Again there has been just a heap of stuff arrive this week.
First we have:
Five Tips to Stop Patient Record Snoopers
Dom Nicastro, for HealthLeaders Media, May 21, 2009
Who can blame you for being worried about patient privacy violations? They have been all over the news lately:
- Kaiser Permanente Bellflower Hospital in Los Angeles fined $250,000 because 23 employees wanted to look at records of the mother who grabbed national headlines after having eight children
- Hackers hijacked 8 million patient records from the Virginia Prescription Monitoring Program Web site
- Hackers stole approximately 160,000 records of personal information of students and alumni of the University of California-Berkeley
In addition, HHS promises more enforcement through the Health Information Technology for Clinical and Economic Health (HITECH) Act, so hospitals must get prepared.
How does the healthcare industry quell the curiosity of staff members who are peeking into patient records?
Some industry leaders say give them what they want–full access to medical records–and see if they take it. In other words, bait them, then catch them in the act.
Monitoring staff members and tracking their access to medical records will only get you so far. Some facilities use fictitious medical records that IT monitors to determine whether anyone is accessing them.
Much more here with links :
Given the fines and firings resulting from such breaches this seems like a very timely article!
Second we have:
Thursday, May 14, 2009
VA Project To Mine EHR Data To Study Efficacy of Treatments
A new nationwide initiative will allow researchers to mine data from electronic health records at the Department of Veterans Affairs to study treatment efficacy, the Salt Lake City Deseret News reports.
The $10 million, four-year project -- called the Consortium for Healthcare Informatics Research -- will be led and coordinated by physicians from the VA Hospital in Salt Lake City. Investigators from California, Connecticut, Florida, Indiana, Massachusetts, Oregon, Pennsylvania and Tennessee also will collaborate on the research.
The initiative will focus on addressing post-traumatic stress disorder and methicillin-resistant Staphylococcus aureus infections, or MRSA.
Much more here:
The second core benefit set of the EHR is to be a source of data that can be ethically mined for clinical research. But you need to have operational EHRs first! We have a way to go on the first before the secondary and crucial benefits can flow.
Third we have:
Three more early adopters for Lorenzo
19 May 2009
Kettering General Hospital NHS Foundation Trust has confirmed it will be the next acute site to implement Lorenzo.
The trust told E-Health Insider that it had become an early adopter site for the iSoft patient administration system, as part of the National Programme for IT in the NHS.
A primary care trust and a mental health services trust have also committed to deploying Lorenzo, which is currently being used on a limited scale by two acute trusts and one PCT.
NHS Bury’s Informatics Plan says NHS Bury and Pennine Care NHS Foundation Trust will move from iSoft's iPM to Lorenzo Regional Care. The plan also says that Pennine Acute Hospitals NHS Trust will implement Lorenzo.
Reporting continues here:
http://www.e-health-insider.com/news/4848/three_more_early_adopters_for_lorenzo
It seems the roll out is slowly picking up pace. A good thing for the NHS (and shareholders of which I am one!)
Fourth we have:
Mental illness and behavorial health challanges, electronic medical records
May 16, 2009
MADISON - The complexities of mental illness and behavioral health and their stigmas present unique challenges to the use of electronic medical records (EMR) by psychiatrists, says a national expert on the subject at the recent Digital Healthcare Conference in Madison. An EMR system developed by a team lead by Dr. Ken Gersing is improving the care received by patients at the 25 institutions across the country where it is deployed.
Dr. Gersing, director of clinical information services for the Department of Psychiatry at Duke University Medical System, says that the difficulty in managing mental illness begins with the trouble that health care professionals have in identified the scope of the problem.
“It is really hard to get good numbers about the prevalence of mental illness,” Gersing says.
According to Dr. Gersing, a 1993 study estimated that roughly 28 percent of Americans have a mental or addictive disorder. He believes the percentage of Americans afflicted with mental illness lies closer to 20 percent. One-third of primary care visits concern mental health, and the majority of mental health patients, 54 percent receive their care through primary care providers.
“The real problem,” says Dr. Gersing “are those patients who have no mental illness, and are still getting care through their primary care physician.”
The EMRs of these patients—the “worried well,” according to Dr. Gersing—present one of a number of difficulties in the use of EMRs in psychiatry. These EMRs are not “clean,” Dr. Gersing says, because they include, for example, a diagnosis of major depression by the primary care physician only so that physician can get paid. That these records contain false information about the patient makes efforts to learn more about mental illness through data mining very difficult.
There are other problems that make the use of EMRs in psychiatry difficult. These difficulties, Dr. Gersing says, include the different way in which psychiatrists document the care and status of their patients, the treatment of patients through group therapy that makes post-visit documentation unusually burdensome, and the anti-technology bias of psychiatrists. Less than five percent of psychiatrists use EMRs, Dr. Gersing says.
More here:
http://wistechnology.com/articles/6085/
I have to say this is an interesting issue. Most EHRs have not to date, as far as I know, addressed the specific issues of psychiatry and the functions needed to successfully support this form of care delivery.
Fifth we have:
New York City public hospitals credit IT for health boost
- By John Moore
- May 15, 2009
Computer-based registry helps city doctors manage improvements in diabetic health indicators
New York City’s Health and Hospitals Corp. credits a computer-based patient registry as a key factor behind improving health indicators among its diabetic patients. In its latest data, HCC saw 2008 diabetes indicators improve almost 3 percent over 2007 results among city residents. The figures also showed improvement over 2007 results at the state and national levels.
HHC, which operates public hospitals and clinics providing health care to 1.3 million New Yorkers, has over 50,000 diabetic patients in its registry.
In 2008, 45.5 percent of adult diabetic patients under routine care at HHC facilities had healthy blood sugar levels (a Hemoglobin A1c test result of less than 7), HHC reported. Patients with good diabetes control represented 42.6 percent slice of monitored patients in 2007. HHC, citing state Department of Health figures, said the statewide tally for patients with good diabetes control was 35 percent in 2007.
The health care system also cited an increase the number of diabetic patients who achieved healthy blood pressure and cholesterol levels.
More here:
http://govhealthit.com/articles/2009/05/15/nyc-hospitals-health-it.aspx
This is really good news to see steady improvement in the types of measurements that will mean less lives lost and a better quality of life for diabetes suffers. Health IT working again – as expected.
Sixth we have:
HIT Standards Committee Meets
May 15, 2009
Members of the new HIT Standards Committee met for the first time on May 15 and decided to focus initial efforts on three priorities set a few days ago by the new HIT Policy Committee.
Both committees were authorized under the American Recovery and Reinvestment Act. The policy committee will advise David Blumenthal, M.D., national coordinator for health information technology, on a range of issues related to implementation of a national health information network. The standards committee will advise Blumenthal on standards, implementation specifications and certification criteria for the electronic exchange of health information.
The policy committee, meeting for the first time on May 11, formed three workgroups to focus on developing recommendations covering the meaningful use of electronic health records, certification and adoption of electronic records, and information exchange.
More here:
http://www.healthdatamanagement.com/news/stimulus-28213-1.html
The US is really ramping up efforts in the standards space to ensure they can leverage the funds that have now become available.
A lot more detail is available here:
http://www.modernhealthcare.com/article/20090518/REG/305189994
HIT advisory panels meet, with limited time for results
By Joseph Conn / HITS staff writer
Posted: May 18, 2009 - 5:59 am EDT
Seventh we have:
Cerner's Clean Bill of Health - Barron's
Cerner (CERN), a leader in health-care information technology, should get a bump from wider use of electronic medical records, explains Barron's Lawrence C. Strauss. Shares are up 50% since March on stimulus plans to encourage more health-care IT, and there could be another 40% upside over the next 12 months.
Shares may look a little pricey at 22.8 times this year's profit estimates, but bulls argue there's plenty more upside as national gaps in health-care IT start to get filled. Part of Obama's stimulus plan earmarks $36B of incentives to encourage wider use of electronic medical records, and penalizes providers that don't make that effort. The company estimates its clients could receive around $8B of stimulus incentives, half of which could flow to Cerner. And hospitals and doctors' offices have another incentive to adopt health-care IT - the savings from the move could total more than $77B per year.
More here:
http://seekingalpha.com/article/138110-cerner-s-clean-bill-of-health-barron-s
Seems Wall St is starting to take notice of what is happening with Health IT in the US!
Eighth we have:
Mayo Clinic, doctor battle over software rights
By Walter F. Roche Jr.
TRIBUNE-REVIEW
Saturday, May 16, 2009
The Mayo Clinic, the famed health care organization, and its data processing partner Cerner Corp. are asking a federal judge to slap a gag order on a key former employee to bar him from even speaking about a new health technology product.
In a lawsuit pending in federal court, Rochester, Minn.-based Mayo charged that "once trusted" executive Peter L. Elkin walked off with key backup data on a software program developed while he was a full-time employee. Worse yet, he has been making speeches about it, Mayo lawyers charge.
Elkin countered charging that Mayo and Cerner are blocking the free flow of technology that could be used to deal with everything from threats of bio-terrorism to epidemics such as the swine flu outbreak. His lawsuit charges that another Mayo employee took an unauthorized copy of the source code for his software program and turned it over to a Mayo partner.
Elkin's lawyers contend that Mayo and Cerner "want the exclusive right to sell" his software, "violating the terms of federal grants that paid Mayo millions of dollars to develop software for the public good."
The court battle over the ownership of the "natural language" health care software occurs as the Obama administration has earmarked $19 billion to promote the use of electronic medical records by physicians and hospitals. Mayo and Cerner executives were recently named to a federal panel overseeing those electronic data health efforts.
Long full article here (registration required) :
http://www.pittsburghlive.com/x/pittsburghtrib/news/mostread/s_625414.html
It is a bit sad that we have fights over intellectual property that might help save lives.
Ninth we have:
Monday, May 18, 2009
Is It a Matter of Time Before Physicians Are Replaced by Expert Online Medical Content?
by Thomas H. Lee M.D.
Over the past several years, it's become increasingly evident that the newspaper publishing industry is not just struggling, but struggling to survive. Venerable institutions ranging from the Boston Globe to the San Francisco Chronicle face bleak economic futures, while others such as the Seattle Post-Intelligencer and the Rocky Mountain News have already closed their doors.
But what appears to be specific to newspapers today could occur to other forms of content and media in the near future. IT is rapidly disrupting the landscape of content and content publication, and it is agnostic to form or function. Witness the rise of Wikipedia, Blogger, YouTube, iTunes, Kindle, and Hulu.
Some might describe this as the great commodification of content. Large, entrenched owners of valuable content are being outcompeted and replaced by smaller, tech-savvy substitutes who have found a better way to deliver content more conveniently and affordably. Business models and businesses are being disrupted, while content is becoming more accessible and affordable to all.
Though physicians may take comfort in practicing out of brick-and-mortar service businesses, a significant part of health care is essentially a content business. Consumers seek answers to clinical questions. Today, that content (or knowledge) primarily resides in the inconvenient and expensive domains of physician office visits.
Is it simply a matter of time before physicians are replaced by expert online medical content? Will all professional knowledge ultimately become Googlefied? Or are there limitations to where the disruptive nature of IT can reach?
Much more here:
I am not sure the premise here is right. There is a lot of quality health information available to the public on the web. The real issues in my view is to make sure individuals are able to distinguish between reliable fairly presented information and infomercials and deception masquerading as facts.
Tenth we have:
The 'Nana' generation
BY ANA VECIANA-SUAREZ
As the American population ages and grandparents become more tech-savvy, a growing number of manufacturers are designing souped-up -- or stripped-down -- gadgets for the senior set. The devices boast larger fonts, brighter lights, bigger knobs and louder sound.
The generation that grew up before the arrival of TV, the dawn of cellphones and the advent of the Internet may prove to be the healthiest segment of the tech market yet. From talking pill bottles to bathroom scales that record information for physicians, these gadgets are part of what some have dubbed ''nana'' technology.
''In a market that has stayed essentially flat, this makes good business sense,'' says Robin Raskin, New York-based tech consultant who has advised such companies as Sony, Intel and Nickelodeon. ``You're going to see a whole bunch of designers doing a whole lot of focus groups and testing to try out their products.
``Actually, they already are.''
Wearing special suits or equipment to simulate the effects of advancing age, researchers and designers use ''empathy sessions'' to develop devices. The AgeLab at MIT, for instance, recently released AGNES 2.0, which consists of pads and elastic wraps that hamper movement in order to imitate the effect of arthritis and spinal deterioration. The Macklin Intergenerational Institute in Ohio asks trainees to wear vision-impairing glasses before trying to read maps. And at GE's industrial headquarters, some employees shove cotton balls in their ears to simulate hearing loss.
Seniors tend to adopt technology for specific reasons: safety, health, independence or social engagement. They also want easy-to-use gadgets that compensate for diminishing vision and hearing.
More here:
http://www.miamiherald.com/360/story/1049406.html
This is an interesting trend – and something that will need to be pursued if we are to take maximum advantage of the assistive technologies that are coming down the track.
Eleventh for the week we have:
UPenn Health System Uses eICU to Lower VAP Rates
Heather Comak, for HealthLeaders Media, May 21, 2009
Ventilator-associated pneumonia (VAP) has been a constant headache for hospitals around the country, and on the list of IHI interventions since the inception of the 100,000 Lives Campaign in 2006. It is one of the most-acquired conditions by intensive care unit (ICU) patients on ventilators and its presence exacerbates existing conditions, as well as adds costly days spent in the ICU.
UPenn Health System (UPHS) in Philadelphia utilized an electronic ICU (eICU), which uses telemedicine to monitor patients, already in place to help lower its rates of VAP and realized a cost savings of more than $138,000 over a two-year span.
An eICU can add an extra level of monitoring for ICU patients. Not only does it provide visual surveillance, but it offers a level of data and analysis that simply utilizing bedside caregivers cannot.
"Telemedicine receives alerts and alarms through a software package," says Joseph DiMartino, BSN, RN, outcomes coordinator for UPHS. The eICU monitors different quality initiatives at the Hospital at The University of Pennsylvania, Presbyterian Hospital, and Pennsylvania Hospital. "That allows us to see and detect alerts for patients earlier than maybe the bedside nurse might see."
He explains that often bedside caregivers set patient alarms so that they only go off in an extreme emergency and are not ringing all day, as a distraction. The eICU's system is set to be alerted whenever there is a 20% or higher change in a vital sign and the eICU staff members can alert the bedside caregiver if it is necessary.
Much more here:
This technology is increasingly the way to go for those hospitals who can’t support full time intensivist cover it seems.
Twelfth we have:
Kaiser subscribers can access health records in a flash
By Bobby Caina Calvan
bcalvan@sacbee.com
Published: Thursday, May. 21, 2009 - 12:00 am | Page 8B
Last Modified: Thursday, May. 21, 2009 - 12:19 am
Electronic medical records, hailed as a bold and necessary new frontier in medicine, are taking another leap forward – even as many medical offices scramble to catch up.
Kaiser Permanente subscribers in Northern California now have access to most of their health records on pocket flash drives, a convenience the health system touts as a potential lifesaver.
"I can't tell you how many times I've been in an emergency situation and people aren't sure what their medical history is," said Dr. Dennis Ostrem, an internist and assistant physician-in-chief at Kaiser's Sacramento Medical Center.
More here:
http://www.sacbee.com/business/story/1879519.html
Sounds like a good idea to me!
Thirteenth we have:
Government CIOs Diagnose Health Information Technology Options
May 19, 2009, By David Raths
The U.S. economic stimulus package is the biggest thing that's ever happened in health IT.
That's what Dr. Mark Leavitt says about the American Reinvestment and Recovery Act (ARRA) of 2009, which promises to spend nearly $20 billion on technology use in health care.
Leavitt, chairman of the Certification Commission for Healthcare Information Technology, which certifies electronic health records (EHRs), recently compared the challenge of creating a nationwide network of interoperable EHRs by 2014 to NASA's manned spaceflight mission to the moon in the 1960s.
The federal government plans to kick its purchasing power into high gear by offering Medicare and Medicaid bonuses to physicians and hospitals that demonstrate "meaningful use" of interoperable, certified EHRs starting in 2011. The stimulus package also provides billions of grant dollars to federal and state organizations for research and the promotion of health-IT adoption.
One ramification is that state CIOs will begin paying much more attention to health projects, predicts Erica Drazen, managing partner of emerging practices at research firm CSC Global Healthcare Sector. The states pay for a lot of care, she noted, and if there continue to be islands of automation that can't share data, states won't see the quality or cost improvements they hope to achieve. "For states that have made progress on health-information exchange, this is their time in the limelight," she said. "For ones that haven't made much progress, it is time to step up."
The sudden flurry of activity has put a spotlight on public-sector CIOs who have been working in the field for years. The following are profiles of five federal, state and municipal IT leaders; their ongoing efforts to make use of health IT; and their thoughts on the stimulus act's impact on their work.
Much more here:
http://www.govtech.com/gt/articles/689397
This is a good review of the various US Govt initiatives in the Health IT domain.
Fourth last we have:
The changing model of effective and efficient use of information.
In 1910, Dr. William J. Mayo shared, "As we men of medicine grow in learning, we more justly appreciate our dependence upon each other. . The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary. .It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, ." (http://www.mayoclinic.org/needs-of-patient/mayo-quote.html)
The collective community of providers is today's "cooperative science". Such cooperation is supported in part by real time sharing of patient history, among clinicians involved in that patient's care, with consent as required by current legislation.
Only in the last 15 years have we significantly advanced the usefulness of medical records by having them become part of an electronic medical record (EMR). This has led to use of information for:
· extending evidence-based medicine;
· enabling quality assessments in outcomes;
· managing chronic disease;
· extending documentation events to drive other workflow (e.g. charge on administration from nursing medication administration); and
· enhancing communication and continuity of care within an integrated an integrated delivery network, and now beyond that network to the community.
Much more here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199897
This is a useful discussion of the present state of Health Information Exchanges.
Third last we have:
Research award granted to establish Canadian e-health observatory
Recipient of new Applied Health Services and Policy Chair Award in e-Health named
May 20, 2009 (Toronto, ON) - The Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (CIHR-IHSPR) and Canada Health Infoway (Infoway), announced today Dr. Francis Lau, University of Victoria, as recipient of the Applied Health Services and Policy Chair award in e-Health.
The Chair award in e-Health is jointly funded by Infoway and CIHR-IHSPR, and represents an exciting new partnership between the organizations. Over the next five years, the $925,000 award will enable Dr. Lau to focus his research, training and knowledge translation initiatives on the development of an e-Health observatory to monitor the effects of health information system deployment in Canada.
“Infoway is pleased to support the work of Dr. Lau through the first Applied Chair award in e-Health. His research will help build greater understanding of the benefits of electronic health record solution implementation as Canada moves forward with its vision of an electronic health record for all residents,” said Richard Alvarez, President and CEO, Canada Health Infoway.
Much more here:
http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/432
Would be nice to have a similar thing here – I guess there is not enough to observe yet?
Second last for the week we have:
CCHIT releases ambulatory EHR, e-Rx criteria
By Joseph Conn / HITS staff writer
Posted: May 20, 2009 - 11:00 am EDT
The federally supported Certification Commission for Healthcare Information Technology has released its latest batch of final testing criteria for the 2009-10 certification cycle for electronic health-records systems used in ambulatory care, inpatient and emergency department environments as well as for stand-alone electronic-prescribing systems.
More here:
http://www.modernhealthcare.com/article/20090520/REG/305209991
These are useful specifications that should be closely reviewed by all those interested
Last, and very usefully, we have:
Health IT program needs ID management
- By Alice Lipowicz
- May 19, 2009
Privacy becomes an issue with electronic health records
The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.
The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.
For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.
Much more here:
No doubt an important truth that should not be ignored.
There is an amazing amount happening. Enjoy!
David.
