Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, March 19, 2011

Weekly Overseas Health IT Links - 19 March, 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://healthcareitnews.com/news/blumenthal-stage-2-meaningful-use-track

Blumenthal: Stage 2 meaningful use on track

March 09, 2011 | Patty Enrado, Special Projects Editor

WASHINGTON – As concerns about the preliminary Stage 2 meaningful use criteria mount and the search for his replacement continues, David Blumenthal, MD, remains steadfast in the direction and focus of the Office of the National Coordinator (ONC).

“We’re on track for meaningful use Stage 2,” said the outgoing national coordinator for health IT.

The ONC Health IT Policy Committee’s working groups are actively looking at recommendations for Stage 2. Referring to recent objections by several professional organizations that the preliminary criteria are too aggressive, Blumenthal said, that "having these comments is very helpful and is part of the process; it shows our commitment to continued openness and transparency and making sure that we listen to all points of view.”

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http://www.fierceemr.com/story/drug-naming-standard-ehrs-expanded/2011-03-10

Drug-naming standard for EHRs expanded

March 10, 2011 — 11:15am ET | By Janice Simmons - Contributing Editor

The RxNorm standard clinical drug vocabulary produced by the National Library of Medicine (NLM) has added more accurate and complete connections between national drug codes (NDCs)--the product identifiers assigned by American manufacturers and packagers of drugs--and standard nonproprietary names of medications recommended for use in electronic health records (EHRs).

Providing new connections between NDC product codes and RxNorm standard names and identifiers will have many potential uses within an individual patient's EHR, according to the NLM. These include the use of NDCs on medicine bottles to speed up standard data entry or to trigger an alert written in the RxNorm standard to prevent a medication error.

No single source currently contains all the NDCs for all medications marketed nationwide. RxNorm, though, has included NDCs provided by the Food and Drug Administration, the Department of Veterans Affairs, and the Multum and Gold Standard drug information sources for several years.

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http://www.modernhealthcare.com/article/20110311/NEWS/303119989/

EHR costs for docs top $46,000: study

By Joseph Conn

Posted: March 11, 2011 - 12:00 pm ET

The total cost of planning, buying, implementing and operating an electronic health record-system for the first year in a five-physician primary-care practice averaged $46,659 per physician, a federally funded team of Texas researchers has concluded.

A write-up of their research, "The Financial and Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices” appears in the March issue of the policy journal Health Affairs.

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http://www.egovmonitor.com/node/41022

Norway: Launch Of eHealth Blog

Date: 3 Mar 2011 - 11:41

Source: ePractice EU

A new blog site, Ehelsebloggen, has been created to support debate in Norwegian on the digitisation of healthcare, it was announced on 11 February 2011.

Ehelsebloggen (eHealth blog, in English) will feature different sides of the debates, links to other media and interesting articles, and the opportunity to comment on them.

Nard Schreurs, editor of the IT health magazine which is supporting the project, said: "I think there was a need for another channel of information and a forum for discussion. The blog is intended for anyone interested in health and technology, whether at local, national or international level."

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http://www.news-medical.net/news/20110308/New-research-finds-OSS-for-health-IT-may-be-more-secure-than-other-systems.aspx

New research finds OSS for health IT may be more secure than other systems

Published on March 8, 2011 at 7:17 AM

Globally the sale of health care information systems is a multibillion dollar industry. The vast costs, frequent failed systems, and inability of systems to talk to each other regularly attract media comment. However policy makers still shy away from a class of software, Open Source, that could address many of these problems, because of worries about the safety and security of Open Source systems. Now new research by the University of Warwick's Institute for Digital Healthcare, and the Centre for Health Informatics and Multiprofessional Education at UCL Medical School, finds that Open Source software may actually be more secure than its often more expensive alternatives.

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http://www.fierceemr.com/story/could-some-meaningful-use-objectives-be-too-aggressive/2011-03-10

Could some Meaningful Use objectives be too aggressive?

March 10, 2011 — 1:33pm ET | By Janice Simmons - Contributing Editor

As we examined in last week's commentary, many provider and healthcare industry groups had a lot to say about what they would like to see in Stages 2 and 3 of achieving Meaningful Use for electronic health records (EHRs).

This week, a new perspective is offered by the Certification Commission for Health Information Technology (CCHIT) on what maybe should be held back for the current time. CCHIT, a federally authorized health IT testing and certification body, conducted a survey, which sought to find out current opinions on Meaningful Use objectives and measures--incorporating both clinical workflow perspectives and perceived technological challenges.

According to a post by CCHIT Chair Karen Bell, MD, they received an earful from the survey's 468 responders that included providers (36 percent), electronic health record (EHR) vendors (29 percent), and others (29 percent).

Of the nine proposed Stage 2 Meaningful Use core measures that are enhancements of Stage 1 objectives and measures for successful EHR use, all nine were considered "too aggressive" by at least one-third of the survey participants. Several measures were even considered too aggressive by most of the survey respondents.

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http://www.modernhealthcare.com/article/20110310/NEWS/303109987/

Robots handling Rx orders at UCSF

By Rebecca Vesely

Posted: March 10, 2011 - 12:00 pm ET

Robots are filling prescriptions in San Francisco. UCSF Medical Center has opened a $15 million robotic pharmacy.

Located in a secure, sterile environment at the UCSF Mission Bay campus, the automated system prepares oral and injectable drugs for patients throughout the hospital system. The goal is to improve patient safety and cut down on human error. No errors occurred in the 350,000 doses of medications prepared during the pharmacy's phase-in period, according to hospital officials.

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http://www.ihealthbeat.org/perspectives/2011/physician-quality-reporting--the-hidden-requirements-of-meaningful-use.aspx

Thursday, March 10, 2011

Physician Quality Reporting -- the Hidden Requirements of Meaningful Use

The American Recovery and Reinvestment Act of 2009 includes incentive payments for hospitals and eligible professionals (EPs) who are able to demonstrate meaningful use of certified electronic health record technology.

Many of the Stage 1 meaningful use requirements address data capture. For EPs, the core requirements include not just prescription writing, but also problem lists, allergies, smoking status and vital signs. Quality reporting is another one of the core requirements. EPs must also meet five additional requirements selected from a menu of 10 options.

Most of the Stage 1 quality measures are familiar, having previously been incorporated into the CMS Physician Quality Reporting Initiative. A typical health system or medical group likely will have individual EPs reporting on all of the six possible core measures and many of the selectable measures because of the nature of the practices.

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http://healthcareitnews.com/news/survey-shows-how-hospitals%E2%80%99-it-uses-compare-patients

Survey shows how hospitals’ IT uses compare to patients'

March 07, 2011 | Molly Merrill, Associate Editor

ROUND ROCK, TX – Hospital executives and patients agree that healthcare needs a revamp, and they're looking to information technology to make that happen, according to a recent survey. But when it comes to their technology desires and concerns there are some differences.

The survey was conducted by Dell in the fall of 2010, polling 150 hospital executives and 309 hospital patients on issues facing the healthcare industry.

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http://prescriptions.blogs.nytimes.com/2011/03/08/a-team-approach-to-patient-care-falters/

March 8, 2011, 7:00 am

A Team Approach to Patient Care Falters

By ANAHAD O'CONNOR

For many doctors and health care experts, the future of medicine lies in transforming primary care practices into something else entirely: centers where every patient’s care is team-based, preventive and comprehensive.

But a new study published this month found that converting traditional practices into the newer model — patient-centered medical homes — creates a host of challenges. Some are logistical, like putting in place the extensive technology needed to make the centers effective. Other problems are more intangible, like trying to require doctors and other medical staff to give up their old roles of treating individual patients in private, one-on-one encounters and instead working within more collaborative teams.

The new study, published in the current issue of the journal Health Affairs, based its findings on data from the National Demonstration Project, the first large-scale experiment with patient-centered medical homes. As part of the project, 36 family practices across the country were recruited and turned into patient-centered practices.

To do this, the practices installed electronic record-keeping and expanded patient access with longer hours and open scheduling. They also began incorporating preventive care, rather than treating just single episodes of illness, into a broader approach. And patients were no longer treated by just one doctor, but by teams of nurses, doctors and assistants who worked together.

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http://www.healthleadersmedia.com/content/MAG-262169/How-Mobile-Apps-Improve-Quality-of-Care

How Mobile Apps Improve Quality of Care

Cheryl Clark, for HealthLeaders Media , March 4, 2011

A subtle but significant sign that mobile apps to improve quality of care have come of age appeared when Apple launched its “iPad is Amazing” TV commercial in the fall of 2010.

For just a second, obstetrics doctors and nurses would recognize the streaming waves undulating across the tablet as those from a fetal heart rate monitor at a patient’s bedside.

With this app, AirStrip Remote Patient Monitoring, providers can view these waves from wherever they happen to be—while treating another patient or attending a soccer game. With mobile access on the iPad or iPhone, or any mobile device, they can see trouble as it starts, both historic and in real time.

The developer, AirStrip Technologies, decided to classify the software as a medical device, similar to a pacemaker, hearing implant, or imaging test. In so doing, it subjected the technology to review for safety and efficacy by the U.S. Food and Drug Administration.The company decided that its software did not just send information from one source to another, like calling up the Stedman’s Medical Dictionary online.

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http://www.healthdatamanagement.com/news/study-phr-consumer-ehr-personal-health-record-42110-1.html

Study: Promise of PHRs Still Elusive

HDM Breaking News, March 7, 2011

A new study of the personal health records software market finds that the promises of the technology remain a long way off, despite some large delivery systems adopting PHRs and the federal government encouraging their use.

"Unfortunately, despite the renewed buzz and some well-publicized initiatives, the reality is that we are still no closer to a true personal health record than we were five or 10 years ago," according to the report from information technology services/advisory firm Computer Sciences Corp., Falls Church, Va. "Fundamental barriers still exist, and without major changes in behavior and dramatic increases in adoption of technology, a true PHR--and the benefits associated with it--will not be possible."

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http://govhealthit.com/newsitem.aspx?nid=76440

'Physician champions' help other docs with EHR adoption

By Mary Mosquera

Friday, March 04, 2011

The Office of the National Coordinator for Health IT, through its regional extension centers, has started recruiting “physician champions” who are well on their way to becoming meaningful users of electronic health records (EHRs) to help others in their area get over the hurdles of digitizing their medical records.

Meaningful Use Vanguard (MUV) participants work with their area extension center to assist providers who are struggling to deploy EHRs and become meaningful users, so they can qualify for incentive payments from the Centers for Medicare and Medicaid Services.

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http://www.chcf.org/publications/2011/02/the-connected-patient

The Connected Patient: Charting the Vital Signs of Remote Health Monitoring

Jane Sarasohn-Kahn, THINK-Health

The Connected Patient: Charting the Vital Signs of Remote Health Monitoring (1.16Mb)

February 2011

Remote health monitoring technologies — devices that gather a patient’s health data and relay it to a care provider — have been the subject of much study in recent years. Proponents have lauded their potential to reduce health care costs and improve patients’ quality of life, while skeptics pointed to the lack of persuasive clinical evidence supporting such claims. Meanwhile, technology vendors have begun testing the waters, launching both pilot projects and products into what they hope will prove to be a robust market.

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http://www.healthdatamanagement.com/blogs/Quammen_big_bang_EHR-42096-1.html

Big-Bang EHR: The Right Choice

Becky Quammen

Health Data Management Blogs, March 2, 2011

While conventional wisdom typically says to bet on the tortoise, I’m putting my money on the hare when it comes to electronic health records implementations. Slow and steady simply doesn’t work in this race.

First off, there are those American Recovery and Reinvestment Act deadlines. With the pressure to not only implement but to prove the meaningful use of electronic records technology only months away, there’s simply no time for the long, drawn out, phased-in implementation.

But even without the added meaningful use pressure, I still advocate strongly for big-bang implementations over phased-in approaches. Why? When it comes to information technology in the clinical care setting, I’ve learned that a phased-in approach simply doesn’t work.

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http://www.modernhealthcare.com/article/20110308/NEWS/303089989/

Most docs eligible for EHR money: study

By Joseph Conn

Posted: March 8, 2011 - 12:00 pm ET

About 76% of office-based physicians could qualify for federal incentives for purchasing an electronic health-record system under the Medicare provisions of the American Recovery and Reinvestment Act, according to research (subscription required) published in the March issue of the policy journal Health Affairs.

In addition, about 15% of office-based physicians could qualify for potentially higher EHR payments under federally subsidized state Medicaid incentive programs.

Medicare offers physicians as much as $44,000 in EHR incentives over five years.

Medicaid payments max out at $63,750 over six years, although pediatricians who don't have a high enough proportion of Medicaid payments to be able to qualify for top pay may still be able to receive as much as $42,500 in Medicaid incentives over six years.

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http://www.healthleadersmedia.com/print/TEC-263436/PR-for-EHRs-More-to-the-Story-Than-Data-Breaches

PR for EHRs: More to the Story Than Data Breaches

Gienna Shaw, for HealthLeaders Media , March 8, 2011

An annual study by the internet security firm White Hat Security found that the average website had 230 "serious vulnerabilities"—those that could lead to breach or data loss—in 2010. The good news is that healthcare websites were among the most secure, with an average of 35 serious vulnerabilities in 2010, edging out even banking and financial services sites.

The bad news? It doesn't matter how many or how few times a healthcare organization's data is breached or even if it is only potentially breached. In the healthcare industry, it takes just one event—a lost laptop, a misfired e-mail, or a website that leaks sensitive, user-specific data—to make headlines.

Healthcare leaders are rightly concerned about it. In the 2011 HealthLeaders Media annual industry survey, we asked technology leaders to rank their top three concerns about electronic medical records and/or patient portals: privacy and security was the number one ranked choice.

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http://www.fiercehealthit.com/story/hisps-evolve-facilitate-direct-messaging-low-government-interference/2011-03-06

HISPs evolve to facilitate Direct messaging with low government interference

March 6, 2011 — 6:17pm ET | By Ken Terry

The advent of the Direct Project protocol for secure clinical messaging already has spawned a new type of connectivity service and a new acronym: HISP, which stands for health information service provider. HISPs are necessary because health information exchanges (HIEs) still are not well-developed, yet physicians must exchange data to show they're meaningful users of EHRs. That need was the catalyst for the Direct Project, although physicians who don't have EHRs also can use the protocol.

At the recent HIMSS conference in Orlando, Fla., potential HISP vendors were much in evidence. They ranged from EHR companies such as Allscripts, which debuted a "referral network" for its users; to e-prescribing vendor Surescripts, which recently launched a new clinical messaging network; to established connectivity vendors such as RelayHealth, Axolotl, Medicity, and Kryptiq (Surescripts' partner). The Office of the National Coordinator of Health IT (ONC) also is working with several HIEs that want to use Direct messaging.

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Majority Of Patients Want Online Access To Doctors

Nearly three-quarters of people want to be able to get lab results, request appointments, pay medical bills, and communicate with their doctor's office through secure portals, finds Intuit Health study.

By Nicole Lewis, InformationWeek

March 4, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229300352

As a growing number of Americans use the Internet to perform a variety of health-related tasks, a new study shows that nearly three-quarters of those polled say they want the convenience of having an online connection to their doctor's office.

These findings come from Intuit Health's second-annual Health Care Check-Up Survey, which found that 73% of Americans surveyed would use a secure online communication solution to make it easier to get lab results, request appointments, pay medical bills, and communicate with their doctor's office.

Doctors should take note of these trends, particularly since a connected office may determine the number of patients they attend to. The survey also found that almost half of respondents would consider switching doctors to a practice that offered the ability to communicate and complete important healthcare tasks online.

The survey, which was conducted in January by Decipher Research for Intuit Health, polled 1,000 American adults online. The survey confirmed what other studies have shown, that Americans are increasingly turning to the Internet to help them manage various aspects of their healthcare.

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http://healthcareitnews.com/news/global-market-telehealth-tech-upswing

Global market for telehealth tech on upswing

March 04, 2011 | Bernie Monegain, Editor

MOUNTAIN VIEW, CA – Remote patient monitoring, or telehealth, has taken huge strides forward, with demand for this technology on the rise – especially among home-care agencies, disease management companies and clinical trial groups, according to a new report from market research firm Frost & Sullivan.

The advent of low-energy Bluetooth, near-field communication (NFC), secure data management and wireless sensor platforms together are driving a change in how healthcare is delivered – from a hospital-centric to a patient-centric approach, the report notes. Participation from market giants, such as GE, Google, HP, IBM, Intel, Microsoft, Philips, Qualcomm, Siemens and Wal-Mart, has enabled development of remote monitoring products that effectively interface IT and life science technologies.

Frost & Sullivan’s analysis, Remote Patient Monitoring Technologies – A Strategic Assessment, finds that with the escalating need to manage chronic diseases such as diabetes, chronic obstructive pulmonary disorder (COPD), asthma, liver diseases and congestive heart failure, especially in the elderly population, the demand for wireless monitoring has increased significantly over the past few years.

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http://www.medcitynews.com/2011/03/emerging-health-it-trends-to-watch/

3.3.11 | Dr. John D. Halamka

Emerging Health IT trends to watch

I’m keynoting this year’s Intersystems Global Conference on the topic of “Freeing the Data” from the transactional systems we use today such as Enterprise Resource Planning (ERP), Customer Relationship Management (CRM), Electronic Health Records (EHR), etc. As I’ve prepared my speech, I’ve given a lot of thought to the evolving data needs we have in our enterprises.

In healthcare and in many other industries, it’s increasingly common for users to ask IT for tools and resources to look beyond the data we enter during the course of our daily work. For one patient, I know the diagnosis, but what treatments were given to the last 1000 similar patients. I know the sales today, but how do they vary over the week, the month, and the year? Can I predict future resource needs before they happen?

In the past, such analysis typically relied on structured data, exported from transactional systems into data marts using Extract/Transform/Load (ETL) utilities, followed by analysis with Online Analytical Processing (OLAP) or Business Intelligence (BI) tools.

In a world filled with highly scalable web search engines, increasingly capable natural language processing technologies, and practical examples of artificial intelligence/pattern recognition (think of IBM’s Jeopardy-savvy Watson as a sophisticated data mining tool), there are novel approaches to freeing the data that go beyond a single database with pre-defined hypercube rollups. Here are my top 10 trends to watch as we increasingly free data from transactional systems.

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http://www.ama-assn.org/amednews/2011/03/07/bica0307.htm

Groupon, similar sites target medical services for deals

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted March 7, 2011.

Sean Doherty, MD, a plastic surgeon at Boston Plastic Surgery Associates, said his group wanted to attract new patients by introducing them to easy-to-perform procedures and treatments. So it did what a lot of restaurants, shops and vacation destinations have done: It offered a deal through the online site Groupon.

Chicago-based Groupon was the first in a growing number of Internet companies offering daily deals designed to be "too good to pass up" for people looking to try a new product, restaurant, hobby or vacation destination. In recent months, the growing list of services has included medical and health procedures.

Here's the way it works: A company offers a deal -- generally at least 50% off -- on the Groupon site, but only if a predetermined number of people agree to buy the service. Numerous online sites -- Living Social, Daily Dibs and Zulily, among the largest -- offer similar "daily deals" by e-mail or a website link. Many sites offer geographically targeted deals or personalize deals based on a customer's profile.

Buyers of the Boston Plastic Surgery Associates deal could get laser hair removal, skin-rejuvenation treatments or 50 units of Dysport, an injectable wrinkle remover. The best deal was laser hair removal for $129, regularly priced at $800.

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http://www.ihealthbeat.org/features/2011/keeping-california-in-front-of-the-telehealth-curve.aspx

Monday, March 07, 2011

Keeping California in Front of the Telehealth Curve

For a couple decades, California has been a leader in exploring ways to use telecommunication technology in health care. In 1996, the California Legislature passed the Telemedicine Development Act to lay policy groundwork for developing technology. The law has been updated a few times in an effort to keep up with new tools and new ways of doing things.

The time has come not only for more updates -- including changing terms like "telemedicine" to the more broadly interpreted "telehealth" -- but also for removing barriers in the health care system so telehealth can flourish, according to a new report from the Center for Connected Health Policy.

The report, titled "Advancing California's Leadership in Telehealth Policy: A Telehealth Model Statute & Other Policy Recommendations," is directed at legislators and policymakers. Although it's aimed at creating a welcoming policy environment for telehealth in California specifically, officials at the Center for Connected Health Policy hope other states follow similar paths.

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Enjoy!

David.

Friday, March 18, 2011

I Wonder Will This Be What Pops Up Next In Australia. IBM Seems to Be Everywhere Right Now.

The following appeared a week or so ago.

IBM showcases patient portal technology

March 03, 2011 | Molly Merrill, Associate Editor

HANOVER, GERMANY – IBM unveiled its new patient portal on Thursday, one designed to boost patients' involvement in their care and expand the types of information, alerts, recommendations and interactive coaching that providers can offer their patients online.

The company is previewing the system this week at CeBIT, a digital technology tradeshow being held in Hanover, Germany.

The IBM Patient Empowerment System is based on new technology out of IBM Research. Healthcare organizations can host the system and allow physicians and patients to sign in for services.

The system is a standards-based platform that enables patients to access data from a vast range of sources including third-party health portals, hospital electronic medical record systems, sensors, home devices for monitoring health conditions, U.S. Food and Drug Administration (FDA) alerts, medical sites such as PubMed and more.

The IBM Patient Empowerment System was born as a result of the collaboration among three IBM centers around the world: the IBM Ubiquitous Computing Laboratory in Korea; IBM Research – Haifa and IBM Research – China. The technology was also developed in collaboration with physicians and administrators of the Gacheon University Gil hospital in Korea. Among the largest medical centers in Korea, with approximately one million patients, the hospital recently decided to provide physicians and patients with access to the portal as part of a pilot project to increase efficiency and reduce costs.

“Today, patients want to be more involved in managing their clinical data, and are eager to discover relevant and useful medical information for their benefit,” said DongKyun Park from Gacheon University Gil Hospital in Korea. “By giving patients access to information that is relevant to them in an easy and understandable form, we can greatly improve patient safety during medical treatments.”

Officials said the system is designed to protect privacy at various levels of granularity, enabling members to exercise fine-grained control over the level of information in their profile that can be viewed by others and its usage.

“Most patients do not have the same access to information available to physicians, such as treatment updates or new warnings from the FDA,” said Joseph Jasinski of IBM Research. “And physicians are not always privy to ongoing patient updates, such as eating habits or long-term monitoring of vital signs. These partial pictures limit the level of care that physicians can provide, as well as the care patients can provide for themselves. The IBM Patient Empowerment System merges these realms, bringing important data to both parties.”

Alerts for adverse drug events (ADE) can be created using the platform’s knowledge-bases alongside public repositories for drug-drug, drug-disease, drug-food, and pharmacogenetics interactions; these are then analyzed together with the most current patient clinical and genetic data. The output is an alert that can be given at the point of care to avoid potential harm associated with various drug interactions.

More here:

http://www.healthcareitnews.com/news/ibm-showcases-patient-portal-technology

It would be interesting to see more detailed information on just how information is integrated (as well as being partitioned) to ensure optimal utility and how access to such a system could be integrated into care workflows.

As discussed earlier in the week running parallel systems can be messy, confusing and potentially dangerous.

We await further information in due course.

David.

Thursday, March 17, 2011

Canada Chooses A Different Path on E-Health To Australia. Seems They Might Know Something We Are Ignoring!

The following press release appeared a few days ago:

Province launches eChart Manitoba

March 9, 2011 (Winnipeg, MB) - Manitoba's electronic health-record system, known as eChart Manitoba, was launched today by Health Minister Theresa Oswald at Kildonan Medical Centre, the first site to implement the new system.

"This is the culmination of a great deal of work, including the development of a number of systems to feed patient information into eChart, and it is very exciting to see it all come together," said Oswald. "As more sites become linked to eChart, it will be possible for a person's key health information to travel with them to different health providers across the province."

EChart Manitoba is a tool for authorized health-care providers to view key information about a patient such as dispensed medications, immunization and laboratory test results. As eChart continues to evolve, more information from additional sources will feed into eChart, said Oswald. The system is designed to provide instant access to the information that health-care providers require to make informed care decisions leading to increased patient safety and reduce unnecessary duplication of tests. The $40-million cost of the program was included in funds announced for medical information systems in April 2007 and includes a $27.5-million investment by Canada Health Infoway, the federally funded organization investing in information and communications technology projects across Canada.

Kildonan Medical Centre was the first site to go live with five more sites quickly following in Winnipeg, Brandon and Notre Dame de Lourdes. By July, the system will be in use in 30 sites across Manitoba, Oswald noted. Initially eChart will be available in selected primary-care and emergency-department settings and additional sites in future phases. The phases have been scheduled to be of the most benefit to the most patients, the minister said.

"EChart Manitoba is connecting care across the province," said Dr. Ricardo Lobato de Faria of Manitoba eHealth's Electronic Health Record Project Steering Committee. "If your family physician is in Notre Dame de Lourdes and you get tests done in Winnipeg, your doctor will have immediate, electronic access to those results. In time, every doctor will have the opportunity to be able to access their patients' eChart records so that they have the information they need, when they need it."

"The milestone we are celebrating today is one that will place the information that health professionals need to make proper care decisions in their hands quickly and securely," said Richard Alvarez, president and CEO, Canada Health Infoway. "When clinicians are properly informed, patient care is improved, time and money are saved, as are precious lives."

Only those health-care providers who are involved in a patient's care are allowed to access that patient's information. Every authorized user of the system will have a unique user name and password. All access in eChart will be tracked and audited, said Oswald. Manitobans have the option to add a disclosure directive to hide their personal health information in eChart Manitoba. They can also request a copy of their information held in the system and find out who has viewed their record.

"It's critical that health-care providers have the information they need but just as critical that people's personal information is protected," the minister said.

With the launch of eChart, an awareness campaign will also get underway to ensure the members of the public are aware of how health information is managed and secured as well as how they can exert control over their records. Print, radio and web advertisements will be run over the next few weeks and information will be available at health service sites as they join the system.

Formed by Manitoba Health in 2006, Manitoba eHealth is a province-wide initiative, housed within the Winnipeg Regional Health Authority. It has been tasked with the development of health information technology for Manitoba. Funding for eHealth projects is provided by Manitoba Health and Canada Health Infoway, an independent, not-for-profit organization funded by the federal government.

Manitobans are encouraged to access www.connectedcare.ca/echartmanitoba for more information.

Canada Health Infoway is an independent, not-for-profit organization funded by the federal government that invests with public sector partners across Canada to implement and reuse compatible health information systems that support a safer, more efficient health-care system.

More here:

https://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/701

The key part of the release is this:

“EChart Manitoba is a tool for authorized health-care providers to view key information about a patient such as dispensed medications, immunization and laboratory test results. As eChart continues to evolve, more information from additional sources will feed into eChart, said Oswald. The system is designed to provide instant access to the information that health-care providers require to make informed care decisions leading to increased patient safety and reduce unnecessary duplication of tests.”

The strategy here is clearly to get information into the hands of providers in the first instance. I suggest that is what we should also be doing first before moving on to less evidence based initiatives such as the PCEHR.

It is really all too silly the strategy we are adopting in my view.

David.

Wednesday, March 16, 2011

Here Is Another Issue We Need To Consider Around the PCEHR. It Will Be Neither Cheap or Easy to Address.

This appeared a week or so ago.

Panel favors two factors for remote user ID

By Mary Mosquera

Friday, March 04, 2011

The Health IT Policy Committee has expressed its support for two-factor authentication for users who remotely access electronic health information through virtual private networks or online applications.

A committee panel, the privacy and security tiger team, sought the experience of committee members, many of whom are physicians, to help them understand the practicality of requiring two factors before they finalized their recommendations.

The tiger team is weighing user authentication among its recommendations to support privacy and security in health information exchange. They believe that more than just a password should be required for to assure that a person is who they claim to be.

Remote access is generally considered a greater security risk than on-campus and local access.

However, the panel members could not agree on whether to require two factors and, if they did, whether to specify the types of factors to be considered, said Deven McGraw, chair of the privacy and security tiger team.

She is also director of the health privacy project at the Center for Democracy and Technology.

Among the physicians offering their experience, Dr. David Blumenthal, national coordinator for health IT, said that for years he used two-factor authentication in the form of a password and randomly generated number. It took a while to get used to the process.

“I stopped noticing it after a few months,” he said. “It’s a behavioral issue. But it’s a real issue, and one that requires persuasion and management to overcome.”

Providers must establish policies to prove identity and to authenticate users who access electronic health records, consistent with the Health Insurance Portability and Accountability Act (HIPAA).

The tiger team has cited as a model the assurance levels described by the National Institute for Standards and Technology (NIST) in its number 800-63 privacy and security document, including using a knowledge token, such as a password, and a hard token, such as a one-time assigned password.

More here:

http://www.govhealthit.com/newsitem.aspx?nid=76416

The issue this raises for all of us is, assuming at some point there is some patient information available within the PCEHR system - just how will access to that information be managed?

On the basis that, as far as an individual is concerned, access will be via a PCEHR system portal, what level of identity verification would be provided.

The options would appear to be basic and a variety of two factor approaches. For health information it would seem unlikely that simply issuing a password would be good enough.

As soon as you move beyond this you are looking at a range of options, all of which (smartcard, Medicare card stripe, USB key or other one time use token such as the banks provide) will come at a considerable cost and will need a whole infrastructure to manage and maintain them.

It would be interesting to know just how much is in the budget for this - recognising that it seems likely that NASH or some equivalent will be used for provider verification.

Of course the issues of all the varieties of access sharing one might envisage just makes the sense that it will be possible to provide reasonable confidence as to the protection of private information without considerable complexity and cost seem unlikely.

Again I guess we will have to just wait and see!

To put all this in context the following is useful - being from the most advanced Healthcare Portal that is publicly available I am aware of - excluding that from Kaiser and similar organisations which have a clear membership focus.

About Sundhed.dk - patient portal

Prior to Sundhed.dk the Danish health service consisted of silos of information which comprised of individual solutions and databases with no means of integrating it together. Sundhed.dk helped share the information contained in these individual databases making the information available to the users 24/7.

Sundhed.dk was broken down and implemented in three main phases. The first phase which was launched in December 10th, 2003 was an informational portal. The next phase aimed at decreasing the number of duplicate lab orders by consolidating information from various sources into one central source. In 2004, the final phase of the portal was implemented, the portal now uses a patient record for each patient that has all the information necessary to identify a patient and his/her medical condition at the point of care.

Sundhed.dk is a consent based model where patients give permission either online or during the treatment. During treatment the patient's health care professional can receive verbal consent and then fill a form online on behalf of the patient. The consent information is available on Sundhed.dk and the patient has the ability to verify who accessed his/her information.

In January 2009, the site registered 304,000 unique visitors, 448,000 total visits and 2,800,000 page impressions. These numbers correspond to a total Danish population of 5.4 million.

Sundhed.dk is a complex platform and has high maintenance costs. The reasons for such high maintenance costs are the implementation approach which is very fragmented, law of privacy which limits the sites functionalities, and lack of a common data model.

In spite of this limitation Sundhed.dk provides every citizen and every health professional with access to personal health information and online services, provided that the have a digital signature. A digital signature is free and available to every person in Denmark above 15 years of age. Sundhed.dk then personalizes its pages based on the logged users attributes and shows relevant information especially around online lookups which are customized to the logged user's treatment needs.

The health professionals are including Sundhed.dk in their own channel strategy using all or a selected range of services.

More here:

http://www.hitug.org/CA/article_read.asp?title=Understanding+Danish+eHealth+portal+Sundhed.dk&item=34

So, in Denmark it is digital certificates for all.

For those who want a bit more on what is done and might be required elsewhere the following links may be useful:

On Kaiser:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213471/

and on a proposed approach:

http://www.ncbi.nlm.nih.gov/pubmed/10219949

The bottom line is that if you plan put healthcare records on the web you will need to design in and least bank level security and access control and this will not be cheap to operate and maintain!

David.