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:
By Joseph Conn / HITS staff writer
Posted: September 14, 2009 - 11:00 am EDT
What could possibly go wrong or right with health information technology?
The American Medical Informatics Association has developed what it is describing as “a framework for classifying and assessing unintended consequences of health information technology and policy” as well as what to do about them during its 4th annual Invitational Health Policy Conference held Sept. 9-10 in Reston, Va. One topic of discussion at the conference was the unintended consequences of federal regulation of software used by blood banks and whether what was gained in terms of patient safety is any longer worth what has been lost in terms of flexibility and facility with which the systems can change, adapt to and interface with new health IT.
More here:
http://www.modernhealthcare.com/article/20090914/REG/309149952
An interesting presentation is found here:
http://www.amia.org/files/shared/Conference-final-edited_Leveson_Presentation.pdf
This is a very important area and was clearly a useful conference.
Full details and materials (with the framework) are here:
http://www.amia.org/2009healthpolicymeeting
Must not miss stuff.
Second we have:
An Empirical Model to Estimate the Potential Impact of Medication Safety Alerts on Patient Safety, Health Care Utilization, and Cost in Ambulatory Care
Saul N. Weingart, MD, PhD; Brett Simchowitz, BA; Harper Padolsky, MD; Thomas Isaac, MD, MBA, MPH; Andrew C. Seger, PharmD; Michael Massagli, PhD; Roger B. Davis, ScD; Joel S. Weissman, PhD
Arch Intern Med. 2009;169(16):1465-1473.
Background Because ambulatory care clinicians override as many as 91% of drug interaction alerts, the potential benefit of electronic prescribing (e-prescribing) with decision support is uncertain.
Methods We studied 279 476 alerted prescriptions written by 2321 Massachusetts ambulatory care clinicians using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts, estimating the likelihood and severity of adverse drug events (ADEs) associated with each alert, the likely injury to the patient, and the health care utilization required to address each ADE. We estimated the cost savings due to e-prescribing by using third-party–payer and publicly available information.
Results Based on the expert panel's estimates, electronic drug alerts likely prevented 402 (interquartile range [IQR], 133-846) ADEs in 2006, including 49 (14-130) potentially serious, 125 (34-307) significant, and 228 (85-409) minor ADEs. Accepted alerts may have prevented a death in 3 (IQR, 2-13) cases, permanent disability in 14 (3-18), and temporary disability in 31 (10-97). Alerts potentially resulted in 39 (IQR, 14-100) fewer hospitalizations, 34 (6-74) fewer emergency department visits, and 267 (105-541) fewer office visits, for a cost savings of $402 619 (IQR, $141 012-$1 012 386). Based on the panel's estimates, 331 alerts were required to prevent 1 ADE, and a few alerts (10%) likely accounted for 60% of ADEs and 78% of cost savings.
Conclusions Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts. Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts.
More here:
http://archinte.ama-assn.org/cgi/content/abstract/169/16/1465
Another evidentiary brick in the wall.
Third we have:
HM groups need a proactive approach to health technology design and implementation
by By Richard Quinn
This spring, before Sentara Norfolk General Hospital in Virginia went live with eCare, its electronic health record (EHR) system, hospitalist Ryan Van Gomple, MD, would admit patients using the same system physicians have used for decades: hastily scrawled patient history notes, paper orders, and phone dictation. But eCare’s introduction—and subsequent tweaking in the past few months—has brought a radical transition to the 543-bed tertiary-care facility. Dr. Van Gomple and other hospitalists at institutions on similar systems can enter and access a patient’s data using desktop computers, handheld devices like Blackberrys or iPhones—even their personal laptops at home.
“One of the advantages is we can go back … not only with notes from the hospital stay; a lot of people are doing outpatient notes in the system, so you can start to piece together a total picture of a person’s medical care,” says Dr. Van Gomple, a hospitalist with Sentara Medical Group. “That’s one of the big goals of [EHR]—to have a streamlined system. One of the challenges is, How do you connect with different systems? That’s a great question.”
Dr. Van Gomple might not have the answer, but thanks to ambitious goals laid out by President Obama, the topic is in the national spotlight and already has nearly $20 billion in stimulus money scheduled for release in July 2010. Digitizing healthcare records to create a more efficient care delivery system—through improved record keeping, shortened patient length of stay (LOS), and increased ED throughput—isn’t a new idea. Hospitals have struggled for more than a decade with the EHR question, debating whether they should—not to mention how they would—create a computerized system to input patient records into a database that is accessible in real time to hospitalists, nurses, primary-care physicians, insurers, and so on. There have been long-stalled discussions on how to settle privacy concerns that arise from electronic records (see “EHR Upgrade Faces Privacy, Communication Obstacles,” p. 27). Still, a multi-billion-dollar federal pledge has created a moment in time to take EHR beyond the discussion phase.
Much, much more here:
http://www.the-hospitalist.org/details/article/321433/Digital_Dilemma.html
This is a useful long discussion on the possible impact of EHR introduction on Hospitalists (employed clinical staff who work in hospitals). Well worth a browse.
Fourth we have:
By Joseph Conn / HITS staff writer
Posted: September 14, 2009 - 11:00 am EDT
Mark Rothstein wears a number of hats: healthcare lawyer, college professor, medical ethicist and health information technology privacy expert.
Most recently he has donned the garb of a healthcare privacy policy “literary critic” in authoring a critique of an Institute of Medicine report, “Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research,” on the secondary use of clinical data. The IOM report was published in February by its Committee on Health Research and the Privacy of Health Information.
“It was obvious,” Rothstein wrote that, despite its title, the IOM report is “not about enhancing privacy,” but rather “about the committee's view of improving health research by relaxing privacy protections.”
Rothstein levels his criticisms in “Improve Privacy in Research by Eliminating Informed Consent? IOM Report Misses the Mark,” a commentary appearing in the Fall 2009 issue of the Journal of Law, Medicine & Ethics.
Rothstein is the director of the Institute for Bioethics, Health Policy and Law at the University of Louisville (Ky.) School of Medicine. He previously served as a member of the National Committee on Vital and Health Statistics and chairman of its subcommittee on privacy and confidentiality.
Rothstein starts off his commentary praising a number of the recommendations in the IOM report, including the IOM's call that privacy protections in general should apply to all research regardless of the funding source.
Much more here (registration required):
http://www.modernhealthcare.com/article/20090914/REG/309149953
This is an important and interesting debate about balancing privacy and access to information for research purposes.
Fifth we have:
Consumer Engagement in Developing Electronic Health Information Systems
The AHRQ’s National Resource Center for Health Information Technology report provides an in-depth understanding of consumers' health care awareness, beliefs, perceptions, and fears concerning health IT.
Link Provided From Here:
http://www.worh.org/node/6956
The report can be downloaded from here:
http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_888520_0_0_18/09-0081-EF.pdf
This is really a useful report. We should do similar research here in Australia.
Sixth we have:
By Jean DerGurahian / HITS staff writer
Posted: September 15, 2009 - 11:00 am EDT
The Health Information Technology Standards Committee accepted recommendations by its privacy and security work group to update standards and implementation guidelines.
The work group's goal is to move from developing low-level standards to a “higher, more constrained” implementation approach that protects the privacy and integrity of medical data, said Dave McCallie Jr., a physician who is a member of the group. McCallie is vice president of medical informatics for Cerner Corp. The recommendations were made during the health IT committee's monthly meeting as it works toward ensuring health IT adoption under the American Recovery and Reinvestment Act of 2009. The committee was created under ARRA to oversee IT adoption.
More here (registration required):
http://www.modernhealthcare.com/article/20090915/REG/309159940
The standards process is really ramping up with the ARRA act. Read more on the link above and download all sorts of meeting material.
Fourth last we have:
Margaret H. Reckmann, BSc, BPharma, Johanna I. Westbrook, GradDipAppEpid, MHA, PhDa,*, Yvonne Koh, BPharm(Hons)a, Connie Lo, BPharm(Hons)a and Richard O. Day, MDb
a Health Informatics Research & Evaluation Unit, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
b Clinical Pharmacology, St Vincent’s Hospital, University of New South Wales, Sydney, NSW, Australia
* Correspondence: Professor J. Westbrook, Director, Health Informatics Research and Evaluation Unit, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe 1825, Sydney, Australia
Received for publication: 10/23/08; accepted for publication: 05/13/09.
Previous reviews have examined evidence of the impact of CPOE on medication errors, but have used highly variable definitions of "error". We attempted to answer a very focused question, namely, what evidence exists that CPOE systems reduce prescribing errors among hospital inpatients? We identified 13 papers (reporting 12 studies) published between 1998 and 2007. Nine demonstrated a significant reduction in prescribing error rates for all or some drug types. Few studies examined changes in error severity, but minor errors were most often reported as decreasing. Several studies reported increases in the rate of duplicate orders and failures to discontinue drugs, often attributed to inappropriate selection from a dropdown menu or to an inability to view all active medication orders concurrently. The evidence-base reporting the effectiveness of CPOE to reduce prescribing errors is not compelling and is limited by modest study sample sizes and designs. Future studies should include larger samples including multiple sites, controlled study designs, and standardized error and severity reporting. The role of decision support in minimizing severe prescribing error rates also requires investigation.
The Full Text is here.
http://www.jamia.org/cgi/content/full/16/5/613
I suppose it must be me, but I fail to see the point of pretending it is possible to draw conclusions of any strength from this sort of analysis of very disparate studies which are conducted on small numbers over a decade. The study which is the second down in the collection I find much more compelling. Large scale, distinct real world effect etc.
Third last we have:
David W. Bates1,2,3,4*, Adam Wright1,3,4
1 Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America, 2 Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America, 3 Harvard Medical School, Boston, Massachusetts, United States of America, 4 Partners Healthcare, Boston, Massachusetts, United States of America
Citation: Bates DW, Wright A (2009) Evaluating eHealth: Undertaking Robust International Cross-Cultural eHealth Research. PLoS Med 6(9): e1000105. doi:10.1371/journal.pmed.1000105
Academic Editor: Aziz Sheikh, The University of Edinburgh, United Kingdom
Published: September 15, 2009
Copyright: © 2009 Bates, Wright. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The full text is available here:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000105
The paper makes useful and important points. Well worth a read.
Second last we have:
By Joe Carlson / HITS staff writer
Posted: September 15, 2009 - 11:00 am EDT
Wisconsin hospitals have spent heavily on health information technology in the past few years, but independent providers and critical-access hospitals are lagging in implementation despite spending the same amount of money on the systems as everyone else.
A new survey by the Wisconsin Hospital Association finds that the 125 acute-care hospitals in the state have made advances in technology use since the 2006 adoption of the Wisconsin eHealth Action Plan.
For example, half of the hospitals were characterized as “high” users of health IT, defined in the survey as facilities that use at least 13 of the 16 most common types of systems. The number of hospitals considered high users rose by 25% between 2007 and 2008, the most recent year for which data were available. Fully 92% had instituted a laboratory information system, and 82% had a master person index that is used to track all patient records.
More here:
http://www.modernhealthcare.com/article/20090915/REG/309159944
Interesting ‘on the ground’ research. Worth a browse. It shows that planning and co-ordination can make a difference.
Lastly we have:
Charting a New Course
Electronic Medical Records Are Here, and They Come Not Without Challenges, Controversy or Expense
(CBS) For all the sound and fury about reforming health care, one very big change in the way our health system works is already quietly underway. Our Cover Story is reported now by David Pogue of The New York Times:
"I understand how difficult this health care debate has been," president Obama told Congress on Wednesday. "I know that many in this country who are deeply skeptical that government is looking out for them."
The president's plan to redesign the nation's health care system turns out to be just the tiniest bit controversial - as footage from a recent protest ("Pure government take-over!") reveals.
But what you may not know is that Congress has already approved and funded one program: the plan to computerize your medical records.
"Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives," Mr. Obama said Wednesday.
Much more here:
http://www.cbsnews.com/stories/2009/09/13/sunday/main5306927.shtml
There is a link to the 10 minute or so video on this page. Provides a good perspective on the US Health IT discussions.
Enjoy!
David.
