Here is Another Study That Will Stir Some Debate! Take it From Me it Is Essentially Useless Rubbish - But I Would Say That Wouldn’t I?

The following article appeared in the Health Section of the Saturday Australian on Saturday.

Experts challenge e-health critique: researchers suggests they may not be worth the money

• Leigh Dayton, Science writers
• From: The Australian
• January 22, 2011 12:00AM

DESPITE widespread support for electronic patient records, electronic prescribing and other e-health technologies, a global review by British researchers suggests they may not be worth the money.

Specifically, a team led by physician and epidemiologist Aziz Sheikh with Edinburgh University reported this week in the journal PLoS Medicine that evidence supporting the benefits of e-health technologies is weak and inconsistent, "despite being frequently promoted by policy-makers and techno-enthusiasts".

Worse, they found some evidence that introducing e-health technologies can generate new risks, such as prescribing practitioners becoming over-reliant on the technology, resulting in errors.

This may surprise Australian taxpayers who, in the two years to June 2012 will have spent $467 million on a national e-health record system that does not yet exist.

That excludes another $218m spent during the same period on the National E-health Transition Authority, established in 1995 by the Australian, state and territory governments to develop better ways of electronically collecting and securely exchanging health information.

Sheikh and his colleagues analysed systematic reports, so-called meta-reviews, published from 1997 to 2010, identifying 53 that evaluated the impact of e-health technologies on the quality, cost and safety of healthcare delivery.

They conclude that given the lack of evidence supporting e-health, it's vital that e-health technologies should be rigorously evaluated against a comprehensive set of measures, from design to implementation and adoption.

According to Australian Medical Association vice-president Steve Hambleton, the PLoS paper shows that data being collected "isn't useful" and that evaluation of e-health technologies has "been exceptionally poor to this point".

Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, agrees evidence is patchy and better methods of evaluation are needed. But he disputes the claim by Sheikh and co that there's no good evidence e-health technologies are cost-effective and improve patient outcomes. "They looked at weak literature as opposed to primary sources," says Coiera.

More commentary is found here:

http://www.theaustralian.com.au/news/health-science/experts-challenge-e-health-critique-researchers-suggests-they-may-not-be-worth-the-money/story-e6frg8y6-1225991983661

There has also been coverage here:

Little Evidence To Support Most E Health Technologies, Such As Electronic Patient Records

19 Jan 2011

Despite the wide endorsement of and support for eHealth technologies, such as electronic patient records and e-prescribing, the scientific basis of its benefits-which are repeatedly made and often uncritically accepted-remains to be firmly established.

Furthermore, even for the eHealth technologies that have proven to be successful, there is little evidence to show that such tools would continue to be successful beyond the contexts in which they were originally developed. These are the key findings of a study by Aziz Sheikh (University of Edinburgh, Edinburgh, Scotland) and colleagues, and published in this week's PLoS Medicine.

In the study, the authors systematically reviewed the published systematic review literature on eHealth technologies and evaluated the impact of these technologies on the quality and safety of health care delivery. The 53 reviews (out of 108), that the authors selected according to their criteria and critically reviewed, provided the main evidence base for assessing the impact of eHealth technologies in three categories: 1) storing, managing, and transmission of data, such as electronic patient records; 2) clinical decision support, such as e-prescribing; and 3) facilitating care from a distance, such as telehealthcare devices.

The authors found that the evidence base in support of eHealth technologies was weak and inconsistent and, importantly, that there is insubstantial evidence to support the cost-effectiveness of these technologies. They also found some evidence that introducing these new technologies may sometimes generate new risks, such as prescribing practitioners becoming over-reliant on clinical decision support for e-prescribing or overestimate its functionality, resulting in decreased practitioner performance.

More here:

http://www.medicalnewstoday.com/articles/213661.php

The article also got coverage in Time Magazine

Are Electronic Health Systems Cost Effective? Not So Much

By Alice Park Wednesday, January 19, 201

If you've visited the doctor or a hospital recently, you can't help but notice how much of your care depends on some form of electronic information exchange. From the prescription your doctor writes to the chart she consults, medicine is very definitely going digital.

But how effective is all this electronic data capture? Is it making the health care system more efficient? And what about patient care — are e-health technologies improving health outcomes for people who are sick?

Unfortunately, the answer is no, according to research published in PLoS Medicine. And this is despite the billions that governments like the U.S. have poured into such technologies — the Obama administration approved $38 billion to digitize the American health care system.

After analyzing 53 reviews of electronic technologies in health care, researchers led by Dr. Aziz Sheikh at the University of Edinburgh report that there is little or weak evidence to support the massive investment that policy makers have made in electronic systems such as electronic health records and computerizing physician orders and other decision-making. The strongest evidence in support of digitizing medical information came in electronic prescriptions, which showed a small benefit in reducing errors and streamlining ordering.

More here:

http://healthland.time.com/2011/01/19/are-electronic-health-systems-cost-effective-not-so-much/

There is a very interesting comment on the Time Article

Paul Shekelle

As the author of 3 of the reviews summarized in the original PLoS article, I am concerned that readers of this summary, and of the PLoS article, might inadvertantly come away with the impression that the evidence is that electronic health systems don't improve patient care and are not cost effective. I don't think that's what the data support. Rather, I think the published data support that the evidence is mixed, but that in some institutions the electronic health system has been transformative in the way care is delivered, with real and measurable improvements in care. So the question is - how can these results be realized by more health care organizations? At the time of our original 2005 review, there were no examples published outside of the few leaders in the field. By the time of our 2008 update, there were published a small number of successful results at other institutions. This is a fast moving field - the PLoS "review of reviews" isn't going to capture what's happened recently, and will tend to give more emphasis to older studies - in some cases, more than a decade old. Almost nobody today uses the mobile phone or computer that they used 10 years. I don't think data from 10 years ago on the value of electronic health systems is very informative for what's going today, and what is possible tomorrow and next year.

You can read about the commenters biography here:

http://www.rand.org/about/people/s/shekelle_paul_g.html

My reaction to that comment is that Dr. Shekelle MD PhD is right on the money!

That view is further confirmed by downloading the file found here.

http://www.plosmedicine.org/article/fetchSingleRepresentation.action?uri=info:doi/10.1371/journal.pmed.1000387.s002

This file lists the papers that were reviewed and what I found impressive was just how many were over a decade old. These papers were written before not only the iPad but also the iPod. Technology and our experience of what works and what doesn’t has advanced quite a way since 1990 when some of the papers seen as contributing to the evidence reported here were written - meaning the work was done in the 1980’s when all sorts of things were yet to come - e.g. the graphical user interface.

The second point is that this paper is a review of reviews. At no point did the authors use primary sources as far as I can tell. This is not the way things sensibly work. Science works by building on previous direct observation and experience - not by reading about it in summaries and then constructing conclusions from summaries papers. Meta, meta analysis is just too silly for words when attempting to draw any conclusions from the findings of studies with ages of up to 20 years and scopes and objectives that are quite different.

Last point is that we know there are examples where e-Health really works - viz Kaiser Permanente in the US, a number of Scandinavian countries and elsewhere as well.

Frankly this paper is just an ill-considered distraction to the pursuit of how to do things better and learn from the mistakes made. Just looking at summary reviews does not get you there in my view.

David.

Weekly Overseas Health IT Links - 21 January, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

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http://www.upi.com/Health_News/2011/01/13/Most-hospitals-to-adopt-medical-records/UPI-50001294963588/

Most hospitals to adopt medical records

Published: Jan. 13, 2011 at 7:06 PM

WASHINGTON, Jan. 13 (UPI) -- Eighty-one percent of U.S. hospitals and 41 percent of physicians say they want to use federal funds to use electronic health records, surveys indicate.

The surveys were commissioned by Office of the National Coordinator for Health Information Technology and carried out in the course of regular annual surveillance by the American Hospital Association and the National Center for Health Statistics, part of the Centers for Disease Control and Prevention in Atlanta.

Dr. David Blumenthal of the National Coordinator for Health Information Technology says the survey numbers represent a reversal of the low interest in recent years in electronic medical records adoption -- attributed mainly to the cost and time needed to set up a health technology system. If there are high rates of adoption, about $27 billion in incentive payments would be allocated during a 10-year period, Blumenthal says.

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http://www.healthdatamanagement.com/news/ehr-market-share-report-meaningful-use-41714-1.html

IDC Pegs EHR Market for 2009-2015

HDM Breaking News, January 10, 2011

The U.S. market for inpatient and outpatient electronic health records software was nearly $1.98 billion in 2009 and will steadily increase to $3.8 billion in 2015, according to a new report from research firm IDC Health Insights, Framingham, Mass.

For purposes of the market survey, the figures cover only software license and maintenance costs for products that meet or exceed meaningful use certification criteria.

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http://www.healthdatamanagement.com/news/comparative-effectiveness-research-hhs-hitech-41716-1.html

HHS Seeks to Consolidate CER Data

HDM Breaking News, January 11, 2011

The Department of Health and Human Services wants to build a Web-based Comparative Effectiveness Research Inventory database to categorize and catalogue federal and non-federal CER research.

"The CER Inventory will serve as a valuable tool for researchers, providers, patients, policymakers and other users," HHS notes in a notice published Jan. 11 in the Federal Register.

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http://www.healthdatamanagement.com/news/breach-ehr-medical-records-tucson-hospital-41738-1.html

Records of Shooting Victims Breached

HDM Breaking News, January 13, 2011

University Medical Center in Tucson, Ariz., has announced the firing of three employees for improperly accessing electronic health records of victims of the shooting spree on Jan. 8. A contracted nurse also was fired by the nurse's employer.

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http://www.modernhealthcare.com/article/20110113/NEWS/301139952/

Comments sought on Stage 2 recommendations

By Joseph Conn

Posted: January 13, 2011 - 11:00 am ET

The federal Health Information Technology Policy Committee is seeking public comment on its proposed Stage 2 meaningful-use recommendations for electronic health-record system subsidies under the American Recovery and Reinvestment Act of 2009.

A 19-page set of instructions (PDF) for individuals and organizations seeking to submit comments is posted on HHS' website. Included in the instructions are the committee's draft recommendations.

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http://www.modernhealthcare.com/article/20110113/blogs02/301139955

Navigating the IT river

The leadsman's cry, "By the mark, twain," signaled a depth of two fathoms. It meant there was sufficient water running beneath the riverboat, but not so much that it couldn't soon run aground. (It also inspired a famous author's pen name.)

A similar cry, I think, went up Tuesday from healthcare providers, most of whom are early adopters of health information technology systems.

They told members of a federal advisory work group that they and their provider organizations were paddle-wheeling ahead, following the course piloted for them by the federal electronic health-record subsidy program. But most shared their anxieties, too.

I wrote yesterday about what three physician group leaders said. I'll be blogging today about additional physicians' presentations and later about hospitals.

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http://www.ihealthbeat.org/features/2011/final-rule-gets-ball-rolling-for-permanent-certification-program.aspx

Friday, January 14, 2011

Final Rule Gets Ball Rolling for Permanent Certification Program

by Kate Ackerman, iHealthBeat Senior Editor

Earlier this month, the Office of the National Coordinator for Health IT released a final rule to establish the permanent certification program for health IT. The rule did not include any big surprises, something stakeholders say they are pleased about.

"Everybody worries about a big surprise, and there really weren't any," Karen Bell, chair of the Certification Commission for Health IT, said, adding, "Most of the rule is actually very procedural."

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http://www.time.com/time/health/article/0,8599,2041900,00.html

The Medical Insider

The Health IT Paradox: Why More Data Doesn't Always Mean Better Care

By Dr. Zachary F. Meisel Wednesday, Jan. 12, 2011

Recently, while I was working an overnight shift in the emergency department, two paramedics wheeled an elderly woman into the busy ER. She was clearly very ill: her eyes were sunken and her mouth was parched, she was slumped over and unable to do much more than moan. The paramedics told me that her family members, who had stayed home (not uncommon!), wanted to make sure we knew that she wasn't usually "like this" and that she had recently been hospitalized at a different facility where many tests and "other stuff" had been done. Unfortunately, all her records were locked up at the other hospital's medical-record room, which was closed in the middle of the night.

We had to start from scratch. We ordered a CAT scan of her brain to look for stroke, put a catheter in her bladder and gave her a chest X-ray to look for infection, and applied a rectal exam to look for bleeding. We may have ended up doing all of this anyway, but having more information about her recent hospitalization would clearly have allowed us to be more efficient and directed in her care. My colleague, another doctor, turned to me and said, "I cannot wait until HIT [industry shorthand for 'health-information technology'] makes this problem goes away."

The "problem," of course, is that medical errors and excess costs increase when health information isn't portable or easily accessible. The conventional wisdom is that electronic medical records, electronic prescriptions and electronic order-entry systems save costs and lives. Since 2009, the federal government has invested over $20 billion into improving HIT. And this month, the federal government will start doling out dollars to doctors' offices and hospitals to encourage them to adopt electronic health records. On its face, this makes absolute sense — who, after all, would argue that more information isn't essential to improved care at lower cost? During the last presidential campaign, both Senators John McCain and Barack Obama called for HIT enhancements as key to fixing health care.

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http://govhealthit.com/newsitem.aspx?nid=75900

Medical images may get a role in meaningful use

By Mary Mosquera

Wednesday, January 12, 2011

Medical images should have a role in the next stage of meaningful use of electronic health records because of the wide use of radiologic and other images in diagnosis and treatment in healthcare, according to health IT experts.

Dr. David Blumenthal, the national health IT coordinator, gave support to considering the concept at the advisory Health IT Standards Committee meeting Jan. 12, saying “the role of imaging as a meaningful use aspect raises a number of important and interesting questions that I think we will be looking at tackling.”

Clinician access to images, such as timed serial images of portions of the heart, is increasing with the capabilities of electronic and tele-health systems and mobile technologies, said Dr. Robert Pettigrew, director of the National Institute of Biomedical Imaging and Bioengineering in the National Institutes of Health.

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http://geekdoctor.blogspot.com/2011/01/early-experiences-with-hospital.html

Monday, January 10, 2011

Early Experiences with Hospital Certification

As one of the pilot sites for CCHIT's EHR Alternative Certification for Hospitals (EACH), I promised the industry an overview of my experience.

It's going very well. Here's what has happened thus far.

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http://www.healthdatamanagement.com/news/medication-management-pharmacy-home-41723-1.html

Researchers Call for a 'Pharmacy Home'

HDM Breaking News, January 11, 2011

Establishment of a "pharmacy home" model, similar to a medical home model, could better coordinate medication therapies for chronically ill patients with many prescriptions, according to a study published Jan. 10 in the Archives of Internal Medicine.

Provider organizations, according to authors, need to find ways to help patients simplify, synchronize, centralize and organize their medication management. There is a particular need to synchronize medication regimens because "those who make numerous trips to the pharmacy to pick up their medications, or fill prescriptions at different pharmacies, may have difficulty taking their medications as prescribed," the report contends. Report authors also recommend experimenting with programs and technologies to make it easier for patients to better organize their medications.

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http://www.modernhealthcare.com/article/20110114/NEWS/301149952

N.Y. schools to offer health info master's program

By Joseph Conn

Posted: January 14, 2011 - 12:00 pm ET

The Rochester (N.Y) Institute of Technology and the University of Rochester have created a two-year, 14-course master's degree program in healthcare informatics, according to a news release from the schools.

Classes will begin in September, with a target initial enrollment of 12 students, according to RIT spokesman John Follaco.

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http://www.healthleadersmedia.com/content/TEC-261367/Preview-HLM-Intelligence-Report-on-EHealth-Systems

Preview: HLM Intelligence Report on E-Health Systems

HealthLeaders Media Staff , January 14, 2011

Healthcare physician leaders and executives mostly support the national initiative to implement electronic health systems, and say they will improve efficiency and quality. But they're also uneasy about the cost, value, and functionality of their own systems, a new HealthLeaders Media Intelligence analysis has found.

A survey of 242 healthcare leaders from hospitals, physician groups, and health plans, detailed in the latest HealthLeaders Media Intelligence Report, E-Health Systems: Opportunities and Obstacles, found that more than 80% of healthcare leaders say the government's push for electronic health systems will improve quality of care industry-wide, and 89% say it will improve quality and safety at their own organizations.

That confidence cools considerably when it comes to the capabilities of their systems. Only about half of hospital and health system leaders are either very satisfied (13%) or somewhat satisfied (41%) with the overall functionalities of their systems. Among physician leaders, the numbers are similar: 16% are strongly satisfied and 44% are somewhat satisfied.

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http://www.fierceemr.com/node/9051/print

EMRs can improve infection control

By Sara Jackson - Contributing Editor

Created Jan 13 2011 - 2:21pm

The dreaded MRSA infection has one enemy your infection control officer might not have thought of: Your hospital's EMR.

In an article in the November issue of the Journal of Antimicrobial Chemotherapy, researchers report that when staff have access to an EMR, they are more likely to review charts and recommend the infection control measures. The result: MRSA infections at two North Carolina hospitals--East Carolina University and Pitt County Memorial Hospital--fell by 45 percent, and nosocomial infections from clostridium dropped 19 percent. The study reviewed infection rates from January 2005 through December 2009.

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http://www.fierceemr.com/story/start-educating-staff-security-now/2011-01-13

Start educating staff on security now

January 13, 2011 — 4:03pm ET | By Sara Jackson - Contributing Editor

Training staff on IT security will be a key component for protecting your electronic health record integrity in 2011, according to a new Kroll survey on the top data security trends for 2011. Most important: Privacy awareness training for all employees, from the c-suite down to the janitorial staff, Brian Lapidus, Kroll's COO tells FierceEMR. "It's really a mantra [at Kroll]--privacy awareness training is the cornerstone of any data security program," he says.

Think it's not a top priority? As part of its work for HIMSS Security of Patient Data report, Kroll surveyed healthcare providers who had experienced a breach. Nearly 80 percent said the first task they had to undertake was additional staff security training. And staff training is increasingly being required in the voluntary compliance plans hospitals have to create after a breach, so you know it's something regulators want.

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http://healthcareitnews.com/news/interoperability-gives-upmc-leg-meaningful-use

Interoperability gives UPMC a leg up on meaningful use

January 09, 2011 | Patty Enrado, Special Projects Editor

PITTSBURGH – When it comes to exchanging patient data with other healthcare providers under the Stages 2 and 3 meaningful use criteria, the University of Pittsburgh Medical Center (UPMC) will be able to create a unified and connected patient record.

UPMC has been offering multiple ways for affiliated physicians - no matter their level of health IT capability - to connect to the integrated delivery network. An important next stage of its affiliated integration, as well as its own internal electronic medical record, is to enable a Continuity of Care Document (CCD) exchange with physicians who move their patients in and out of the system, according to Lisa Khorey, vice president of enterprise systems and data management.

As primary care physicians (PCPs) refer their patients to UPMC employed specialists, the CCD from the physicians' EMR should come with the patient or with the consult, she said. As patients move through UPMC's program - whether it be transplant, cancer care, pediatric emergency department visit, or other area - the CCD should accompany the patient directly to the next provider of care as part of the transition. "That's an important part of connecting the affiliate community for us," Khorey said.

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http://blogs.wsj.com/health/2011/01/10/the-three-health-technologies-caregivers-want-most/

• January 10, 2011, 11:50 AM ET

The Three Health Technologies Caregivers Want Most

No less a tech guru than the WSJ’s own Walt Mossberg has challenged the tech world to come up with devices that make it easier for consumers to track and manage their health. Now a new survey looks at what health-management technologies caregivers are most interested in.

The survey, released over the weekend by the National Alliance for Caregiving and UnitedHealthcare at the Consumer Electronics Show’s Silvers Summit, identifies three technologies that seemed to have the most appeal. More than half of the 1,000 people surveyed — all of whom have already used some form of tech to help out with caregiving — said none of the usual barriers, such as cost or privacy worries, would stop them from trying the following (things).

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http://www.ama-assn.org/amednews/2011/01/10/bil10110.htm

Physician EMR use passes 50% as incentives outweigh resistance

Age demographics of doctors and financial assistance to help them adopt the technology are responsible for the transition, analysts say.

By Bob Cook, amednews staff. Posted Jan. 10, 2011.

For the first time, a majority of office-based physicians are using an electronic medical records system, according to a survey by the Centers for Disease Control and Prevention's National Center for Health Statistics.

The survey doesn't explain why EMR use in offices rose to 50.7% in 2010, more than double the adoption rate in 2005. However, peer pressure is apparently moving from fighting EMRs to embracing them. "We're in an electronic age. You either go with it, or you're in the Dark Ages," said Pat Willis, RN, chief nursing officer for seven-physician Big Sandy Healthcare, in eastern Kentucky, which installed its first EMR in July.

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http://govhealthit.com/newsitem.aspx?nid=75894

ONC will share proven EHR methods of extension centers

By Mary Mosquera

Tuesday, January 11, 2011

The Office of the National Coordinator for Health IT is developing an online, interactive dashboard that will continuously track the performance of regional health IT extension centers and allow for the timely sharing of lessons learned.

A first-look “static” version of that progress summary should be available by the end of January, according to Mat Kendall, director of ONC’s Office of Provider Adoption and Support.

The 62 centers, spread across the US, offer a variety of services, including education, vendor selection and project management, to help health providers establish and become meaningful users of electronic health records (EHRs) and to help them redesign their workflow.

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http://www.modernhealthcare.com/article/20110112/NEWS/301129953/

Docs talk challenges of 'meaningful use'

By Joseph Conn

Posted: January 12, 2011 - 11:15 am ET

Physicians from group practices with extensive experience adopting and using electronic health-record systems testified before a federally chartered advisory group Tuesday.

The elite EHR users—who self-defined their groups in terms of EHR implementation to be in the upper 25% of all EHR users nationwide—said that meeting the Stage 1 meaningful-use criteria to receive federal EHR incentive payments presents multiple challenges to their practices.

They also warned federal rulemakers against setting the bar too high when second and third stages of the meaningful-use requirements are set for 2013 and 2015.

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http://www.ihealthbeat.org/perspectives/2011/physician-compare-site-could-be-game-changer-but-challenges-remain.aspx

Wednesday, January 12, 2011

Physician Compare Site Could Be 'Game Changer,' but Challenges Remain

by David Lansky and Steven Findlay

On Dec. 30, 2010, the Obama administration launched Physician Compare, a website that will eventually include data gleaned from the Medicare meaningful use incentive program and that has the potential to dramatically change the way Americans choose their doctors.

Imagine comparison shopping for a doctor based on patient reviews, a set of easily comprehended measures of quality and other criteria. It's one of the Holy Grails of a truly patient-centered system!

The health reform law required HHS to launch the site by Jan 1. For now, it's mainly an updated directory of doctors and other health care providers nationwide -- 932,000 in all -- who accept Medicare beneficiaries. It's searchable by ZIP code, city, state and medical specialty. Doctors who are participating in Medicare's Physician Quality Reporting System have a mention of that in their profile. Those participating in Medicare's electronic prescribing initiative will have that added to their profiles this year.

The long-term plan is to add information to the site over time, with the reform law pushing the government to post the first patient assessments and measures of clinical care quality by 2015.

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http://healthaffairs.org/blog/2011/01/12/unfreezing-the-health-it-market/

Unfreezing The Health IT Market

January 12th, 2011

by David Kibbe and Brian Klepper

Washington Post columnist Ezra Klein recently described the Obama administration’s consistent efforts to improve troubled private markets:

Isolate the eight key economic decisions of the Obama presidency: The intervention in the financial sector, the intervention in the auto sector, the intervention in the housing sector, the stimulus package, the health-care bill, financial regulation, and the tax deal…Where there was a market that they considered functional-but-frozen, they worked to unfreeze it.

Intervention into health IT should be added to this list. Nowhere has this administration’s activities to unfreeze private markets been more dramatic than in the health IT products and services sector, especially for electronic health records (EHRs).

When the President was elected, this market was dominated by the vendor-controlled Certification Commission for Health IT (CCHIT). The entry rules were intentionally complex and expensive, safeguarded by an interlocking system of standards organizations and both open and clandestine industry alliances that defended against innovation and new entrants.

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http://www.healthdatamanagement.com/issues/19_1/moving-target-mobile-devices-41628-1.html

Moving Target

Elizabeth Gardner
Health Data Management Magazine, 01/01/2011

A Colorado physician loses his iPhone in the mountains, and the health system he’s affiliated with erases all of its contents remotely so that no one can illicitly access patient data.

A California hospital uses dedicated iPhones to let nurses receive voice messages, text messages and alarms, and they no longer have to cram their pockets with multiple pagers.

A Texas health system gives Blackberries to its transport staff to improve their ability to get radiology equipment where it needs to be. They save hours of time daily, and wear and tear on both equipment and employees.

A New York City hospital has all its administrators bring iPads to leadership meetings and doesn’t allow paper.

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http://www.healthdatamanagement.com/issues/19_1/the-long-shadow-of-meaningful-use-41636-1.html

The Long Shadow of Meaningful Use

Gary Baldwin

Health Data Management Magazine, 01/01/2011

Raise the issue of what the "hot technology" in 2011 will be, and Keith Fraidenburg gives a quick answer: "anything associated with meaningful use." Fraidenburg serves as vice president of education and communications for the College of Health Information Management Executives, a member organization of 1,400 hospital CIOs. Its fall forum in 2010, which focused on the federal EHR incentive program, drew nearly 400 of them-an organizational record. In 2011, CHIME members will continue to focus on the key technologies that will enable organizations to apply for meaningful use incentive money (see related story, page 48), including order entry and personal health records, Fraidenburg says. "We will also see more investment in infrastructure."

If anything, 2011 may be remembered as the year of industry focus when it comes to health I.T. At hospitals across the country, CIOs will be leading the charge on upgrading infrastructure and systems, revising documentation and workflow requirements, cajoling vendor cooperation, keeping tabs on system certification, and expanding their efforts to loop in physicians via integrated-or at least highly interfaced-ambulatory EHR ventures. The allure of billions in federal incentive dollars (plus the long-term Medicare payment cuts for providers not in compliance) has clarified these near-term goals for many a hospital. Med schools too are hopping aboard the I.T. bandwagon (see sidebar, page 53).

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http://www.modernhealthcare.com/article/20110111/NEWS/301119997/

Cleveland Clinic launches personalized-care center

By Joseph Conn

Posted: January 11, 2011 - 11:45 am ET

The Cleveland Clinic has launched a new Center for Personalized Healthcare "for the identification, analysis, adoption and integration of select new services and technologies that will allow for personalized care of patients," according to a news release from the clinic.

Dr. Kathryn Teng, a primary-care physician, has been selected to direct the new center.

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http://www.nhbr.com/businessnewsstatenews/904911-257/n.h.-e-health-framework-approved.html

N.H. e-health framework approved

Tuesday, January 11, 2011

New Hampshire has taken one more step toward efforts to connect health-care providers in cyberspace.

The state Department of Health and Human Services has received approval from the federal government of its Health Information Exchange Strategic and Operational Plans for the New Hampshire Health Information Exchange Planning and Implementation Project, a massive information technology project creating an electronic network to exchange health-care information among providers.

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http://www.modernhealthcare.com/article/20110110/NEWS/301109996/

High court to hear prescription-drug data case

By Paul Barr

Posted: January 10, 2011 - 10:00 am ET

The U.S. Supreme Court agreed to hear a case in which a Vermont law seeking to restrict the use of prescription drug data in the marketing of pharmaceuticals to physicians was overturned on appeal.

At issue is whether the Vermont law restricting such use violates the First Amendment, an argument brought forth by the original plaintiffs in the suit and the winners on appeal in the 2nd U.S. Circuit Court of Appeals in New York. The Supreme Court decision would settle conflicting decisions occurring in the lower courts regarding similar laws in Maine and New Hampshire.

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http://www.modernhealthcare.com/article/20110110/NEWS/110119997/

ONC forms PCAST report work group

By Joseph Conn

Posted: January 10, 2011 - 11:30 am ET

A new federal work group will meet this week to discuss the recommendations in the report by the President’s Council of Advisors on Science and Technology.

HHS' Office of the National Coordinator for Health Information Technology announced Friday the formation of the PCAST Report work group under the purview of its Health IT Policy and Standards committees. The group is scheduled to meet Friday, Jan. 14, from 2 to 4 p.m. ET.

The new group's tasks are "to synthesize and analyze the public comments and input into the PCAST Report relative to implications on current and future ONC work," according to a statement on the ONC's website.

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Motion Computing Debuts Rugged Tablet For Healthcare

The CL900 Windows 7 tablet is geared to clinicians who need a durable tablet to read patient X-rays and charts -- and want to keep the device sanitary.

By Marianne Kolbasuk McGee, InformationWeek

Jan. 5, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229000057

Motion Computing is extending its offering of tablet PCs for healthcare with a new rugged, ultra-light “reader” model.

The new CL900 is suited for clinicians such as respiratory therapists in acute care settings and home health care workers out in the field who often “need a reader more than a full function tablet,” to view patient charts and images. It offers an alternative to devices designed for heavy data entry or to access multiple enterprise applications at the same time, said Mike Stinson, VP of marketing at Motion.

Priced at about $1,000 and weighing about 2 lbs., the CL900 is a thin client tablet running Windows 7 and is powered by Intel’s Atom processor. Options for healthcare use include two cameras that can be used for video conferencing and documentation of care, such as wound care, said Stinson.

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http://govhealthit.com/newsitem.aspx?nid=75862

CMS counts 4,000 providers initially registering for EHR incentives

By Mary Mosquera

Friday, January 07, 2011

In the first four days since its launch, about 4,000 healthcare providers initiated registration for the electronic health record incentive program, according to the Centers for Medicare and Medicaid Services. The agency provided the preliminary count as of Jan. 6.

“We expect that number will continue to increase daily,” said CMS spokesman Joseph Kuchler.

Providers access the CMS registration portal, which became operational Jan. 3, to participate in the Medicare and Medicaid electronic health record (EHR) incentive program.

Eligible professionals who demonstrate meaningful use have the opportunity to receive incentive payments of up to$44,000 from Medicare, or $63,750 from Medicaid. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

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Enjoy!

David.

The Smart Pill - It Seems Is It Coming Soon to A Pharmacist Near You!

I thought this article just took clinical technology to another level!

Pills with a mind of their own

A main problem with prescriptions is getting patients to follow dosage properly. Technology steps in with some ideas.

By Amber Dance, Special to the Los Angeles Times

January 10, 2011

"Did you take your medicine today?" Soon, patients won't have to rely on their memories for the answer. Scientists are developing tablets and capsules that track when they've been popped, turning the humble pill into a high-tech monitoring machine.

The goal: new devices to help people take their meds on time and improve the results coming out of clinical trials for new drugs.

Doctors can already prescribe pills that release drugs slowly or at a specific time. They even have camera pills that take snaps of their 20- to 40-foot journey through the gastrointestinal tract. The new pills tote microchips that make them even cleverer: They will report back to a recorder or smart phone exactly what kind and how much medicine has gone down the hatch and landed in the stomach. Someday they may also report on heart rate and other bodily data.

This next generation of pills is all about compliance, as it's termed in doctor-speak — the tendency of patients to follow their doctors' instructions (or not). According to the World Health Organization, half of patients don't take their pills properly. We skip doses, take the wrong amount at the wrong time or simply ignore prescriptions altogether. In a 2006 survey of 1,000 people by two pharmacist associations, three-quarters of those queried admitted to occasional noncompliance.

Medication misuse can lead to hospitalizations and deaths. Those preventable events cost the healthcare system $100 billion to $300 billion annually, according to a 2009 report by the Pharmaceutical Research and Manufacturers of America.

The most common reason for medication mistakes is forgetfulness, particularly among the elderly — just the age group, of course, that has to manage multiple medications. "The number of doctors that they have and the number of prescriptions that they get is mind-boggling," says Jill Winters, dean of the Columbia College of Nursing in Milwaukee, Wis., who says she often sees older people come to the ER toting a bag of prescription bottles. According to a 2004 report by the Centers for Disease Control and Prevention and the Merck Institute of Aging and Health, the average 75-year-old takes five different drugs.

Often, occasional lapses don't matter. Smart pills like these are "not for your aspirin or even simple antibiotics," says Maysam Ghovanloo, an electrical engineer at the Georgia Institute of Technology in Atlanta. The new technology is aimed at time-sensitive or costly medications.

For certain medications, not taking every pill can have serious consequences. For example, people who are mentally ill may require regular treatment to stay stable. Chemotherapy drugs and antibiotics for treating tuberculosis are time-sensitive as well.

Blood pressure medication works only when taken on a regular basis, and suddenly stopping it can cause blood pressure to skyrocket, says Daniel Touchette, a pharmacist and researcher at the University of Illinois in Chicago.

With drugs for transplant patients, a person who misses a dose risks rejection of the new organ. Novartis International AG, based in Basel, Switzerland, is developing pills for transplant recipients; the pills communicate with a patch on the skin when they reach the stomach.

And in the case of tuberculosis, which is common in many countries, treatment requires a six-month course of antibiotics that come with side effects such as nausea and heartburn. Many people don't understand why they have to keep taking the unpleasant drugs once they feel better — but going off the medication can make patients contagious again and allow drug-resistant tuberculosis to develop. Currently, the World Health Organization recommends that healthcare personnel observe patients as they take every dose — an inconvenience for patients and a burden on healthcare workers.

Yet another arena where compliance is crucial is in clinical drug trials. Drugmakers can only be sure their medicine works if they're sure subjects are actually taking it as directed. For now, experimenters rely on diaries where participants record their medication use. But people may fudge the data, not wanting to admit they dropped a pill down the drain or forgot to take it for a few days. To account for people who miss their meds, drug companies have to spend extra money — trials cost hundreds of millions of dollars — for larger trials just so enough people will actually take the drug.

Necklace tracer

Technology already offers some solutions, with cellphone reminders and pill bottles that record when they're opened. But none of these actually confirm that the medicine has been swallowed.

"You don't know who opened it," Ghovanloo says. "You don't know what is done with the pill."

Ghovanloo hopes to improve compliance with a necklace that records every time a special pill slides down the esophagus. He calls the system MagneTrace. By sounding an alarm or sending a cellphone message, the necklace also would inform the wearer when it's time for another dose. Caretakers or doctors could monitor the signals too.

The system works by radio-frequency identification, or RFID. You experience RFID every time you exit a large store: The pair of pillars you pass through on the way out converse with RFID chips on the products you're carrying to confirm you did indeed pay for them.

.....

So open wide and swallow your meds. The smart pills of the future will know if you don't.

Lots more here:

http://www.latimes.com/health/la-he-future-pills-20110110,0,6413192.story

The list of medicines you really need to keep taking - and the cost of not doing so potentially - makes this sound all quite interesting. It will be interesting to see if it can make it to market in a cost effective way.

David.

A Couple of Useful Reports Released by the US National Quality Forum - Invaluable Stuff!

Two interesting reports were released in the last week or two.

http://www.modernhealthcare.com/article/20110106/NEWS/301069997/

National Quality Forum issues health IT reports

By Maureen McKinney

Posted: January 6, 2011 - 12:00 pm ET

The National Quality Forum released two reports Thursday about health information technology and performance improvement. The first report provides a model for measuring use of health IT, according to a news release from the Washington-based organization, while the second focuses on potential quality gains form clinical decision support systems.

…..

The reports stem from work done by NQF’s Health Information Technology Utilization Expert Panel as well as its Clinical Decision Support Expert Panel.

More here:

http://www.modernhealthcare.com/article/20110106/NEWS/301069997/

Here is the project description from the first:

Health Information Technology Utilization Expert Panel

Expert Panel Report:

Driving Quality-A Health IT Assessment Framework for Measurement

The Opportunity

Health information technology (HIT) has the potential to improve the quality and efficiency of our healthcare system. As clinicians and health care organizations increasingly adopt certified electronic health records (EHRs), a critical next step beyond EHR acquisition is to promote effective health IT utilization. Measuring effective utilization will require identifying system capabilities needed to track and monitor when and how health IT is used.

While quality measures evaluate clinical conditions, structural measures evaluate infrastructure. In August 2008, NQF endorsed nine HIT structural consensus standards to assess and encourage HIT adoption by clinicians. The next step in the process is to determine effective usage automatically from the logs in the EHR system, such as which components have been used, by whom, and how often (e.g. frequency of electronic laboratory ordering or electronic prescriptions). Current measures require the clinician to manually enter a quality code every time an electronic prescription is ordered. It seems logical that the EHR, and health IT in general, should keep track of such activity and automatically measure that utilization. Therefore, this expert panel will develop a model that can provide specific data elements to inform future performance measures and practices, including those to identify unintended consequences of health IT usage.

About the Project

In January 2010, the National Quality Forum (NQF) convened the Health Information Technology Utilization Expert Panel to examine, define, and organize the information needed to measure effective health IT use.

The Expert Panel’s output, the Health IT Utilization Assessment Framework is designed to help define a method for expressing data that can be captured by health IT systems to understand and measure their usage.

More here:

http://www.qualityforum.org/Projects/HIT_Utilization.aspx

Here is the abstract:

Abstract

Health information technology (health IT) offers great promise to improve health­care quality, safety, and affordability, and the health of the population. Passage of the recent Health Information Technology for Economic and Clinical Health Act (HITECH) in the American Recovery and Reinvestment Act (ARRA) is expected to significantly drive increased adoption of health IT systems. This report examines, defines, and organizes the data needed to measure effective health IT use to better understand how health IT tools can improve healthcare delivery. The Health IT Utilization Assessment Framework is designed to define a method for expressing data that can be captured by health IT systems to understand and measure their effectiveness. Health IT use assessment can provide valuable information for most healthcare stakeholders, including the quality improvement community, the health IT vendor community, providers, payers, purchasers, and policymakers.

and the second:

Clinical Decision Support Expert Panel

Expert Panel Report:

Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support

The Opportunity

To improve healthcare quality, safety, and effectiveness, relevant clinical knowledge represented within quality measures and guidelines of care must be evident at the point of care and implemented in a manner that promotes optimal care. Properly positioned, clinical decision support (CDS) tools can play an important role in matching patient information with relevant clinical knowledge to help users incorporate that knowledge into decisionmaking.

Decision support can be broadly defined as any tool or technique that enhances decisionmaking by clinicians, patients, and/or their surrogates in the delivery or management of health and healthcare. CDS is an essential capability of health IT systems; however, a common classification of information that connects quality improvement information and CDS is needed.

About the Project

In November 2009, the National Quality Forum (NQF) convened the CDS Expert Panel to develop the NQF CDS Taxonomy, a classification of the information that connects quality measurement and CDS in clinical information systems.

More here:

http://www.qualityforum.org/Projects/Clinical_Decision_Support.aspx

Here is the abstract:

Abstract

Increasing deployment, adoption, and meaningful use of electronic health records (EHRs) and health IT systems in the United States offers great potential to im¬prove the healthcare system. An important means to advance this goal is to measure performance, ensuring that relevant clinical knowledge is available at the point of care and implemented in a manner that promotes optimal care delivery. Properly positioned, clinical decision support (CDS) tools can play an important role. This report describes the development of the NQF CDS Taxonomy, the relationship between quality measurement and CDS, and the mapping of the Taxonomy to the QDS Model—an information model that lays the foundation for automatic, patient-centric, longitudinal quality measurement. The CDS Taxonomy should assist health IT system developers, system implementers, and the quality improvement community to develop tools, content, and procedures that are compatible and enable comprehensive use of CDS, thereby improving delivery of appropriate, evidenced-based care.

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Both these reports contain very useful information and especially the first will make it clear that the US believes what you place in the hands of clinicians and then measure is much more important that what is in the hands of patients - until at least the frailties of the clinicians in information management and sharing are much more fully addressed.

As far as the second report is concerned it is discussing a future state in Clinical Decision Support (CDS) we are a little way from just yet! Nevertheless we need to be working to get there!

David.