Again there has been just a heap of stuff arrive this week.
First we have:
by GoozNews ~ 27 Jul 2009 10:54am
Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles.
What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.”
Will the Obama administration’s $20 billion push to flood the nation’s physician offices and hospitals with electronic medical records (EMRs) suffer a similar fate? The July/August cover story in the Washington Monthly by Phillip Longman pointed to one possible stumbling block on the road to widespread diffusion of EMRs – self-interested software firms pushing proprietary systems that can’t talk to each other.
But there may be an even greater danger. The people who actually deliver care will fail to achieve the potential health benefits of having every patient’s EMR at their fingertips.
That was the reality facing Kaiser Permanente’s Colorado medical group in Denver five years ago. The health maintenance organization, touted as an exemplar of quality care, was an early adapter of EMRs. And what those records told local managers when it came to controlling blood pressure -- a major goal -- was troubling. Despite annual free checkups and prescribing lots of blood pressure pills, only 59 percent of patients had achieved control in follow-up visits. “Putting a blue sticker on a piece of paper that says you have high blood pressure wasn’t working,” said Sean Riley, the medical director of the group.
Since Kaiser is a unified health system with salaried physicians, it had a direct stake in raising compliance. Greater blood pressure control would almost immediately translate into fewer heart attacks, fewer hospitalizations and lower costs. But how could office-based medical groups reach into patients’ homes and lives to get them to change behavior?
Much more here:
http://www.gooznews.com/node/3025
This is an excellent article that makes a useful point. Once you have information you have to action it to make a difference. Of course if you don’t have the information there is just no chance of change and improvement!
Second we have:
Published: Monday 27 July 2009
Corporations will pump billions of euros into e-health R&D in a bid to steal a march on competitors in a sector expected to be a major driver of economic growth, Pamela Passman, corporate vice-president at Microsoft, told EurActiv in an interview.
Pamela Passman is corporate vice-president and deputy general counsel at Microsoft Global Corporate Affairs.
.....
What are you doing in health?
We're doing a number of things. I think it's one of the most exciting businesses we're in. Then there's the Health Vault, which allows personal health information to be captured from devices.
I can share this with my doctor or I can actually learn more about my own health and better manage my health. We think there is huge opportunity with chronic illnesses to manage their own healthcare.
On the hospital side, people often complain that there are different software packages in use in radiology and surgery, which causes practical difficulties. What are you doing in this area?
We are using Amalga in hospitals to break down the silos between data, where it's X-ray information, laboratory or surgical information. We have huge partnerships with major hospitals in the United States. It has been incredibly well received.
A great deal of effort is underway to help healthcare institutions aggregate and share information. Amalga is able to cut across all these different software applications and suck out the data. It is a very significant contribution to what is a very challenging environment. There are a lot of custom-designed products in use.
On the consumer side, people often talk about the digital divide, but will some of these technologies which allow you to track your health be exclusively available to the few?
Health Vault is something that can be done as part of a telecoms company's package. In the US, it's an advertising-based model – which might not work everywhere. But there are certain governments who view this as a very cost effective way to provide a service to their citizens, so I think it's something that will be broadly available and broadly relevant to people.
The whole issue about whether or not people will have access to computers and have the digital skills to use the tools: that's why the work the EU and NGOs are doing is critical. Computer technology is becoming central to managing your health, finding a job, doing basic office skills.
What's the next Windows or the next Facebook or Google?
Well, the health sector has huge opportunities. The whole issue of energy efficiency and the role of software as an enabler of that will be big. The innovations will come in the application of technologies to specific areas where there are huge challenges like smart transportation, how to meter things better.
Distance learning, telecommuting – these are things that are still in their infancy but will change the way we live; the whole concept of search and being able to analyse large amounts of information and finding the really important things that are relevant from all the information that's available. When we think about search today, it's very static. Bing is taking a step forward, but there are more steps to take.
Lots more here:
http://www.euractiv.com/en/innovation/microsoft-health-drive-future-innovation/article-184406
This is a useful brief summary of the approach Microsoft is adopting in the e-Health space.
Third we have:
Tuesday, July 28, 2009
by George Lauer, iHealthBeat Features Editor
Many involved in health IT -- physicians, hospital administrators, industry leaders, legislators and policymakers -- believe rapid, comprehensive movement toward digital health care in this country must be aligned with a major overhaul of the entire health system.
With a new administration in the White House, a Democrat-dominated Congress and a big spending package full of programs to stimulate health IT, it's been full-speed ahead for several months on both fronts -- reform and health IT.
But there is considerable talk in recent days about health reform losing steam in Congress. It's pretty clear there won't be a bill before the August recess, and some say major reform of any kind is unlikely this year.
If Congress fails to pass reform legislation this year, what will happen to health IT? And what, specifically, will it mean for American Recovery and Reinvestment Act funds designated for health IT expansion?
Reporting continues here (with links):
http://www.ihealthbeat.org/Features/2009/If-Reform-Stalls-How-Will-Health-IT-Efforts-Be-Affected.aspx
This article asks an interesting question, there is no doubt each will influence the progress of the other.
Fourth we have:
By Joseph Conn / HITS staff writer
Posted: July 27, 2009 - 5:59 am EDT
Part one of a two-part series.
The Veterans affairs Department has tabled development work—and as much spending as possible—on 45 information technology projects, most of which involve healthcare IT systems. During the hiatus, VA brass will subject the projects to internal review and the strictures of a newly adopted IT project management scheme.
The IT program reviews come in the wake of a report, released in late May by the VA's inspector general's office, that chastised the department for its lack of IT management rigor. It also comes as a deadline looms for the VA to achieve its goal of making its clinical IT systems "interoperable"with those of the Defense Department's Military Health System.
Veterans Affairs Secretary Eric Shinseki and Assistant Secretary for Information and Technology Roger Baker made the joint announcement about the forced delays July 17.
Of the 300 IT projects currently under way at the VA, the 45 now on hold are at least one year behind schedule or more than 10% over budget, although "there tends to be a pretty good overlap on both of those," according to Baker.
Much more here (registration required):
http://www.modernhealthcare.com/article/20090727/REG/307279994
The US Veterans Affairs Department is a major health IT user. Their plans are always worth keeping an eye on.
Fifth we have:
TOM PULLAR-STRECKER - The Dominion Post
The cost of an electronic health record system to store New Zealanders' medical data looks likely to fall between $50 million and $150m.
Argument has flared up again over the merits of the great leap forward for health sector technology.
Bennett Medary, managing director of The Simpl Group, says the cost estimate is based on responses from 30 suppliers to a request for information issued late last year. The Simpl Group is managing the procurement process on behalf of the Health Management System Collaborative (HMSC).
Mr Medary dismisses as "scaremongering" a suggestion by Orion Health, New Zealand's largest software exporter, that the bill for a system could be as high as NZ$100m to US$300m (NZ$459m).
HMSC, comprising seven district health boards, plans to issue a tender for the system next year. It could lead to a single electronic health record for each New Zealander that all health providers and each patient could access.
Mr Medary says such a system has the potential to save the health sector hundreds of millions of dollars a year. "The heath sector spends $6b to $7b a year. What we are talking about [spending] is 0.25 per cent of that. This could easily be self-funding."
But Orion Health chief executive Ian McCrae says the investment may not provide value for money and doubts it will be the "big leap forward we are all looking for".
The DHBs appear "pretty keen on getting a big American product in here" and New Zealand already has had a couple of cracks at importing American health IT systems, he says. "SMS was one of those which went into Capital and Coast Health and Health Waikato. It didn't go so well."
Mr McCrae says hospitals have invested very little in health technology over the past few years and feel as though they haven't made much progress. But he advises a "middle path" whereby DHBs would maintain a summary record of patient data at a regional level.
In that space, Orion is "hugely competent, and we would beat just about any vendor out there, as evidenced by deals we have won in Europe, Australia and Canada".
That would be instead of a full-blown electronic medical records system that would record all the "nitty-gritty pieces of information" gathered during treatments. Mr McCrae says most of these use "old technology" and would require that each hospital maintained its own subset of data.
"Instead of going from zero to $200m of investment, I am sure New Zealand could get some good solutions for quite a lot less. If they are New Zealand-supplied solutions, we can take that intellectual property and can sell it to the rest of the world."
More here:
http://www.stuff.co.nz/national/health/2675112/E-health-record-bill-up-to-150m
I suspect it might cost a bit more than they imagine...0.25% may not be enough! Good to see the serious planning is underway however.
Sixth we have:
Key players in the agency's contract and spending scandal
Last Updated: Wednesday, July 22, 2009 | 10:16 PM ET
EHealth Ontario became embroiled in a scandal focusing on more than $5 million in untendered contracts. (CBC)
The revolving door at eHealth Ontario has been spinning quickly since the provincial agency was first fashioned out of the rubble of its failed predecessor.
Premier Dalton McGuinty proclaimed the agency's creation last September and put Dr. Alan Hudson and Sarah Kramer at its helm, in hopes the two health-care problem solvers could turn the organization around.
But seven months later, Kramer became the first to take the fall for a mounting scandal focused on more than $5 million worth of untendered contracts, conflicts of interest and anger over high-price consultants nickel-and-diming taxpayers.
The agency's goals were lofty: create an electronic health record system by 2015, cut emergency wait times and increase patient safety.
Here's a rundown of the predecessor organization, key players and the companies who received untendered contracts.
All the details here:
http://www.cbc.ca/canada/story/2009/07/22/f-ehealth-players-0722.html
This is a great summary of the cast of this scandal. What a mess!
Seventh we have:
The federal government is funding a transition to digital medical records, reducing errors
By James Reed
July 26, 2009
For investors, recent changes in U.S. health care laws offer a classic example of trying to make lemonade from lemons.
Although health care is being restructured significantly by Congress, and longtime favorite health care names are suffering, nimble investors should be able to identify what is to come, regardless of what they wish would occur.
Regardless of what unfolds, medical information technology companies are likely to benefit. Canada, the United Kingdom and the Scandinavian nations already have, or are implementing, national health care IT programs under their nationalized health care plans.
This year, Congress passed the Health Information Technology for Economic and Clinical Health Act.
This act, along with significant stimulus funding, is expected to kick-start a transition to a digital health care system, from one that is paper-based. Advocates point to reduced medical errors and better patient outcomes during the first interaction with the physician or hospital as advantages of a computerized system.
Much more here:
http://www.investmentnews.com/apps/pbcs.dll/article?AID=/20090726/REG/307269996/1005
It is interesting to see the markets take an interest in Health IT.
Eighth we have:
Carrie Vaughan, for HealthLeaders Media, July 28, 2009
I'm certainly coming across more examples of health information exchanges. Here are two HIEs that I read about in just the past couple of weeks.
New York Clinical Information Exchange. Comprised of nine hospitals and two other health institutions in New York this exchange has started sharing data for emergency patients. The EDs use a Web portal to access information on patients, including demographics, lab and pathology test results, discharge summaries, and medication histories. The exchange also feeds data to a project sponsored by the New York State Department of Health Centers for Disease Control that is studying the role of HIEs in biosurveillance.
Transforming Healthcare in Connecticut Communities. A coalition of hospitals, physician practices, federally qualified health centers, insurers and employers in Connecticut aim to build a statewide health information exchange; support small physicians efforts to implement electronic health records, develop training and deployment tools for physicians and healthcare workers; and develop quality measures and performance improvement targets. The THICC initiative will initially be funded solely by THICC members and will work in conjunction with the Connecticut Department of Public Health. The exchange will rely on Web-based components and community systems that hospitals and doctors can use to share patient health summaries and clinical data like x-rays.
Full article here:
http://www.healthleadersmedia.com/content/236593/topic/WS_HLM2_TEC/The-State-of-Health-Information-Exchanges.html
The buzz around Health Information Exchanges certainly seems to be building in the US.
Ninth we have:
By Marion Davis
Contributing Writer
Patients at Barrington Family Medicine know they can count on the doctors to answer a page at midnight or on a Sunday, and that living in town, they’ll even go into the office at odd times. But with the help of technology, they often don’t have to.
Drs. Lisa Denny and Andrea Arena use a secure Web portal where patients can book appointments, get test results, and e-mail questions – nothing urgent, but perhaps a concern about a drug’s side effects, or an update on blood sugar levels.
“It’s just another way for them to communicate with us,” said Denny, who has offered patients the Web tools since the office opened early last year. She and Arena have a “micropractice,” stripped down of costly support staff and focused on maximizing direct doctor-patient contact, and they pay extra to have a patient portal on their medical records software, eClinicalWorks.
“People particularly love getting their lab results the same day, and the appointment reminders are nice, too,” Denny said. The practice doesn’t offer “virtual visits,” as some doctors in other states do, but about 80 percent of patients get at least e-mail appointment reminders, and 40 to 50 percent use other features, too, she said.
Yet Denny and Arena are actually rare exceptions in Rhode Island when it comes to online communications with patients. An informal Providence Business News survey of local doctors and electronic medical records (EMR) software providers found little use of even readily available tools, and a general reluctance by doctors to venture in that direction.
Across the country, however, more and more doctors are using e-mail, Web portals, Web cameras, remote diagnostics equipment and even mobile phone applications to connect with their patients, especially in markets where insurers are willing to pay for such services.
A recent survey by the health-information firm Manhattan Research, a division of Decision Resources Inc., found 39 percent of doctors said they had communicated with patients online, up from 31 percent in 2007 and 19 percent in 2003, when the federal Health Insurance Portability and Accountability Act (HIPAA) imposed a slew of new privacy requirements. The vast majority of U.S. doctors – 84 percent – are now online, the firm found.
Much more here:
http://www.pbn.com/detail/43772.html?sub_id=43772&page=1
Despite the title this is an interesting article on how EHRs are actually being used.
Tenth we have:
27 Jul 2009
NHS Connecting for Health has announced that EMIS’s LV system has achieved full roll out approval for the Summary Care Record, which the agency has described as major breakthrough for the programme.
It said EMIS LV is used by about 45% of GP practices in England and the SCR implementation team would now begin working with those primary care trusts using the system.
James Hawkins, SCR programme director, said: “This milestone provides a catalyst for a significant shift in place and momentum in the rollout of SCR nationally for those NHS trusts implementing SCRs through EMIS LV.
"The news is also good for patients. It has been a long time coming but we can get on with the job of rolling out.”
The programme has been frustrated by the time taken by EMIS to become compliant with the SCR.
Healthcare IT system supplier Synergy system was the first GP system to achieve approval for national roll-out, followed by TPP’s SystmOne earlier this year. CfH said INPS’s Vision system has achieved limited roll-out approval so far.
More here:
http://www.ehiprimarycare.com/news/5065/emis_lv_approved_for_scr_roll_out
This looks to me like a major piece of progress for the UK’s National Programme.
Eleventh for the week we have:
HDM Breaking News, July 29, 2009
A notice in published July 29 in the Federal Register starkly demonstrates administrative burdens of complying with the HIPAA privacy rule.
The Department of Health and Human Services published the notice as part of its intent to continue requiring documentation of compliance. The notice lists a dozen documentation requirements, such as authorization to use and disclose protected health information, and notices of privacy practices.
More here (registration required):
http://www.healthdatamanagement.com/news/privacy-38740-1.html?ET=healthdatamanagement:e954:100325a:&st=email
This shows just how expensive it can be to comply with legislation – the lesson is of course to think carefully before pulling the legislative lever!
Twelfth we have:
Cerner Corp.'s (CERN) second-quarter earnings rose 24% despite flat revenue as the health-care information technology company benefited from lower costs.
But the company gave a downbeat outlook for the current quarter, pushing shares down 3.7% after-hours, to $62.75. The stock through the close Wednesday was up 69% in 2009.
Cerner expects third-quarter earnings of 57 cents to 63 cents a share on revenue of $410 million to $430 million. Analysts surveyed by Thomson Reuters, on average, projected 63 cents and $447 million, respectively. And while reiterating its 2009 earnings target, the company lowered its revenue view by $50 million.
Much more here (subscription required):
http://online.wsj.com/article/BT-CO-20090729-718701.html
Interesting to see just how large Cerner has grown.
Thirteenth we have:
By Jean DerGurahian / HITS staff writer
Posted: July 30, 2009 - 11:00 am EDT
The first half of 2009 indicated an uptick for markets, with healthcare information technology stocks gaining on promises of federal funding in the future more than on their current performance, according to an analyst's report.
Health IT stocks outperformed wider markets this year, showing a 30% gain compared with the Standard & Poor's 500 index, which grew 2%, according to the Q2 2009 Healthcare IT Transaction Summary, by Healthcare Growth Partners.
Most of that reflects the assumption that funding provisions and IT adoption mandates through the American Recovery and Reinvestment Act of 2009 are going to motivate hospitals and doctors to buy health IT over the next few years, said Christopher McCord, principal of Healthcare Growth Partners. But those drivers are still in the early stages, and it will take several more quarters before the market sees whether the expectations become reality, he said. “Meaningful use still needs to be better understood.”
More here (registration required):
http://www.modernhealthcare.com/article/20090730/REG/307309990
And it seems other companies are also pushing forward.
Fourteenth we have:
Tags: Conservatives Google Health Health Vault
29 Jul 2009
Google’s global privacy counsel has hit back at former shadow home secretary David Davis for an article criticising the Conservative Party’s reported plans to hand over medical records to the search giant.
In a lively post on his European Public Policy Blog, Peter Fleischer said Google had been “surprised and disappointed” to read Davis’ “vitriolic” attack in a column in the Times.
Davis’ column was aimed as much at his own party as Google. He described newspaper reports that the Tories might let patients lodge their records with Google Health or Microsoft Health Vault as “naïve” and “dangerous.”
Much more here:
http://www.e-health-insider.com/news/5076/davis:_google_hits_back
Seems Google thinks they are safe!
Fifteenth we have:
FBI agents accuse two people of stealing private patient records from Jackson Memorial Hospital and selling them to a lawyer seeking personal-injury clients. A JMH employee admitted she sold the files.
BY JAY WEAVER
Ambulance chasing just took a reckless turn -- at the intersection of healthcare and the law.
A Miami man was charged Thursday with buying confidential patient records from a Jackson Memorial Hospital employee over the past two years, and selling them to a lawyer suspected of soliciting the patients to file personal-injury claims.
Ruben E. Rodriguez allegedly paid JMH ultrasound technician Rebecca Garcia $1,000 a month for the hospital records of hundreds of patients treated for slip-and-fall accidents, car-crash injuries, gunshot wounds and stabbings, federal authorities said.
Rodriguez then brokered the patients' names, addresses, telephone numbers and medical diagnoses to the lawyer, according to an indictment. The lawyer, not identified in court papers, used the information ``to improperly solicit JMH patients with hopes of representing them in future legal proceedings.''
Later, the lawyer paid Rodriguez a percentage of the legal settlements won from the patients' personal-injury claims, authorities said.
Lawyers are allowed to advertise on TV and billboards and in the Yellow Pages, but are prohibited from soliciting clients by phone or at their home or in the hospital.
``Whatever the low-water mark would be, this is it,'' prominent South Florida personal-injury attorney Stuart Grossman said of the JMH case. ``I don't know what would be worse, other than staging an accident.''
Much more here:
http://www.miamiherald.com/486/story/1165065.html
I can but agree with the last sentence!
Sixteenth we have:
by Ken Alltucker - Jul. 31, 2009 12:00 AM
The Arizona Republic
Imagine a health-care system that rewards doctors for quality over quantity.
Such an experiment is taking place in Arizona thanks to the efforts of IBM, which wants more bang for its health-care buck.
The computer giant persuaded a health insurer, UnitedHealth Group, to test a new system in Arizona that pays doctors based on keeping patients healthy. That represents a departure from the fee-for-service model that pays doctors based on the number of patients they see and procedures they perform.
Local participants say the "medical home" system merits attention because it coordinates the major stakeholders in health care - employers, insurers, doctors and patients.
The idea is that if doctors and their patients are encouraged to better manage chronic health conditions such as diabetes or high cholesterol, patients are less likely to land in a hospital emergency room - the most expensive place to provide health care.
Advocates say the approach, in which doctors become a person's medical home for all their health issues, can keep patients healthier and reduce costs.
"Health care has gotten so expensive that people can't afford to get sick these days," said Dr. Danielle Sink, a Phoenix internal medicine doctor who is participating in the UnitedHealth pilot program. "Insurance companies are now motivated to pay up front."
As Congress debates ways to reform the nation's health-care system, the medical-home concept has gained momentum.
Much more here:
http://www.azcentral.com/arizonarepublic/news/articles/2009/07/31/20090731biz-medicalhome0730.html
I hope this model of care is close to where we wind up – this one we can be pretty sure works!
Fifth last we have:
Howard J. Anderson, Executive Editor
Health Data Management Magazine, August 1, 2009
Electronic health records are in the spotlight, thanks to the federal economic stimulus package. Many hospitals and physician groups are scrambling to draft strategies to fully implement EHRs in time to qualify for maximum federal incentive payments. Relatively few have rolled out every component of a truly comprehensive EHR.
But Kaiser Permanente is entering the home stretch in what's turned out to be a seven-year drive to implement comprehensive EHRs, personal health records and related systems at all of its hospitals and clinics. The experiences of the Oakland-Calif.-based not-for-profit organization, which owns 431 medical offices and 35 hospitals plus a large health plan, provide valuable insights for others that aren't as far along.
Key lessons learned along the long and winding road, says Andrew Wiesenthal, M.D., associate executive director of The Permanente Foundation, include:
* Training and related productivity losses represent more than 50% of the total cost involved in a big EHR project.
* Training of clinicians is more effective if it's done "on the job" rather than in classes before the EHR is rolled out.
* Deploying EHRs throughout a hospital in one "big bang" is more effective that phasing it in unit by unit.
* Organizations that own several hospitals can benefit from rolling out EHRs at one organization, studying what works and what doesn't, and then using the same implementation formula at all other hospitals.
But perhaps the biggest lesson of all, Wiesenthal says, is that implementing a clinical system is never really over.
"What we are doing now is going back to everyone who has been trained in the 'get along' phase of system usage and assessing what they know how to do and helping them learn how to do things better," he says. "The 'final' phase is learning how to change how we do things better for patients and transform care. We're just at the threshold of all sorts of wonderful stuff."
That "wonderful stuff" includes, among other things, using clinical data to identify what treatments yield the best results and then alter treatment protocols, Wiesenthal says. He serves as co-leader of the EHR effort in his role at the foundation, which is the parent company of The Permanente Medical Group, the group practice arm of Kaiser.
Kaiser's efforts to alter the practice of medicine by leveraging data in EHRs could provide a valuable example to other organizations down the road, says Laura Jantos, principal at ECG Management Consultants, Seattle. Although Kaiser "is so large and so complex" that its EHR technical strategies may not fit a number of other smaller organizations, Jantos says Kaiser's efforts to revamp care delivery offer lessons on true health care reform.
Vastly more here
http://www.healthdatamanagement.com/issues/2009_69/-38718-1.html
A must read for all interested in how it can be done.
Fourth last we have:
By Joseph Conn / HITS staff writer
Posted: July 31, 2009 - 11:00 am EDT
It took more than a hundred pages and about three months of labor to create a crosswalk between the previous work of the Healthcare Information Technology Standards Panel and the mandated eight categories of “meaningful use” criteria that will trigger federal subsidies for electronic health-record systems and were specifically mentioned in the American Recovery and Reinvestment Act of 2009.
HITSP was created in 2005, and has been working ever since on identifying and harmonizing standards with an eye to enabling EHR systems to more readily exchange patient information between each other. But the stimulus act changed the focus of the federal IT development effort—from standards organized around specific “use cases”—to a system targeting a still only loosely defined set of criteria against which hospitals and office-based physicians will be judged as to whether they are using an EHR in a “meaningful manner.”
The stimulus act also dramatically grabbed the attention of providers by switching the federal effort from a largely “market based” approach—i.e., no federal money provided—to a proposed economic stimulus effort that calls for spending an estimated $34 billion on EHR subsidies to be paid through Medicare and Medicaid to compliant providers.
The crosswalk is contained in a 115-page document, EHR-Centric Interoperability Specification. It was the largest of four specifications approved by the panel at its meeting July 8 in Arlington, Va., and publicly announced last week. The other three are: Exchange Architecture and Harmonization Framework Technical Note, 46 pages; Data Architecture Technical Note, 43 pages; and Emergency Message Distribution Service Collaborations, nine pages.
Much more here (registration required):
http://www.modernhealthcare.com/article/20090731/REG/307319991
Just a reminder – from last week – that this material is available.
Third last we have:
Thursday, July 30, 2009
by Deven McGraw
Greater adoption of electronic health records and health information exchanges could be as transformative for the U.S. health care system as online financial transactions have been for the commercial marketplace and online social networking sites have been for human interaction.
Done right, health IT will help us access and deploy data to enhance health care quality, reduce medical errors, decrease (or at least rationalize) health care costs, expand clinical research and improve public health.
But health data are highly personal and have a level of individual sensitivity for which there are few, if any, parallels. Increasing access to this data greatly increases the privacy risks. Failure to adequately address these risks will weaken public support for, and participation in, new e-health systems.
Some non-treatment uses of health data -- including quality, research and public health -- can be done with data where sufficient patient identifiers have been removed to make it anonymous to the recipient.
For example, such "anonymized" data can be used to assess the efficacy of health care treatments and strengthen our capacity to provide patients with better, more efficient health care. But our health privacy laws today do not promote the use of anonymized data. Instead, our laws, in many cases, either permit or require the use of fully identifiable data (including patient names, addresses, phone numbers, etc.) for these functions, providing little incentive to remove identifiers from data before its use.
Much more here (with links etc):
http://www.ihealthbeat.org/Perspectives/2009/Anonymized-Medical-Data-Protects-Privacy-Improves-Care.aspx
This is an issue that will need to have more thought given to is as we have more information in electronic form to analyse.
Much more also here:
http://news.idg.no/cw/art.cfm?id=B277FF99-1A64-67EA-E4DB4DEAD839AF9B
Jay Cline
25.07.2009 kl 14:52 | IDG News Service
Second last for the week we have:
By Frederick D.S. "Rick" Marshall
Posted: July 29, 2009 - 11:00 am EDT
On May 26, the Veterans Affairs Department released a memorandum effectively denying VA hospitals the right to customize their medical-information software, known as VistA, to meet their local needs. The memo describes the new policy as a reasonable and necessary response to recent problems, but it is a disaster for veterans.
VistA policy from 1978 through the mid-'90s was designed to fulfill the VA's medical mission: serving veterans' healthcare needs. That meant putting the needs of its patients—and of the hospitals and clinics that serve them directly—ahead of the needs of the national VA bureaucracy.
For example, each hospital decided which VistA software to use. It could make its own changes to national ("Class I") software, and decide for itself which local ("Class III") software to develop and use. National developers could not force hospitals to run their software; they had to make it useful enough that hospitals would choose to adopt it. Local developers didn't work for the national offices; they answered only to their local hospitals. And the hospitals themselves answered to their own doctors, nurses and other users—the only people who understand what they need to best serve their patients.
This classic VistA policy recognized that only hands-on users can keep enough reality in the software-development lifecycle to keep it from becoming slow and irrelevant. Medicine and medical technology change continuously, and users in those fields are far more likely to demand useful, innovative functionality than bureaucrats who no longer (or never did) actually use the software. Having VistA developers serve their users first and foremost allowed VA to develop software so effective that it reduced medical errors and helped turn the VA into a healthcare leader.
More here (registration required):
http://www.modernhealthcare.com/article/20090729/REG/307299957
It seems hard to argue that to maintain usefulness systems have to evolve!
Last, and very usefully, we have:
Change Adoption and CPOE: Three Keys to Success
Successfully implementing CPOE requires getting multiple parties on board with the new system.
By Jacob Kretzing
The difficulties hospitals and health systems face in realizing the true benefit of computerized physician order entry (CPOE) stem largely from the fact that CPOE affects so many stakeholders in such profound ways. The order-entry process is central, and impacts workflow across the breadth of the organization.
As the third party managing CPOE implementation projects -- or the fourth party, if one considers IT, clinical staff and the vendor as distinct parties -- organizations such as ours have identified three core priorities that help facilities reach rollout with a high probability of success. As project managers, our focus is on promoting adoption and ensuring that physicians, nurses, pharmacists, ancillaries and other staff will be ready to embrace change. The ideal outcome is to implement a change-management process that better understands the "people side of change" in order to manage clinician expectations.
Much more here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=203655
At the very least the bases described here must be addressed for CPOE success.
Good stuff!
Much more here:
There is an amazing amount happening. Enjoy!
David.
