Again there has been just a heap of stuff arrive this week.
First we have:
By Nicholas Timmins, Public Policy Editor
Published: April 27 2009 23:20 | Last updated: April 27 2009 23:20
Main suppliers to the stalled £12.7bn National Health Service’s programme to create an electronic record of patients have been given until the end of November to demonstrate real progress in installing the systems in big acute hospitals.
If the seven-month deadline is not met, “we will look at alternative approaches”, Christine Connelly, the Department of Health’s chief information officer, told the Financial Times.
Asked whether that could involve termination of the billions of pounds’ worth of important contracts held by BT, CSC, Cerner and Isoft, she said: “At this point, we are not ruling anything out.”
She stressed, however, that “it is in all our interests to make the systems and solutions we currently have a success”.
Her comments came as she outlined the latest plan to get back on track the troubled records programme, which is running at least four years late. Under the plan, she said:
● All hospitals will be given greater freedom to configure the system to their local needs.
● A “library” of such adaptations will be built, so trusts can choose which version is closest to their requirements and then, if need be, adapt it further.
Much more here (Subscription required):
http://www.ft.com/cms/s/0/bae2ae52-3358-11de-8f1b-00144feabdc0.html
It seems we are getting towards the end game in terms of Cerner and iSoft delivering real working implementations. Can’t be much fun for those in the middle.
There is more reporting on the issue here:
28 Apr 2009
Christine Connelly has given the main suppliers to the National Programme for IT in the NHS seven months to demonstrate "significant progress" in delivering information systems to the acute sector.
In a keynote speech to the Healthcare Computing conference in Harrogate, the newly styled Director General for Informatics said “we will look at alternative approaches” if the November deadline is not met.
More here:
http://www.ehiprimarycare.com/news/4790/connelly_sets_a_november_deadline_for_suppliers
Hard to be much clearer than this! Except maybe here.
The CIO of Britain's Department of Health says outsourcers working on the long-delayed project have seven months to get it right -- or they may have to get out.
By Paul McDougall, InformationWeek
April 28, 2009
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=217200451
Second we have:
Details of thousands of patients waiting for treatment have been lost, investigation reveals
Thousands of patients' details have been discovered on "lost" waiting lists at hospitals in London, as they struggle with a controversial new computer system installed as part of the government's troubled £12.7bn overhaul of NHS IT, an investigation has revealed.
The discovery has embroiled several trusts in a crisis which has already cost tens of millions of pounds in lost revenues and mounting bills for remedial work. It has also reduced the number of patients treated by hospitals. Trusts have been forced to put on additional clinics in a push to clear the backlog and have drafted in a legion of IT troubleshooters to fix the waiting list mess.
The Barts and the London trust has launched a "serious untoward incident" investigation - an NHS procedure reserved for crises that could cause serious harm or attract public concern - though officials insist no patients have come to clinical harm.
A joint investigation by the Guardian and Computer Weekly has found Barts and the London is now so overwhelmed by patient record confusion that it has stopped providing monthly data to the Department of Health on the government's key waiting list target, conceding it does not have reliable figures. IT mayhem at Barts and the London has also caused several neighbouring primary care trusts to miss their waiting list targets, with some urgently looking at alternative destinations for patients requiring hospital treatment.
Much more here:
http://www.guardian.co.uk/society/2009/apr/28/nhs-it-cerner-computers-hospitals
Continuing issues with the NPfIT that have doubtless prompted the first article tomorrow.
Third we have:
April 24, 2009 - 11:55 AM
Tom Philpott
Special to the Sun Journal
President Obama's ambitious plan to establish a lifetime electronic record for service members and veterans will improve delivery of benefits, speed processing of claims and, over time, open VA health care to any veteran, regardless of their medical condition or income level.
VA Secretary Eric Shinseki first raised the idea of a more sophisticated electronic record system, and linked it to automatic enrollment by all veterans in the VA health system, during a House hearing in February.
This week, through a press spokeswoman, Shinseki confirmed that universal access to VA health care is integral to the administration's plan to develop as quickly as possible a 21st Century electronic record system.
"Secretary Shinseki and the whole (VA) team believe that ‘uniform registration' " in the VA health system "is an essential part of the lifetime virtual record," said Katie Roberts, his press secretary, in an e-mail.
Shinseki and Defense Secretary Robert Gates were with the president April 9 in the Old Executive Office Building when Obama announced to an audience of veterans a "huge step toward modernizing the way VA health care is delivered and (VA) benefits are administered."
Obama described a comprehensive electronic record system, to be developed and used jointly by the Department of Defense and VA, which would hold all service-related documents, administrative and medical, on individuals from the time they enter service until "they are laid to rest."
Reporting continues here:
http://www.newbernsj.com/articles/electronic_45103___article.html/shinseki_record.html
This is a very interesting initiative given the scale and importance of the VA Health System in the US and its history of Health IT innovation.
Fourth we have:
Howard J. Anderson, Executive Editor
Health Data Management, May 1, 2009
This is part two of a three-part series on patient safety. Part three, on clinical decision support for physician group practices, will appear in the October issue.
When it comes to using information technology to support medication administration, there’s no tried-and-true recipe for success. Many hospital executives agree that a handful of technologies can play key roles in improving medication safety. But creating a “closed loop” process to automate all the steps from the ordering to the distribution of medications is a remarkably complex undertaking.
There’s no consensus on what comes first, second or third in automating all the steps involved. And technology won’t solve anything unless it’s paired with changes in doctors’ and nurses’ workflows.
Computerized physician order entry certainly can play a critical role in improving medication administration. But only about 8 percent of hospitals have the costly technology in place so far (see January 2009 issue, page 18). That could change, however, as a result of looming extra payments from Medicare and Medicaid to hospitals under the federal economic stimulus package. Hospitals that use qualifying electronic health records systems that enable physicians to place orders electronically stand to gain extra payments.
Other technologies that can help improve medication safety include electronic medication administration records, which often, but not always, are subsets of broader electronic health records; automated medication dispensing cabinets; pharmacy information systems; and bar codes on medications and patient wristbands. In addition, some hospitals are devising ways to automate the medication reconciliation process, keeping more accurate records of all the drugs patients take before, during and after a hospital stay (see sidebar, page 28.)
Pioneering organizations and analysts alike say that it’s difficult to measure the success of medication administration automation efforts because it’s tough to pinpoint errors that are avoided and near-misses. And many hospitals lack meaningful data on error rates.
A great deal more here:
http://www.healthdatamanagement.com/issues/2009_65/-28110-1.html
This is a useful discussion of the place of ‘full cycle’ medication management and what the components are that make it up.
Fifth we have:
April 24, 2009
Hospitals that want to make an educated guess on how the federal government will define “meaningful use” of electronic health records under the economic stimulus package can use an existing benchmark, one expert says. They can refer to the qualifications for earning Stage 4 on the seven-level rating system of hospital EHR functionality from HIMSS Analytics, a Chicago-based research firm.
Jerri Hiniker, program manager at Stratis Health, a Bloomington, Minn.-based quality improvement organization, predicts the federal government likely will set standards for meaningful use of EHRs that align with HIMSS Analytics’ Stage 4. That stage calls for the use of both clinical decision support and computerized physician order entry, among other functionality.
More here:
http://www.healthdatamanagement.com/news/EHRs-28101-1.html
For more information on the HIMSS Analytics standards, visit himssanalytics.org.
This is a very live debate after the term was used in the Health IT stimulus legislation. All sorts of groups are contributing to the debate.
More here:
http://www.healthdatamanagement.com/news/stimulus-28127-1.html?ET=healthdatamanagement:e855:100325a:&st=email&channel=electronic_health_records
April 28, 2009
And here:
http://govhealthit.com/articles/2009/04/28/blumenthal-health-it-agenda.aspx
The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.
And here:
http://www.modernhealthcare.com/article/20090429/REG/304299995
By Joseph Conn / HITS staff writer
Posted: April 29, 2009 - 10:00 am EDT
The idea Tuesday was to have the National Committee on Vital and Health Statistics hold the first of two days of hearings on the “meaningful use” of electronic health-record systems.
The NCVHS got a lot more to chew on—a daylong discourse on the ills of the nation’s healthcare system and a broad overview of what role health information technology might play in healthcare reform.
In the 785-page American Recovery and Reinvestment Act of 2009, terms relating to “meaningful use” appear 108 times in the sections on Medicare and Medicaid incentives and penalties for using or not using health IT. According to a Congressional Budget Office estimate, the stimulus act will funnel as much as $34 billion into the IT subsidy program. (lots more follows).
And here:
http://industry.bnet.com/healthcare/1000595/lets-limit-meaningful-use-of-ehrs-to-what-really-works/
By Ken Terry | April 29th, 2009 @ 2:54 pm
And here:
http://www.healthdatamanagement.com/news/EHRs-28137-1.html?ET=healthdatamanagement:e858:100325a:&st=email&channel=electronic_health_records
April 29, 2009
And last here:
http://www.healthdatamanagement.com/news/EHRs-28136-1.html?ET=healthdatamanagement:e858:100325a:&st=email&channel=policies_regulation
April 29, 2009
Sixth we have:
April 24, 2009
The Agency for Healthcare Research and Quality has contracted with the Rand Corporation, Santa Monica, Calif., to develop a toolset for implementing electronic prescribing systems.
The toolset will be a "how to" guide for implementing e-prescribing across various provider settings, according to a notice AHRQ published April 24 in the Federal Register.
Despite efforts of Medicare to encourage e-prescribing, adoption remains limited, the agency notes. "On the surface, e-prescribing involves getting a prescription from point A to point B," according to the notice. "In reality, the complexity of e-prescribing reflects all aspects of the process from appropriate prescribing, through dispensing, to correct patient use."
More here:
http://www.healthdatamanagement.com/news/e-prescribing-28098-1.html
Good to see some positive action in providing help in moving e-prescribing forward. Link provided in article.
Seventh we have:
A federal judge in Vermont rejected a challenge to a state law that blocks the use of prescriber-identifiable data for marketing. U.S. District Judge J. Garvan Murtha wrote that the prescribing information represents protected speech under the First Amendment but can be appropriately limited to advance a substantial government interest, granting deference to the Vermont Legislature’s conclusion that it has one. The decision consolidates two lawsuits, one filed by a group of data vendors and another by the Pharmaceutical Research and Manufacturers of America, which sought an injunction blocking a provision of the law compelling drug companies to pay a fee to support an “evidence-based education” program.
More here:
http://www.modernhealthcare.com/article/20090427/REG/304279935
I have never understood why this data should be used for marketing. It is a noxious business that, in my view, should indeed be illegal. Good one the more enlightened States in making the move.
Eighth we have:
By Tevi Troy
Sunday, April 26, 2009
Are electronic health records the panacea for all our health-care ills? Congress seems to think so: With strong cheerleading from President Obama, it has approved $20 billion for EHRs as part of the stimulus package. Health information technology undeniably holds a lot of promise, but it's still in its infancy. Is it worth a stimulus now? A look at some health IT myths:
1. Electronic health records will cure our health system.
EHRs will potentially provide a lot of benefits, most notably by reducing medical errors -- e.g., doctors prescribing medications to patients with an allergy to them -- that kill as many as 98,000 Americans each year. A much-cited 2005 Rand Corp. study of EHRs found that they could save $77 billion annually and potentially eliminate 200,000 adverse drug reactions. Yet a more recent analysis, by Stephen Parente and Jeffrey McCullough in Health Affairs, found that "the evidence base is not yet sufficient" to show that EHRs would improve outcomes.
Implementing EHRs to improve billing -- which would be the simplest and least creative way to spend Congress's money -- is not enough. EHRs can improve our system and help achieve the assumed cost savings only if they bring about changes in the way we practice medicine. Doctors have extremely limited time with their patients. EHRs would help by giving them access to the patients' documents, including all previous tests and conditions, in advance, and by allowing patients to communicate with physicians via e-mail. With the right kind of EHRs, doctors could obtain real-time guidance on the best care for a specific patient from databases containing all the latest diagnostic and therapeutic guidelines.
But this technology is evolving rapidly, and implementing systems in the right way will require thoughtfulness and creativity. As pediatrician and health IT expert Kenneth Mandl, who co-wrote a skeptical analysis of subsidizing EHRs for the New England Journal of Medicine, told the New York Times, "If the government's money goes to cement the current technology in place, we will have a very hard time innovating in health care reform."
Full article here:
http://www.washingtonpost.com/wp-dyn/content/article/2009/04/23/AR2009042303943.html
Read about the other 4 “myths” at the web-site. Comments welcome.
Ninth we have:
Carrie Vaughan, for HealthLeaders Media, April 28, 2009
Chief information officers are not always a member of the CEO's inner circle. In fact, only a quarter (25.23%) of CEOs listed a CIO as members of their senior executive team, according to the 2009 HealthLeaders Media Industry Survey. But the passage of the American Recovery and Reinvestment Act of 2009 may have just elevated their position. The federal government's $36 billion incentive package to install electronic health records means that more CIOs will report directly to the CEO and help set the strategy of the organization.
The role of the CIO has been evolving during the past several years beyond a position that focuses solely on technology and is viewed as the "keeper of information resources." In the April issue of HealthLeaders magazine ("Not Just Techies Anymore"), we examine how that role has evolved during the past several years. Now more than ever, CIOs are helping drive the operational strategy for the organization, says Asif Ahmad, vice president for diagnostic services and CIO for Duke University Health System and Duke University Medical Center. "If you look at the for-profit sector, most of the time the person who is running operations is also responsible for making sure the technology works," he says. "Healthcare needs to follow in those footsteps."
Much more here:
http://www.healthleadersmedia.com/content/232195/topic/WS_HLM2_TEC/Making-the-Business-Case-for-HIT.html
It is interesting to see how the role of the CIO is evolving as there is increasing recognition of the importance of the role in the health system and its sustainability
Tenth we have:
April 28, 2009
Microsoft Corp. has introduced a version of its Amalga data aggregation and reporting software for the life sciences industry.
More here:
http://www.healthdatamanagement.com/news/research-28126-1.html?ET=healthdatamanagement:e855:100325a:&st=email&channel=systems_integration
More information is available at microsoft.com/amalga.
More evidence of the Microsoft interest in the health sector.
Eleventh for the week we have:
By Joseph Conn / HITS staff writer
Posted: April 28, 2009 - 10:00 am EDT
West Virginia, a small, mostly rural state, is the adopted home of Democratic Sen. Jay Rockefeller, and, arguably, also where open-source healthcare information technology has been most widely adopted.
It is in keeping, then, that Rockefeller, past chairman and current member of the Senate Veterans Affairs Committee, and current chairman of the health subcommittee of the Senate Finance Committee, announced last week that he was introducing legislation to “facilitate nationwide adoption of electronic health records, particularly among small, rural providers.”
The Rockefeller bill seeks to do so by creating a public utility software system based on the clinical IT systems developed at taxpayer expense by the VA and the Indian Health Service, according to a news release and Rockefeller’s testimony in the Congressional Record.
The senator’s Health Information Technology Public Utility Act of 2009 would, according to a news release, “build upon the successful use of open-source electronic health records” by the VA, related software developed by the Indian Health Service and the federal health information exchange software released as open source earlier this month.
More here (registration required):
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090428/REG/304289994
It will be interesting to see how the balance between proprietary and open source plays out over the next few years.
Twelfth we have:
Health informatics is key to Defense Department efforts to reduce costs and improve quality as well as to the future shape of the national health care system.
That was one of the conclusions of a symposium that brought together government and private health care officials to discuss health reform, health care costs and the role of information technology in future health care systems. The conference took place on Friday at the National Defense University in Washington.
“We’re trying to get the new administration off to a good start,” said Dr. Ward Casscells, the assistant secretary of Defense for Health Affairs, speaking at a press wrap-up at the conclusion of the conference. “Secretary [Robert] Gates has asked us to do what we can to control costs while improving ease of access to health care and not jeopardizing quality. The president has set the same goals for the country as a whole.”
Lots more here:
http://govhealthit.com/articles/2009/04/27/cascells-farewell-remarks.aspx?s=GHIT_280409
These comments certainly define what is hoped for out of the planned Health IT investments.
Thirteenth we have:
Public health agencies in Utah have deployed what the state calls the first open-source, Web-based infectious disease tracking and management system in the U.S.
The rollout of the open-sourced CSI TriSano disease tracker began with two local health departments in January and has since expanded to a total of 12 local agencies as well as the Utah Department of Health.
The state originally planned to acquire a commercial disease-tracking system. But the systems under consideration cost as much as $2 million before customization, according to David Jackson, product manager with the Utah Department of Health.
Instead, the state pursued an open-source development project, partnering with the Collaborative Software Initiative, a Portland-based software company.
CSI TriSano was built to replace a number of siloed systems in use at state and local health departments, noted Jackson.
Much more here:
http://govhealthit.com/articles/2009/04/23/utah-open-source-disease-tracker.aspx?s=GHIT_280409
Definitely topical work as we watch the potential pandemic emerge!
Fourteenth we have:
28 Apr 2009
The largest primary care trust in England has decided not to implement the Summary Care Record in the next 12 months and to expand its own shared care record system instead.
The Hampshire Health Record (HHR) already covers 65% of the Hampshire population and NHS Hampshire plans to roll it out to 90% of residents by the end of March next year.
It also covers Southampton City PCT, where 80% of residents have records, and Portsmouth City PCT, where 35% of residents have records.
NHS Hampshire said the HHR contains more information than the SCR currently holds and already accepts feeds from all GP systems. It also argued that promoting both the SCR and HHR could be confusing.
However, it said it was actively looking at how patients might be able to access the HHR through the national secure health portal, HealthSpace.
In a statement issued to EHI Primary Care, Jenny Nash, chief information officer for NHS Hampshire said: “Since the HHR project began, the national NHS Summary Care Record service has started.
Much more here :
http://www.ehiprimarycare.com/news/4792/hampshire_rejects_scr_for_hhr
One really has to wonder just how sensible this is. However with all the problems in the NPfIT it might turn out to be pretty smart!
Fifteenth we have:
28 Apr 2009
At least four hospitals in the south of England intend to implement CSC’s Lorenzo, according to informatics plans, with community and mental health trusts taking systems from both TPP and CSE-Servelec.
In South Central SHA several hospital trusts that have yet to receive a system under the National Programme for IT appear to be planning for a move to Lorenzo.
The informatics plan from NHS Hampshire , obtained by GP Dr Neil Bhatia under the Freedom of Information Act, reveals that Portsmouth Hospitals NHS Trust plans to implement Lorenzo in 2010/11 “if [it] provides required functionality”. Frimley Park Hospital NHS Foundation Trust is renewing its patient administration system contract for three years but will also implement Lorenzo “once tried and test and delivering benefits.”
More here:
http://www.ehiprimarycare.com/news/4791/at_least_four_southern_trusts_plan_for_lorenzo
A little good news I suspect if things work out – especially after the dire reporting in the top article in this collection!
Sixteenth we have:
By Howard J. Anderson, Executive Editor May 1, 2009
Data mining can be the foundation for meaningful changes in the practice of medicine. Inova Health System has evidence that proves this is far more than just a hypothesis. The Falls Church, Va.-based system, which owns five hospitals, is using the information pinpointed by data mining to help devise new clinical processes. Then it's using its electronic health records system to guide clinicians on how to follow those processes, providing rules and alerts to steer them on the right path.
The result? Serious safety events-those that cause serious harm or even death-declined by 60% from May 2005 to February 2009 at Inova's hospitals. Hospital-acquired infections declined 60% during the same period. And the mortality rate has substantially declined.
Inova is using Web-based data mining software called Quality Manager from Premier Inc., a Charlotte, N.C.-based purchasing alliance. It's a participant in Premier's Quest, a quality improvement benchmarking project. The alliance recently announced that it will expand the project beyond the original 166 hospitals.
Very much more here:
http://www.healthdatamanagement.com/issues/2009_65/-28117-1.html
Just more news about the utility of Health IT once you get started. A good article!
Fourth last we have:
April 27, 2009 | Bernie Monegain, Editor
WASHINGTON – The recession has forced more than half the nation's hospitals to either scale back information technology projects already in progress or postpone them, according to a new survey from the American Hospital Association.
The findings are based on 1,078 responses that the AHA calls "broadly representative of the universe of hospitals."
The survey shows that 28 percent scaled back IT projects already in progress, while 27 percent decided not to move forward on planned projects. Six percent halted IT projects that were already under way.
Hospitals also reported scaling back or eliminating clinical technology plans, with 34 percent deciding to not move forward on their plans and 32 percent scaling back. Six percent stopped clinical technology projects already in the works.
Hospitals are finding themselves financially squeezed in other ways, too.
More here (with slides):
http://www.healthcareitnews.com/news/recession-puts-squeeze-hospital-it-projects
Hardly a surprise!
Third last we have:
April 29, 2009
In notices published on April 29 in the Federal Register, David Blumenthal, M.D., the national coordinator for health information technology, has established the HIT Policy Committee and the HIT Standards Committee.
Both committees are mandated under the American Recovery and Reinvestment Act. The HIT Policy Committee will advise Blumenthal on a range of issues related to implementation of a national health information network. The HIT Standards Committee will advise Blumenthal on standards, implementation specifications and certification criteria for the electronic exchange and use of health information.
More here (with links):
http://www.healthdatamanagement.com/news/economy-28130-1.html?ET=healthdatamanagement:e856:100325a:&st=email&portal=hospitals
Clearly no plan to waste time getting rolling!
Second last for the week we have:
Tracking and communications could play a key role in combating a pandemic.
By Michael Day
The World Health Organization (WHO) admitted on Tuesday that it's too late to contain swine flu, and experts say that it is now vital to track the spread of the virus in order to mitigate its effects. Vaccines and antivirals will be crucial to the effort, but tracking and communications technologies could also play a key role in monitoring the virus, distributing accurate health information, and quelling outbreaks.
Bloggers and social-networking sites were among the first to follow the outbreak's rapid spread from its epicenter in Mexico--where swine flu has been linked to more than 150 deaths--to cities across the United States and on to Europe, Israel, and New Zealand.
The need for fast information has seen the Centers for Disease Control and Prevention (CDC) build up a large following on Twitter. Groups ranging from fellow federal institutions, such as the National Institute for Occupational Safety and Health, to local Red Cross divisions, as well as many regular Twitter users, are employing the service to receive updates. Some experts, however, warn that Twitter can just as easily spread misinformation and panic. According to data from the medical tracking site Nielson, conversations related to swine flu reached 2 percent of all messages on Twitter over the weekend. By contrast, Google's Flu Trends, a site that aims to spot flu outbreaks by monitoring search queries related to flu symptoms and treatment, has shown little increase in activity in recent days.
Much more here:
http://www.technologyreview.com/web/22554/?nlid=1986
This is a good summary of the various e-Health approaches being used.
This provides some rich information on the same topic.
http://mashable.com/2009/05/01/swine-flu-cdc/
May 1st, 2009 | by Jennifer Van Grove
Last for this week we have:
Rob Drewniak for HealthLeaders Media, April 28, 2009
When the uninitiated think of electronic health record implementations, they focus on build and rollout. Most likely, the implementation is considered an "IT project," and the communication machine starts rolling just before staff members are affected. However, the initiated know that EHR implementations—successful ones, that is—are process, workflow, and operational in nature. They are considered operational improvement projects with a healthy dose of change management, and communication begins when the decision to move to an EHR is made.
With the American Recovery and Reinvestment Act's HITECH incentives, healthcare organizations are being urged to roll out EHRs and use them in a "meaningful" way. The following are three areas that often get the short shrift during an EHR implementation, but they are as critical to success as the functionality itself.
Communication. One of the first steps in an EHR implementation is to carefully create a communication plan that focuses on all classes of end users. The message should address the benefits of the new system's functionality, as well as, the changes that will occur post-implementation to people's everyday workflow. From implementation experience at academic medical centers, ambulatory facilities, and community hospitals, my colleagues and I have identified the need to better prepare end users for the effects on their daily processes.
The learning and change process begins with these early communications. In addition to the "training" concept inherent in it, early adoption questions can surface that may alter the build and the training program. In addition to end users, leadership and the project team require early and frequent knowledge. You can use e-demos and training materials based on actual scenarios to help assimilate everyone involved to the new environment.
Much more here:
http://www.healthleadersmedia.com/content/232196/topic/WS_HLM2_TEC/EHR-Implementations-Success-Lies-Beyond-the-Build.html
This is very much the best being held back to last. Excellent set of points on how to improve the chances for success.
There is an amazing amount happening. Enjoy!
David.
