Useful and Interesting Health IT News from the Last Week – 26/07/2009.

Again, in the last week, I have come across a few news items which are worth passing on.

First we have:

E-prescribing a ‘freaking mess’

23-Jul-2009

A race to sign up GPs to electronic prescribing systems is undermining the public good, independent observers say.

E-script software brands Medisecure and eRx are both calling on GPs to register with their software for free, and start using scripts with barcodes to reduce transcription errors at the pharmacy.

They say that once the Federal Government rolls out patient and provider health identifier numbers from next year, the e-scripts may start to replace paper scripts altogether.

But because the two systems are not interoperable, an e-script will only function if the pharmacist uses the same software as the GP.

Health IT specialist Dr David More said the situation was "a complete freaking mess".

.....

A spokeswoman for the Federal Health Department would not comment on whether GPs should start using either system.

Dr Mukesh Haikerwal, an advisor to NEHTA, said prescriptions needed to be readable one system to another, and not dependent on the supply of software.

"The problem is these two companies have beaten the standards setters to the post," he said. "They are not helping anyone."

More here (subscription required):

http://www.australiandoctor.com.au/articles/71/0c062a71.asp

Three points:

First your blogger is going to be a bit more reserved in chatting with journalists (but the quote is accurate)!

Second obviously NEHTA and DoHA are not all that impressed either with what is going on.

Third – does anyone remember this tender?

RFT 272/0809

REQUEST FOR TENDER

EPRESCRIBING AND DISPENSING OF MEDICINES BENEFITS REALISATION AND IMPLEMENTATION PLAN

LODGEMENT OF TENDERS (Refer Part A, Section 3.1)

Tenders must be lodged by “Tender Closing Date” (2.00pm local Canberra time on Thursday 23 April 2009).

I am told that it will still be a week or two before the contract to do this work is awarded – at the earliest – and given the work is to take 34 weeks we are looking at close to the middle of 2010 before DoHA will even have a plan of what to do. Just amazingly pathetic in my view!

Invaluable background is found here:

Canberra fails to follow the online script

Karen Dearne | July 18, 2009

Article from: The Australian

DOCTORS and pharmacists have lined up behind rival electronic prescribing systems that will eventually spell an end to paper scripts, despite an e-prescribing policy vacuum in Canberra.

Two main players have emerged to claim the new market, with the Pharmacy Guild's 50 per cent owned eRx Script Exchange first out of the blocks. MediSecure, endorsed by the Royal Australian College of General Practitioners, is not far behind.

At stake is a potential $60 million annually, with both players set to charge a 25cent fee for each transaction out of 240million prescriptions issued each year.

They are forcing the pace as federal Health Minister Nicola Roxon has yet to provide clear direction. As well, the Department of Health and Ageing is scrambling to complete internal investigations of key management and operational concerns.

A spokeswoman says the department is ``still considering'' the outcome of a tender earlier this year calling for consultants to draw up an e-prescribing business and implementation plan in response to a previous critical report from financial advisory firm KPMG last year.

But the spokeswoman indicates the department may play ball on transaction fees, an item certain to be on the agenda as the Pharmacy Guild sits down to thrash out the fifth community pharmacy agreement. Negotiations are gearing up now.

``The issue of payment arrangements will be considered if it arises, taking into account the business efficiencies that e-prescribing and dispensing provides,'' the spokeswoman tells Weekend Health.

Much more detail here:

http://www.theaustralian.news.com.au/story/0,25197,25796849-23289,00.html

Second we have:

Essential e-health is watertight

Article from The Advertiser

July 20, 2009 12:01am

THE implementation of a national e-health system may well save money and probably lives.

Eight in 10 Australians believe it is a good idea. But, as with any genuine reform, the Federal Government must be sure it gets the process right. Doctors and their patients must be satisfied that the system is secure and reliable.

In 2004, a national body was set up by the country's health ministers to drive e-health forward. In 2006, then-opposition health spokeswoman Julia Gillard attacked the Howard government for lagging on the issue. She said it was "dangerously close" to being an "expensive failure".

It was then spruiked at Prime Minister Kevin Rudd's 2020 Summit, and the details released in today's Advertiser are another important step forward.

Shared electronic records will give patients more control over their medical care by allowing them to easily access their own information, such as vaccination, prescription, and chronic disease information.

It will give doctors more control by helping to stamp out "doctor shopping" and allowing better continuity of care.

More here:

http://www.news.com.au/adelaidenow/story/0,22606,25807068-5006336,00.html

It is good to see we are now even seeing editorials on how useful e-Health could be. They do also not it has to be done right – that is where the risk lies right now!

Third we have:

AMA criticises plans for 'e-health' medical records reform

Plans to give Australians access to their health records online are being criticised by the nation's peak medical body.

The proposal has reportedly been put forward by the National Health and Hospitals Reform Commission (NHHRC).

Under the plan doctors would have to link patient records to a national database, with those who don't comply to miss out on lucrative medicare payments.

But AMA President Andrew Pesce says threats won't result in a quality system.

"It would be much better to provide adequate incentives to recognise there will be an initial financial outlay and cost to developing properly working medical records."

The NHHRC says an e-health system would save the government up to $8 billion over 10 years, making it easier to track the progress of chronic disease sufferers and store test results, scans and x-rays.

More here:

http://livenews.com.au/news/ama-criticises-plans-for-ehealth-medical-records-reform/2009/7/20/213407

Dr Pesce is dead right to point out that imposing penalties without some prior incentives is just crazy!

More AMA commentary is here:

http://www.news-medical.net/news/20090720/e-Health-revolution-will-give-Australian-patients-access-to-their-health-records.aspx

e-Health revolution will give Australian patients access to their health records

20. July 2009 01:01

The Australian Medical Association (AMA) which represents than 27,000 doctors across Australia has criticised the government's plans for 'e-health' medical records reform.

And here:

http://www.australianit.news.com.au/story/0,25197,25819833-15306,00.html

E-health vital to rural areas: AMA

Karen Dearne | July 22, 2009

E-HEALTH infrastructure in rural Australia must be a priority for federal and state governments, the new president of the Australian Medical Association, Andrew Pesce, has warned.

Fourth we have:

Experts warn of e-health privacy threat

22-Jul-2009

By Sarah Colyer

PRIVACY experts are warning of mayhem -- including greater identity theft and dubious secondary use of patient information -- when Medicare begins its rollout of electronic health identifiers next year.

The proposed system is designed to allow health professionals to send data to each other without the risk of the information being intercepted or corrupted by third parties.

In a discussion paper released last week, the Australian Health Ministers' Advisory Council said Medicare would introduce operational identifiers for patients and health providers from mid-next year -- before national privacy legislation had been finalised.

Existing federal, state and territory privacy laws would apply in the interim, it said, despite noting that the laws were inconsistent and confusing.

Chairwoman of the Australian Privacy Foundation's health sub-committee Dr Juanita Fernando (PhD) said, "in any kind of project management situation this would be laughed at".

Full article here:

http://www.australiandoctor.com.au/articles/c4/0c0629c4.asp

This debate has a while to run yet I believe.

Fifth we have:

Doctors issue deadly warning

David Bancroft | 23rd July 2009

IT seems incredible that a patient record system that aims to improve treatment could kill people, but that is a claim being made about a new system that is almost certainly going to be introduced into the Grafton Base Hospital next week.

Earlier this month, leading health officials from the Lismore Base Hospital wrote to the North Coast Area Health Service (NCAHS) claiming a new Surginet electronic medical record system that had been operating in the hospital for several months would 'inevitably' lead to the death of patients.

But the health service said changes had been made to the Surginet electronic medical record (EMR) system since the concerns were raised by the four senior clinicians on July 2, and the system had been operating 'satisfactorily' in Sydney without patient concerns being raised.

In their letter to NCAHS chief executive officer Chris Crawford, which was copied to the Minister for Health John Della Bosca, the four medical specialists said there had been recurring problems over several months and 'these have not improved'.

“This has resulted in unnecessary compromise of patient safety,” they wrote.

“There have been repeated well demonstrated cases of near miss disasters due to these problems.

“We believe that negative patient outcomes, including death, will inevitably result from the continuing use of this system.

“Surginet is fundamentally flawed.

“New technology should: improve the quality of our work; help us to be more efficient, and; make routine tasks easier.

“EMR Surginet does none of these; in fact it has had the opposite effect.

More here:

http://www.dailyexaminer.com.au/story/2009/07/23/doctors-issue-a-deadly-warning/

It seems there are some ongoing issues with these implementations in the rural areas. I will be interested to hear comments from those involved.

Sixth we have:

Crikey July 23, 2009

3 . Aboriginal patients may end up the real losers in ACC victory

Paul Smith, political editor of Australian Doctor, writes:

After a long-running legal tussle, a remote Aboriginal health clinic has lost its battle against the Australian Crime Commission (ACC) to safeguard the privacy of its patient records. Subject to another appeal, the clinic will have to hand over the records of eight Indigenous children to the ACC.

Whether those records contain information which is of sufficient importance to justify the protracted efforts of the country's most powerful crime-fighting organisation to seize them is one of many unanswered questions about this case. But I doubt the ACC bosses will have been celebrating its legal victory with much enthusiasm.

Firstly the court case itself has lifted the lid on activities it was desperate to keep secret. It used a series of gagging orders to stop anyone approached for medical records revealing to either patients or the wider public what was happening. The penalties were fines and jail sentences.

Secondly when you read the Federal Court ruling, you get a picture of an organisation that seemed to pay little regard to the implications of its actions -- for the clinic, the Indigenous community or the patients treated at the clinic.

The Federal Court found the ACC had a legal obligation to consider "the interests of the children" when forcing the clinics to hand over the records. It seems the commission managed to do this -- just. The Federal Court ruled that by acknowledging the clinic's concerns that the children and others may not seek medical attention if they discovered their files were being secretly handed over to crime investigators, the ACC had met its obligation.

But it is important to stress the court did not consider whether the commission had, for instance, carefully weighed the pros and cons and come to a well-informed, reasoned decision to issue its legal orders. The court never looked at that issue (it was not part of the appeal) even though it described ACC's attempts to document in the paperwork its reasons for seizing the records as "laconic, formulaic and often unhelpful", suggesting it may have been a "tick-box" exercise.

Much more here (subscription required):

http://www.crikey.com.au/2009/07/23/aboriginal-patients-may-end-up-the-real-losers-in-acc-victory/

This is an issue that still has a way to run. I don’t feel what was done here was in any way appropriate. The way the ACC went about this is repressive in the extreme I believe. As a commentator points out all sorts of similar records are likely to vanish unexpectedly at the first sign of a request for information of this kind!

Seventh we have:

HCL Axon bags Ramsay SAP deal

Fran Foo | July 21, 2009

HCL Axon has scored a gig worth almost $1.5 million with Ramsay Health Care for its multi-million-dollar SAP project.

Despite the economic crunch, Australia's largest private hospital operator in January began the selection process for a partner to undertake its ambitious SAP plan.

Ramsay is in the midst of deploying SAP ERP 6 for financials, purchasing and inventory management, as it moves to consolidate legacy systems gained through acquisitions.

Half of Ramsay's sites run on an older SAP platform, while Pronto Software, a Melbourne-based ERP player, powers the other half.

According to Brian Pereira, HCL Axon's head of Asia-Pacific, Japan and Middle East, Ramsay will be able to standardise business processes and information currently not possible, as the two systems are structured and configured differently.

"Key benefits will be the elimination of duplication in data, reporting and processes," Mr Pereira said. "Ramsay went through a selection process in January and the actual project commenced in March 2009. Our consulting services component is worth nearly $1.5m."

In Australia, SAP will be deployed in three stages -- until March next year -- covering about 70 Ramsay sites.

More here:

http://www.australianit.news.com.au/story/0,24897,25810041-15306,00.html

Here we have a large hospital chain doing the other important aspect of e-Health, improving efficiency and information flows in the administration of their hospitals.

Eighth we have:

Medical mix-ups add to patient's misery

Laurann Yen | July 25, 2009

Article from: The Australian

WHEN Doris Lessing, the 2007 Nobel Prize winner for literature, was asked whether she was still writing, she said she didn't have the time at her age.

She was either at the doctor, chemist, physiotherapist or taking someone else to see them.

People living with chronic illnesses need to manage the logistics of their many appointments and the complex nature of their treatment. It can be a full-time job. Patients who live at home might take more than 30 medicines a day. They struggle to balance their health with the demands of everyday life.

The health round table, an industry benchmarking collaborative, has shown that regardless of the reason for admission, people with multiple illnesses have longer stays in hospital.

Governments have attempted to improve the clinical quality of care through guidelines and incentives, but patients are burdened with services that are delivered by myriad players with different agendas and rules.

Making life manageable for people with chronic illnesses requires reform in the organisation and delivery of health care. There needs to be better co-ordination between all involved, from patients to senior specialists.

A focus on inter-professional learning and practice in a system that is patient-focused may offer our best hope of achieving change.

Patients need comprehensive and co-ordinated care across all jurisdictions, but they don't get it. The Pharmaceutical Benefits Scheme, for example, may list a medication but not include appliances needed to administer and monitor the drug. States and territories have different rules about what a resident is ``entitled'' to and funding depends on different definitions of comparative need and risk.

Much more here:

http://www.theaustralian.news.com.au/story/0,25197,25829258-23289,00.html

Another recognition of the importance of e-Health in improving patient safety.

Ninth we have:

Stephen Conroy is confronting a tangled web

Jennifer Hewett | July 25, 2009

Article from: The Australian

STEPHEN Conroy is not a man to concede too many problems. So the fact that Kevin Rudd has given his Communications Minister a seemingly impossible task doesn't appear to have dinted Conroy's confidence that he can deliver high-speed broadband to every home in Australia.

The era of POTS -- Plain Old Telephone Service -- has long been relegated to the dinosaur era. But the official message is that Australia's move to high-speed broadband will transform the way society and the economy work. It is a popular line with the public and it will be repeated by the government from now until the next election. The Prime Minister already likes to refer to it as his legacy to the country. What lies beneath the rhetoric is considerably more messy.

The government is about to announce the chairman of the national broadband network company, as well as the lead adviser for the six-month implementation study on how to pull off the "nation-building" project. Melbourne, Sydney and Brisbane are jostling to host the headquarters. A chastened Telstra is being extremely polite about its determination to engage with Canberra and to become involved with the grand vision for the country's telecommunications. No more aggressive talk of protecting shareholders from the depredations of oppressive government regulation. The new Telstra would rather wash its ducts out with soap and water than even hint at criticism of government.

Even the voters don't appear to have been blinked at the theoretical price tag massaged into shape via the Department of Finance and then finessed into a $43billion headline figure by Conroy and his department. And an army of lawyers and financial and technical advisers on the project have their own version of government stimulus spending to keep them busy while private sector opportunities remains so dismal.

Much more here:

http://www.theaustralian.news.com.au/business/story/0,28124,25830445-5013565,00.html

This is an excellent article that highlights just how difficult this may be to move forward.

Lastly the slightly more technical article for the week:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

Microsoft wraps up Windows 7, declares RTM

Freezes code, signs off on build, hands over to OEMs

Gregg Keizer 23 July, 2009 07:59

As anticipated, Microsoft this afternoon announced that it had finished work on Windows 7, declaring that the new operating system had met the "release to manufacturing" (RTM) milestone.

"Today, after all the validation checks were met, we signed off and declared build 7600.16385 as RTM," said Microsoft spokesman Brandon LeBlanc in a message that will be added later today to the company's Windows 7 blog.

Microsoft also announced that Windows Server 2008 R2, the server software companion to Windows 7, reached RTM today. Both Windows 7 and Server 2008 R2 are slated to launch Oct. 22.

"The RTM code will be delivered to our partners within the next few days who will then start preparing to deliver some amazing new products timed to hit at General Availability (GA) of Windows 7," said LeBlanc today, referring to the Oct 22 public debut.

Much more here:

http://www.computerworld.com.au/article/312119/microsoft_wraps_up_windows_7_declares_rtm?eid=-255

I have to say this seems to be going very smoothly. The following article makes the point that if you are an Win XP user the upgrade is a major pain – so find out details before leaping.

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

For Some, Move To Windows 7 Will Be Tough

By WALTER S. MOSSBERG

On October 22, Microsoft will finally release a new version of Windows that will be as good as the deeply disappointing Windows Vista should have been when it came out in January 2007. The new edition, called Windows 7, is a big improvement over both Vista and the sturdy, 2001-vintage Windows XP still widely in use. It will give Apple’s long-superior Mac OS X operating system a run for its money (though Apple might maintain its edge with a new version, called Snow Leopard, due in September).

Full article here (subscription required):

http://online.wsj.com/article/SB10001424052970204900904574304283334746634.html?mod=djemptech

More next week.

David.

Report Watch – Week of 20, July, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download or browse. This week we have a few.

First we have:

Monday, July 13, 2009

Health Care Stimulus Funding Process Picking Up Speed

by Helen Pfister and Karyn Bell, Manatt Health Solutions

Since the American Recovery and Reinvestment Act was signed in February, the federal government has been moving relatively rapidly to get balls rolling on multiple fronts. In health care, the process is picking up speed in several areas as a result of recent efforts, including:

The release of the Office of the National Coordinator for Health IT implementation plan for health IT;

• The release of CMS' implementation plan (including guidance on Medicare and Medicaid electronic health record incentive payments);
• The development of a definition of "meaningful use" as it pertains to stimulus payments; and
• Broadband access.

Full article here :

http://www.ihealthbeat.org/Features/2009/Health-Care-Stimulus-Funding-Process-Picking-Up-Speed.aspx

Clearly after the legislation was passed things are happening. The following documents show where things are up to at present:

• EHR Incentive Payment Timetable (.pdf)
• ONC Implementation Plan Timeline (.pdf)
• FCC rural broadband report (.pdf)

Second we have:

Rand report focuses on RFID in health

Tags: European Commission RFID

15 Jul 2009

A major new research report commissioned by the European Commission has detailed the opportunities for, and barriers to, the deployment of auto-tracking technology in European healthcare systems.

The report, which focuses on Radio Frequency Identification (RFID), says that despite being a useful tool in logistics and operational management it is so far “less successful in patient care and quality of care improvement.”

The report states: “Compared to logistics, patient care delivery applications face greater implementation problems. Interference of RFID and other wireless equipment with electronic equipment remains the single biggest obstacle to RFID roll-out in healthcare.”

The study titled: “Requirements and options for Radio Frequency Identification application in healthcare,” was conducted by RAND Europe, the US-based policy research organisation.

The report includes an assessment of expert views from the healthcare industry and seven case studies from healthcare organisations in Italy, the Netherlands, Germany, Switzerland, America and the UK in order to establish the cost benefits of existing RFID applications.

It stresses that RFID is not unique in many of its functionalities and that other more consolidated auto tracking technologies, such as bar coding and DataMatrix [2-D bar coding], provide similar capabilities, often for a lesser cost.

....

The report concludes that the benefits of RFID depend largely on organisational, financial and technical considerations and that, in particular, strong commitment of senior management and direct engagement of all relevant interests are essential.

More here:

http://www.ehealtheurope.net/news/5032/rand_report_focuses_on_rfid_in_health

Report Link

Study on the requirements and options for Radio Frequency Identification application in healthcare

Interesting indeed! Not surprisingly, the report points out you have to choose the application to get the benefits – and also review alternatives!

Third we have:

Calif. P4P program sees IT improvements: report

By Rebecca Vesely / HITS staff writer

Posted: July 17, 2009 - 11:00 am EDT

The largest private pay-for-performance program in the country has had major successes, including health information technology adoption, but has overall "fallen short of expectations," according to a retrospective report.

The Integrated Healthcare Association's California Pay for Performance program, now in its seventh year, today includes eight health plans, 35,000 physicians and 11.5 million HMO members.

In a report looking at its achievements since 2006, Oakland, Calif.-based IHA concludes that patient experience gains have been marginal and costs should have been a consideration earlier on.

Although average clinical performance has steadily improved, there are significant regional variations across the state, according to the report.

On a brighter note, IT to support better care has substantially improved. In 2007, two-thirds of physician groups participating showed some IT capability for measuring pay-for-performance, about double since 2003. And one-third have robust care-management processes, according to the report.

More here:

http://www.modernhealthcare.com/article/20090717/REG/307179991

This is an interesting report – again highlighting the need to measure what you are doing if you are to know if you are getting anywhere!

Fourth we have:

E-Health Intelligence Report – WHO

July 14, 2009

eHealth Worldwide

:: Afghanistan: Telemedicine in Afghanistan (8 July 2009 - Federal Telemedicine News)
Roshan the leading telecom operator in Afghanistan announced that telemedicine is expanding beyond Kabul to include provincial hospitals. Bamyan Provincial Hospital (BPH) will be the first provincial medical facility linked to the telemedicine project to use broadband technology, wireless video conferencing, and digital imaging transfer.

Reports and Articles (30+) continue here:

http://www.who.int/goe/ehir/2009/14_july_2009/en/index.html

Large collection of useful and interesting material

Fifth we have:

Policy Post 15.13, July 13, 2009

A Briefing On Public Policy Issues Affecting Civil Liberties Online from The Center For Democracy and Technology

Government Information, Data.gov and Privacy Implications

A full copy of the memo upon which this Policy Post is based is held here.

1) Government Information, Data.gov and Privacy Implications

2) De-identification ad Re-Identification of Data Sets

3) Key Principles for De-Identification and Use of Data Sets

The article is found here:

http://cdt.org/publications/policyposts/2009/13

Much of this is applicable to health data and there are links provided to more information

Lastly we have the:

100 Most Wired Report for 2009.

Start Browsing the Information from here:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2009/0907HHN_Coverstory&domain=HHNMAG

Lots of useful and interesting information on the impact of Health IT on Quality, Safety etc.

Enough for one week!

Enjoy!

David.

International News Extras For the Week (20/07/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

State helping to shape US efforts to digitize health records for all

By Scott Kirsner, Globe Columnist | July 12, 2009

Almost 50 years ago, a Harvard-educated president gave voice to a lofty ambition: to send men to the moon before the end of the 1960s. A collection of brainiacs at MIT and Raytheon designed and built the electronic navigation system that safely guided six Apollo spacecraft to the lunar surface.

Earlier this year, another Harvard-educated president laid down another big challenge: By 2014, every American will have an electronic medical record, with the goal of cutting the cost - and improving the quality - of healthcare.

While having your healthcare history digitized may not be as inspirational as seeing Neil Armstrong step off that ladder, it’s likely to affect your life much more directly over the next decade.

On the job this time is a posse of Massachusetts-based doctors, professors, entrepreneurs, and information technology experts from local hospitals and insurers, armed with $20 billion of stimulus money. And local companies like Westborough-based eClinicalWorks Inc. and athenahealth Inc. of Watertown, which sell software and services to maintain electronic records, will be likely beneficiaries of that spending.

“Massachusetts is like the Silicon Valley of healthcare information technology,’’ says Paul Egerman, who began writing medical records software in the early 1970s, after he took a job at Massachusetts General Hospital.

Egerman went on to start one company, IDX Systems Corp., that was bought by General Electric for $1.2 billion, and another, eScription Inc., that was acquired by Nuance Communications Inc. last year for $363 million. He is now a volunteer adviser to David Blumenthal, the national coordinator for health information technology - and a former Harvard professor and Mass. General physician.

Much more here:

http://www.boston.com/business/technology/articles/2009/07/12/state_helping_to_shape_us_efforts_to_digitize_health_records_for_all/

I suspect this just about gets right the scale of what President Obama is trying to do in e-Health!

Second we have:

Killer Smartphone Apps for On-the-Go Physicians

Cynthia Johnson, July 10, 2009

After Michelle Eads, MD diagnosed her pregnant patient with a bladder infection, she quickly reached for her Apple iPhone. The Colorado primary care doctor wasn't planning to call an urologist for a consult, however. She used the smartphone to research antibiotics that are safe for pregnant women using Epocrates, a comprehensive drug and disease reference application developed by San Mateo, CA-based Epocrates, Inc.

Eads doesn't have a list of antibiotics that are safe for pregnant women committed to memory. But, she does know that physicians need to be very careful about prescribing medications that may harm an unborn baby.

"With Epocrates, I'm able to research very quickly and figure out what the safest options are, review them with the patient, and make a decision," she says.

Eads is one of a growing number of physicians using smartphones—mobile phones that combine online access to information with PDA functionality. According to an April report by Manhattan Research, the number of physicians using smartphones more than doubled to 64% over the past year.

The results of the survey indicate that physicians like Eads are spending more time online using smartphones to access medical and pharmaceutical resources during the course of their busy day.

"It's rare for me to have an encounter—whether it's a phone visit, a virtual visit, or an office encounter—that I don't use Epocrates," says Eads. "If I'm getting ready to talk to a patient and I want to know what the different alternatives and side effects are, I do a little research before the appointment. I'm using it constantly."

Avoiding medication errors

Eads primarily uses the Epocrates application to look up drug interactions, side effect profiles, adverse reactions, and contraindications. Epocrates, Inc. launched the application in 1999 and offers users a free version of the tool as well as subscription-based versions with additional functionality. Michelle Snyder, Epocrates senior vice president of subscriptions, says over one in three doctors in the United States are actively using the application on a mobile device.

According to Eads, this use of her smartphone increases her productivity. If a patient is concerned about stomach upset, for example, Eads looks at antibiotics that are least likely to cause that.

It also allows her to look up drug interactions, including drug herbal interactions, which she says are somewhat popular with residents in Colorado. "There are a lot of people on some strange things out here," she says.

In a study of how examining if Epocrates helps doctors reduce medication errors, researchers at Brigham and Women's hospital found that 50% of Epocrates physicians surveyed reported averting one to two errors per week.

"It really helps them prescribe the right medication and avoid adverse drug events," says Snyder. She says when a drug is recalled, the company is able to update their drug database within the hour so physicians are constantly accessing the latest information.

Eads can view different types of medications in the same family or the same class. The application also tells her what the patient's copayment will be given their insurance plan (not all insurers pay Epocrates to include this information). Eads says this allows her to find lower copayment options for her patients. It also reduces the need for a callback from the patient's pharmacy if a particular drug isn't covered by the patient's insurance plan.

"My patients like that I can check and find out what medicine they can use given their insurance," she says. "It's nice to have that information to give them more choices."

According to Snyder, when the new Medicare part D program went into effect, Epocrates had all of the plans already loaded into their application. "That was a huge help to physicians. It's difficult for the physician to keep track of what's covered under which plan."

In general, the response that Eads has gotten from her patients regarding her use of the smartphone has been extremely positive. "My patients know that I'm very technology oriented and that it allows me to spend more time with them."

She says they don't view her reliance on the phone's reference applications as a weakness. "I don't know absolutely everything," she says. "I think they're glad to see that I'm double checking things and also making sure that there aren't interactions or problems."

For example, when she has a patient who isn't quite sure of the name of the medication he or she is taking but can describe what the pill looks like, Eads can use the search function in the application and show the patient a picture of it.

"So many times people say it's the little red pill that I need to have refills on. Finding the actual picture is very helpful."

The infectious disease information in the Epocrates application is also helpful, she says. If she is treating a patient who has sinusitis, it allows her to see what the current recommended antibiotic is.

"If you have an idea of what you're treating, then you can search for it by what part of the body is affected with the infection and you can find out what the recommendations are."

Lots more here (including a top applications list for the iPhone):

http://www.healthleadersmedia.com/content/235750/topic/WS_HLM2_TEC/Killer-Smartphone-Apps-for-OntheGo-Physicians.html

It is amazing just how quickly the application capability of the iPhone has been adopted and exploited.

Third we have:

Surescripts merger 1 year old as ARRA pushes e-Rx

By Joseph Conn / HITS staff writer

Posted: July 13, 2009 - 11:00 am EDT

Part one of a two-part series:

This month marks the one-year anniversary of the merger of the two largest electronic-prescribing exchanges, SureScripts and RxHub, creating a market-dominant, privately held, for-profit company just in time for the federal government to all but mandate that physicians e-prescribe.

So, how is the merger going? The answer depends on who's talking.

“The question you may be asking is, has the merger yielded any benefits and we're happy to say, it absolutely has,” said Harry Totonis, CEO of the merged company, now called Surescripts.

Totonis only recently joined Surescripts—in April—after serving as head of adviser services at MasterCard, and previously working 14 years as a consultant with Booz Allen Hamilton, which works extensively in healthcare as well as for the federal government in defense and national security and intelligence programs.

“E-prescribing volume has just skyrocketed and we've handled that without adding a lot of new people,” Totonis said. “We're processing twice as many transactions with relatively the same number of people. The efficiency we get is benefiting everyone.”

Justin Barnes is a vice president of Carrollton, Ga.-based Greenway Medical Technologies. In that post, he oversees corporate development, strategy, marketing and government affairs for the electronic health-record system vendor. Barnes also serves as chairman of the Electronic Health Record Association, a trade group for EHR vendors that is an arm of the Healthcare Information and Management Systems Society.

Vendors, Barnes said, while not hostile to Surescripts having such predominance, are “not completely comfortable” with the situation, either.

“It's kind of pushed on us,” Barnes said. “When you have no competition, they may not want to listen to people. Competition breeds excellence at the end of the day. It always has and always will.”

The merger, which seems natural now, pooled the resources of two competing companies whose rival sponsors that either are themselves or have members that are still battling for market share in prescription drug sales. Both SureScripts and RxHub were formed in the aftermath of the 2000 bursting of the dot-com bubble that wiped out scads of e-prescribing startup companies.

Reporting continues here (registration required):

http://www.modernhealthcare.com/article/20090713/REG/307139971/1029

There just might be a lesson here for Australia in having for-profit companies involved in e-Prescribing.

Part 2 is here, and provides useful insights on areas like data-mining of prescription data:

http://www.modernhealthcare.com/article/20090714/REG/311140002/1029

Fourth we have:

AMDIS recognizes eight for IT achievements

By Elizabeth Gardner

Posted: July 13, 2009 - 7:00 am EDT

Getting a healthcare institution to embrace meaningful clinical automation takes dedication, drive and deep knowledge of what clinicians need. For the past 10 years, the Association of Medical Directors of Information Systems has recognized outstanding achievement in applied medical informatics.

This year, the eight winners include two institutions, one team and five individuals. There were 43 nominees. The judges were: William Bria, M.D., AMDIS president and chief medical information officer at Shriners Hospital for Children system, Tampa, Fla.; Howard Landa, M.D., CMIO, Hawaii Permanente Medical Group, Honolulu; Harris Stutman, M.D., executive director of research, MemorialCare Medical Centers, Long Beach, Calif.; Blackford Middleton, M.D., director of clinical informatics research and development, Partners HealthCare System, Boston; Ray Aller, M.D., director, automated disease-surveillance systems for the Los Angeles County Health Department; Bill Childs, executive vice president, R3 Health Partners, Santa Ana, Calif.; John Glaser, chief information officer, Partners HealthCare; and Brian Malec, professor of health administration, health sciences department, California State University at Northridge.

Much more here (registration required):

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090713/MODERNPHYSICIAN/307059990&AssignSessionID=173341085331769&AssignSessionID=173341085331769

This list of winners shows how some good things are being done at the bleeding edge.

Fifth we have:

July 13, 2009, 5:30 am

Electronic Health Records: A Texas Model

By Steve Lohr

The Obama administration this week will outline what the nation’s doctors and hospitals must do to qualify for billions of dollars in government support to adopt electronic patient records. The most closely watched part of the announcement will be further definition of what the economic stimulus legislation called the “meaningful use” of digital health records.

The draft due Thursday from the office of the national information technology coordinator, Dr. David Blumenthal, will not be the final word. There will be time for public comment, and lobbying, until the end of the year.

But the work done so far by Dr. Blumenthal and his team, health experts say, is encouraging. The tentative plan, they say, calls for a requirement that physicians and clinics be able to first report health quality measures, like blood pressure and cholesterol levels of patients. Then, step by step, year by year, the administration foresees moving health providers from electronic reporting to being reimbursed for better health outcomes, such as a higher percentage of a doctor’s diabetes patients keeping their blood sugar levels at recommended levels.

The technology approach, health experts say, is pretty much agnostic. The focus is not on a specific technological path but on using computing tools to capture, track and monitor data.

More here:

http://bits.blogs.nytimes.com/2009/07/13/electronic-health-records-a-texas-model/?hp

If incentives are to be paid to clinicians using desired clinical outcomes seems a pretty good way to be going about it.

Sixth we have:

Healthcare reform needs to ‘go beyond digitizing a broken system’

17 July 2009

The Institute for e-Health Policy’s Steering Committee on Telehealth and Healthcare Informatics held a meeting this week where Harris Corporation vice president of Healthcare Solutions Jim Traficant spoke to members, telling them that an integrated, interoperable enterprise system was needed to transform the nation’s healthcare infrastructure.

The Institute for e-Health Policy’s Steering Committee on Telehealth and Healthcare Informatics is an educational and research-based organization that produces educational sessions and healthcare information technology demonstrations for members of Congress, congressional staff, key federal agency officials, industry professionals and the general public.

Honorary Steering Committee Co-chairs are: Senators Kent Conrad (D-ND); Mike Crapo (R-ID); John Thune (R-SD); Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R-VA); Rick Boucher (D-VA); Bart Gordon (D-TN); Allyson Y. Schwartz (D-PA); and David Wu (D-OR).

As part of the team that developed the software for the National Health Information Network (NIHN) CONNECT Gateway, Harris VP Traficant told the Institute that a centralized, reliable network was needed to connect the nation’s fragmented systems. “Healthcare reform must go beyond digitizing a broken system to enable an integrated, interoperable one.”

Much more here:

http://civsourceonline.com/2009/07/17/healthcare-reform-needs-to-go-beyond-digitizing-a-broken-system/

An obvious but important point!

Seventh we have:

Doctor improperly accessed women’s medical records at Fletcher Allen

By Sam Hemingway, Free Press Staff Writer

A Fletcher Allen Health Care family physician has admitted he accessed the medical records of eight women without their permission or for any medical purpose, according to the state Medical Practice Board.

The women were not his patients at the time he accessed their medical records, the board said.

The actions by the doctor, Joshua A. Welch, were deemed by the board to be a violation of the Health Insurance Portability and Accountability Act, or HIPAA, as well as the Vermont Patient’s Rights Act, the board said in publicly reprimanding Welch.

The board, in an interim stipulation and consent order issued earlier this month, said it was alerted to Welch’s actions in September, 2008, by a woman who said she had a “personal relationship” with Welch and had learned that he had accessed her medical records without her permission.

Much more here:

http://www.burlingtonfreepress.com/apps/pbcs.dll/article?AID=200990711008

This is something that is, very occasionally, inevitable. The important thing is to have the systems to identify the breeches, punish offenders and discourage most from indulging their curiosity / evil intent.

Eighth we have:

Laptops in ambulances boost emergency care

Ability to access patients' records while en route to the hospital may be unrivalled

By Shari Rudavsky
shari.rudavsky@indystar.com

Metro-area ambulance crews are among the first in the world with the power to tap into patient medical records in the field.

Wishard Health Services began testing the system on Marion County's 40 or so ambulances this month. Hamilton County emergency medical vehicles also are equipped with laptops that link to hospital records.

The ability to check a patient's medical history from afar will help paramedics provide better care, experts say, and open the door for research into which emergency treatments produce the best outcomes.

Full article here:

http://www.indystar.com/article/20090713/LIVING01/907130339/1083/LIVING01/Laptops+in+ambulances+boost+emergency+care

An inevitable next step I guess.

Ninth we have:

Senate Allocates $3.3 Billion In IT Funds For VA

Much of the money would go toward electronic medical records projects at the Veterans Administration.

By J. Nicholas Hoover, InformationWeek

July 10, 2009

Under a spending authorization bill approved Monday by the Senate Appropriations Committee, the Veterans Administration would get $3.31 billion to spend on information technology in 2010, an increase of 30% over the agency's 2009 budget.

Much of that money would go toward electronic medical records projects at the VA, as well as the integration of those medical records with the medical records kept by the Department of Defense. In all, the committee recommendation includes $800 million for new program development.

"The committee understands that effective healthcare delivery in the 21st century requires robust and modern IT systems and remains strongly dedicated to providing the VA with the resources it needs to accomplish this modernization," the committee said in a report accompanying the bill.

More here (registration required):

http://www.informationweek.com/news/showArticle.jhtml?articleID=218401416

That is certainly a serious sum – especially the $800 Million for new projects!

Tenth we have:

Canada issues alert on virus attack on EHR service

By Joseph Conn / HITS staff writer

Posted: July 13, 2009 - 11:00 am EDT

The Office of the Information and Privacy Commissioner of Alberta in Canada has issued an alert to the public that the provincial electronic health-record service, Alberta Netcare, had been attacked by a computer virus designed to steal data.

More here (registration required):

http://www.modernhealthcare.com/article/20090713/REG/307139969/1153

Not a good look at all!

From this it looks like it was actually quite serious.

http://www.healthdatamanagement.com/news/breach-38647-1.html?ET=healthdatamanagement:e936:100325a:&st=email

Alberta Breach Wallops Thousands

Eleventh for the week we have:

Telephone check-in system cuts re-admissions by 54%

Posted By DONNA CASEY, SUN MEDIA

Posted 2 days ago

A daily telephone check-in system for heart failure patients has cut readmission rates by 54 per cent, according to a study by the University of Ottawa Heart Institute.

A new study of heart failure patients shows that a telehealth monitoring system that lets patients dial in their daily blood pressure, weight and medication levels helps keep them healthy and out of hospital.

The hospital followed 121 heart failure patients in 2007- 2008 and found only 14 per cent of those who were tracked by the telehealth monitoring were readmitted.

This compared with 69 per cent of patients readmitted at least once in the six-month period who were not getting the daily telephone monitoring.

More here :

http://www.saultstar.com/ArticleDisplay.aspx?e=1652207

That looks like a pretty good outcome for a fairly simple intervention.

Twelfth we have:

KLAS report: Digital mammography provides ROI

July 09, 2009 | Molly Merrill, Associate Editor

OREM, UT – Digital mammography is providing a strong return on investment for healthcare providers, according to a new KLAS report.

KLAS, an Orem, Utah-based research and marketing firm, interviewed more than 200 healthcare professionals about their use of full-field digital mammography (FFDM) solutions. According to the FDA, roughly half of the Mammography Quality Standards Act (MQSA)-certified facilities in the United States have now adopted digital mammography equipment.

The KLAS report shows many of those who have made the switch to FFDM systems have increased their capacity for patient throughput, leading to a strong ROI for the new technology.

More here:

http://www.healthcareitnews.com/news/klas-report-digital-mammography-provides-roi

Hardly a surprise, but important to know.

Thirteenth we have:

Scotland delivers e-prescription service

Tags: Scotland

14 Jul 2009

Scotland has announced that it has become the first country in the UK to deliver an electronic prescription service, with more than 90% of prescriptions now submitted electronically.

Scottish health secretary Nicola Sturgeon said the electronic Acute Medication Service (eAMS) was the first national system of its kind to go live anywhere in the UK and was now enabled in 99% of Scottish GP practices and pharmacies.

The eAMS prints a barcode on prescriptions at a GP surgery and sends a message to Scotland’s ePharmacy Message Store.

When a patient presents at a pharmacy with their barcoded prescription, the pharmacist can scan the barcode to pull down the prescription and dispense the medicine.

Dispensing a prescription triggers the creation of an electronic claim message to NHS National Services Scotland (NSS).

The Scottish government said eAMS cuts the risk of errors between GPs and pharmacists, delivers improvements such as the use of universal codes for virtually all medicines, and boosts efficiency.

More here:

http://www.e-health-insider.com/news/5022/scotland_delivers_e-prescription_service

Seems like Scotland beat eRx to it! And it is standards based and the information can be used for research etc sponsored by Government. A much better plan!

Fourteenth we have:

Seven Ways to Get Value From Your EMR

Carrie Vaughan, for HealthLeaders Media, July 14, 2009

EMRs were thrust once again into the national spotlight when the Obama administration committed nearly $19 billion in stimulus funding for health IT as part of the American Recovery and Reinvestment Act of 2009. The objective is to use electronic medical records to make the health system more efficient, safer for patients, and, ultimately, to reduce costs and improve quality.

While EMRs have the potential to meet those objectives, implementing the technology simply isn't enough. A lot depends on how organizations use the systems, which is why the HITECH Act calls for providers to be deemed "meaningful users" of certified EMR technology before they qualify for stimulus dollars. The legislation uses a carrot and stick approach. It offers providers incentive payments if they can meet the meaningful use criteria, however, organizations and physicians that are not meaningful users of HIT by 2015 will start incurring penalties.

Implementing the technology in a short timeline will be a difficult for providers. But the real challenge will be getting value out of the systems put in place.

For the July issue of HealthLeaders magazine, I spoke to executives at four hospitals and health systems about how they were moving past implementation and getting value from their electronic medical records systems ("Where's the Value?").

Much more here:

http://www.healthleadersmedia.com/content/235904/topic/WS_HLM2_TEC/Seven-Ways-to-Get-Value-From-Your-EMR.html

A sensible set of points to consider in moving forward.

Fifteenth we have:

Kaiser Permanente Survey Shows Seniors Embrace Internet to Manage Their Health

New Data Show Medicare Beneficiaries are Overwhelmingly Satisfied with My Health Manager, Kaiser Permanente's Personal Health Record

By: PR Newswire

Jul. 14, 2009 08:31 AM

OAKLAND, Calif., July 14 /PRNewswire/ -- New data show that Medicare beneficiaries registered to use My Health Manager, Kaiser Permanente's personal health record, are overwhelmingly satisfied with using the Internet to manage their health care online. Results from the recent Kaiser Permanente survey examining Web site usage and Medicare beneficiary satisfaction were presented today at the World Health Care Congress' 5th Annual Leadership Summit on Medicare in Washington, D.C.

The e-mail survey received 4,560 responses and had a response rate of 23 percent. It looked at respondents' comfort in using computers, Internet use habits, and current health status, including chronic conditions and prescriptions. More than 87 percent of respondents were satisfied or very satisfied with My Health Manager on kp.org.

Vastly more here:

http://au.sys-con.com/node/1034443

It is good to see there is good usage of quality PHR services among older people.

Sixteenth we have:

Reminder Program Dramatically Increases Mammography Rates, Kaiser Permanente Study Finds

Posted : Tue, 14 Jul 2009 07:01:03 GMT

Largest Study to Examine Electronic Health Records-assisted Mammogram Reminder Program PORTLAND, Ore., July 14

PORTLAND, Ore., July 14 /PRNewswire/ -- A reminder program aimed at screening for breast cancer when it is most treatable boosted mammography rates by more than 17 percentage points, according to a new study by Kaiser Permanente's Center for Health Research in the August issue of the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls.

The study of 35,000 Kaiser Permanente members is the largest to test a reminder program involving this three-pronged approach. By the second year of the program in 2008, mammography rates jumped from 63 to more than 80 percent among women aged 50-69.

Much more here:

http://www.earthtimes.org/articles/show/reminder-program-dramatically-increases-mammography-rates-kaiser-permanente-study-finds,890456.shtml#

Again we have proof of how quality clinical directed decision support can improve health system performance.

Fourth last we have:

Enhancing access to health care

July 15, 2009 (Toronto, ON) – Northern Ontario is once again at the leading edge of an important new e-health service. The service, called a Diagnostic Imaging Repository or “DI-r” will enable electronic transfer of medical images and the associated doctors’ reports between hospitals in Northern and Eastern Ontario. Today marked the official opening of the repository’s data centres in Thunder Bay and in Sudbury with a visit to the Thunder Bay Data Centre by representatives of Canada Health Infoway (Infoway) and eHealth Ontario, the project’s funders.

Forty hospitals in the North West and North East Local Integration Networks (LHINs) and 19 hospitals in the Champlain LHIN (the greater Ottawa region) are involved in the project; also referred to as NEODIN – the Northern and Eastern Ontario Diagnostic Imaging Network. When completed in 2011, sharing of images and reports through the NEODIN DI-r will service almost two million Ontarians across 840,000 square kilometres from the Manitoba border in the west to Cornwall and Hawkesbury in the east. The result will be better access to health care services, particularly for patients in smaller communities. The $34.8 million project is funded by eHealth Ontario and Infoway.

Much more here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/440-enhancing-access-to-health-care

For all the ups and downs we do seem to be getting some distinct progress happening all over Canada.

Third last we have:

How a robot can terminate medical errors for kids

RIVA the robot is ready with an IV and the right dosage

By Eric Lai

July 14, 2009 04:59 PM ET

Computerworld - In a children's hospital, dispensing medicine is more complicated than putting pills in a bottle. Youthful patients come in a wide variety of ages and sizes, which means their dosages must be individually tailored.

Hundreds or thousands of medicines must be made up and delivered daily. Combine that with the breadth of not-always-easy-to-distinguish medicines and dosages and even careful pharmacists and other medical personnel can slip up when tired or distracted.

Now, technology has arrived that its makers promise can drastically cut down on drug-related errors. The Robotic Intravenous Automation (RIVA) device made by Winnipeg-based Intelligent Hospital Systems is a robotic arm that can prepare sterile IV syringes and bags behind its glass case.

More here:

http://www.computerworld.com/s/article/9135522/How_a_robot_can_terminate_medical_errors_for_kids

Sounds like a useful and interesting advance.

Second last for the week we have:

Spotlight on CCHIT's future during HIT policy meeting

By Joseph Conn / HITS staff writer

Posted: July 15, 2009 - 11:00 am EDT

Not surprisingly, when a work group of the federally chartered Health Information Technology Policy Committee met Tuesday for a day-long discussion on certification and adoption of healthcare IT systems, the past, present and future role of the federally supported Certification Commission for Healthcare Information Technology, or CCHIT, was on the agenda.

CCHIT was established in 2004 by the Healthcare Information and Management Systems Society, the American Health Information Management Association and the National Alliance for Health Information Technology at the behest of David Brailer, the first head of the Office of the National Coordinator for Health Information Technology at HHS.

More here:

http://www.modernhealthcare.com/article/20090715/REG/307209991

This is important to get right as the CCHIT has certainly motivated some improvements and forward planning.

Last, and very usefully, we have:

Tieto and InterSystems create Swedish National Patient Summary Record

The first stage of the Swedish National Patient Summary project was successfully deployed on 4 May in Örebro County Council and the Municipality of Örebro.

Mats Sandstrom, InterSystems’ country manager, Nordics, explains how the project is a vital part of a wider programme to implement the national IT strategy for the healthcare and welfare sector in Sweden, and discusses some of the legal, consent and technical issues that have been overcome so far.

The National Patient Summary service (known as the NPÖ) is part of the Swedish national IT strategy for the healthcare and welfare sector, which focuses on common solutions to improve the accessibility, quality and safety of healthcare services.

At the moment, a patient will often have access to services from several care providers, many of whom will have their own system for medical records.

In consequence, it can be difficult to get a comprehensive overview of previous medications, laboratory results and diagnoses; which, in turn, may complicate or delay treatment, particularly in an emergency, when there may not be time to get information from other care providers.

In 2008, the Swedish Healthcare Advisory Organisation (Sjukvårdsrådgivningen SVR AB) selected Tieto to deliver the development, implementation and hosting of the NPÖ. This is the first national electronic health record for Sweden, and one of the first of its kind in the world.

Tieto chose InterSystems HealthShare as its health information exchange software platform. It took just over a year from the contract award to establish the legal context, patient consent and IT infrastructure for the service, and to connect the first healthcare region - Örebro County Council and the Municipality of Örebro.

Vital information

The National Patient Summary makes it possible for authorised healthcare and welfare professionals to obtain important patient information from the county councils’, municipalities’ and private care providers’ patient record systems.

Professionals access the NPÖ through a web interface with the consent of the patient concerned; but the information displayed is recorded and kept in the local healthcare system of the relevant provider.

InterSystems HealthShare is the innovative software product that creates this overview. HealthShare provides aggregation and sharing of clinical data among multiple provider organisations on a regional or national basis – up to, and including, a full electronic health record.

It can be easily extended to provide additional functionality, such as e-prescribing or order communications, through the addition of business rules and business processes, composite applications, and applications provided by InterSystems’ partners.

Much more here:

http://www.e-health-insider.com/Features/item.cfm?appTimeOut=yes&docId=304

Note carefully the approach – use data from local systems and assemble it for access – rather than have a separate Shared Record. Much better idea and more trustworthy that the NEHTA IEHR plan in my view.

There is an amazing amount happening. Enjoy!

David.