Again there has been just a heap of stuff arrive this week.
First we have:
Rolling Out the Red Carpet
Howard J. Anderson, Executive Editor
Health Data Management, April 1, 2009
American consumers are accustomed to using technology to get better service in almost every sector of the economy except health care. Now they're demanding that hospitals, clinics and insurance companies provide easier access to information as well as convenient online services, such as the ability to communicate with a doctor via e-mail or pay a bill on a Web portal.
This rise of consumerism is leading many health care organizations to rethink their information technology strategies. "In the past, decisions about the kinds of technologies to purchase and implement were driven by how they would make our lives easier here," says Jim Beinlich, associate CIO at University of Pennsylvania Health System. "Now the perspective is 'how does this technology support creating the ideal patient experience?'"
To make sure consumers' demands are met, health care organizations must take steps to involve physicians, nurses and marketers, as well as technology experts, in their strategic decisions about I.T., Beinlich says. "If the I.T. department was the only group trying to make these decisions, we wouldn't be as sensitized to the consumer aspect of this as we are," he adds.
"Consumerism is really impacting what patients expect with regard to how they interact with health care providers and payers," says Dan Garrett, health care I.T. practice leader at Price Waterhouse Coopers, a New York-based consulting firm. Consumers want easier access to information as well as better access to clinicians via e-mail, telemedicine and other options, he says.
Lots more here:
http://www.healthdatamanagement.com/issues/2009_64/-27952-1.html
This long feature article makes the point well that there are rising patient expectations and steps need to be taken to address these. Technology can help.
Second we have:
NQF forum focuses on battling waste with quality
By Jean DerGurahian / HITS staff writer
Posted: March 30, 2009 - 5:59 am EDT
The Rock and Roll Hall of Fame is still some days away from inducting its latest members, but Cleveland last week was the site to spotlight celebrities in healthcare.
The National Quality Forum, in hosting its annual spring conference March 25-27 in the Hall of Fame’s home town, brought together leaders and organizations that have made significant strides toward creating meaningful, measurable and sustainable improvements in quality of care and safety. The quality-endorsing body hopes to highlight these successes as it tackles waste in the healthcare system.
Waste—defined as the overuse, misuse and underuse of health services—accounts for a portion of healthcare costs, quality advocates say. Some have estimated it to be as high as 60% of costs, according to panelists at the conference. What is challenging is measuring that waste, said Janet Corrigan, president of the quality organization. Much of the NQF conference, dubbed Waste Not Want Not—The Right Care for Every Patient, went to studying overuse of treatment, because that’s where healthcare gets expensive, she said. If the industry can identify appropriate vs. inappropriate care, they can free up resources going toward overuse to help combat issues of misuse and underuse, she said.
So the nearly 300 audience members listened to representatives from medical institutions such as 289-bed Virginia Mason Medical Center, Seattle, where initiatives have re-engineered workflows and implemented information technology to virtually eliminate unnecessary tests, such as MRIs; and Arizona State University, which has helped develop nurse care-coordination tools that have helped reduce hospital admissions among patients coming from nursing homes. In the meantime, professional societies representing doctors, surgeons, pathology and medical education are discussing the guidelines and measurements they have developed to improve clinical and diagnostic practices.
More here (registration required):
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090330/REG/303309950/1029
The figure for waste was what caught my eye with this article. Given all the ways technology can help one can understand the US enthusiasm for moving forward with more Health IT.
Third we have:
Electronic Health Records: Lessons from the iPhone
Open programs to third-party developers, say two tech-savvy physicians.
By Emily Singer
Thanks to the $19 billion designated for health-care information technology in the recent stimulus bill, electronic health records (EHRs) have garnered a great deal of attention in the past few weeks. The bill sets aside $17 billion in incentives for physicians and hospitals that use qualifying EHRs beginning in 2011, and $2 billion for the development of standards and best-practice guidelines over the next two years.
The bill does little to specify the types of technology that health-care providers must use, leaving the details to a newly appointed national coordinator for health information technology. Given the amount of money at stake, both EHR vendors and the medical community are anxious to see exactly how these details will unfold over the next two years. In an article in the current issue of the New England Journal of Medicine, physicians Kenneth Mandl and Isaac Kohane outline their prescription for creating an effective EHR system. Their approach is modeled on successful IT products outside of health care, including the iPhone and Facebook, which rely on innovative applications from third-party programmers. Mandl and Kohane propose what they call a platform approach, in which EHR vendors sell a flexible, basic platform that is designed to work with components from other vendors, much as the iPhone works with applications made by a myriad of third-party developers.
Mandl and Kohane, both members of the Harvard/MIT Health Sciences and Technology Program at Children's Hospital Boston, spoke with Technology Review about why their approach is crucial in digitizing health care.
Interview continues here:
http://www.technologyreview.com/biomedicine/22360/?nlid=1896
An interesting interview with some useful links. Certainly the industry needs to do better to make the technology fit the roles it is expected to play.
Fourth we have:
Santa Cruz doctors offer patients e-mail privileges for a fee
Posted: 03/29/2009 01:30:29 AM PDT
SANTA CRUZ -- Would you be willing to pay $60 a year for the privilege of having an online conversation with your doctor?
That's what the Santa Cruz Medical Foundation is about to find out.
You know how it is when you try to reach a doctor. You call the office, wait in line for the receptionist, explain what you want. Then you wait.
Here's how the doctor sees it: An e-mail arrives from the receptionist. The doctor reads the message in between seeing other patients, sends a message to the medical assistant, who calls the patient. It could be 15 minutes or more.
An online system, which made it possible for 120,000 patients at Santa Cruz Medical Foundation to check their medical records online, receive lab results and make an appointment for free, now allows them to e-mail their doctor for a fee of $5 a month.
Patients will have to decide whether they would rather phone for free or pay to use e-mail.
Dr. Michael Conroy, 46, an internal medicine specialist, is among the early adopters of the new system.
On Friday, he responded via e-mail to a patient who had a blood test drawn by another physician, looking for his advice based on the results.
"I got a clear, unfiltered message from the patient and replied immediately," he said. "It saves patients' time so they don't have to wait on the phone."
The new system was championed by Dr. Paul Tang, chief medical officer of the Palo Alto Medical Foundation, parent of the Santa
Cruz Medical Foundation. Tang is an advocate of electronic health records and a member of a new organization formed to promote the creation and use of a nationwide health information system.
More here:
http://www.santacruzsentinel.com/ci_12022205
It is inevitable that e-mail will be used more for doctor / patient communication and it is also inevitable that some way to pay for the doctor’s time needs to be found if it is to happen. This seems sensible to me. Will be interesting to see how it works out.
Fifth we have:
Wales publishes pathology shortlist
31 Mar 2009
Six companies have been shortlisted as potential providers to develop a national pathology laboratory system for Wales.
The procurement is expected to award a £7.9m national contract for pathology services to become available in 2010.
The Welsh IT agency Informing Healthcare has announced that Cerner, Clinisys, EMIS, iSoft, InterSystems and Technidata have been selected to respond to a more detailed requirement following publication of an Official Journal of the European Union procurement notice.
Informing Healthcare said 17 companies submitted proposals to deliver the new all-Wales Laboratory Information Management System (LIMS), a national networked pathology system that will replace the 13 systems currently in use across 18 pathology laboratories.
More here:
http://www.ehealtheurope.net/news/4706/wales_publishes_pathology_shortlist
This looks like it will be a pretty large Lab System implementation given it will serve about three million people!
Sixth we have:
DOD, VA set new target for lifetime health record
- By Peter Buxbaum
- Mar 27, 2009
The Defense and Veterans Affairs departments have formed a working group to pursue a joint lifetime electronic heath and benefits record for service members, veterans, and their families.
Rear Adm. Gregory Timberlake, director of the DOD/VA Interagency Program Office said yesterday the decision to form the group was made March 24 at a meeting of the Joint Executive Council, chaired by Defense Secretary Robert Gates and Veterans Affairs Secretary Eric Shinseki.
The idea to start the group followed discussions between Gates and Shinseki with White House staff, which has expressed interest in the project.
Timberlake told a gathering of the Armed Forces Communications and Electronics Association in Washington March 26 that the objective of the group is to explore making a “lifetime longitudinal virtual electronic record” for service members, veterans, and their beneficiaries.
Lots more here:
http://govhealthit.com/articles/2009/03/27/joint-lifetime-health-record.aspx
This seems sensible for the US – given the US Veteran’s Affairs Department provides a lot of care both in service and afterwards.
Seventh we have:
Foundations for modern NHS have been laid
Monday 30th March 2009
The foundations for the creation of a modern, joined-up IT service in the NHS have now been laid, says the head of NHS Connecting for Health (NHS CfH) in an interview with BCS magazine HI Now.
Mr Bellamy will make a keynote speech on the second day at April’s HC 2009 conference Shaping the Future, in Harrogate.
Mr Bellamy, who is Director of Programmes and Systems Delivery at the Department of Health, is expected to tell delegates how systems already delivered in the NHS are helping real people. He will also point to the priorities for the next 12 months, including the deployment of care record systems like Cerner and Lorenzo, in large hospital trusts.
So far, he points out, complex central projects such as N3, the Spine, NHS email systems, PACS, C&B, and Electronic Prescriptions have been successfully delivered.
More here:
NHS bashing is always a fun sport but the truth is that progress has been made, which is not to be sneezed at, given the size of the health system involved. Certainly there is more to come and it would be good if the rate of progress could accelerate!
The full detailed interview is found here:
http://www.computing.co.uk/computing/analysis/2239460/interview-martin-bellamy-head
Interview: Martin Bellamy, head of NHS Connecting for Health
The man in charge of the NHS National Programme for IT reveals his goals for the future of the £12.7bn project
Written by Helen Wilcox
Eighth we have:
Online Age Quiz Is a Window for Drug Makers
Americans yearn to be young. So it is little wonder that RealAge, which promises to help shave years off your age, has become one of the most popular tests on the Internet.
According to RealAge, more than 27 million people have taken the test, which asks 150 or so questions about lifestyle and family history to assign a “biological age,” how young or old your habits make you. Then, RealAge makes recommendations on how to get “younger,” like taking multivitamins, eating breakfast and flossing your teeth. Nine million of those people have signed up to become RealAge members.
But while RealAge promotes better living through nonmedical solutions, the site makes its money by selling better living through drugs.
Pharmaceutical companies pay RealAge to compile test results of RealAge members and send them marketing messages by e-mail. The drug companies can even use RealAge answers to find people who show symptoms of a disease — and begin sending them messages about it even before the people have received a diagnosis from their doctors.
While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.
Full article here:
http://www.nytimes.com/2009/03/26/technology/internet/26privacy.html?_r=2&ref=business
Nice expose! I must say. I sure would not touch it now I know its covert purpose!
Ninth we have:
Institute to Support Wireless Innovation
March 30, 2009
A foundation, integrated delivery system and wireless services vendor have teamed to create the West Wireless Health Institute to support the use of wireless technologies in health care.
The Gary and Mary West Foundation in Carlsbad, Calif., has committed $45 million to establish the San Diego-based institute. Scripps Health in San Diego is the founding health care affiliate. Qualcomm Inc. is the founding sponsor.
More here:
http://www.healthdatamanagement.com/news/research-27974-1.html
The institute web site can be found here:
http://www.westwirelesshealth.com/
This seems like good news to get some serious research done with some serious funding!
Tenth we have:
Stimulus Funds Can Lead to Health Information Exchange Networks
Kathryn Mackenzie, for HealthLeaders Media, March 31, 2009
With the announcement that the federal government's plans to spend $19 billion to spur the use of computerized patient records, the industry has a renewed interest in how and when hospitals should begin to adopt electronic health records.
But what about hospitals already entrenched in EHR? What's next for them?
Physicians at the Medical Clinic of North Texas have been using an EHR for nearly 10 years, says CIO Mike Yerrid. He will be focusing on expanding into the health information exchange arena, to connect other physicians within the Dallas-Fort Worth region, with the eventual goal of establishing a medical home model.
"We are a large primary care medical group, and there's value to exchanging our electronic information with other groups in the area," says Yerrid. "We're hoping people will join the game. We're trying to sell the benefits and create an attractive package for specialists and primary care groups."
More here:
An important question – how to make sure those that are already rolling keep pushing the barriers and improving.
Eleventh for the week we have:
15 workers fired for accessing octuplet mom's file
By the Associated Press
Posted: March 31, 2009 - 5:59 am EDT
Fifteen hospital workers have been fired and another eight disciplined for looking at medical records of octuplet mother Nadya Suleman without permission, hospital officials said.
Kaiser Permanente Bellflower (Calif.) Medical Center reported the violations of healthcare privacy laws to the state and has warned employees to keep away from Suleman's records unless they have a medical purpose, the 218-bed hospital’s spokesman Jim Anderson said.
More here (registration required):
http://www.modernhealthcare.com/article/20090331/REG/303319992
Somehow people don’t learn..a tough time to get fired!
Twelfth we have:
‘Usability’ missing ingredient in CCHIT formula
Posted: March 31, 2009 - 5:59 am EDT
In response to the Health IT Strategist reader poll: "HITS readers have proposed that the Certification Commission for Healthcare Information Technology consider ease of use before certifying an EHR system. Do you believe CCHIT's EHR certification criteria should include a usability rating?":
The stimulus act, at least as far as funding EHR systems goes, is betting the farm that existing, traditional EHR systems will succeed, and solve much of the healthcare industry’s woes. The incentives assume that all that needs to be done is fund it for practices that are reluctant or financially unwilling to risk the investment. Based on the "success" of EHR systems over the past 10 years, this bet could be akin to AIG's bets on credit default swaps.
The high EHR failure rate is largely attributable to the fact that either they are just too hard to use for many physicians, or slow them down too much. Stimulus funding for EHR deployment depends on too many nonfinancial barriers being solved by (inadequate) financial incentives. While the hard-dollar cost of an EHR is certainly a concern to many physicians and practices, that problem would not even be solved by providing these traditional EHR products free of initial costs to each of them. "Usability" is an essential missing ingredient in the CCHIT formula.
.....
Jack Callahan
Executive vice president -Corporate development
SRSsoft
Montvale, N.J.
More here (registration required):
http://www.modernhealthcare.com/article/20090331/REG/303319988/1031
Can I say I have to agree.
Others are also noticing this issue:
See here for example.
http://www.usercentric.com/about/newsletter2009Q1-wyee.php
Understanding the Impact of EHR Interfaces
Walking a Mile in Physicians' Shoes
and here:
http://www.usercentric.com/about/newsletter2009Q1-usability-stimulus.php
Usability's Role in the Stimulus Package
Thirteenth we have:
New law helps open source
- By John Moore
- Mar 30, 2009
The economic stimulus law mentions health information technology dozens of times, establishing an agenda to promote electronic health records, form standards committees and work out health information privacy and security impasses.
However, the $20 billion package also contains a more obscure provision that has buoyed hopes among advocates of open-source technologies projects that have struggled to gain acceptance in the health IT marketplace.
Tucked away in the law is a call to explore open-source technologies in the healthcare setting. The provision directs the Health and Human Services Department to conduct a report on the “availability of open-source health information technology systems.”
More here:
http://govhealthit.com/articles/2009/03/30/arra-open-source.aspx?s=GHIT_310309
This is good news..I will look forward to the report.
Third last we have:
Hospitals breaking DPA every day
31 Mar 2009
The BMA says hospitals are breaking the Data Protection Act on a daily basis by sending referral correspondence to the senior partner in a practice rather than the referring GP because of changes to hospital software.
The Personal Demographics Service was changed in 2008 to record patients as registered with a practice rather than with an individual doctor, reflecting changes agreed in the 2004 GMS contract. Some hospital patient administration systems are also set up in the same way, although newer versions include a field for ‘usual GP.’
The BMA’s General Practitioners Committee says hospitals are either not using the facility to select ‘usual GP’, or do not have it and are not taking the time to find out who the referring GP is when sending letters to practices.
However NHS Connecting for Health told EHI Primary Care that correspondence is only sent to the senior partner when the referring GP is not known and it would not change its systems further unless GMS regulations changed.
Much more here:
http://www.ehiprimarycare.com/news/4709/hospitals_breaking_dpa_every_day
This is interesting as it has potential impact here and certainly could impact on the design of systems for discharge summary transmission. (DPA is the Data Protection Act – which has a similar role to parts of our Privacy Act – old and proposed)
Second last for the week we have:
Hospital-to-hospital health information exchange begins
Published: Wednesday, 1-Apr-2009
LifeBridge Health has begun an electronic exchange of health information between its two hospitals, Sinai Hospital of Baltimore and Northwest Hospital, and Saint Agnes Hospital, a community hospital with an overlapping service area.
When patients arrive at Sinai, Northwest or Saint Agnes hospitals, an electronic query is sent to the other organization requesting clinical information. Any clinical information that is electronically available is returned to the requesting hospital in less than three minutes.
This health information exchange (HIE) is the first example of a hospital-to-hospital exchange in Maryland. The exchange allows for the standards-based exchange of clinical summaries that were based upon the Continuity of Care Document (CCD). The solution is entirely built on HealthUnity's HIE software and Microsoft's NET platform and servers.
LifeBridge Health utilizes Cerner's PowerChart as its electronic medical record (EMR) platform, and Saint Agnes Hospital uses Meditech for its EMR. LifeBridge Health received a grant from CareFirst Blue Cross Blue Shield to fund this project.
"Our HIE project is a unique partnership between two leading providers and funded by a major payer. We demonstrated in a short period of time the interoperability between different information technologies used by two independent provider organizations," said Karen Barker, vice president and CIO for LifeBridge Health.
The system is completely automated allowing for standards-based clinical summary exchange to support continuity of care between providers without negatively impacting their workflow.
More here:
http://www.news-medical.net/?id=47726
It is good to see standards based information flows supporting actual interoperation between systems.
Last for this week we have:
Thursday, April 02, 2009
Blumenthal Has Tiger by the Tail as New National Coordinator for Health IT
by Bruce Merlin Fried, Esq.
We should all be pleased by the announcement that David Blumenthal will be the next national coordinator for health IT. I won't recount Blumenthal's many accomplishments and honors since they are readily available through a Google search.
I will share with you my impressions of him and why I think he is the right person for the job. Beyond his significant abilities as a physician, Blumenthal for many years has been a serious student of health care policymaking and public policymaking in general. It is precisely this breadth of view that I think makes his selection particularly insightful.
Some in the health IT community may be unfamiliar with Blumenthal's background. Indeed, I would not classify him as a health IT wonk. But that is not what is needed at this juncture in the development and execution of a workable national health IT policy.
Instead, as we confront the real opportunities and challenges offered by the health IT incentives found in the American Recovery and Reinvestment Act, we will quickly learn that offering cash to physicians and hospitals for "meaningful use of certified electronic health records" is not enough to create the data-driven health care system that lies at the heart of health care reform. It is his wide range of experience and involvement in so many aspects of the health care policy debate that leads me to believe Blumenthal is the right guy for this job at this time.
Very much more here:
I think Bruce is right here. This is a huge task. The good thing is that someone who might pull it off has been chosen. His resume is indeed awesome.
The New York Times has already also noticed in an editorial.
http://www.nytimes.com/2009/04/02/opinion/02thu2.html?_r=1&hpw
April 2, 2009
Editorial
Miles to Go on E-Health Records
There is an amazing amount happening (lots of stuff left out). Enjoy!
David.
