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, June 04, 2011

Weekly Overseas Health IT Links - 04 June, 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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IT Is Not The Doctor's Real Enemy

Information technology is not medicine's enemy but an ally that can ultimately improve patient care and reduce costs.

By Jason Burke, InformationWeek

May 25, 2011

URL: http://www.informationweek.com/news/healthcare/clinical-systems/229625530

The latest digital issue of InformationWeek Healthcare featured an intriguing article by Paul Cerrato suggesting that some of my ideas regarding evidence-based medicine are a source of animosity between CIOs and their physician stakeholders--physicians whom he believes consider information technology "the enemy" of good medicine. His article touches on several key issues that should be top of mind for every physician leader and CIO today. But is IT really the enemy of good medicine?

Is Medicine An Art or A Science?

At the heart of the article is a very old debate: Is medicine an art or a science? I've never understood why it can't be both. But the more important question is the degree to which we pursue the art at the expense of science, Carl Sagan, my childhood idol, once wrote of the origins of modern medicine:

"Hippocrates introduced elements of the scientific method. He urged careful and meticulous observation: 'Leave nothing to chance. Overlook nothing. Combine contradictory observations. Allow yourself enough time.' … He stressed honesty. He was willing to admit the limitations of the physician's knowledge."

The man behind the oath every practicing physician takes was very much an advocate for science. And any physician advocating art over science is ignoring centuries of transformative medical progress made through science. Personally, I don't run into many physicians like that anymore--they are literally a dying breed.

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http://healthcareitnews.com/news/docs-find-upgrading-new-ehr-difficult-despite-rx-benefits

Docs find upgrading to a new EHR difficult despite Rx benefits

May 26, 2011 | Healthcare IT News Staf

NEW YORK – Newer electronic health record systems can aid in the reduction of prescription errors, but making the upgrade to these systems can be very difficult for doctors, according to a new study.

A team of physician-scientists from Weill Cornell Medical College tracked the prescription errors of 19 physicians in an adult ambulatory clinic before the switch from an older EHR to a newer system, then again 12 weeks after the switch and once again a year later.

The new electronic system provided extra guidance for prescribing to improve safety, such as alerts notifying providers about use of inappropriate abbreviations that can result in patient harm, as well as checks for drug-allergy interactions, drug-drug interactions and duplicate drugs.

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http://www.itworldcanada.com/news/e-health-raises-issues-of-data-management-privacy-panel/143216

E-health raises issues of data management, privacy: panel

By: Kathleen Lau On: 26 May 2011 For: ComputerWorld Canada

While electronic health records means more lives will be saved with broad access to patients’ medical information, a panel of experts discuss the challenges brought on by going digital. Plus, Ontario Shores’ cloud journey

TORONTO—Currently, in Canada, 80 per cent of medical images exist in digital form as the health care industry continues to move toward widely implementing electronic medical records. But out of this, arises the challenge of managing this huge amount of digital data from all sources, said a Dell Inc. executive during a panel discussion on innovation in health care.

Jamie Coffin, vice-president and general manager of health care and life sciences with the Round Rock, Tx.-based vendor, pointed out that, by the year 2015, 35 per cent of all health care information in Canada will be digitized. Besides medical images, that will also include data such as lab results and measurements taken from smart medical devices.

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http://healthcareitnews.com/news/service-give-parents-access-their-kids-phrs

Service to give parents access to their kids' PHRs

May 26, 2011 | Healthcare IT News Staff

MENLO PARK, CA – A new personal health record platform set to launch this summer aims at giving parents anytime, anywhere access to a comprehensive view of their children's health records.

MotherKnows, a provider of online medical records for moms based in Menlo Park, Calif., launched their online platform May 24 at TechCrunch Disrupt, giving parents a way to instantly and securely access their children's health records any time – from life-threatening emergencies to routine school, daycare and camp registrations – from a smartphone or easy-to-use website.

While the service will open to the public this summer, the website is accepting signups from interested parents. Those that sign up now gain the opportunity for early access.

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Advanced Health IT Needed For ACO Initiatives

Data analytics tools, clinical applications, and other technologies technologies can help accountable care organizations deliver on the promise of curbing costs and improving care.

By Nicole Lewis, InformationWeek

May 26, 2011

URL: http://www.informationweek.com/news/healthcare/clinical-systems/229700076

As the drive to design a workable accountable care organization model gets under way, the Centers for Medicare and Medicaid Services announced several Affordable Care Act initiatives that require a robust health IT infrastructure to support doctors, hospitals, and other healthcare providers in improving care with Medicare through ACOs. The new ACO models could save Medicare up to $430 million, CMS said.

Among the initiatives introduced is the Pioneer ACO Model, an ACO model that will be available to providers this summer and is designed for advanced organizations ready to participate in shared savings. The Center for Medicare and Medicaid Innovation will support this model, CMS said.

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http://www.ama-assn.org/amednews/2011/05/23/bisb0523.htm

Doctors driving IT development with their mobile technology choices

Their adoption of smartphones and tablet computers has resulted in demand for systems in which they can use them.

By Pamela Lewis Dolan, amednews staff. Posted May 23, 2011.

When physicians at Albany (N.Y.) Medical Center started adopting smartphones a few years ago, they almost immediately looked for ways to use them in their clinical lives.

Doctors liked being able to access their patients' records and clinical tools anytime, from any place, so they pressured the hospital to give them access.

With an estimated 81% of physicians using smartphones (up from 72% in 2010), according to a survey of 2,041 physicians released May 4 by Manhattan Research, Albany Medical Center was not alone in feeling pressure from physicians to allow them mobile access. Hospitals and health information technology vendors are realizing that the way to sell physicians on health information technology is to make it mobile. Instead of hospitals and vendors telling physicians to adapt to their preferred ways of using technology, physicians are gaining the power to sway hospitals and vendors to their preferred way of using it.

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http://www.modernhealthcare.com/article/20110527/NEWS/305279967/

HHS proposes changes to HIPAA records-sharing rules

By Joseph Conn

Posted: May 27, 2011 - 1:00 pm ET

HHS' Office for Civil Rights has posted proposed changes to rules regarding the disclosure of patients' health information that could give patients more insight into how their information is shared.

The 95-page proposed rule (PDF), to be published in the May 31 issue of the Federal Register, proposes changes to the privacy regulations under the 1996 Health Insurance Portability and Accountability Act.

The Civil Rights Office has enforcement authority for the HIPAA privacy rule and said the proposed rule reflects changes mandated by the Health Information Technology for Economic and Clinical Health Act, or HITECH, which are part of the American Recovery and Reinvestment Act of 2009. However, the Civil Rights Office noted that it also is looking to exercise the "more general authority" granted to it through HHS under HIPAA itself.

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http://www.modernhealthcare.com/article/20110527/NEWS/305279965

Data mining finds drug-combo danger

By Maureen McKinney

Posted: May 27, 2011 - 11:45 am ET

Data mining of electronic health records and an adverse-event database has led to the discovery of an unexpected and dangerous side effect that could result from a combination of two commonly used medications, a group of researchers reports.

According to a report on the study published online in the journal Clinical Pharmacology and Therapeutics, the researchers analyzed the U.S. Food and Drug Administration's adverse-event reporting database and electronic health-record data from Stanford University, Palo Alto, Calif.; Vanderbilt University, Nashville; and Harvard Medical School, Boston.

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http://healthcareitnews.com/news/it-could-aid-problem-growing-drug-side-effect-lists

IT could aid problem of growing drug side effects lists

May 24, 2011 | Healthcare IT News Staf

INDIANAPOLIS – The lists of potential side effects that accompany prescription drugs have ballooned in size, but thanks to computer software designed to monitor side effects on drug labels, physicians may be able to better identify which medications would be best for their patients.

The average list of drug side effects on a label is 70 reactions per drug, a number that can overwhelm physicians trying to select suitable treatments for their patients, according to a new study of drug labels.

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http://www.fierceemr.com/story/ehrs-used-customize-diabetes-care/2011-05-26

New tool uses EHRs to customize diabetes care

May 26, 2011 — 10:58am ET | By Janice Simmons

Patients with diabetes who receive treatment at HealthPartners clinics soon may be able to use a new personalized tool--called the Diabetes Wizard--which may be one of the first applications to use electronic health records to customize individual care.

The Wizard has been designed by researchers and physicians at the Minneapolis-based organization to help physicians--particularly in primary care settings--work with diabetic patients to tailor the best treatment plans for them. This will include evaluating appropriate lifestyle improvements and determining the medications that provide the best blood pressure, blood sugar, and cholesterol control.

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http://www.fierceemr.com/story/infant-deaths-reduced-through-emr-use/2011-05-26

Infant deaths reduced through EMR use

May 26, 2011 — 10:46am ET | By Janice Simmons

Even a 10 percent increase in the hospital use of electronic medical records could save 16 babies for every 100,000 live births in the U.S. And, making a complete national transition to EHRs could save an estimated 6,400 infants each year nationwide, according to a new study published in the Journal of Political Economy.

The study looked at the death rates of infants at hospitals with and without EMRs in more than 2,500 counties nationwide over a 12-year period. The data set permitted the researchers--Amalia Miller of the University of Virginia and RAND, and Catherine Tucker of the Massachusetts Institute of Technology Sloan School of Management--to control for other factors that could impact infant mortality, such as an area's socioeconomic status.

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http://www.ihealthbeat.org/perspectives/2011/can-covered-entities-take-advantage-of-the-cloud-and-still-comply-with-hipaa.aspx

Thursday, May 26, 2011

Can Covered Entities Take Advantage of the Cloud and Still Comply With HIPAA?

by Bruce Merlin Fried and Rebecca Fayed

Cloud computing offers users significant efficiencies by outsourcing IT systems, along with the management and administration of those systems. This might include, for example, having data stored, processed and managed by the cloud computing provider. Although privacy and security issues affect any cloud user, the highly regulated health care industry should remain cautiously optimistic when weighing the financial benefits of the cloud against the potential compliance risks.

So the question remains: Can HIPAA-covered entities (e.g. health care providers and health plans) store protected health information (PHI) in the cloud and still comply with HIPAA privacy and security regulations? The answer is: It depends. It depends on the cloud computing service provider and how that provider sees itself and its obligations to protect the privacy and security of the data. The better answer to the question then is that covered entities can store PHI in the cloud and still comply with HIPAA, assuming they choose the right cloud computing provider. But who is the right cloud computing provider?

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Anesthesia Delivery Market To Reach $4 Billion

Sales of anesthesia information management systems are driving much of the growth, according to an iData Research report.

By Nicole Lewis, InformationWeek

May 24, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/229625517

The anesthesia, respiratory, and sleep management device market will reach approximately $4 billion by 2017, and much of that growth will be driven by sales of anesthesia information management systems, or AIMS, a report from iData Research shows.

The report, "U.S. Market for Anesthesia, Respiratory, and Sleep Management Devices," shows that in 2010 the market was valued at more than $2.5 billion, a 3.7% increase over the previous year. The overall market is estimated to grow at a midlevel single-digit rate over the forecast period.

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Healthcare Puts Tablets To The Test

iPads and other mobile consumer devices have made their way into the exam room, bringing with them concerns about security, tech support, and infection control.

By David F. Carr, InformationWeek

May 21, 2011

URL: http://www.informationweek.com/news/healthcare/mobile-wireless/229503427

Since gadget-happy doctors got their hands on the iPad last year, many have turned it from a toy into a professional tool.

Dr. Jeffrey Westcott, cardiology board chair at Swedish Medical Center, a four-hospital complex in Seattle, even sees it as a lifesaver. It can "help me avoid mistakes by knowing more about the patient when I'm asked to make a decision."

Just the other day, he got a phone call from a pain doctor who wanted to attach electrodes into the epidural area around the spine of a mutual patient and wanted to take her off her anticoagulant in preparation for the surgery. Westcott was at home when he got the call, but he had his iPad and logged into his hospital's Epic electronic medical records system's iPad client and was able to see that the woman had an artificial aortic valve and must remain on the drug for that reason.

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http://www.modernhealthcare.com/article/20110525/NEWS/305259987

ONC wants input on provider directories for data sharing

By Joseph Conn

Posted: May 25, 2011 - 12:00 pm ET

HHS' Office of the National Coordinator for Health Information Technology kicked off a new process today to receive public input on a project meant to improve secure communications protocols for health information exchange.

The Provider Directories and Certificate Interoperability Initiatives aim to give ONC advice on creating ways to access a proposed set of provider directories and digital certificates that parties to an exchange of patient records can use to ensure those records are going to and coming from the intended, appropriate authorized parties.

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http://www.ehi.co.uk/news/acute-care/6901/outline-of-new-csc-deal-takes-shape

Outline of new CSC deal takes shape

24 May 2011 Jon Hoeksma

Negotiations on the terms of a potential new deal with local service provider CSC have been completed, NHS chief information officer Christine Connelly has told eHealth Insider.

Any new deal though remains contingent on a review of the National Programme for IT in the NHS by the Cabinet Office’s major projects review group, which is expected to last a week.

Approval of a new deal will also require joint Cabinet Office and Treasury approval.

Assuming any new deal survives these steps unscathed it would then have to be approved by the Secretary of State for Health.

Connelly spoke to EHI the day after she was grilled by the Commons’ public accounts committee on the National Audit Office’s third report on the National Programme for IT in the NHS.

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http://www.ft.com/intl/cms/s/0/5059da92-863f-11e0-9e2c-00144feabdc0.html?ftcamp=crm/email/2011525/nbe/DrugsHealthcare/product

IT group’s NHS contract bid under fire

By Sally Gainsbury and Nicholas Timmins

Published: May 24 2011 23:12 | Last updated: May 24 2011 23:12

The biggest contractor to the troubled NHS IT programme was accused on Tuesday of seeking a one-third reduction in the cost of its contract in return for doing two-thirds less work.

The allegation, to the Financial Times, by Margaret Hodge, chairman of the public accounts committee, followed a proposal from the Computer Sciences Corporation, that its contract should be reduced by £264m in return for slashing the number of NHS trusts that would receive new systems from 220 to 80.

CSC’s suggestion was revealed in a leaked memo prepared for Francis Maude, Cabinet Office minister and seen by the Financial Times. The company is struggling to meet the original demands of its £3bn contract. However if the proposal were to be implemented it would lead to two-thirds of NHS trusts in the north, Midlands and east of England being left without planned electronic patient record systems.

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http://www.govhealthit.com/news/qa-good-bad-and-otherwise-cloud-computing-federal-health-it

Q&A: The good, bad, and otherwise of cloud computing in federal health IT

May 23, 2011 | Tom Sullivan, Editor

Among the top agencies listed in Federal Chief Technology Officer Vivek Kundra’s cloud-first policy are the Departmment of Defense, Health and Human Services and the Veterans Administration. All three will turning to clouds, be those of the public, private, or hybrid variety, under Kundra’s plan.

Government Health IT Editor Tom Sullivan spoke with Aileen Black, vice president of public sector for VMware, about what the potential spread of cloud computing into government means to the federal health IT realm, the advice she has for government health IT organizations tasked with creating a cloud, and why taxpayers want the model.

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http://www.modernhealthcare.com/article/20110524/NEWS/305249987/

VistA needs ‘dramatic vision,' programmers say

By Joseph Conn

Posted: May 24, 2011 - 12:00 pm ET

Two longtime programmers at the VistA Community Meeting Monday at George Mason University in Fairfax, Va., offered a history of the U.S. Veterans Affairs Department's VistA electronic health-record system and a way forward for VA and military brass planning an estimated $28 billion retooling of VistA and a counterpart EHR within the Military Health System.

The meeting is being held by WorldVistA, a not-for-profit organization that promotes the use of an open-source version of the VA's health IT system in the U.S. and abroad.

Programmer Tom Munnecke, who started working at the VA in 1978, noted that the VistA precursor, the Decentralized Hospital Computer Program, was developed in spite of opposition from a centralized IT bureaucracy at the VA in Washington. He likened the development of VistA to the development of the Internet, which relied on three basic open-source components—URLs, http and html. DHCP, in comparison, was based on acceptance of a common database and programming environment.

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http://www.modernhealthcare.com/article/20110526/NEWS/305269989/

VA's Baker talks VistA goals

By Joseph Conn

Posted: May 26, 2011 - 12:00 pm ET

Roger Baker, assistant secretary for information technology at the U.S. Veterans Affairs Department, said the VA is committed completely to pursuing an open-source model for modernization of its VistA electronic health-record system.

"There is no half-hearted in this from the VA standpoint," Baker told his audience at a community meeting of World VistA, a not-for-profit organization formed to promote the use of an open-source version of VistA outside the VA. "We either succeed with open source or spend $16 billion" on switching to a commercial EHR system, he said.

A decade ago, according to Baker, the VA had the best EHR system in the world, but since then VistA's rate of improvement has diminished while the pace of progress among private-sector products has accelerated. VistA has "been ignored for a while," he said.

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http://www.healthleadersmedia.com/print/TEC-266545/Technology-Revs-Up-Revenue

Technology Revs Up Revenue

Gienna Shaw, for HealthLeaders Media , May 24, 2011

Wouldn't it be nice if someone gave you $206,817.63—simply because you asked for it? Well, that's more or less what happened at the Houston-based Richmond Bone & Joint Clinic.

"We were missing a big opportunity at our check-in desk to address balances in advance of the patient's visit," says CEO Juliet Breeze, MD. "So we would check the patient in and because the check-in people were so busy, they would sometimes forget to talk to the patient about the balance that we already knew was due."

The practice installed check-in kiosks that are integrated with its payment management system. The kiosks alert patients to current and past balances—they can pay with the swipe of a credit or debit card. Patients who don't pay can't complete the check-in process without speaking to a financial counselor.

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Health IT Boosts Bottom Line For Hospitals

The Fitch Ratings analysis suggests that better informatics and adherence to quality standards really do drive the bottom line.

By Nicole Lewis, InformationWeek

May 23, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/229625385

Hospitals with advanced health information technology systems and a high quality of care achieve greater revenue growth, attend to more patients, enjoy a superior reputation for excellence, and are better able to contain costs, a report from Fitch Ratings has revealed.

As hospitals accelerate the adoption of electronic health records, computerized physician order entry systems, electronic prescription technology, and other health IT, the findings give greater currency to the Obama administration's claim that its health IT incentive programs are worthwhile and will have a positive impact on improving the quality of care while containing healthcare costs.

The special healthcare report, Enhanced Accountability and Financial Performance noted that as health reforms accelerate the adoption of quality reporting and health IT investments, it's important to analyze the impact of these two drivers on hospital operations.

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http://www.fiercehealthit.com/story/regional-information-exchanges-peril-think-again/2011-05-22

Regional information exchanges in peril? Think again

May 22, 2011 — 4:44pm ET | By Ken Terry

A new Harvard study published in the Annals of Internal Medicine questions whether regional health information organizations (RHIOs) will ever be able to function on their own. What's interesting about the survey is that its data is substantially the same as that in the latest survey of the eHealth Initiative, an organization that promotes RHIOs (better known today as regional health information exchanges). Yet the eHealth Initiative sees promise where the Harvard researchers see failure.

The Harvard researchers found that only 75 of the 197 known regional HIE initiatives were up and running, with only 25 not dependent on government grants. Similarly, the eHealth Initiative notes that last year, there were 73 operational initiatives, up from 57 in 2009, and 18 of the operational HIEs were financially independent.

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http://www.healthleadersmedia.com/print/TEC-266455/ONC-Announces-Exams-for-HIT-Pros

ONC Announces Exams for HIT Pros

Margaret Dick Tocknell, for HealthLeaders Media , May 23, 2011

The Office of the National Coordinator for Health Information Technology has released its first set of exams designed to help healthcare providers and other employers assess the health IT competencies of their existing staff and potential employees.

The health information technology professionals examinations will measure skill levels in the competencies identified as essential for key health IT professional workforce roles, including clinician/practitioner consulting, implementation management and support, practice workflow and information management redesign, technical/software support, and training.

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http://www.healthdatamanagement.com/news/ehr-electronic-health-records-meaningful-use-lessons-42509-1.html

Small Clinic Meaningful User Shares Lessons

HDM Breaking News, May 19, 2011

Childs Medical Clinic in Samson, Ala., successfully attested for meaningful use of electronic health records on April 19 and a month later was one of the first practices in the nation to receive an incentive payment from Medicare. Practice administrator Jule Childs has several tips for peer organizations, most importantly, "It's worthwhile."

The one physician, one nurse practitioner clinic spent three months working on collecting the data to attest. Several EHR vendors offer a dashboard application that tracks progress toward meeting meaningful use objectives and Childs found the dashboard with her EHR from Greenway Medical Technologies Inc. to be invaluable. The dashboard, for instance, pinpointed patients seen each day but not added to the numerator for applicable meaningful use measures.

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http://www.modernhealthcare.com/article/20110523/BLOGS02/305239999/

The potentially high cost of patient-record breaches

By Joseph Conn

How much does a breach of patient records really cost?

It's what I asked Nick Economidis, an underwriter with Beazley, a specialty insurance group with headquarters in London and U.S. offices in Farmington, Conn., and Beth Diamond, Beazley's claims focus group leader for technology media and business service.

The company provides security and privacy liability insurance for health plans and hospital groups.

There have been rules of thumb tossed around—$250 to $300 per breached record—but don't buy into that, the two insurers say. It could be a lot less, but if it is, that doesn't mean you're lucky.

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http://www.modernhealthcare.com/article/20110523/NEWS/305239989

ONC unveils health IT competency exams

By Maureen McKinney

Posted: May 23, 2011 - 11:45 am ET

The Office of the National Coordinator for Health Information Technology has released a set of competency exams created to more easily identify expert-level IT professionals.

"The exams allow individuals to demonstrate their level of skill in competencies identified as essential for key health IT professional workforce roles," according to an e-mailed notice from the ONC. The exams also will let providers assess current staff members' health IT competency, according to the notice.

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http://www.modernhealthcare.com/article/20110523/NEWS/305239946/

Interoperability key to realizing health IT goals: IOM

By Rich Daly

Posted: May 23, 2011 - 2:30 pm ET

Without "seamless interoperability," health information technology's potential will go unmet, a report on the healthcare digital infrastructure from the Institute of Medicine found.

That was the conclusion of health IT experts during a series of “expert meetings” organized by the Institute of Medicine in the summer and fall of 2010 at the request of the federal Office of the National Coordinator for Health Information Technology. Those experts—among them, researchers, computer scientists, privacy experts, clinicians, healthcare administrators, HIT professionals and representatives of patient advocacy groups—agreed that a digital health infrastructure cannot be effective unless it is integrated seamlessly within the healthcare processes "from which it draws and is meant to support care delivery, research, quality improvement and population health monitoring."

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http://www.computerworld.com/s/article/9216855/Verizon_releases_mobile_app_that_finds_cheapest_meds

Verizon releases mobile app that finds cheapest meds

The app also warns of possible harmful drug interactions

By Lucas Mearian

May 19, 2011 12:09 PM ET

Computerworld - Verizon Wireless and Medco Health Solutions today released a mobile application that guides BlackBerry and Android smartphone users to locations where they can purchase the lowest-cost prescription drugs.

Verizon said the new Medco Pharmacy mobile app can also identify potentially harmful drug interactions based on Medco members' medication histories.

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http://healthcareitnews.com/news/health-it-no-1-list-top-10-hot-careers

Health IT No. 1 on list of top 10 'hot' careers

May 20, 2011 | Healthcare IT News Staff

SAN DIEGO – Healthcare information technology tops the list of top 10 ‘hot careers’ for college graduates in 2011, according to a new study from the University of San Diego Extension.

Due to government initiatives in recent years, the study states, the healthcare industry adopted an advanced technology system for managing and utilizing health information, medical establishments have the goal of transferring all healthcare information to an advanced technology-driven database within the next decade.

“This fueling a demand for health information technicians who can support medical record reform,” say the authors of the study.

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Reimbursement Mechanisms, Sustainability Are Keys To Telehealth Success

New Mexico study shows promise in extending specialty care to rural areas, but new payment models are needed.

By Neil Versel, InformationWeek

May 20, 2011

URL: http://www.informationweek.com/news/healthcare/mobile-wireless/229600741

Telemedicine has great potential for extending the reach of a strained healthcare workforce and improving care coordination, but it needs to be accepted as just another means of providing care if the technology is to be sustainable, according to a newly published study.

"To make a substantial impact on how healthcare is delivered across the United States, the model needs to be incorporated into the healthcare system so that reimbursement mechanisms are created to pay for the various services it provides," researchers from the University of New Mexico School of Medicine, Albuquerque, wrote this week in the policy journal Health Affairs.

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http://healthcareitnews.com/news/pharmacy-cds-systems-missing-potentially-dangerous-interactions

Pharmacy CDS systems missing potentially dangerous interactions

May 19, 2011 | Healthcare IT News Staff

TUSCON, AZ – Only 28 percent of pharmacies' clinical decision support software systems correctly identified potentially dangerous drug-drug interactions, according to a study conducted at the University of Arizona College of Pharmacy.

The study was conducted at 64 pharmacies across Arizona. Members of the research team tested the pharmacy software using a set of prescription orders for a standardized fictitious patient. The prescriptions consisted of 18 different medications that posed 13 clinically significant drug-drug interactions. Of the 64 pharmacies, only 18 correctly identified all of the eligible drug-drug interactions and non-interactions.

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http://www.healthdatamanagement.com/news/ehr-electronic-health-records-meaningful-use-incentive-check-salazar-42515-1.html

Meaningful User: Anyone Can Do It

HDM Breaking News, May 20, 2011

Juan Salazar, M.D., a solo internal medicine practitioner in McAllen, Texas, recently received one of the first Medicare electronic health records meaningful incentive checks (for $18,000). He's been practicing for three decades and only adopted an EHR about 18 months ago.

Salazar understands the fears of peers to switch to electronic records, believing them to be cumbersome and adding little value to their practice. "When I started with EHRs I had the same fears," he notes. "I was changing cultures."

But he'll never return to paper because the ambulatory EHR from Cerner Corp. has made him and the office far more efficient while improving care. Patients, for instance, can see their health status trends on the laptop "and it gives a sense of wellbeing that they're getting better."

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http://www.ihealthbeat.org/features/2011/milestones-mark-arra-hitech-first-quarter.aspx

Monday, May 23, 2011

Milestones Mark ARRA, HITECH First Quarter

by Helen Pfister, Susan Ingargiola and Rachel Sam, Manatt Health Solutions

The first quarter of 2011 brought a couple of notable milestones in the federal government's implementation of the American Recovery and Reinvestment Act of 2009 -- the arrival of a new national coordinator for health IT and an invitation to the public to help define the country's health IT strategy. This update summarizes key first-quarter ARRA developments -- including those involving the Health Information Technology for Economic and Clinical Health Act.

David Blumenthal, former national coordinator for health IT, announced in February his intention to leave the Office of the National Coordinator for Health IT to return to Harvard University, where he was a practicing physician, tenured professor and researcher before President Obama named him to head ONC in March 2009. In April, he was replaced by Farzad Mostashari, ONC's former deputy national coordinator.

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http://fcw.com/articles/2011/05/20/joint-interface-to-be-completed-by-july-for-common-va-dod-health-record-official-says.aspx

Common VA-DOD health record interface nearing completion

The first milestone for the upcoming joint Veterans Affairs and Defense Department electronic health record platform is a common graphical user interface to be in place by July, according to W. Scott Gould, deputy secretary for the VA.

A prototype interface already has been developed, Gould told the Senate Committee on Veterans Affairs on May 18.

The user interface provides the front end and a point-of-entry for physicians to interact with the digital medical record system, he said.

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Enjoy!

David.

Friday, June 03, 2011

Draft Blog for a Guest Posting on Australian E-Health And Its Impact.

I had in mind this rather high level post. Comments welcome!

Where Is The Consensus on Australian E-Health and How Can A Shared EHR Vision Be Progressed?

In recent times the National E-Health Transition Authority (NEHTA) has released a Concept of Operations for the proposed Personally Controlled Electronic Health Record (PCEHR). Submissions providing comment have been requested ending in early June, 2011.

Substantial funding ($450M+) for this initiative has been made available for an initial two years (ending June, 2012) and work is currently underway with a range of solution providers, NEHTA and the Commonwealth Department of Health and Ageing to make this rather grand vision (which originated in the Final Report to Government in 2009 of the National Health and Hospitals Reform Commission) a reality.

At the core of the proposal is that there would be an internet accessible national electronic health record system created in a series of national repositories and indexed in such a way that the patient had control of what information was to be made available to anyone (clinicians, friends, relatives etc.). The information to be held in the record for each individual was intended to be sourced from Medicare, diagnostic test providers, hospitals, specialists and primary care provider computers and assembled into a health summary and then a series of so called ‘event summaries’. There was also intended to be a facility for ‘consumer contributed information’ and commentary.

Review of the currently available submissions suggests that while the concept of an easily accessible and available summary health record to support continuity of care and care in emergency situations is universally supported (provided via either access to provider systems or a health information exchange) beyond this the ‘how’ this might be achieved is by no means clear and additionally it is recognised there are a very large number of barriers (including privacy and security, information quality, currency and reliability, overall system governance and management, consumer and clinician engagement, clinician workflow and incentive requirements and patient consent issues) to successful delivery of what seems like a simple and quite intuitive objective. It also needs to be pointed out that while intuitively it seems such a system would provide obvious benefits and usefulness the evidence supporting the value of such a care record is still by no means clear. This is to be distinguished from the very much stronger evidence for the clinical value of well-designed records intended for use by individual clinicians in their care delivery and decision making.

From this writer’s perspective Australian E-Health has rather got ahead of itself in attempting such an ambitious Shared EHR program without laying and proving the organisational and operational infrastructure as a number of initial and required steps.

These steps include:

1. Developing a Governance Framework and Leadership which properly engages clinicians, consumers and other stakeholders.

2. Recognition of the need to focus on achieving quality standardised implementations of effective clinician care support systems both in practices and hospitals .

3. Development and stabilisation of safe, secure, standardised clinical document sharing between each element of the health sector (as is now being undertaken rather slowly by NEHTA). This needs to cover clinicians, diagnostic service providers, hospitals, allied care providers etc.)

4. Evolution and training of an adequate workforce of clinically ‘savvy’ IT specialists to guide and manage the much increased level of activity.

5. Grasping some high impact ‘low hanging fruit’ in terms of projects that can make a real patient difference. (Consumer and clinical information portals and the like for example).

Only once these projects are well advanced, and the skills and governance in place, should consultation and development of a shared electronic health record be considered. At present the present proposals from Government very much put the ‘cart before the horse’ and in my view will have the effect, in failing to deliver a reasonable outcome, of severely impairing the chances of the Australian population receiving the benefits of technology implementation that has so improved other sectors of our economy and improved the overall quality of life for so many citizens. There is no doubt e-Health has a lot to offer but it needs to be delivered in a planned, considered, careful and consultative way. This is presently not what is happening in Australia.

-----

David.

Thursday, June 02, 2011

This Is A Trend That Just Seems to Be Getting Bigger - Mobile Point of Care Information.

The following article popped up a few days ago.

Health care goes unwired

  • Article by: BRIDGET CAREY , McClatchy Newspapers
  • Updated: May 25, 2011 - 8:59 AM

MIAMI - When Dr. Jose Soler got a late-night call about a critically ill patient, he grabbed his iPad and checked the results of the electrocardiogram test that just had been administered. Thanks to an app that zooms within half a millimeter of every heartbeat rhythm variation, Soler made a diagnosis within two minutes.

Before the Northwest Medical Center cardiologist began using the AirStrip Cardiology mobile application, he had to wait for a nurse to fax him a printout or log into a computer to load the data in PDF format, which was often hard to read.

"Having the ability to get that information on your iPhone to make a quick decision versus looking for a fax machine -- it just changed the paradigm," Soler said.

Soler is among 40 cardiologists at HCA East Florida Hospitals who are the world's first physicians to incorporate the EKG-reading app into their practices. Doctors at three HCA hospitals began using it recently on their personal iPads and iPhones.

Increasingly, doctors are using mobile apps to access patient information. Hard data is scarce. For instance, the annual market for mobile monitoring devices is estimated to be a $7.7 billion to $43 billion industry, as cited by a PricewaterhouseCoopers report, "Healthcare Unwired," released in September 2010.

But the trend is clear.

"This level of adoption is unprecedented. Things are changing very quickly," said health care innovation analyst Chris Wasden of PricewaterhouseCoopers.

10,000 health care apps

According to a Manhattan Research study released this month, 75 percent of U.S. physicians own some form of Apple mobile device, whether it's an iPad, iPhone or iPod. The iPhone is the top smartphone choice for doctors, according to the study. About 30 percent have an iPad, and another 28 percent say they plan to buy one within six months.

Apple's popularity, says the study, is largely driven by the increasing number of apps providing access to electronic medical records.

In the past, the health care industry was often behind the curve when it came to work-management technology, he said. But now, hospital staff can't keep up with physicians' demands for patient data access via mobile devices.

"Mobile health technology is the first information technology that improves their workflow to allow them to practice medicine in a different way," Wasden said.

Lots more here:

http://www.startribune.com/lifestyle/wellness/122530824.html

Really all that can be said is as the ubiquity of 3 and 4G wireless networks improves we are going to see increasing use of mobile data access devices to connect to all sorts of clinical applications. I suspect over time this will transform the way much clinical work actually gets undertaken.

An exciting time indeed!

David.

This Is Really An Interesting and Difficult To Address Issue. Information Overload Versus Missing Something Really Important.

This interesting article appeared a few days ago.

IT could aid problem of growing drug side effects lists

May 24, 2011 | Healthcare IT News Staff

INDIANAPOLIS – The lists of potential side effects that accompany prescription drugs have ballooned in size, but thanks to computer software designed to monitor side effects on drug labels, physicians may be able to better identify which medications would be best for their patients.

The average list of drug side effects on a label is 70 reactions per drug, a number that can overwhelm physicians trying to select suitable treatments for their patients, according to a new study of drug labels.

Long lists of drug side effects—whether found in magazine advertisements or in package inserts—are a familiar sight to patients and doctors. Now researchers from the Regenstrief Institute and the Indiana University School of Medicine have quantified just how complex drug labels have become.

In the study, appearing in the May 23, 2011, issue of the Archives of Internal Medicine, the researchers found that the average label contains 70 different side effects, with more commonly prescribed drugs averaging around 100 side effects. The upper range was remarkably high, with a single label containing as many as 525 reactions. The study involved analysis of more than 5,600 drug labels and more than half a million labeled effects.

"Having a high number of side effects on a drug's label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits," said lead author Jon Duke, MD, Regenstrief Institute investigator and assistant professor of medicine at the IU School of Medicine.

"But having all these labeled side effects can overwhelm doctors who must weigh the risks and benefits when prescribing a medication. The Food and Drug Administration has taken steps to discourage such 'overwarning,' but at present information overload is the rule rather than the exception," Duke said.

.....

The study, "A Quantitative Analysis of Adverse Events and 'Overwarning' in Drug Labeling" was co-authored by Dr. Duke, Dr. Friedlin and Patrick Ryan, M.Eng. of the University of North Carolina. The work was conducted with support from the Regenstrief Institute and the National Library of Medicine.

Lots more here:

http://healthcareitnews.com/news/it-could-aid-problem-growing-drug-side-effect-lists

I am not sure anyone really has the answer to this - and there is no doubt that as the number of medications grows management of ‘what goes with what’ and more important what does not mix is getting beyond the human brain to manage and needs to be helped by really smart decision support!

Clever ideas welcome.

David.

Wednesday, June 01, 2011

The Australian Medical Association Wants Nothing to Do With the PCEHR as Presently Proposed By NEHTA. Time For Plan B!

The following appeared today.

PCEHR an expensive legal trap: AMA

The AMA has spoken out against proposals for the Personally Controlled Electronic Health Record System saying it will create “medicolegal risks” and a financial burden for doctors.

In its submission to the Department of Health on the draft concepts of the introduction of the PCEHR, (see link) the AMA says the proposals have “fundamental flaws” and its complex design could see medical practitioners unable to access or contribute to it.

The doctors’ group insists the flaws are a consequence of the decision to make the record system opt-in rather than opt-out, which will lead to doctors not able to find a record for some of their patients, which could eventually see them giving up on the system altogether.

It says giving patients the option of several access settings will mean doctors may not be able to access important information.

Meanwhile the doctor’s obligation to discuss the system’s clinical risks with their patients will create a “medicolegal minefield”.

More here:

http://www.6minutes.com.au/news/pcehr-an-expensive-legal-trap--ama

Here is the summary of the AMA Submission:

AMA Submission to the Department of Health and Ageing on the Draft Concept of Operations Relating to the introduction of a Personally Controlled Electronic Health Record System

The AMA submission on the proposed PCEHR expresses concerns that the proposed form of the PCEHR will provide only limited safety benefits and these are significantly outweighed by its inherent clinical and medico-legal risks for medical practitioners and the administrative burden it will impose on medical practices.

The AMA submission advocates for:

  • a shared electronic medical record (that sits within a personally-controlled electronic health record) that contains reliable and relevant medical information about individuals that has been posted by medical practitioners;
  • health consumer participation in the PCEHR to be opt-out. An opt-in system will mean that doctors eventually give up looking for PCEHRs after failing to find them for other patients; and
  • system protocols that align with clinical workflows and integrate with existing medical practice.

The submission highlights that the proposed PCEHR:

  • will be extremely complex to use because it is built around exceptions to clinician access and input to the record;
  • allows health care providers who are not medical practitioners to upload information;
  • allows patients to hide key pieces of medical information, thus compromising its usefulness to medical practitioners;
  • creates significant exposure to medico-legal liability for participating medical practitioners;
  • must not impose penalties on medical practitioners if they do not use the PCEHR; and
  • imposes significant administrative and financial burdens on participating medical practitioners and practices.

The submission concludes that the cumulative effect of these points will mean that medical practitioners are unlikely to use the PCEHR in the form proposed.

The full submission is linked to from this page:

http://ama.com.au/node/6777

To me this spells the end of the present incarnation of the PCEHR. The AMA is clearly not happy Joyce and unless they are on board no amount of change management will be enough!

No substantial change in the Health System has ever succeeded without at least tacit support from the AMA and their Submission is a long way from that!

They have been saying they are not happy for quite a while as has been mentioned on the blog.

See here:

http://aushealthit.blogspot.com/2011/05/final-version-as-submitted-to-doha-of.html

(Point 8 of the body of the Submission).

I can see it all now - Ms Roxon and Ms Halton blaming the AMA for blocking their brilliant proposal when in actuality they are actually saving them from themselves.

Time for the ‘big rethink’! That the AMA is not ‘pre lined up’ only shows how incompetent NEHTA and the e-Health Group at DoHA actually are.

David.

Extension of Deadline for Submissions On Draft PCEHR Concept of Operations. You Have A Week!

The following e-mail just arrived from ehealthsystems@health.gov.au.

“With over 4,000 downloads to date, a wide range of stakeholders have been providing feedback on the Draft Concept of Operations - Relating to the introduction of a PCEHR system.

Due to the high level of interest in this document—a key building block in creating an e-health system for Australia’s future—the consultation period has been extended for another week.

Submissions will now be accepted until midnight on Tuesday, 7 June 2011.

To make a submission, go to www.yourhealth.gov.au. The Draft Concept of Operations document can be found under "Consultations".

----- End E-Mail.

So if you have a burning need to say something about the document you have a few more days.

David.