized physician order entry systems have long been touted as the IT solution for preventing medication errors by targeting the first step in the medication process -- physician ordering -- but adoption to date remains low. The HIMSS 2008 Stages of EMR Adoption survey shows that less than 6% of U.S. hospitals and health systems have adopted CPOE.
Despite numerous benefits -- improved medication safety, greater compliance with evidence-based medicine, reduced overutilization, and faster order processing -- lack of physician acceptance for standardized clinical care has hampered CPOE adoption. In fact, most hospitals have taken an "optional" approach -- allowing physicians to continue ordering on paper if they prefer -- as opposed to mandating adoption. As a result, even those hospitals that have implemented CPOE have failed to drive universal adoption.
Much more here:
http://www.ihealthbeat.org/Perspectives/2009/A-Lower-Bar-for-CPOE-Adoption-Is-It-Worth-It.aspx
Links are here:
This is an important issue to discuss. Well worth following up the links.
Second we have:
Basic IT infrastructure key to healthcare's future
By William Braithwaite
Posted: September 8, 2009 - 5:59 am EDT
Our healthcare system is badly broken and in crisis. Study after study report the bad news: Up to 98,000 preventable accidental deaths in hospitals annually; getting research results into clinical practice takes an average of 17 years; up to $300 billion spent annually on treatments with no health yield; access to specialty care is highly dependent on geography; patients who are minimally involved in their own health decisions; public fear of identity theft and loss of privacy; fragmented and untimely public health surveillance; meaningful use of health information technology occurs in only a small proportion of clinical environments; and the litany goes on.
Healthcare reform cannot fix these problems without health HIT, because the healthcare system is so complex and so information dependent. Without integrated health IT support, we clinicians are not humanly capable of practicing healthcare without killing people by accident. Although we blame—and sue—individual clinicians when things go wrong, as often as not, it is the “system” that is to blame, not the individual. The quality and safety of healthcare delivery can be improved only at the point of service—reminding clinicians long after service delivery that their care did not meet a standard, when the clinicians are not given the data or the tools to help them make the right decisions, leads only to frustrated clinicians. We must direct the efforts of healthcare reform to fix the entire system so that it prevents these accidents while providing higher-quality care and controlling cost.
Having an electronic health record system in every doctor's office is necessary, but not sufficient to solve the underlying problems. It would be like supplying the moon shot with a lunar lander; a necessary part, but one that cannot solve the problem at hand without the infrastructure and all the other parts integrated into a functioning whole system. Higher-quality, lower-cost healthcare can result only if we incorporate into the EHR system intelligent advice about what actually works. Using these “best practice” rules does not dictate how to practice medicine; it just means that each clinical decision can be informed by what has been shown on a national basis to have the best outcomes given what is known—so-called evidence-based medicine.
More here: http://www.modernhealthcare.com/article/20090908/REG/309089958
As clear a 3 paragraphs on the importance of Health IT than I have seen in quite a while!
Third we have:
CCHIT Rolls Out Preliminary E-Health Certification
New certification from the Certification Commission for Health IT comes as the industry waits for government's final "meaningful use" definition.
By Marianne Kolbasuk McGee, InformationWeek
Sept. 8, 2009
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=219700027
The federal government won't have its definition of "meaningful use" for health IT products finalized until the end of the year. But in the meantime, the organization that has been certifying e-medical record systems unveiled new programs Tuesday to qualify products for what's known so far about the American Recovery and Reinvestment Act's criteria for health IT.
The Certification Commission for Health IT (CCHIT) in October will begin providing to e-health vendors preliminary certification and inspection services to evaluate how products match up against the minimum "meaningful use" standards developed so far by the U.S. Dept. of Health and Human Services (HHS) under ARRA.
CCHIT, an independent non-profit organization that's been certifying e-health record products since 2006, is still the only industry group that is certifying health IT products for interoperability and a host of other functionality with recognition from HHS.
Reporting continues here:
http://www.informationweek.com/news/healthcare/policy/showArticle.jhtml?articleID=219700027
It is good to see the CCHIT is pushing on to assist the US EHR push.
Fourth we have:
Medicaid programs must prep for federal subsidies
By Joseph Conn / HITS staff writer
Posted: September 8, 2009 - 5:59 am EDT
State Medicaid program officials should begin taking the first steps toward getting their programs in shape to provide federal subsidies to physicians and other providers for the purchase of electronic health-record systems under the American Recovery and Reinvestment Act of 2009, according to a CMS advisory letter.
States may immediately request federal matching funds for up to 90% of state expenses for planning on their end of the health information technology subsidy program, according to the Sept. 1 letter from Cindy Mann, director of Medicaid and state operations at the CMS.
To get started, states must submit and receive approval for their “HIT Advance Planning Document” before they initiate planning activities and start spending money, Mann said.
Under the Medicaid provisions of the stimulus law, states will be reimbursed by Medicaid for up to 100% of direct subsidy payments to providers, which can include money for technology, support and staff training. As it does for Medicare, the federal program calls for Medicaid to subsidize providers for up to 85% of cost for these items.
More here (registration required):
http://www.modernhealthcare.com/article/20090908/REG/309089996
This is an interesting article that outlines the scale of the planned Health IT incentives the US has in mind.
Fifth we have:
Tuesday, September 08, 2009
Catching Fake Meds in a Snapshot
Two-dimensional bar codes could reduce drug counterfeiting in the developing world.
By Rachel Kremen
Researchers from New York University have proposed a system for authenticating and tracking drugs distributed in the developing world. The system, called Epothecary, would use cell phone cameras to read two-dimensional bar codes affixed to packages and assigned to distributors and pharmacists. The researchers hope the system can be used to prevent the distribution of counterfeit drugs through legitimate channels.
The World Health Organization estimates that more than 10 percent of drugs in the developing world are counterfeit. Some counterfeit meds contain the right ingredients in the right quantities, but others are substandard or even poisonous.
Michael Paik, a PhD candidate at New York University's Courant Institute of Mathematical Sciences, saw the problem firsthand while working with a relief agency in Sudan three years ago. "One of the problems that we were seeing was in the tracking of medication," Paik says. "I'd also read reports of people dying due to poisoned meds or subtherapeutic meds."
Paik thinks that Epothecary can greatly reduce such incidents and provide a simple drug-tracking scheme as well. Under the system, every shipping crate, box, and individual drug container would be labeled with a unique two-dimensional bar code: a black and white image that represents information about the contents of the package, such as the name of the drug and the number of tablets included. Each distributor and retailer would also get two-dimensional bar codes, printed on a photo ID.
To buy new medication, a retailer logs in to the Epothecary system on his cell phone and provides his password. The retailer then takes a picture of his own bar code, as well as the distributor's bar code and the bar codes for the medication he wants to buy. Cell phone software deciphers the information encoded by the two-dimensional bar code, and that data is encrypted and sent to a central server via Short Message Service (SMS). The software then checks that the distributor is the legitimate owner of the drugs in question. (If possible, the phone would also transmit its GPS location to the server and that information would be checked against the known address of the distributor and retailer.) If everything checks out, the retailer can purchase the drugs and record that transaction on the server, via his cell phone.
More here:
http://www.technologyreview.com/communications/23369/?nlid=2330
A good use of an older technology that is pretty inexpensive.
Sixth we have:
Health data exchange praised
La. system lets hospitals exchange records online, cut costs
- By MARSHA SHULER
- Advocate Capitol News Bureau
- Published: Sep 5, 2009 - Page: 1A
A patient shows up in the emergency room at Bunkie General Hospital complaining of pain in his abdomen. He had been hospitalized at the LSU Medical Center in Shreveport with a similar complaint a couple of days before and left feeling better.
But the pain is back.
Instead of having to start from scratch, the attending physician in Bunkie goes online to access medical tests done in Shreveport. No repeated expensive CAT scan or extensive blood work required as the physician tries to pinpoint the reason for the pain.
The LSU and Bunkie hospitals are part of an electronic medical records system through which patient information is exchanged among LSU and 14 hospitals in rural communities from central to north Louisiana.
The electronic medical records system is improving patient care and saving money at the same time, said Bunkie physician Don Hines, a former state legislator and prime mover behind the project.
“It allows the physician to coordinate medical information at the bedside,” Hines said.
It helps hospitals operate more efficiently, and avoid medical errors and duplication of tests, he said.
The project is attracting national attention as a model for establishing the type of information exchange networks the federal government contemplates developing across the nation. States will be fighting for their share of $20 billion in federal funding beginning next year.
“While everybody has been sitting around talking about the need to do this, the Rural Hospital Coalition got up and did it,” state Department of Health and Hospitals Secretary Alan Levine said.
“They have the exchange. That’s what we hope to create statewide,” he said.
The project is a collaboration among the Louisiana Rural Hospital Coalition, the Louisiana Rural Health Information Exchange and LSU Health Sciences Center in Shreveport.
The work recently was recognized as 2009 IT Project of the Year by Advance for Health Information Executives magazine — outscoring other contenders in “project scope, clinical excellence and overall performance.”
More here:
http://www.2theadvocate.com/news/57469717.html
It is a good to see competition between the States is pushing towards improvement.
Seventh we have:
GP practices report benefits from GP2GP
08 Sep 2009
Clinicians and administrative staff have reported a range of substantial benefits from use of Connecting for Health’s GP2GP electronic records transfer programme, according to CfH.
The Department of Health’s IT agency said initial findings from an online survey of GP2GP users were “extremely positive” with “high proportions” of clinicians and administrative staff reporting that GP2GP brings a range of substantial benefits to clinicians and patients.
CfH told EHI Primary Care that the full results of the survey were still being collated and would be released to strategic health authorities and primary care trusts by the end of 2009.
In the mean time the third clinical system to be submitted for formal GP2GP testing, iSoft’s Synergy 2, is due to begin clinical safety testing this week. The system will be piloted in NHS Hampshire from January next year before roll-out to more than 400 Synergy 2 practices.
More here:
http://www.ehiprimarycare.com/news/5184/gp_practices_report_benefits_from_gp2gp
It is good to see there is real progress with this program as it makes life much easier for patients.
Eighth we have:
CfH consults on future of GP systems
09 Sep 2009
Connecting for Health has begun a consultation on what stakeholders want from GP systems and work on an enhanced roadmap for GP Systems of Choice.
CfH told EHI Primary Care initial consultation has started with key stakeholders from GPs, patients, the Department of Health, strategic health authorities and primary care trusts.
The DH’s IT agency is looking to the future of GP systems and its GPSoC framework after announcing that 88% of GP practices have joined the scheme and 99.2% of those practices, a total of 7,237 practices, have signed a PCT-practice agreement.
CfH said the high take up provided it with a mandate to work with stakeholders to extend the roadmap for general practice IT.
GPSoC allows practices to choose to continue to use the GP system that they already have in their practice or migrate to a different system that better needs their needs. CfH said most GP practices have chosen to retain their existing system and receive upgrades of new functionality such as GP2GP and Summary Care Record applications as they become available.
Full article here:
http://www.ehiprimarycare.com/news/5186/cfh_consults_on_future_of_gp_systems
This level of adoption certainly suggest the level of co-ordination of UK General Practice is pretty good.
Ninth we have:
Lloydspharmacy installs virtual GPs
Tags: Lloydspharmacy Pharmacy
03 Sep 2009
High street pharmacy giant Lloydspharmacy is rolling out 300 'virtual GPs' to enable customers to consult a doctor remotely and pick up a prescription immediately.
The service is an extension of the online doctor service Lloydspharmacy already offers on its website, run by Dr Thom.
Customers going into 300 Lloydspharmacy outlets will be able to consult a doctor via a computer terminal on a range of health needs, including hair loss treatments, contraception, sexual health and travel vaccinations.
If appropriate, the GP will write a prescription and send it immediately to the pharmacy electronically. Consultations are free but prescriptions are issued privately and costs vary according to the cost of the medicine.
Last month, the company added swine flu anti-virals to its list of available services online.The cost for Tamiflu is £48.50.
The roll-out of the service coincides with the publication of a report commissioned by Lloydspharmacy on the future of remote diagnosis and prescription services.
The report from consumer and business trends think-tank The Future Foundation says the National Pandemic Flu Service could pave the way for a rapid growth in remote diagnosis and prescriptions.
Report lead author Judith Kleine Holthause said the NPFS demonstrated that remote diagnosis could be an efficient way of dealing with certain conditions.
More here:
http://www.ehiprimarycare.com/news/5169/lloydspharmacy_installs_virtual_gps
I am not sure this is such a great idea. It would need to be carefully designed to minimise risk.
Tenth we have:
New iPhone application tracks disease outbreaks
Wed Sep 2, 4:12 pm ET
WASHINGTON (AFP) – Apple iPhone owners wondering if there is a case of swine flu nearby can now find out instantly with a new program that tracks outbreaks of infectious diseases.
"Outbreaks Near Me" is an application for the popular smartphone developed by researchers at Children's Hospital Boston in collaboration with the Media Lab of the Massachusetts Institute of Technology.
The application, which was developed with support from Google.org, the Web giant's philanthropic arm, enables users to track and report outbreaks of infectious diseases such as swine flu in real time.
It is available for free from Apple's iTunes App Store.
The "Outbreaks Near Me" program is associated with HealthMap, an online resource that collects, filters, maps and disseminates information about emerging infectious diseases.
More here:
http://news.yahoo.com/s/afp/20090902/hl_afp/usithealthflutechnologyapplemit_20090902201304
For those hard – “shall I wear a mask today?” situations!
Eleventh for the week we have:
Web helps strengthen patient-safety movement
By Jean DerGurahian/ HITS staff writer
Posted: September 9, 2009 - 5:59 am EDT
The Internet has been a contributing force to the effectiveness of the patient-safety movement, advocates say.
In the past decade, there has been a grass-roots swelling of patients and families demanding a stronger role in healthcare reform and quality improvements. That is not a coincidence: 10 years ago, the Institute of Medicine released its landmark To Err is Human report and, hospitals suddenly found a spotlight shining on their practices. Although medical errors were happening before 1999, there was a lot more awareness of them after the report, said Helen Haskell, who became a safety advocate as a result of medical complications that led to her son's death.
Haskell, along with advocates Dale Ann Micalizzi, Susan Sheridan and many others, have taken their efforts to the Internet to connect with families who have endured similar experiences in hospitals and who want to try to change the system. In the beginning, everyone was fragmented, Haskell said. But now “we're all in touch, we all know each other.”
Social-networking sites and Web pages have allowed safety advocates to establish connections that otherwise would be difficult to create, she said.
More here (registration required):
http://www.modernhealthcare.com/article/20090909/REG/309099996
Clearly this sort of benefit is worth considering as citizens become more connected.
Fourth last we have:
Improved Quality and Efficiency through a PHR
Portal consolidates and organizes medical information.
By Robert N. Mitchell
Electronic patient records are important to the cause of advancing quality and efficiency, federal government leaders say. So, when myNYP.org, New York Presbyterian Hospital's personal health record (PHR) launched earlier this year, there was a huge media splash, because the hospital was reportedly the first in the country to implement a PHR portal.
For their part, New York Presbyterian Hospital leaders believe the system -- including its software and technology platform -- is the first of its kind to be launched by a major health system, and the only such system that provides security, privacy and portability to patients from all walks of life.
The PHR also made a splash in health IT circles because of its technology platform -- Microsoft's HealthVault and Amalga technologies. HealthVault's open, security-enhanced platform allows users to create a Web-based account that can store several sets of medical records from across the health ecosystem - anything from blood tests to CAT scans, for an individual or an entire family's medical history - enabling improved health management. Amalga aggregates large amounts of clinical, administrative and financial data from disparate information systems, what are commonly referred to in health IT as "silos." Hospitals commonly have more than 100 disconnected silos of data at any given time.
Patients can select and store personal medical information gathered from their doctor, hospital visits and from other providers, and store it in their HealthVault account. Using "pull technology," myNYP.org asks patients if they want to copy their medical data into their HealthVault account and enables access their personal information using a secure username and password through any Web-enabled device.
More here (free) :
http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=205320
This provides another way that PHR systems can be delivered and made useful!
Third last we have:
Health Network Protects Thousands of Confidential Patient Records
CIO uses virus attack to put controls on network and portable devices.
By Robert N. Mitchell
Rob Israel, CIO and CSO at Phoenix-based John C. Lincoln Health Network, discovered in 2003 that he didn't like sticks. These weren't the kind that grow leafy branches on trees, but were actually USB sticks sometimes attached to a computer.
And Israel quickly discovered that those sticks were a breeding ground for viruses into his health care organization's PCs.
"I don't think the threats we were facing back then were any different than any other organization faced, but as more patient information became electronic, we saw the growing threat of the potential for patient data to be taken off of our network or loaded onto our network, whether intentionally or unintentionally," he said.
With more than 80 terabytes of storage needed by the organization, Israel and his colleagues at John C. Lincoln realized they didn't have much control over the threats. "Back in the early 2000s we were hit with the Slammer virus and we tracked it back to a floppy disk that someone had brought in while working on a term paper on our computers. The person loaded it and the PC had to be rebooted so it didn't have updated antivirus on it then. With the term paper now loaded onto the network, the Slammer virus went flying throughout our network. That was a real eye-opener for us as to what we didn't have control of on our peripherals."
Portability led concerns
Portability -- in the form of floppy drives, USB sticks, scanners and PDAs -- led to concerns about HIPAA privacy and security of patient data. "We knew people were bringing in different types of devices. People were calling and saying they loaded a piece of software and now their computer wasn't working properly, or they got a blue screen after putting a floppy disk into their PC. We knew there was a problem, but couldn't really get our arms around it," he said.
CIOs have a responsibility to hospital employees, patients and the public at large, to make sure data is secure. Israel said: "We're in a lot of ways like a bank, and we have a lot of information about patients already when they come through our hospital's doors. It's not just medical treatment information; we have a lot of other data, as well. Not only is it federally mandated that we protect it, it's our moral obligation."
More here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206109
There is no doubt this is a problem area with the size of current USB sticks etc!. You can cart a hell of a lot of data away very easily
Second last we have:
Ethiopians offered free AIDS tests by text message
Tue Sep 8, 2009 1:23pm EDT
ADDIS ABABA (Reuters) - Ethiopia is sending text messages to mobile phone users offering free HIV/AIDS tests ahead of New Year celebrations, in a drive to have more people checked in sub-Saharan Africa's second most populous nation.
"New Year! New Life! Test for HIV, test with your partner, get your children tested and brighten the future of your family! Free testing. Happy New Year!" says an SMS message which is being sent in batches ahead of this week's celebrations.
Ethiopia follows a calendar long abandoned by the West that squeezes 13 months into every year and entered the 21st century in 2007. It will become 2002 in Ethiopia on September 11.
More here:
http://www.reuters.com/article/Continental/idUSTRE5874V720090908
Now here is basic e-Health maybe making a difference!
Last, and very usefully, we have:
Singapore's one patient one record plans on track
Singapore’s vision to be among the first in the world to implement an electronic health record scheme is on track for its November 2010 rollout and aims to revolutionise the way healthcare is offered and how providers work within the system, according to Dr Sarah Muttitt, CIO of Ministry of Health Holdings (MOHH), the holding company of the city-state’s public healthcare assets.
The S$200 million (US$140 million) project comes at a time when the Singapore Government has expressed its commitment to developing and enhancing the healthcare industry. In his recent National Day Rally address, Prime Minister Lee Hsien Loong said that the focus on elderly care and integrated care for the community will be cornerstones of the healthcare industry in future.
The MOHH partnered with more than 300 clinicians across the island to define the requirements for the e-health records system architecture, identifying from the end-users what they required and needed. The project promises to offer substantial improvements in productivity, accessibility to information and better quality of care.
In an interview with FutureGov, Muttitt explained that one of the key challenges initially faced was building the expertise and skill-sets needed to drive the project. MOHH brought in a team of international hailing from Canada, Australia and UK to design the architecture and spearhead training and knowledge transfer.
“The other challenge was the issue of governance,” added Muttitt. “It’s a living breathing architecture that constantly needs to be revisited, validated, maintained, enhanced and evolved. It is a large national programme which involves a large investment over many years. So strong strategic leadership, compliance and accountability is critical.”
Much more here:
Note the disciplined and consultative way this has been managed. This sounds like it is being done sensibly.
There is an amazing amount happening. Enjoy!
David.
