Useful and Interesting Health IT News from the Last Week – 13/09/2009.

The Australian E-Health Press provided a good serve this week. It included these:

First we have:

Why health reform?

Steven J Lewis and Stephen R Leeder

MJA 2009; 191 (5): 270-272

Abstract

· Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice.

· There is abundant evidence that traditional means of delivering health care are obsolete.

· Concerns are deepening about persistent and widening gaps in health status that health care cannot overcome.

· Increased spending on health care has never definitively solved the problems of access, quality, or equity.

· Non-medical determinants of health indicate that the solutions to health problems lie mainly outside health care.

· The current financial crisis may create the urgency and courage to both eliminate the fundamental problems in health care delivery and reduce health disparities.

More here:

http://www.mja.com.au/public/issues/191_05_070909/lew10514_fm.html

Thos six points give a better analysis that I have seen in a while regarding the issues that we need to address. Addressing at least 3 of them are distinctly e-Health dependant.

Second we have:

Electronic patient discharge summaries finally take shape

Elizabeth McIntosh - Friday, 11 September 2009

ELECTRONIC discharge summaries are finally on the horizon, with the release of new standards from the National E-Health Transition Authority (NEHTA), but a leading IT expert has questioned the complexity of the specifications.

The electronic discharge summaries have long been touted as a measure that would improve continuity of care, and the new blueprint now outlines their design and content.

Under the standards, the discharge summaries will contain a patient’s personal identification, medical history, procedures carried out and medications prescribed.

.....

NEHTA’s clinical lead Dr Mukesh Haikerwal dismissed the criticism, saying the standards needed to be robust enough for future e-health technology leaps.

“We’ll try it now and get it ready for the future – for when people can use unique patient identifiers and correct [e-health] terminologies,” he said. “It’s better to start with too much rather than too little. That way, we’re building for the future rather than the past – if they’re not enough, we’re already out of date.”

More here:

http://www.medicalobserver.com.au/News/0,1734,5268,11200909.aspx

All I can say about these comments is that I disagree. Walking before you run is by far the best incremental way forward in e-Health in my view.

Third we have:

GPs unite to safeguard data

by Michael Woodhead

Primary care groups have united to form a governing body that will oversee how data generated by GPs is collected, managed and disseminated.

The RACGP-hosted General Practice Data Governance Council is chaired by former AMA president Dr Mukesh Haikerwal and includes members from organisations representing practice managers, divisions, practice nurses and rural doctors.

…..

“Any collection of data in general practice needs to be mindful of patient privacy and confidentiality. We need to be assured of the security of practice data provided by GPs to other agencies. The medicolegal impacts of data sharing must be clarified. The General Practice Data Governance Council is committed to exploring these issues and developing profession led initiatives in these areas. This is a very exciting time for general practice,” said Dr Haikerwal.

More here:

http://www.6minutes.com.au/articles/z1/view.asp?id=497852

This can’t be altogether a bad thing, but might have some implications. I will write in detail in the next few days on it. The areas to be addressed are all important but it is a pity there is not a mention of data quality.

Fourth we have:

Breakthrough e-health tool launches free to Australian families

YourChildsHealthRecord.com is the breakthrough e-health tool that offers parents and guardians peace-of-mind by enabling them to independently control and manage their child’s personal health and medical records, in a safe, secure and convenient online environment.

A great way to store scattered medical information, the site helps users build an online journal of their child’s key health and developmental milestones. This includes recording results from all health appointments; maintaining an accurate immunisation record; updating health check outcomes from birth to 4 years as well as monitoring asthma, sleep patterns, height and weight. Parents will also be able to record allergies, medications and any current health conditions to ensure a full summary of their child’s health at all times.

Featuring an intuitive data-entry system and an easy to use interface, parents are instantly empowered with the knowledge that all of their child’s personal health information is instantly accessible, for an emergency or if they should move, travel, or change doctors. Printing out information for school excursions or health insurance is as simple as ‘point-and-click’. So the next time families go on holiday, or move, having their child’s accurate medical records instantly accessible is no longer something that will keep parents up at night.

Lots More here:

http://ourkidz.com.au/content/view/490/294/lang,en/

Interesting development – I wonder what sort of uptake it will achieve?

Fifth we have:

Queensland Health appoints Ray Brown as CIO

Internal candidate will lead the state's e-health agenda

Tim Lohman (CIO) 07 September, 2009 11:48

Tags: queensland health, e-health, cio, careers

Queensland Health has appointed acting CIO, Ray Brown, as its new CIO as the government body moves to implement the State’s e-health agenda.

Brown, who has been acting in the role for the past eight months following the departure of then CIO, Richard Ashby, said e-health was one of several important IT strategies at Queensland Health.

“E-health will deliver information and communications technology that will enable clinicians to find the information and equipment they need to communicate and work together to improve patient outcomes,” he said in a statement.

According to Brown, the benefits of the state’s four-year, $243 million IT project were already being realised with the recent rollout of a state-wide electronic discharge summary system.

The system electronically forwards information to a patient’s GP following their discharge from a hospital.

“Already, more than 55,000 discharge summaries have been sent from about 56 hospitals across the State and by June next year this will be occurring from over 120 Queensland Health facilities,” Brown said.

Brown said another system, the Queensland Radiology Information System, is also up and running in 12 rural and remote hospitals, allowing diagnostic images to be taken in one area and diagnosed by specialists in another.

A spokesperson for Queensland Health said Brown would be responsible for "arguably the largest and most complex ICT environment in Queensland", with more than 65,000 staff using a complex suite of software for both business and medical requirements.

As CIO, Brown's top three ICT priorities will be implementation of an electronic medical record, the enterprise discharge summary and Queensland radiology information system, the spokesperson said.

Full article here:

http://www.computerworld.com.au/article/317550/queensland_health_appoints_ray_brown_cio?eid=-6787

All we can do is wish Ray luck. There has been a bit of a revolving door syndrome at Qld Health, where it seems bureaucracy is pretty byzantine.

Sixth we have:

5 free project management applications you must try

Putting together a project plan can sometimes seem more daunting than completing the project itself. When you need to track each step of a project, along with your costs, staff, and other factors, you probably need a project management application.

Howard Wen (Computerworld (US)) 08 September, 2009 14:19

Tags: project management

Project management applications are usually centered around Gantt charts, where each step in a project is represented as a bar in the chart. These visuals are linked to lists of the resources tied to each task (such as the person, team, company or another entity responsible for doing any given job). Everything is synchronized to a calendar, which updates you on the progress that your project should have achieved at any given time during its life cycle.

It's a simple idea, actually. Yet project planning can be intimidating, especially if you're unfamiliar with the methodologies behind it. As a result, learning to use project management applications can be a project in itself -- and you have to pay for the privilege.

For example, because of its brand and its place in the market, Microsoft Office Project is a popular choice for beginners. But at US$600, Office Project is expensive, especially if you just want to use it for some simple projects, or if you're not sure you really need a project management app.

For this roundup, I'll take a look at five free alternatives to using Microsoft Office Project. None of these are from major software companies -- four out of the five are open source while the fifth, jxProjects, is advertising-supported. On the one hand, this means that you don't get the amount of hand-holding that you would from a commercial product. On the other hand, these products often employ more innovative methods than commercial software.

In this roundup, I'll examine what each of these applications offers, how easy each is to use and how useful each choice may be for those unfamiliar with project planning.

Gantter.com

Although Gantter.com is Web-based, it has no online collaboration features. Rather, Gantter.com is meant to be used like a standalone desktop application.

Like a desktop application, Gantter.com loads up in only a few seconds; feedback from clicking through its menus and functions was so snappy I hardly noticed that I wasn't using a standalone application.

The user interface resembles the look and feel of Google Docs -- so much so that I found myself instinctively looking for the ability to save my plan to my Google Docs account.

Gantter.com doesn't have nearly as many features as for-pay applications such as Microsoft Office Project, which includes collaboration, synchronizing with different calendars across several resources, networking and additional enterprise-worthy features. In fact, it pretty much operates at a beginner's level of charting; it focuses simply on planning, and time and budget estimation of your project via Gantt charting in the most elementary, quickest and simplest manner possible. With this in mind, a standout feature of Gantter.com is that you can easily create custom calendar templates, in which you can, for example, mark any day (other than the traditional weekend) as a non-working day.

Microsoft Office Project files can only be imported into Gantter.com if they are first exported to XML. Gantter.com cannot directly read the proprietary Office Project file format. So information and formatting may be lost exporting to XML and then loading the file into Gantter.com. Not surprisingly, Gantter.com cannot save your plan to the Office Project file format.

Another drawback: You cannot print your plan from within Gantter.com. Its developer, Volodymyr Mazepa, says he plans to add print functionality in the future. But for now it's best to use this project management app to create XML-based project plans from scratch.

I really like the tutorial that the site provides. Don't know what Gantt charts are, what a "resource" is, what a "task bar" represents, or how these elements are compiled and brought together when formulating your project plan? Check out gantter.com and follow the tutorial. You'll learn the basics in less than an hour, if even that. And the general rundown also works as a good primer for anyone unfamiliar with the way a traditional project management program works and how a plan is put together.

So if you're new to the world of project management and the use of Gantt charts, I recommend checking out Gantter.com first to teach yourself the fundamentals.

Read about the other 4 here:

http://www.computerworld.com.au/article/317716/5_free_project_management_applications_must_try?eid=-6787

Project planning is a key part of the delivery of e-Health. It is useful to know where tools can be found to assist with the process. There is no doubt at least some e-Health projects of the last decade may not have been as well planned as might have been desired.

Seventh we have:

Firefox 4.0 to arrive late 2010

Mozilla recently released a product roadmap with a number of new details on what the foundation is hoping to release between now and the end of 2010

Chris Brandrick (PC World (US online)) 08 September, 2009 05:19

Tags: web browsers, mozilla firefox, mozilla, firefox

Mozilla recently released a product roadmap with a number of new details on what the foundation is hoping to release between now and the end of 2010, including information on when to expect the next major iteration of Firefox.

The report details that Firefox 4.0 is due to arrive in either October or November of 2010 and will bring with it a range of new features, such as a new slick user interface and multi-touch gesture suppport. But take note that this report is currently classed as a 'draft' and could be open to any number of changes.

For those existing Firefox users, a plentiful number of changes can be expected prior to the late 2010 release date of 4.0, with both 3.6 and 3.7 lined up for debut before then. These new releases will offer such improvements and features as faster javascript handling, improved form completion tools, bookmark synchronization and pageload enhancements.

Mozilla also revealed that when Firefox 4.0 does hit, it will take a leaf out of Google Chrome's book, as each tab will function with it's own separate process, reducing the instances of losing your precious browser session.

More here:

http://www.computerworld.com.au/article/317641/firefox_4_0_arrive_late_2010?eid=-255

This sounds good for those who use Firefox.

Lastly the slightly more out there article for the week:

Powering the search for answers

September 10, 2009

WolframAlpha is often mistakenly compared with Google but it is about getting the responses you are after. By Kevin Anderson.

WOLFRAM Research launched its "computational knowledge engine" Alpha to mixed reviews in May. However, founder Conrad Wolfram says the launch of Alpha is the first step of a multi-decade project.

Alpha already draws on more than two decades of work on the technical computing application Mathematica (bit.ly/mathematica2), the flagship product of Wolfram Research. The application is well-known in academic circles, where it is used to perform complex calculations, manipulate data and create graphs and visualisations, but the average internet user is probably not aware of it.

Many reviews compared Alpha unfavourably with general search engines such as Google but that is like saying a screwdriver is a bad hammer.

The contributing editor at the blog Search Engine Land, Greg Sterling, writes: "By juxtaposing itself with Google or positioning itself as superior to Google in a number of ways, Wolfram created some confusion (and disappointment) in the market."

Alpha and Google are different tools that do different things. Alpha is best thought of as an answers engine rather than a search engine.

Alpha doesn't search the web; it queries and performs calculations on about 10 trillion pieces of mathematical, geometric, financial, chemical, historical and astronomical data. The data sets are curated by Wolfram Research and have been available in Mathematica since version six, which launched in May 2007.

More here:

http://www.smh.com.au/technology/biz-tech/powering-the-search-for-answers-20090909-fg6k.html

This is fascinating stuff we should all keep an eye on. The health implications may be quite important.

More next week.

David.

Report and Resource Watch – Week of 07, September, 2009

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

First we have:

Issue Date: September 2009

For All the Right Reasons

Approaching CPOE from a patient safety and care quality perspective is the first critical step toward success

by Mark Hagland

Yes, CPOE implementation is hard. It's very hard. What's more, it requires sustained commitment and cultural transformation in order to be truly successful. But the patient safety, care quality, and clinician workflow improvement gains that can be made are tremendous. Indeed, the whole initiative must be driven by patient safety and care quality goals, say the leaders of organizations that have successfully implemented CPOE and then built quality advances using its power. Call it the CPOE value proposition.

What's more, if a CPOE implementation requirement is embedded into the final draft of the ARRA-HITECH legislation's funding disbursement protocols (see “CPOE and Meaningful Use,” p. 42), the lessons learned will be all the more valuable. And what is the key to understanding CPOE success? It's about vision and process.

Much, much more here:

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=9B6FFC446FF7486981EA3C0C3CCE4943&nm=Articles%2FNews&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=F04426E7C1814945A2CA25AC5B5CFC94

A report sized article that makes a lot of important points about how to get in-hospital electronic prescribing to work well. Must read!

Second we have:

Depressed people should get online counselling, study says

People suffering from depression should get counselling online to avoid long waiting times to see a doctor, according to new research.

Published: 7:00AM BST 21 Aug 2009

A study of almost 300 patients found that those given cognitive behavioural therapy (CBT) were two-and-a-half times more likely to recover from their mental health problems that those who received standard care from a GP.

One in six adults suffer from depression or chronic anxiety, and online CBT may offer an alternative to the growing problem.

.....

In the study, patients aged from eighteen into their 70s were recruited from Bristol, London and Warwickshire and 149 were given online CBT along with the usual care while 148 got the customary GP sessions.

After a four month follow up completed by 113 patients in the intervention group and 97 in the control group, almost two fifths of those who got the online CBT recovered from depression compared with one in four of those who did not. After eight months the proportion grew further, according to the findings published in The Lancet.

More here:

http://www.telegraph.co.uk/health/healthnews/6062089/Depressed-people-should-get-online-counselling-study-says.html

The paper is found here (log in for full paper):

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961257-5/abstract

Good stuff to show how well this can work.

Third we have:

CMS issues new ICD-10 fact sheet

August 28, 2009 | Diana Manos, Senior Editor

WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) have issued a new fact sheet on the ICD-10 coding system healthcare organizations will be required to use by Oct. 1, 2013.

According to CMS, the new classification system, used by hospitals and physicians both for classifying disease and for billing, will result in significant improvements over the ICD-9 system by providing greater detail and the ability to capture additional advancements in clinical medicine.

ICD-10-CM/PCS consists of two parts: the ICD-10-CM, the diagnosis classification developed by the Centers for Disease Control and Prevention for use in all U.S. healthcare treatment settings; and the ICD-10-PCS, the procedure classification system developed by CMS for use in the U.S. for inpatient hospital settings only.

More here:

http://www.healthcareitnews.com/news/cms-issues-new-icd-10-fact-sheet

The fact sheet is found here:

http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2009.pdf

It is amazing to think the UK went to this is 1995 and here in Australia in 1998! They are still trying to get there!

Fourth we have:

Report: Gov'ts Boosting I.T. Buying

HDM Breaking News, August 31, 2009

Health information technology investments by local and state governments will increase from $7.6 billion this year to $9.6 billion in 2014, according to a new report.

That's a compound annual growth rate of 4.6% spurred by health care reform and I.T. provisions of the American Recovery and Reinvestment Act, the report states.

.....

--Joseph Goedert

More here:

http://www.healthdatamanagement.com/news/government-38901-1.html?ET=healthdatamanagement:e988:100325a:&st=email

The cost of the report is $3,900. For more information, click here.

Seems like a considerable growth rate!

Fifth we have:

Electronic Health Information Exchange in the US: - New State Alliance for e-Health Report offers guidance

Date: 1 Sep 2009 - 14:31

Source: US National Governors' Association

As the national dialogue on health care reform continues, health information technology (IT) and health information exchange (HIE) have emerged as critical means to ensuring a health care system that is affordable, effective, safe and transparent. A new report from the State Alliance for e-Health, Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange, aims to help states lead the way in using health IT and HIE and guide them as they begin instituting the federal Health Information Technology for Economic and Clinical Health (HITECH) Act.

The State Alliance for e-Health, a consensus-based, executive-level body composed of governors, state legislators, attorney generals and state commissioners, was created by the NGA Center for Best Practices in 2006 to address the unique role states can play in facilitating adoption of health IT and HIE. The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years.

More here:

http://www.egovmonitor.com/node/27565

For more information on the State Alliance, please visit www.nga.org/center/ehealth

Looks like a useful resource.

Sixth we have:

IOM pushes gathering of detailed ethnicity data

By Jennifer Lubell / HITS staff writer

Posted: September 1, 2009 - 11:00 am EDT

The Institute of Medicine has recommended that HHS make available to healthcare providers nationally standardized lists of narrowly defined ethnicity categories and spoken and written languages, as part of a larger effort to standardize collection of information on patient race, ethnicity and language.

By making this information available through electronic health records, it will be possible to “stratify quality performance metrics, combine data from various sources, and make comparisons across settings and payment mechanisms,” according to the IOM's new report Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement.

More here:

http://www.modernhealthcare.com/article/20090901/REG/309019953

The link to the brief is in the report. The same approach could sensibly be applied in Australia given our ethnic diversity and indigenous health problems.

Seventh we have:

Health IT contract failure part of VA mismanagement pattern, inspector says

By Mary Mosquera
Tuesday, September 01, 2009

The Veterans Affairs Department’s failure to manage a key element of its HealtheVet electronic health record system was part of a pattern of the mismanagement of complex information technology projects by the agency, its Inspector General said in a report.

The VA earlier this year canceled a contract for the Replacement Scheduling Application (RSA), a HealtheVet subsystem that would let veterans request and view medical appointments in their EHR accounts. RSA was expected to be the next major roll-out of HealtheVet.

Final testing of the seven-year RSA development project was to be completed this year for a January 2010 deployment. In March, however, VA terminated the contract because the code it developed did not work. Department-level IT management weaknesses led to its failure, the IG said.

“The failure of the RSA project is linked to larger systemic problems relating to the management and implementation of IT projects within VA,” according to the report published Aug. 26. Sen. Richard Burr (R-N.C.), the ranking member of the Senate Veterans Affairs Committee, requested the OIG review.

VA selected the Southwest Research Institute in 2002 to develop and deploy the RSA software. But VA managers continually changed the direction, requirements, management and timing of the project, the IG said, pointing to the lack of IT management experience as a factor in the failure of VA projects.

More here:

http://govhealthit.com/newsitem.aspx?nid=72040

The OIG report is located here.

Seems like there are some lessons to be learnt from this.

Lastly we have:

Study: Medical home model increases quality of care, reduces cost

September 01, 2009 | Kyle Hardy, Community Editor

SEATTLE – A study done by the Group Health Cooperative has demonstrated that a new care model coupled with the use of health information technology could serve as a solution to the nation’s primary care physician shortage.

The study results show that a “patient-centered medical home” model has many benefits to both patients and medical staff. This model gives patients more one-on-one time with the physician, improves caregiver cooperation, and provides more preventative care.

“A medical home is like an old-style family doctor’s office, but with a whole team of professionals,” explained evaluation leader Robert J. Reid, MD, an associate investigator at Group Health Center for Health Studies and Group Health’s associate medical director for preventive care. “Together, they make the most of modern knowledge and technology—including e-mail and electronic medical records—to give patients excellent care and reach out to help them stay healthy.”

The study suggests that this particular model empowers the patient and actively engages the patient in their health. A “medical home” approach is a way that is expected to improve health outcomes, control costs, and help deal with the growing shortage of primary care physicians.

In comparing a sample of 9,200 patients from Group Health’s medical home to a control group, after one year patient visits to emergency room decrease by 29 percent. The rate of hospitalizations dropped by 11 percent and the medical home had 6 percent fewer in-person visits.

By employing the use of technology such as email and mobile phones, physicians in the medical home were able to provide better care that included screening tests, management of chronic illnesses, and monitoring of their medications. Using these methods also helped physicians ease the workload and reported that only 10 percent of medical home doctors and staff felt “burnt out” or emotionally exhausted – a large contrast to the 30 percent reported from the control group.

Much more here:

http://www.healthcareitnews.com/news/study-medical-home-model-increases-quality-care-reduces-cost

See more here:

http://www.ghc.org/GettingCare/MedicalHome.jhtml

The article is here:

http://www.ajmc.com/articles/managed-care/AJMC_09sep_ReidWEbX_e71toe87

Shows what is possible with a bit of common sense and technology!

Enjoy!

David.

International News Extras For the Week (07/09/2009).

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

First we have:

Electronic Medical Record Mandates to Increase Jobs in IT

By: Don E. Sears

2009-08-28

With a $20 billion infusion from the Health Information Technology Act, the EMR market is expected to grow in major ways. Expect jobs to expand in systems integration, programming, project management and training.

Where are IT jobs going to be over the next two years? There are a number of expectations, including a whole lot more in Web application development, including social media, enterprise software and a host of mobile applications for Internet-enabled devices such as the iPhone and competitors.

Another area expected to have growth is in health care, specifically in electronic medical records (EMRs).

With a large economic stimulus package behind it, the EMR market is expected to grow in major ways with a $20 billion infusion from the Health Information Technology Act. As detailed in an article at NWjobs.com (affiliated with the Seattle Times), the EMR market for job growth will run the spectrum from technical sales to training to programming. From the article:

The Bureau of Labor Statistics says employment for medical records and health information technicians is expected to grow faster than average for all occupations, with an 18 percent increase through 2016. Within the field there are 125 job titles in more than 40 settings, says Gretchen Murphy, director of University of Washington programs in health information management.

The companies that make and sell EMR software are a good starting point for employment. Jobs can run the gamut from sales to training to project management.

EMR sales careers can range from entry-level telemarketers with base pay in the $30,000s to the six-figure field sales positions.

Much more here:

http://www.eweek.com/c/a/IT-Management/Electronic-Medical-Record-Mandates-to-Increase-Jobs-in-IT-794969/

This is a positive aspect of a move to e-Health that is often forgotten.

A detailed follow-up article is also found here:

http://blog.marketplace.nwsource.com/careercenter/movement_toward_electronic_medical_records_will_bring_healthy_diverse_job_growth.html?cmpid=2627

Second we have:

New gadgets prod people to remember their meds

By Scott Kirsner, Globe Columnist | August 30, 2009

About 35 years ago, Boston University psychology professor Andrew Dibner had the sort of flash of inspiration that can propel an entrepreneur for years: When an elderly or disabled person falls and needs help, what if there was technology in their home that could summon an ambulance for them - even if they couldn’t get to a phone?

No one was sure the world needed Dibner’s technology - including the senior citizens he wanted to help - and no one wanted to finance his idea, either.

Despite the obstacles, Dibner’s company, Lifeline Systems Inc., created an entire business category - personal emergency response systems, often worn by seniors as a pendant around the neck - and dominated that category for decades before being acquired in 2006 for $750 million. (It was one of Lifeline’s rivals, no longer around, that gave us the unforgettable phrase, “I’ve fallen and I can’t get up!’’)

Dibner, now retired and living amid the golf courses of Sun City, Ariz., is helping to launch another technology start-up targeting seniors. He is an investor and adviser. MedMinder Systems Inc., a Newton start-up, is one of several local companies developing technologies to remind people to take medicine.

But is the world ready for the wirelessly connected pill organizer that flashes, beeps, e-mails, and calls you on the phone?

Amazingly, while the cost of prescription drugs represents a significant chunk of our health care spending, both as individuals and as a country, the cost of not taking the drugs that have been prescribed to us has major economic repercussions.

A study released this month by the New England Healthcare Institute, a Cambridge think tank, found that anywhere from a third to a half of all Americans don’t take their meds, or don’t take them at the right time or at the right dosage. The institute estimated that the result - which can include extra doctors visits and even hospitalization - costs $290 billion annually.

MedMinder has designed an intelligent pill organizer called Maya that’s about the size and shape of a large textbook.

More here:

http://www.boston.com/business/healthcare/articles/2009/08/30/new_gadgets_prod_people_to_remember_their_meds/

Sounds like a great idea to me. Getting my Mum to remember to take her medicine was the bane of the last 10 years of her very long life!

Third we have:

Assessing Demand for EHRs

HDM Breaking News, August 28, 2009

The Medicare and Medicaid incentives for adopting electronic health records will lead to a gradual build in demand for the software, rather than a surge, one investment analyst says. “That’s because some portion of the market will want to wait to see the final rules,” says Raymond Falci, managing director of Cain Brothers & Co., New York, who tracks public health care I.T. firms.

On Aug. 20, David Blumenthal, M.D., national coordinator for health information technology, predicted that the final definition of the “meaningful use” of electronic health records that will be used to determine eligibility for incentive payments under the economic stimulus program will not be available until the middle or end of spring 2010. The preliminary definition of meaningful use requirements will be issued by the end of this year, followed by a 60-day comment period, Blumenthal said.

This timing for defining meaningful use, which is later than many expected, may mean demand for EHRs will ramp up more gradually than if the details were known sooner, Falci says. Regardless, health care organizations are dividing into two camps: Those that are moving forward with plans to qualify for federal electronic health records incentive payments and those that are waiting for the final regulations on incentives, he says.

“A lot of hospital CIOs and group practice administrators have told me that they need to get started now” to ensure they qualify for maximum incentives by having a qualifying EHR in place by 2011, the analyst says.

Falci speculates that the federal government might wind up pushing back all the deadlines called for under the American Recovery and Reinvestment Act, much as it did when creating the rules to carry out HIPAA. “My guess is, in the big picture of what the government is trying to accomplish, they’re going to have to modify the timeline.”

Regardless, the Wall Street analyst predicts that most clinical software companies “will be pretty busy next year just serving those who want to get a jump start. So I’m not too concerned about the impact on their financial performance.”

Reporting continues here:

http://www.healthdatamanagement.com/news/ARRA-38893-1.html

Given the scale of the program I guess some slippage is inevitable – we shall see!

Fourth we have:

FTC final rule requires quick PHR breach notification

By Joseph Conn / HITS staff writer

Posted: August 31, 2009 - 11:00 am EDT

The Federal Trade Commission weighed in last week with new rules to protect the privacy and security of personally identifiable healthcare information stored on personal health-record systems offered by companies not covered by federal privacy rules under the Health Insurance Portability and Accountability Act of 1996.

The FTC rulemaking on breach notification by vendors of PHRs comes under the authority of the American Recovery and Reinvestment Act of 2009.

Broadly, the new FTC rule calls for customer notification in the event of a breach of identifiable health information. Notification must occur “without unreasonable delay” but no later than 60 days after the breach is discovered.

The FTC estimates that about 200 PHR vendors, 500 “PHR-related entities” and 200 service providers will be covered by the rule. Of these, the FTC estimated there will be 11 breaches a year that will require notification to an estimated 232,000 PHR customers, with a total cost of compliance at $795,000.

The FTC interim final rule said the stimulus law “recognizes there are new types of Web-based entities that collect consumer's health information,” including “vendors of personal health records and online applications that interact with such” PHRs that additionally “are not subject to the existing privacy and security requirements” of HIPAA.

More here (registration required):

http://www.modernhealthcare.com/article/20090831/REG/308319912

I have to say it is good our Privacy Commissioner is also suggesting we have such breach notification.

Fifth we have:

HealthPartners saves money with e-records

Minneapolis / St. Paul Business Journal - by Chris Newmarker Staff writer

HealthPartners is providing some proof for health reform advocates who say that electronic medical records can save health providers money.

The Bloomington-based health provider and insurer says it’s saved $430,000 over the past year by including electronic X-rays, MRIs, CT scans and radiology reports in patients’ electronic health records. Savings included $130,000 that no longer had to be spent on transcribing radiologist reports, and $300,000 that was no longer needed for film storage costs.

That doesn’t include the savings that came from reducing radiology report turnaround times from two days to about four hours.

“The benefits of being paperless include increased efficiency because images can be available quickly at multiple locations and they cannot be lost,” said Kim LaReau, vice president and chief information officer at HealthParters’ Regions Hospital in St. Paul.

More here:

http://www.bizjournals.com/twincities/stories/2009/08/24/daily55.html?s=industry&i=health_care

The evidence on both saving and service improvement continues to build.

Sixth we have:

Standard e-health records a way off yet

Published Monday August 31st, 2009

Digital Technology is not main issue for national file sharing system

SAINT JOHN - Electronic health records won't be standardized country-wide anytime soon, nor should they be, says Norm Archer, professor emeritus at McMaster University.

As all jurisdictions in Canada move towards making digital health records available to any authorized health professional the idea of a national patient file sharing system is seen as the ultimate goal.

But Archer, who spoke on a panel about e-health at a technology conference in Saint John last week, doesn't believe it is possible within five to 10 years, the speculated timeline for country-wide electronic file sharing.

Other panelists, including Jean-Marie Godin of FacilicorpNB, the provincial Crown corporation that manages IT services for provincial health care, say expanding electronic health records across Canada is an achievable goal.

But standardizing is more difficult he says. Godin, who used to work for the former Acadie-Bathurst Health Authority, says it took three months for the gynecologists in Bathurst to standardize ways of recording the 11 different results for a pap test.

"Standards is the issue here, not technology," Godin says.

Archer says standardization should be left to relatively small geographic areas that most people would normally go to receive health care. For New Brunswick this may be the whole province, but for Ontario he says there would have to be multiple regions.

For the rare occasions that someone needs medical attention outside their home region Archer says the doctor can still pick up the phone. He sees country-wide standardization as a much longer-term goal.

More here:

http://nbbusinessjournal.canadaeast.com/front/article/776661

Some interesting views expressed here. Not sure I agree with all of them.

Seventh we have:

InformationWeek Healthcare Launches to Address Changing Needs of Healthcare Technology Professionals Amid Mandate for Improved Patient Care and Lower Costs

New Editorial Portfolio Provides Critical Information, Unique Insights and Tools for Healthcare Technology Professionals in an Industry on the Cusp of Major Transformation

SAN FRANCISCO, Sept. 1 /PRNewswire/ -- InformationWeek, the leading multimedia business technology brand, announced today the launch of InformationWeek Healthcare (www.informationweek.com/healthcare). The new Web site, newsletter (http://www.informationweek.com/newsletters/subscribe.jhtml) and InformationWeek Analytics Reports (http://www.informationweekanalytics.com/), coupled with expanded coverage in InformationWeek magazine and live Web events, helps healthcare technology professionals understand how to apply new technologies for more effective patient care and more efficient operations.

The federal government has set aside close to $20 billion to encourage hospitals, doctors' offices, and other healthcare providers to start digitizing their medical records and processes. The goal: to get at least half of U.S. hospitals and doctors' offices to adopt e-health record systems by 2014, up from less than 10% today.

InformationWeek has covered the IT strategies, issues, and implementations defining the healthcare industry for years. With federal funding and mandates on the table, the pressure is on healthcare technology professionals to get going now. InformationWeek Healthcare is timed to serve healthcare technology professionals tasked with analyzing IT products, services, policies, and vendor strategies aimed at the sector.

More here:

http://sev.prnewswire.com/computer-electronics/20090901/NY6865701092009-1.html

This looks like good news – another source of Health IT coverage.

Eighth we have:

Cerner Client Recognized for Deepest Use of Electronic Health Records Among U.S. Pediatric Hospitals

Children's Hospital of Pittsburgh of UPMC Recognized by KLAS as the Leader in Use of Healthcare Information Technology Among Pediatric Hospitals in the United States

KANSAS CITY, Mo. and PITTSBURGH, Sep 1, 2009 (GlobeNewswire via COMTEX) -- Children's Hospital of Pittsburgh of UPMC, which has used Cerner(r) solutions for 10 years, was recently recognized by KLAS as the leader in its use of healthcare information technology among pediatric hospitals in the United States. Children's Hospital uses Cerner solutions to enable a paperless workflow in every patient care setting in the hospital as well as the health information management department.

(Tweet this: Cerner client, Children's Hospital of Pittsburgh, named leading pediatric hospital in U.S. for HIT use http://bit.ly/cernPR)

"Throughout its journey of automation, the leadership at Children's Hospital of Pittsburgh had a true vision to use healthcare IT to improve patient safety and clinical outcomes," said Trace Devanny, Cerner president. "Cerner is proud to have worked with Children's Hospital to make this vision a reality. We commend the leadership, IT teams, clinicians, and staff at Children's Hospital for the dedication that makes them the leader in use of healthcare information technology among pediatric hospitals in the United States."

Children's Hospital began using Cerner solutions in 1999 when it implemented solutions to automate processes in its pharmacy department. Since then, the hospital has implemented an additional 19 solutions and upgraded to the Cerner Millennium(r) healthcare computing platform.

"This recognition is a real tribute to the hard work and ingenuity of the physicians and employees of Children's Hospital as well as our strategic partnership with Cerner," said Christopher Gessner, Children's Hospital president. "The automation of clinical information across the continuum of care is a highly complex and challenging undertaking that can only be accomplished through outstanding teamwork. Cerner has truly shared our vision of using technology as an enabler for our clinicians to provide better, safer care for our patients. We look forward to our continued work together as we analyze the data available to us and work continuously to improve the care of our patients and workflow of our staff."

Children's Hospital has realized numerous benefits from using Cerner solutions including:

* Reductions in medication errors that cause harm;

 * Elimination of transcription errors;

 * Improvements in documentation and compliance; and

 * Improvements in turnaround times for radiology and lab reports.

Children's Hospital implemented computerized physician order entry (CPOE) in 2002 to improve patient safety, and has seen a reduction in medication safety events since that time. The rate of medication safety events that reached the patient has decreased since CPOE from 0.091/1,000 doses to 0.036/1,000 doses, a 60 percent reduction. Improvements have been seen in each major step of the medication process: ordering, dispensing, and administration.

Full article here:

http://www.marketwatch.com/story/cerner-client-recognized-for-deepest-use-of-electronic-health-records-among-us-pediatric-hospitals-2009-09-01

This is a useful report showing that in the complex paediatric environment Health IT can work and make a difference.

Love the instructions on how to Tweet the news in the press release!

Note just how long it has taken!

Ninth we have:

Hospital Uses EMRs to Avoid Drug Errors

Sarah Kearns, for HealthLeaders Media, August 31, 2009

In 2008, Linda Severson, RN, was called into her superintendent's office after the facility had experienced a near miss pertaining to look-alike/sound-alike drugs. He asked her if there was anything she could do to prevent this kind of problem from happening again.

In response, Severson, who works at Cherokee Mental Health Institute (CMHI), in Cherokee, IA, took matters into her own hands and changed the CMHI computer system settings for all look-alike/sound-alike drugs so that they show up differently than the rest by default. This change brings additional attention to look-alike/sound-alike drugs to the person entering the record.

Since implementing the new process, CMHI has seen and is now tracking a noticeable reduction in errors associated with look-alike/sound-alike drugs.

Electronic medical records
The facility's original medical record system was used as an order entry form. For example, if the practitioner filling out the form worked in pharmacy, he or she would identify pharmacy in the order type. Then the order code would be brought up, which in pharmacy's case, would be the particular type of drug.

When it came time for the pharmacy practitioner to choose the type of drug, this was where CMHI experienced problems.

One particular case was distinguishing between the drug hydroxyzine, an antihistamine used to treat insomnia, and hydralazine, an anti-hypertensive drug used to treat high blood pressure.

"When you chose the drug, you would only have to put a portion of the drug name in," says Severson. "When you typed in [the letters] 'HYDR,' you would get every drug with those four letters in it."

More here:

http://www.healthleadersmedia.com/content/238222/topic/WS_HLM2_TEC/Hospital-Uses-EMRs-to-Avoid-Drug-Errors.html

Note how it is both having the systems – and setting them up intelligently that makes a difference!

Tenth we have:

Survey of Spanish docs online

02 Sep 2009

A third of Spanish doctors say that patient’s looking up details of their condition online can complicate their relationship with patients and even undermine their credibility.

The results come in a study that examines how health information on the Internet is changing the relationship between doctors and patients.

"Although the e-patient is a new phenomenon that is growing exponentially, very few studies analyse it from a doctor's point of view," said José Joaquín Mira, the main author of the working paper published recently in the journal ‘Atención Primaria’ (primary health care).

The researchers analysed the opinions of 660 doctors who all work for the Spanish National Health System - 330 in primary health care and 330 in hospitals - in the provinces of Alicante, Madrid, Zaragoza and Huesca.

Results show that 96% of the doctors surveyed have been questioned by their patients about information they have read on the Internet. In addition, almost three out of every 10 professionals recommend websites to their patients.

More here:

http://www.ehealtheurope.net/news/5167/survey_of_spanish_docs_online

Sounds like the concepts of ‘patient empowerment’ have not made it to Spain yet!

Eleventh for the week we have:

Speech Recognition May Speed EMR Adoption

By: Ericka Chickowski | 2009-08-28 |

With a five-year adoption mandate of electronic health records hanging over health organizations, they are faced with many hurdles—but speech recognition may very well be the critical enablement technology they have been looking for.

As health care organizations strive to improve the way they handle patient records in the digital realm, many are struggling with the ultimate electronic medical records bugaboo. That is, how the heck do they get the doctors to actually use EMRs?

“The big challenge is getting the doctors to use the electronic health records,” says Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center, who cites American Hospital Association numbers that show only about 17 percent of physicians in the United States currently use EMRs.

A study by the New England Journal of Medicine of 3,000 hospitals in April shows even worse adoption rates—only 1.5 percent of all non-federal U.S. health care facilities use a comprehensive EMR system, and just 8 percent have EMRs installed in at least one unit.

Federal lawmakers are trying to promote better adoption of EMRs in order to develop the infrastructure necessary to reap the benefits of pervasive EMR use. With the passage of American Recovery and Reinvestment Act (ARRA) of 2009, the government plans to disperse $36 billion in aid to promote EMR investments nationwide.

But even though the average 500-bed hospital will expect to rake in about $6 million of those funds if they implement EMRs by 2011, that will hardly cover the expense of a full deployment, according to PriceWaterhouseCoopers consultants.

More here (registration required):

http://www.smartertechnology.com/c/a/Technology-For-Change/Speech-Recognition-May-Speed-EMR-Adoption/

Sensible suggestion – we need so good studies with quality systems to see how well it can work.

Fourth last we have:

Summary and Comment

Computerized Alerts Can Influence Drug Prescribing

After computer prodding, physicians ordered fewer prescriptions for potentially inappropriate drugs and heavily advertised drugs.

Computerized decision support is one way to influence drug prescribing. In two new studies, researchers addressed this topic.

One study was conducted in an Indianapolis emergency department (ED) with a computerized order-entry system for all prescriptions. Researchers tracked prescribing patterns for older patients (age, 65) after 63 ED physicians were randomized to a decision-support prescribing intervention or to a control group. In the intervention group, orders for nine drugs that were deemed to be potentially inappropriate for older adults (e.g., promethazine, diazepam, propoxyphene, diphenhydramine) generated computerized alerts that suggested alternatives. During the 2-year study, the proportion of older ED patients who received prescriptions for potentially inappropriate medications was significantly lower in the intervention group than in the control group (2.6% vs. 3.9%).

.....

Comment: These studies indicate that computerized alerts can influence drug prescribing. In the hypnotic drug study, the goal clearly was to limit prescribing of expensive branded drugs. The ED study, however, raises interesting conceptual questions about what should be considered "inappropriate" in geriatric prescribing. That question is addressed in another recently published study (JW Gen Med Sep 3 2009).— Allan S. Brett, MD

Published in Journal Watch General Medicine September 3, 2009

Citation(s):

Terrell KM et al. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial. J Am Geriatr Soc 2009 Aug; 57:1388.

• Medline abstract (Free)

Fortuna RJ et al. Reducing the prescribing of heavily marketed medications: A randomized controlled trial. J Gen Intern Med 2009 Aug; 24:897.

• Medline abstract (Free)

More here (free) :

http://general-medicine.jwatch.org/cgi/content/full/2009/903/1

Useful summary of a couple of papers from the excellent Journal Watch.

Third last we have:

Vendors Launch HIE Platform

HDM Breaking News, September 1, 2009

Orion Health Inc. and Cisco Systems Inc. have combined some of their technologies to create a data exchange platform for providers to report data to public health agencies. The platform also enables providers to receive public health notifications from the agencies.

More here:

http://www.healthdatamanagement.com/news/public_health-38912-1.html

More information is available at cisco.com/go/axp and orionhealth.com.

These are some big players getting together.

Second last we have:

5 decisions that will determine the fate of e-health records

Experts say success hinges on the outcomes of these decisions

• By Alice Lipowicz
• Sep 02, 2009

Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.

The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.

1. Follow the rules or be innovative?

Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance of rigidity and flexibility.

“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.

More here:

http://fcw.com/articles/2009/09/07/fedlist-5-steps-to-ehr-success.aspx

See the other 4 critical success factors by following the link.

Last, and very usefully, we have:

Will the HITECH Act be Effective or a Bust?

Carrie Vaughan, for HealthLeaders Media, September 1, 2009

When it comes to implementing electronic health record systems and exchanging health information electronically, healthcare providers are being incentivized, nudged, or hit with a stick. As everyone reading this probably already knows, healthcare providers have until 2015 to be deemed "meaningful users" of certified EHRs before they are penalized under the regulations outlined in the HITECH Act.

The big question is will we spend this stimulus money in a way that truly makes healthcare more cost effective and improves the quality of care for patients. Almost every one that I talk to makes a point to say that the HIT Policy committee is approaching this the right way—although they may grumble about recommended guidelines being too aggressive or not aggressive enough.

A lot of questions still remain and the final definition of meaningful use and the certification criteria for vendors likely won't be finalized until the first quarter of 2010. So will the HITECH Act—based on where we are headed and the work that has already been done—achieve its goals? I know. It's a tough question to answer and no one has that crystal ball to glimpse into the future. But if we are getting off track, the time to correct the situation is now or we could end up wasting a lot of tax payer money for naught.

"We have a fragmented healthcare system where patient data is not available, so we want informational integration at least," J. Marc Overhage, MD, PhD, director of medical informatics and research scientist at Regenstrief Institute, Inc. and president and CEO of the Indiana Health Information Exchange, told me during an interview for HealthLeaders magazine's August cover story, "Hang On."

Much more here:

http://www.healthleadersmedia.com/content/238261/topic/WS_HLM2_TEC/Will-the-HITECH-Act-be-Effective-or-a-Bust.html

Continuing commentary and discussion about how all this is going to work.

There is an amazing amount happening. Enjoy!

David.

A Minister for E-Health - Is It a Good Idea?

Just after yesterday’s blog was finalised I came across the following. It really follows on from the theme begun yesterday.

Rudd should appoint Minister for eHealth: CSC

by James Riley

Tuesday, 08 September 2009

So complex are the technology issues related to proposed health care reforms, the Rudd Government should consider appointing a Minister for eHealth to assist Nicola Roxon, US technology services giant CSC has proposed.

The scale of health care reform being proposed by Government – with much of it driven by IT – “could be more important than the introduction of Medicare” in the 1970, according to CSC Australia director of health services Lisa Pettigrew said.

“There are many ways to solve this, but one of the ideas that we have is that maybe its time for (the appointment of) a Minister for eHealth … to support the Minister for Health,” Pettigrew told iTWire.

“Unless we’ve got political leadership specifically looking at eHealth, (it will be difficult to implement.)

“eHealth is not an urgent issue like … Swine Flu, but you know what? I like my Health Minister to be focused on urgent health issues, but I still want someone constantly looking at eHealth and keeping that as a priority too,” Pettigrew said. “It is that important.”

CSC’s eHealth Minister proposal was given only tepid support from Labor’s Kate Lundy, who says the technology complexities at Health are the same as those faced by other service delivery agencies like the ATO and Centrelink.

“What is needed is a coordinated and strong political leadership that advocates principles of engagement in an online environment,” Senator Lundy told iTWire.

More here:

http://www.itwire.com/content/view/27544/53/

In yesterday’s blog I was lamenting the apparent lack of co-ordination between the Broadband Minister, the Health Minister and the various Departments.

See here:

http://aushealthit.blogspot.com/2009/09/astonishing-lack-of-co-ordination-in.html

Well can I say I think this is just a ‘bridge too far’, but I very much agree with the comments of Senator Lundy when she says “What is needed is a coordinated and strong political leadership that advocates principles of engagement in an online environment”!

The issue right now is that there is no leadership (weak or strong) and so we see the ‘silliness’ which I know frustrates and annoys so many who read here.

My feeling is that what is needed is something like the US National Co-Ordinator for Health IT and an office like ONCHIT (Office of the National Co-Ordinator of Health IT) with a Prime Ministerial Mandate and a Budget to get on with it! An absorbed NEHTA would provide some of the technical grunt while other required areas would be established anew.

The equivalent office in Australia should be established with legislation, just as the US equivalent has been, which defines goals, objectives, funding and powers etc.

Without that sort of focus you can be sure we will get pretty much nowhere!

David.

Well There Goes the Money for E-Health – For Now at Least!

Last night the e-Health proponents probably had a major blow.

Senate votes down $1.9bn health cuts

Siobhain Ryan | September 10, 2009

Article from: The Australian

THE Senate has dealt a $1.9billion blow to Kevin Rudd's health budget by rejecting plans to means-test taxpayer rebates for private health cover and increase levies on the non-insured.

The Coalition, the Greens, independent Senator Nick Xenophon and Family First senator Steve Fielding combined to defeat the three budget bills, which would have raised health fund premiums for more than two million middle- to higher-income Australians.

Manager of Government Business in the Senate Joe Ludwig appealed to balance-of-power crossbenchers ahead of the vote to pass the savings measure, which the Coalition had long vowed to oppose.

"This is a hard decision and one that was not taken lightly, but it is the right decision for Australia's long-term economic future," Senator Ludwig said. But the government offered no compromises, which sealed the package's fate.

In the process it has set up a potential trigger for an early election, if the bills are knocked back a second time ahead of the measure's July 2010 start date.

Federal Health Minister Nicola Roxon told question time yesterday the Coalition's intransigence on the rebate and other budget cuts in her portfolio had put future health reform at risk. "Nearly $2.5bn of money that could be better used in health is currently being blocked by the Liberal Party in the Senate," shesaid.

More here:

http://www.theaustralian.news.com.au/story/0,25197,26051902-23289,00.html

On August 19, 2009 Ms Roxon linked the passage of this bill to e-Health funding.

She said.

“Better information means better and safer health treatments for patients.

Our reform plans, including those on e-health, will not come cheap.

The Reform Commission has put the price tag of an Individual Electronic Health Record at between $1.1 and 1.8 billion. That’s serious money, and it will require serious consideration on how it could be funded.

Coincidently, you may have noticed that this week in the Senate that the Government is attempting to pass its changes to the private health insurance rebate.

We are trying to change the rebate provided to high income earners with private health insurance – for example couples who earn over a quarter of a million dollars – which is estimated to save the Government $1.9 billion.

So as you can see, the E- health reforms are an example of what we could pay for if the private health insurance measure is passed

You might consider placing a call to your local Coalition or Independent Senator to point this out.”

More here:

http://aushealthit.blogspot.com/2009/08/nicola-roxon-speech-health-e-nation-19.html

A bit sad about that. We clearly need another hollow log to be located!

David.