Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Electronic records help doctors, patients work together
Electronic records help doctors, patients work together
by Connie Midey - Jul. 15, 2008 12:00 AM
The Arizona Republic
When Jesus Saavedra sits down with his doctor, his vital signs - taken just moments before - are displayed on a computer monitor in the exam room.
So are notes from previous visits, results from lab tests and his answers to a series of questions, including whether he uses a seat belt (he does) or smokes (he doesn't).
The order for a prescription he needs travels via the doctor's computer at the Carl T. Hayden VA Medical Center in Phoenix, where the Buckeye Army veteran receives outpatient health care, directly to the on-site pharmacy, where a robot will fill it.
Saavedra, 56, even signs consent forms electronically. Encounters with paper are rare during his appointments with physician Mervin Myrvik, a specialist in internal medicine and the Phoenix VA medical center's chief of informatics.
"It's a very impressive system," Saavedra says. "It even (graphs) my weight changes. They don't want you to miss that."
One of medicine's most enduring icons - the folder brimming with a patient's records - is being replaced by electronic health records, and perhaps nowhere are the changes more apparent than in the VA Health Care System.
At 153 VA hospitals nationwide, a computerized patient record system implemented in 1998 holds electronic files for the 5.5 million veterans treated, 70,000 of them in the Phoenix area. The system operates on the VA's VistA software program, a bundle of about 20,000 regularly updated programs.
VistA is short for Veterans Health Information Systems and Technology Architecture.
"Electronic health records have made a difference," Myrvik says, in the way health-care providers work and in outcomes for patients.
More here:
http://www.azcentral.com/arizonarepublic/arizonaliving/articles/2008/07/15/20080715electronicrecords0715.html
This is a useful reminder that, with time and the right level of investment, it is possible to implement a really rich EHR system that makes a real clinical difference. It’s worth remembering it is possible!
Second we have:
An open source developer community, Open Health Tools (OHT), has announced a collaborative effort to develop common healthcare IT products and services.
Its 26 members consist of national health agencies, government-funded organisations and agencies, major healthcare providers, international standards organisations and companies from Australia, Canada, the United Kingdom and the United States.
The members include NHS Connecting for Health, BT, IBM, Oracle and HL7, among others. Formed in November 2007, OHT's mission is to provide software tools and components that will accelerate the implementation of electronic health information interoperability platforms, which improve patient quality of care, safety and access to electronic health records (EHR).
The results will be available under an open source agreement so anyone may use them to provide interoperable healthcare platforms that will link clinics, hospitals, pharmacies and other points of care to make healthcare systems more efficient.
OHT's health interoperability framework will use standardised, open interfaces and a set of reusable software components that can be assembled into systems and products by health systems and vendors.
OHT is open to membership from any organisation and the results of member efforts are made available under a commercially friendly open source license.
More here:
http://www.mediaforfreedom.com/ReadArticle.asp?ArticleID=10472
This is an initiative that we are all going to hear more about over the next 2-3 years. Worth making sure you are across their activities and can take advantage of the ideas they develop.
Third we have:
States, the federal government and private insurers are experimenting with an idea to cut costs and make patients happier: Paying primary-care doctors extra money to oversee and coordinate patients' care.
The pay boost rewards doctors who reshape their practices to recreate an era when a trusted family physician helped patients through hospitalizations, coordinated specialist care and provided routine screenings. Such efforts may save money by reducing hospitalizations, ER visits and disease.
Dubbed "medical homes," the concept is a modern twist on an idea first promoted in the 1960s. Under most pilot projects being tested, primary-care doctors who have established medical homes will receive additional fees — ranging from just a few dollars a month per patient to more than $35,000 a year per doctor — from states, Medicare or other insurers.
Medicare this year will choose eight states to test whether paying primary-care doctors more per month to treat patients with chronic illnesses in medical home settings results in better care and lower costs than traditional practices.
The concept aims to change rushed doctor's appointments and fragmented specialist care by creating patient care "teams," which could include nurse practitioners, nutritionists or other medical staff. Medical homes also offer longer office hours, electronic medical records and same-day appointments.
More here:
http://www.usatoday.com/news/health/2008-07-13-medical-homes_N.htm
Interesting to see continuing discussion in the mainstream US Media on the Medical Home concept and the linkage of the use of this approach to deployment of EHR services. There is no doubt that EHRs can assist in the care co-ordination and information management roles that GPs perform.
Fourth we have:
Tony Koch and Mitchell Bingemann | July 16, 2008
A WORKER operating a backhoe on a building site at Molendinar on the Gold Coast threw Queensland's communications network into chaos yesterday morning by severing a fibre optic cable.
The Optus network collapsed, rendering landline and mobile phones to and from Queensland useless and leaving internet services blacked out. Automatic teller machines and EFTPOS services were also affected.
Tempers frayed at major business premises where communication was stopped. At Brisbane airport, lines of travellers stretched for more than 100m as they waited hours for their tickets and luggage to be manually processed.
Radio reports indicated that Optus was refusing until late yesterday to explain the collapse of its system, while media organisations were inundated with complaints about Optus.
The system went down at 7.53am and was restored after midday when technicians repaired the damaged cable.
More here:
http://www.australianit.news.com.au/story/0,24897,24028241-15306,00.html
Another amazing piece of news. It seems really very poor that links as vital as this were not duplicated and switch over tested on a regular basis. The impact makes it clear just how dependent we have all become in network communications to conduct ordinary life and business.
The fact that the cable was cut just 2 meters away from a marker alerting diggers that the cable was there – as shown by a Optus photo of the site – shows there are some pretty dumb backhoe drivers around!
The more we treat the Internet as something like water and electricity in daily life the more important it is we have contingency plans for failure. Hospitals have had generators for years – I wonder how well they can cope with network outages.
Fifth we have:
Karen Dearne | July 15, 2008
SMALL businesses remain outside the purview of the federal Privacy Commissioner at a time when they face soaring credit card breaches.
Commissioner Karen Curtis will shortly release voluntary guidelines on reporting data breaches for use by companies and government agencies as an interim measure ahead of the Rudd Government's overhaul of the 20-year-old Privacy Act.
It's not yet clear whether the voluntary guide will involve public notification of breaches, or the industry's preferred need-to-know position. "My office is still working through issues such as this prior to the guide's release during Privacy Awareness Week, the last week in August," Ms Curtis said.
"However, in the consultation draft, it was suggested the preferred method was direct notification either by phone, letter, email or in person to affected individuals.
"Indirect notification, either by website information, posted notices or the media, should generally occur only where direct notification could cause further harm, is prohibitively expensive, or contact information is not known."
More here:
http://www.australianit.news.com.au/story/0,24897,24020190-5013044,00.html
Two points here. First it seems clear to me you are entitled to know promptly if someone has let your private information out of their control and second all organisations holding personal data (including health data) need to proactively ensure such leaks and loss do not happen – and a reasonable penalty regime should be in place to focus the mind of all data custodians.
Without pressure we seem likely to receive the ‘Mushroom Treatment’.
Karen Dearne | July 15, 2008
A STAGGERING 96 per cent of technology decision makers don't think the public should be told when data breaches occur, according to a survey by email and web security specialist Clearswift.
But 82 per cent of respondents do say affected customers should be informed, and only 28 per cent oppose mandatory data breach notification laws.
Clearswift Asia-Pacific managing director Peter Croft says companies fear airing their dirty laundry in public will lead to a loss of customer confidence, while proposed disclosure legislation would be expensive and create work for the technology department.
"Unfortunately, some businesses are unaware of the depth of feeling on this issue," Croft says. "People like to know they can trust the organisations that deal with their personal and financial information.
"Banks like to keep news of breaches to themselves, but they are out of touch with their customers' expectations. They should be much more open about how good they are at handling other people's information."
More here:
http://www.australianit.news.com.au/story/0,24897,24019443-24169,00.html
Sixth we have:
Dan Harrison, Health
July 13, 2008
Interactive sports video games such as the Nintendo Wii are better for children than conventional computer games, but do not tackle the epidemic of childhood obesity, British research shows.
The study, published in the British Journal of Sports Medicine, found that playing virtual sports such as tennis, boxing and bowling on Nintendo Wii burned more than 50% more energy than playing sedentary computer games such as Xbox.
But the children used much less energy playing virtual sports than they would in the real versions. Real boxing burns more than twice as much energy as Wii boxing. Real tennis is 77% more demanding than the electronic version, and conventional bowling uses almost 15% more calories than the virtual kind.
The study authors calculated that in a typical week, a child who played Wii sports would use about 2% more energy than one playing sedentary computer games.
They said the increase was "trivial," and the activity was not intense enough to be counted in the recommended daily amount of physical activity. But the games could play a role in weight management and were preferable to sedentary games.
More here:
http://www.smh.com.au/news/technology/video-sports-have-wii-effect/2008/07/12/1215887493421.html
I must say I think the authors are being somewhat spoiled sports about this. Anything that gets people up an moving – even a little bit – is better than nothing and, of course, if choosing a game to purchase for children it seems hard not to think this might be a slightly preferred choice.
The critics here seem even worse – but then I suppose a small risk exist that some may worry about the body image excessively. I suspect if the Wii game can cause a problem so can all other signals being received by children however.
Wii Fit raises obesity furore
Asher Moses
July 18, 2008 - 9:00AM
Nintendo's Wii Fit game has attracted the ire of childhood obesity experts for telling healthy kids they are fat, which might cause eating disorders and self-esteem issues.
The game assesses players' fitness levels based on their body mass index, labelling them underweight, ideal weight, overweight or obese.
The BMI is a statistical measure of a person's weight relative to height, but experts say this is not an appropriate measure for children because it does not account for their age or stage of development.
The $149.95 Wii Fit was launched in Australia in May and includes a weight- and motion-sensitive balance board, which players can use for yoga, muscle workouts, aerobic exercises and balance games.
More here:
http://www.smh.com.au/news/articles/wii-fit-raises-obesity-furore/2008/07/17/1216163018848.html
Last we have our slightly technical note for the week:
HP and Sony doubled the density of their DAT data storage tapes while IBM and Sun introduced 1T-byte enterprise tape drives.
Stephen Lawson (IDG News Service) 16/07/2008 08:12:45
Two classes of tape storage are jumping to higher densities this week, potentially saving time and money at enterprises as well as small and medium-size businesses.
Hewlett-Packard and Sony on Tuesday announced a coming generation of DAT (Digital Audio Tape) media with twice the capacity of the current technology and a higher transfer speed. On Monday, Sun Microsystems introduced an enterprise-class tape drive that can pack 1T byte on a current type of tape, and on Tuesday IBM also announced a 1T-byte tape drive system.
Along with demand for hard-drive storage that has to be immediately accessible, the need for tape to reliably back up and archive older information is growing fast, according to IDC analyst Robert Amatruda. Higher capacity per tape cartridge can save space, power and money and even allow companies to save more old data, he said. In addition to greater density, the new tape technologies offer faster transfer speeds.
The next generation of DAT, called DAT 320, will be able to hold 320G bytes of data on one cartridge. It was jointly developed by HP and Sony over the past two years and should be generally available in the first half of next year, according to Bob Conway, manager of the tape product marketing team at HP. The new technology will also allow for back up from disks at speeds as high as 86G bytes per hour with 2:1 data compression, he said. Data is typically transferred to DAT decks via USB (Universal Serial Bus) or serial or parallel SCSI.
…..
To achieve the new density on a tape the same size as its predecessor, DAT 160, the companies changed the basic formula of DAT for the first time, from metal particle tape to metal evaporated tape. They also developed narrower tracks, Conway said. The companies will license the DAT 320 technology to anyone for a nominal fee.
HP and Sony's openness will help ensure there are multiple suppliers of media and components, Amatruda said. HP made 55 percent of low-end tape deck shipments worldwide in the first quarter of this year and Sony made 7 percent, he said.
Although there are a growing number of external hard-drive products available for SMB backups, they aren't as reliable as tape, he said.
"At the end of the day, maintaining hard drives is not really data protection," Amatruda said. And it can be important to have old data set aside for disaster recovery or in case of an event like a tax audit.
"If you can't produce critical data that you use to run your business ... you can be in real trouble," he said. The improved efficiency of the new tapes will probably convince more companies to use them for longer term archiving, he added.
More here:
http://www.computerworld.com.au/index.php?id=1630184913&eid=-255
Backup is an important issue that needs to be addressed carefully when acquiring and managing patient data. This is a useful reminder that the technology is getting better – with the 160 Gig drives now of the order of $1000 using a USB interface. At this price and with tape only $20-30 each there is no excuse not to have such an insurance policy in place.
http://www.smh.com.au/news/upgrade/survive-the-backup/2008/07/14/1215887537523.html
Survive the back-up
Adam Turner
uly 15, 2008
Next
If you're not using an off-site back-up system, you're taking your digital life in your hands by not protecting data against fire and theft, as well as hardware failure. It needs to be backed up off-site - preferably at an enterprise-grade data centre.
This article is also worth a browse on the same general topic.
More next week.
David.
