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, August 06, 2011

Weekly Overseas Health IT Links - 06 August, 2011.

Here are a few I have come across this week.

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

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http://www.fierceemr.com/story/emr-data-determines-statin-use-doesnt-lead-cancer/2011-07-28

EMR data determines statin use doesn't lead to cancer

July 28, 2011 — 10:11am ET | By Janice Simmons

The use of statins, a popular drug class in the U.S. prescribed for such conditions as atherosclerosis and various cardiovascular events, did not appear to increase the risk of cancer among patients, according to a retrospective study appearing this week in the Journal of the American College of Cardiology that reviewed more than 11 million electronic medical records (EMRs).

To study any link between cancer and statin use, Claudio Marelli--of Cincinnati-based S2 Statistical Solutions--and colleagues conducted an analysis using records from January 1990 through February 2009, courtesy of GE Healthcare's Centricity EMR database. Clinical information for more than 30 million patients throughout the U.S. can be found in the database.

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http://www.fierceemr.com/story/expanding-registry-universe-one-emr-time/2011-07-27

Expanding the registry universe--one EMR at a time

July 27, 2011 — 6:31pm ET | By Janice Simmons

A new report out this week from the Institute of Medicine on surveillance of chronic conditions notes that registries can be useful for obtaining information about individuals with particular diseases or conditions. However, there's a hitch: the registry data often just reflects a portion of the population--say, with lung or cardiovascular disease or even diabetes--who receive specific treatment and who are entered into the registry.

So, what about everybody else? How about those patients who had one abnormal lab result, or who failed to continue with a treatment? Recent research from the Massachusetts eHealth Collaborative shows that there might be a better way to expand the scope of registries--while improving quality of care--thanks to electronic medical records (EMRs).

The work of the collaborative, a four-year $50 million health information technology program--and how it installed EMRs and initiated workflow redesign--is profiled this month in Health Affairs. What was found was that its provider users of EMRs were far more likely to produce various registries than the less enthusiastic EMR users.

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http://www.fiercehealthit.com/story/disease-surveillance-needs-include-ehrs-social-media-iom-says/2011-07-25

Disease surveillance needs to include EHRs, social media, IOM says

July 25, 2011 — 3:50pm ET | By Ken Terry

The Institute of Medicine (IOM) has proposed that the federal government take the lead in organizing a national surveillance system to track trends in chronic health conditions, focusing primarily on cardiovascular and lung diseases. The aim is to provide public health authorities and policymakers at the federal, state and local levels with a fuller understanding of the continuum of disease prevention, progression, treatment and outcomes.

A number of surveillance systems already exist for these health conditions. But the IOM report points out that the growth in the use of electronic health records and consumer trends provides new opportunities for strengthening disease surveillance.

"Expanding the use of EHRs in surveillance will have challenges, including the relatively low numbers of hospitals and practices now using the technology," an IOM report brief notes. "But use of EHRs is expected to expand as healthcare reforms advance, necessitating their inclusion when planning for a national surveillance system."

.....

To learn more:

- read the IOM report brief (.pdf)
- see this
post on The Hill's Healthwatch blog

- read the AHA's press release

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Hospitals Boost IT Spending Plans

The prospect of Meaningful Use dollars has spurred healthcare providers to spend more in tough economic times, according to a HIMSS Analytics report.

By Neil Versel, InformationWeek

July 28, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231002861

The federal incentive program for Meaningful Use of electronic health records seems to be having its desired early effect by spurring healthcare organizations to adopt more than just basic EHRs, according to a new study. And many hospitals are making plans to spend more on other forms of IT in the next few years, suggesting that EHRs are becoming integral to the overall organizational strategy.

"In hindsight, 2010 proved to be the year organizations ramped up their approach to meet the first stage of the [Meaningful Use] criteria," reads the report, "Essentials of the U.S. Hospital IT Market, 6th Edition," a publication of HIMSS Analytics. In its survey of hospitals and integrated delivery networks nationwide, the research arm of the Healthcare Information and Management Systems Society (HIMSS) found that spending on revenue cycle management (RCM), enterprise data warehousing, and associated areas such as business intelligence will continue growing for at least the next five years.

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http://govhealthit.com/news/ama-and-91-groups-call-cms-alter-e-prescribing-penalties

AMA and 91 groups call on CMS to alter e-prescribing penalties

July 26, 2011 | Molly Merrill, Contributing Editor

The American Medical Association and 91 state and specialty medical societies have submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) expressing concern over the proposed changes to the electronic prescribing penalty program.

“The AMA has continually advocated for changes to the e-prescribing program to ensure it’s fair for all physicians and that as many physicians as possible are able to successfully participate,” said AMA immediate past president Cecil B. Wilson, MD. “While we appreciate the modifications CMS presented in the proposed rule, they don’t go far enough. More changes are needed, including establishing an additional reporting period in 2012 and not applying penalties until 2013.”

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http://www.modernhealthcare.com/article/20110727/NEWS/307279986/

Incentives boost hospital IT budgets: HIMSS

By Joseph Conn

Posted: July 27, 2011 - 12:30 pm ET

Hospital budgets for information technology are on the rebound after a hard knock from the recession, according to a new health IT market report from HIMSS Analytics, the market-research arm of the Chicago-based Healthcare Information and Management Systems Society.

The report, the sixth edition of "Essentials of the U.S. Hospital IT Market," is based on HIMSS Analytics database information on 5,200 hospitals and 32,000 medical facilities in the U.S., including 24,000 ambulatory-care sites.

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http://www.govhealthit.com/news/panel-advances-standards-clinical-quality-hospital-discharge-meds

Panel advances standards for clinical quality, hospital discharge meds

July 21, 2011 | Mary Mosquera

The Health IT Standards Committee has been wrestling this summer with identifying standards for electronic prescribing of medications at hospital discharge, vocabulary for clinical quality coordination, and others to support stage 2 of meaningful use.

The challenge is to come up with technical approaches that are simple yet specific enough for healthcare providers to adopt and vendors to incorporate as part of certification of their electronic health records (EHRs), according to standards committee members at its meeting July 20.

Standards provide the common technical methods that can be installed in EHRs to support functions that improve care and help physicians and hospitals meet meaningful use.

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http://online.wsj.com/article/BT-CO-20110728-726768.html

  • JULY 28, 2011, 4:45 P.M. ET

Cerner 2Q Profit Leaps 30% As Bookings, Backlog Climb

DOW JONES NEWSWIRES

Cerner Corp.'s (CERN) second-quarter profit jumped 30% on a double-digit pop on its top line and a surge in bookings.

The health care information-technology company again lifted its current-year forecast, calling for $1.80 to $1.83 a share on $2.09 billion to $2.12 billion in revenue. For the current quarter, Cerner sees earnings of 46 cents to 48 cents on $520 million to $540 million in revenue, bracketing the 47 cents and $528 million expected by analysts polled by Thomson Reuters.

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http://www.healthcareitnews.com/blog/use-phrs-remains-weak

Use of PHRs remains weak

July 26, 2011 | Jeff Rowe, Editor, HITECH Watch

While the HITECH incentives are intended to move the country toward comprehensive use of EHRs, many HIT proponents have been banking on patient demand for access to their records as the real key to pushing providers forward.

The problem, however, is that if the use of Personal Health Records (PHRs) is taken as a good indication of growing patient interest, that demand is still barely registering.

This observer points to a recent report from CSC that claims "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.”

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http://healthcareitnews.com/news/top-5-worst-emr-myths

Top 5 worst EMR myths

July 26, 2011 | Molly Merrill, Associate Editor

SAN FRANCISCO – Rumors about electronic medical records continue to persist, but one vendor is trying to separate the myths from the facts.

Practice Fusion, a San Francisco-based EMR developer has identified the top five worst EMR myths:

  1. EMRs are bad for “bedside manner." Does a computer ruin the interaction between patients and doctors? The opposite is true, according to a 2010 Government Accountability Office report. The study found that EMRs help doctors have more information about the patient and contribute to better communication. A good EMR allows a doctor to spend more time with a patient and less with paperwork. Plus, patients can get real-time access to their own health records online through the doctor's EMR system.

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http://www.mcall.com/business/ct-biz-0726-bf-health-startups-20110726,0,1256685.story

Web startups aim to give consumers more control over their health

Mobile, social technology employed, bringing digital know-how to bear on age-old problems

By Peter Delevett, McClatchy/Tribune news

July 26, 2011

SAN JOSE, Calif.

— When new mom Leah Dillon needed advice for her son's first fever, she wondered where to turn. Recently arrived in Palo Alto, Calif., she couldn't ask neighbors for guidance and wasn't sure if she should page her son's pediatrician in the dead of night.

So Dillon went to a website called HealthTap, unveiled this spring by a Silicon Valley startup. An interactive Q&A database walked her through a set of recommendations — from doctors, not just anybody with an opinion and a keyboard.

"The Internet is so vast, you don't know where you're getting your information from," she said. "It gives me more confidence if it's backed by pediatricians."

The birth of a child also set Robert Auguste looking for technological help, but for spending, not symptoms.

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http://www.healthcareitnews.com/blog/educated-providers-will-be-publics-best-teachers

Educated providers will be the public's best teachers

July 29, 2011 | Jeff Rowe, Editor, HITECH Watch

A recent survey from Xerox Corp. shows the general public is still very much in the dark when it comes to EHRs.

But while one obvious and necessary response to the findings would be to ramp up public education efforts, policymakers should remember that providers, who are the main point of contact between patients and their records, still need to be educated, too.

Not surprisingly, the survey found that there’s still considerable anxiety among the public about the use of EHRs, with “nearly 80 percent . . . indicat(ing) stolen personal information by a computer hacker to be their number one worry, followed by the threat of lost, damaged or corrupted records at 64 percent and the misuse of information at 62 percent.”

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http://www.healthdatamanagement.com/news/accounting-for-disclosures-hipaa-privacy-42865-1.html

MGMA to HHS: Pull the Disclosures Rule

Joseph Goedert

HDM Breaking News, July 27, 2011

Following a survey of about 1,340 members, the Medical Group Management Association is calling on the HHS Office for Civil Rights to withdraw its proposed rule governing the accounting of disclosures of protected health information.

The association contends the rule is overly burdensome and unworkable, and asks that HHS engage group practices and other stakeholders to develop a consensus-driven solution. "If enacted as proposed, the rule would require medical practices that maintain electronic patient information to have the capability to product a detailed report of every instance a patient's information was accessed by any staff member for any reason, including submitting claims for payment," according to an MGMA statement.

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http://www.ehi.co.uk/news/EHI/7058/mps-blast-government-it-failures

MPs blast government IT failures

28 July 2011 Lyn Whitfield

The Commons’ public administration committee has concluded that the government’s lack of IT skills and over-reliance on an “oligopoly” of large contractors is a “recipe for rip-offs.”

In a report that echoes the findings of successive spending watchdog investigations into government IT, the committee says that the “overall record of developing and implementing new IT systems is appalling” despite an “obscene” amount of public spending.

Although it did not take evidence from the Department of Health, the committee’s verdict that “IT procurement has too often resulted in late, over budget IT systems that are not fit for purpose” sounds very like the latest National Audit Office verdict on the National Programme for IT in the NHS.

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http://healthcareitnews.com/survey-analysis-telemedicine-crucial-part-health-it

Survey analysis: Telemedicine crucial part of health IT

July 25, 2011 | Jamie Thompson, Web Editor

Telemedicine solutions are widespread and varied – but how much of a presence do they have in hospitals’ health IT systems? Healthcare IT News recently surveyed its readers about the role of telemedicine at their organizations.

An overwhelming 79 percent of respondents said that telemedicine is an important part of their health IT infrastructure.

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http://www.itworld.com/it-managementstrategy/186827/e-health-records-still-scare-most-us

E-health records still scare most of us

Healthcare industry needs to put more time into consumer education, survey shows

By Lucas Mearian, Computerworld

July 26, 2011, 3:24 PMNearly 80% of consumers surveyed earlier this year said they're concerned about electronic health records (EHRs) because their personal information might be stolen by hackers or lost.

The online survey, conducted by Harris Interactive for Xerox Corp. in February and released last week, included 2,720 U.S. adults, the majority of whom felt that their personal information could be misused if kept in an EHR.

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http://www.ehi.co.uk/news/EHI/7054/six-more-systems-join-wales%27-etp-project

Six more systems join Wales' ETP project

27 July 2011 Fiona Barr

Six community pharmacy systems have been given roll-out approval for Wales’ electronic transfer of prescriptions project, which is due to be fully rolled-out by the end of the year.

Cegedim’s Pharmacy Manager system was the first to receive roll-out approval in April.

Last month, Cegedim’s Nexphase software, Rx Systems’ ProScript software and software from Positive Systems and AAH received their authority to deploy the 2DRx service.

The 2DRx functionality enables pharmacists to scan 2D barcoded prescriptions, and should be fully rolled-out by the end of the year, according to the NHS Wales Informatics Service.

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http://www.healthleadersmedia.com/content/TEC-269019/ICD10-Is-Gonna-Cost-Me-How-Much.html

ICD-10 Is Gonna Cost Me How Much?

Gienna Shaw, for HealthLeaders Media , July 26, 2011

Last February I asked every CIO I could corner at the annual Healthcare Information and Management Systems Society meeting what his or her organization was doing to prepare for ICD-10.

I got a lot of blank stares.

Sure, the deadline for the massive coding switch-over isn't until in October 2013. But I got the sense that even if folks weren't quite ready to brag about their progress preparing for ICD-10, they were at least starting to think about it with greater urgency.

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http://govhealthit.com/news/cchit-dont-buy-new-ehr-just-yet

CCHIT: Don't buy a new EHR just yet

July 25, 2011 | Diana Manos, Healthcare IT News

Healthcare systems running on legacy software, customized commercial products or homegrown EHR systems that would cost hundreds of millions to replace can breath a sigh of relief, according to CCHIT.

That's because the Certification Commission for Health Information Technology claims that some healthcare organizations, particularly teaching hospitals, have discovered that certifying their own system through a special CCHIT program is the best alternative.

CCHIT announced last week that five new organizations joined Beth Israel Deaconess Medical Center in certifying complete or modular EHRs under its EHR Alternative Certification for Healthcare Providers, or EACH, an ONC-ATCB 2011/2012 certification program for already-installed EHR technology. They are: Health Management Associates, New York University Langone Medical Center, Northwestern University, Tenet Healthsystem Medical and the University of North Carolina Health Care.

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http://www.ehi.co.uk/news/EHI/7037/fda-on-verge-of-regulating-medical-apps

FDA on verge of regulating medical apps

19 July 2011 Shanna Crispin

The American Food and Drug Administration has released guidelines on how it plans to regulate mobile medical apps.

The draft guidance outlines the small number of mobile apps the agency plans to oversee; saying they are “medical apps that could present a risk to patients if the apps don’t work as intended.”

It proposes that manufacturers should classify their applications, annually register with the FDA, and list the apps being produced.

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http://www.healthcareitnews.com/news/survey-finds-trepidation-uncertainty-about-ehrs

Survey finds trepidation, uncertainty about EHRs

July 22, 2011 | Mike Miliard, Managing Edito

ROCHESTER, NY – A new survey from Xerox Corporation shows that more needs to be done to convince patients that their personal health information is secure in electronic health records.

Of the poll's 2,720 respondents, nearly 80 percent of those who have concerns about digital medical records indicated stolen personal information to be their chief concern, followed by the threat of lost, damaged or corrupted records (64 percent) and the misuse of information (62 percent).

“The survey results indicate an urgent need for better patient-provider communication,” said Paul Solverson, partner, strategic advisory services at ACS, a Xerox Company. “Providers need to start conveying the benefits of electronic records, particularly the security advantages over today’s paper-based system.”

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http://govhealthit.com/news/cms-partners-move-beyond-pay-and-chase-anti-fraud-efforts

CMS partners to move beyond 'pay and chase' anti-fraud efforts

July 21, 2011 | Mike Miliard, Contributing Editor

The Centers for Medicare and Medicaid Services revealed intentions to tap predictive modeling to root out Medicare fraud last month, and now has announced the technology and vendors that will make that happen.

Verizon, alongside Northrop Grumman and WellPoint subsidiary National Government Services, has helped develop a technology for the Centers for Medicare & Medicaid Services that improves detection and prevention of fraud and waste.

The new platform incorporates predictive modeling technology from Verizon to transform the way Medicare fraud is detected, and officials say it will provide CMS with a scalable and automated solution that scrutinizes incoming Medicare program claims, routing those that may be fraudulent to case managers for investigation.

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How Health IT-Related Errors Hurt Patient Safety

New analysis explains how the occasional glitches with EHRs and related systems can get out of hand.

By Ken Terry, InformationWeek

July 26, 2011

URL: http://www.informationweek.com/news/healthcare/patient/231002617

As an Institute of Medicine (IOM) committee considers how medical errors related to health IT affect patient safety, a new analysis published in the Archives of Internal Medicine defines these errors, breaks down their "sociotechnical" sources, and suggests some fixes.

"These errors, or the decisions that result from them, significantly increase the risks of adverse events and patient harm," write Dean Sittig and Hardeep Singh in the Archives article. The reason, they explain, is that "there are often latent errors that occur at the 'blunt end' of the health care system, potentially affecting large numbers of patients if not corrected."

In an interview with InformationWeek Healthcare, Sittig, a professor at the University of Texas Health Sciences Center in Houston, explained that problems in a health information system are usually caught fairly soon. But, because they may affect an entire hospital or a multi-hospital system, they can cause a lot of harm in a short time, he said.

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http://www.fiercehealthit.com/story/tennessee-rhio-proving-unsustainable-without-federal-funds/2011-07-19

Public HIE proving unsustainable without federal funds

July 19, 2011 — 3:31pm ET | By Ken Terry

On the heels of our story last week about a lack of sustainable health information exchanges comes word that a Tennessee regional health information organization may have to close its doors due to (gasp!) a sub par business model.

CareSpark, the Kingsport, Tenn.-based RHIO, could shut down, primarily due to an inability to function on its own. After six years, the system--which holds records for 1.28 million patients--failed to come up with a viable plan to stay afloat, causing the Health Information Partnership of Tennessee (HIP TN) to pull federal funding this past March, reports Healthcare IT News. The tale is a cautionary one for publicly funded HIEs, which have been under much scrutiny of late, especially compared to their private brethren.

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http://www.modernhealthcare.com/article/20110725/BLOGS02/307259999/

By Joseph Conn

Mercury falling

The state of hyperfluidity in the deficit-reduction/debt-ceiling discussions in Washington last week could be likened to pouring mercury down a bobsled run—lots of high speed twists and turns, frequent scatterings and gatherings, and who knows what will wind up at the end.

On July 13, when Dave Roberts, vice president of government relations for the Healthcare Information and Management Systems Society, made his annual "Report from the Hill" presentation at the Physician-Commuter Connection symposium in Ojai, Calif., hosted by the Association of Medical Directors of Information Systems, he expressed confidence that the tens of billions of dollars authorized for the federal health information technology incentive payment programs were not really in play with the D.C. deficit hawks.

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http://www.modernhealthcare.com/article/20110722/NEWS/307229957/

Halamka to leave Harvard Medical CIO post

By Joseph Conn

Posted: July 22, 2011 - 5:00 pm ET

Even for the peripatetic, prolific and almost always wakeful and black-clad Dr. John Halamka, there are limits to what one person can do.

Halamka, an emergency-medicine specialist who serves as chief information officer at both Harvard Medical School and Beth Israel Deaconess Medical Center, as well as a member of several federal health information technology advisory panels, has announced he will step down from the Harvard CIO post when a successor can be found.

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http://geekdoctor.blogspot.com/2011/07/preparing-for-future-of-it-at-hms.html

Thursday, July 21, 2011

Preparing for the Future of IT at HMS

Every day I examine my life and think about the roles I serve. I consider all the unresolved issues in my professional and personal life, then ponder the processes needed to address them.

I think about the next week, the next month, and the next year. Hopefully, I'll be able to skate where the puck will be.

As I approach 50, I've become particularly introspective about the challenges in healthcare and medicine that lay ahead.

I believe that Accountable Care Organizations, Patient Centered Medical Homes, and the Partnership for Patients/CMS Center for Innovation will create exponential growth in healthcare IT requirements.

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http://www.ihealthbeat.org/features/2011/google-healths-demise-shows-limitations-of-phr-market.aspx

Monday, July 25, 2011

Google Health's Demise Shows Limitations of PHR Market

Since the early 2000s, personal health records have been touted as a way to improve care coordination and empower patients. Despite the buzz around PHRs, adoption rates have remained relatively low. A 2010 survey from the California HealthCare Foundation found that only 7% of U.S. residents are using a PHR. CHCF publishes iHealthBeat.

Google's announcement last month that it will discontinue its PHR platform, Google Health, on Jan. 1, 2012, has put a new spotlight on the PHR market. In a blog post explaining its decision, the company said that Google Health -- which it launched in 2008 -- "is not having the broad impact that we hoped it would."

The departure by such a major company from the PHR market has raised some concerns about the future of similar PHR platforms. However, experts in the field say that the demise of Google Health will not have much of an effect on the market.

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http://www.fiercehealthit.com/story/home-health-devices-mobile-apps-need-be-connected-providers/2011-07-24

Home health devices, mobile apps need to be connected to providers

July 24, 2011 — 9:27pm ET | By Ken Terry

Home healthcare, an essential ingredient of post-acute care, can help people recover from injury or illness faster, which ultimately can prevent relapses that leads to an emergency room visit or hospital readmissions. Increasingly, home devices are being used to monitor the health status and vital signs of patients; at the same time, there also has been an explosion of mobile apps that can work with such devices, smartphones, and/or tablets to aid consumers in managing their own health. Both of these developments hold promise for improving post-acute and chronic care.

Unfortunately, the guidance from the U.S. Food and Drug Administration on mobile apps and the report from the National Research Council on flaws in home health devices--both released last week--failed to address one of the main problems in health IT for home use: a general lack of connectedness between home and provider information systems. To really apply the new technologies in ways that will prevent readmissions, doctors must be online with their patients and their caregivers, and must receive relevant data from both in a way that's easy to use.

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http://consumer.healthday.com/Article.asp?AID=655095

Women, Whites Most Likely to Seek Health Info Online: Survey

Education, job, income and insurance status also played role in Internet use for this purpose

THURSDAY, July 21 (HealthDay News) -- A new U.S. survey finds that women are more likely than men to use the Internet for medical information, and whites are more likely to do so than minorities.

According to the findings released Thursday by the U.S. National Center for Health Statistics, whites aged 18 to 64 were almost twice as likely as Hispanics to search for health information online.

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Enjoy!

David.

Friday, August 05, 2011

This Has to Mean A Trend is Really On! It Seems Mobility Can Do Almost Anything.

First we had this report.

iPad EHR gains meaningful use certification

July 29, 2011 | Mike Miliard, Managing Editor

MOUNTAIN VIEW, CA – drchrono, which offers a free electronic health record platform on the iPad, has received ONC-ACTB certification, allowing doctors to receive up to $44,000 in incentives for using the app. Officials tout drchrono as the first iPad-native EHR to be certified for meaningful use.

“This certification transforms our EHR app and the iPad into a potentially affordable platform that could finally drive global usage and adoption of electronic medical records,” said Michael Nusimow, cofounder and CEO of drchrono. “The government subsidy offered to physicians who adopt our free EHR solution could be transformational in bringing electronic record keeping into every medical practice.”

The drchrono EHR platform has been awarded ambulatory certification (ONC-ATCB) as a Complete EHR by San Luis Obispo, Calif.-based InfoGard, an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB).

Company execs say the EHR app offers a complete solution to run a physician’s practice on the iPad. Eligible medical providers will receive up to $44,000 in government incentives for downloading drchrono and using it to meet the government’s meaningful use requirements. The drchrono application tracks how much a doctor uses the EHR and automatically gives them key metrics to report to the government in order to get their incentive money for 2011.

Features in the drchrono iPad app include:

  • Real time clinical speech-to-text on the iPad
  • Custom workflows and the ability to integrate photos and videos into a patient chart
  • Integrated electronic medical billing
  • Electronic prescribing to send prescriptions to any pharmacy in the U.S.
  • A streamlined user interface that allow doctors to complete their clinical notes before the patient leaves the exam room

More here

http://www.healthcareitnews.com/news/ipad-ehr-gains-meaningful-use-certification

And then we had this is the same day or two.

Invisible wounds of war: There's an app for that?

When terrifying battlefield memories come rushing back, causing night sweats, flashbacks or a panic attack, some troops and vets now find comfort by reaching for their smartphones.

Using new-age technology to cope with age-old wounds of war, they tap into mobile phone applications, or "apps," designed to help with post-traumatic stress and brain injuries.

"I'm not going to lie -- when this came out, we sort of wanted to slam it," a once skeptical Staff Sgt. Meg Krause said of her group of veteran friends.

"But it surprised us and has been a phenomenal tool," said the 29-year-old reservist and medic, who has had counseling for post-traumatic stress disorder.

A half-dozen apps with names like "T2 MoodTracker," "PTSD Coach" and "Breathe2Relax" have been developed by the Pentagon and Veterans Affairs Department, but not to diagnose illness or replace psychiatric counseling. Rather, the apps offer at-your-fingertips information about what the military calls "invisible wounds" of the wars in Iraq and Afghanistan -- and techniques for managing the symptoms.

All but one were the work of the Pentagon, starting with MoodTracker, which lets users rate how they're feeling -- worthless, happy, lonely and so on -- and keep a record of their ups and downs over time.

The newest, released in May, was a joint Pentagon-VA effort -- PTSD Coach. It helps self-assess symptoms, gives step-by-step instructions in muscle relaxation and breathing, helps users create a phone list of people to call when they need support and helps vets contact the National Suicide Prevention Hotline in an emergency.

"Someone who's struggling ... all they have to do is pull out their smartphone or their iPhone and say, `I can help myself,'" Krause said. "To know that there is something that I can pull out and watch, and it will help me go through my breathing techniques so I don't get to that crisis moment, I think is immensely important."

.....

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Online:

National Center for Telehealth and Technology (T2): http://www.t2health.org

Real Warriors Campaign: http://realwarriors.net

Full article is here:

http://www.businessweek.com/ap/financialnews/D9ONA11G0.htm

It seems to me clear that the mix of a highly useable platform and reasonably easy programmability has turned out to be just a fabulous combination to fill all sorts of e-Health niches.

I suspect the innovation we see on this and the Android platforms will be pretty interesting over the next few years.

David.

Thursday, August 04, 2011

This Is The Sort Of Thing You Can Do When You Have A Developed E-Health Infrastructure.

Two really good examples appeared during the week.

First we had:

Kaiser calls EHR data crucial in genomics project

By Joseph Conn

Posted: July 26, 2011 - 12:30 pm ET

Tags: Electronic Health Records (EHR), Information Technology, Research

Genetics researchers from Kaiser Permanente and the University of California at San Francisco have reached what they describe as a milestone in a two-year research project by genotyping and analyzing the chromosome tips of 100,000 volunteer research subjects.

The genotyping work was funded by a $24.8 million, two-year grant from the National Institutes of Health and conducted by Kaiser Permanente's Research Program on Genes, Environment and Health and by UCSF's Institute for Human Genetics, according to a news release from Kaiser and UCSF.

The Kaiser program focuses on epidemiologic studies of genetic and environmental influences on common health conditions, including asthma, cancer and diabetes. The genetic information was gleaned from saliva swabs taken from Northern California patients with an average age of 65. As part of the project, researchers measured the length of participants' telomeres, described in the release as "tiny units of DNA that bind the ends of chromosomes." Telomeres' length, the release notes, may reflect aging at the cellular level and may be a marker for age-related conditions. Genetic information will now be linked to data gleaned from a participant health survey, each participant's medical records stored in Kaiser's electronic health-record system and state-provided environmental data related to air pollution and water quality as well as "neighborhood characteristics, such as proximity to parks, grocery stores and healthy foods," according to the release.

Kaiser Permanente Northern California's research division founded the genetics-research program in 2005 and began enrolling participants in 2007 with a goal of registering a half-million Kaiser Permanente members by 2014, according to the news release. So far, 188,000 have signed up.

More here:

http://www.modernhealthcare.com/article/20110726/NEWS/307269987/

And then this appeared

EMR data determines statin use doesn't lead to cancer

July 28, 2011 — 10:11am ET | By Janice Simmons

The use of statins, a popular drug class in the U.S. prescribed for such conditions as atherosclerosis and various cardiovascular events, did not appear to increase the risk of cancer among patients, according to a retrospective study appearing this week in the Journal of the American College of Cardiology that reviewed more than 11 million electronic medical records (EMRs).

To study any link between cancer and statin use, Claudio Marelli--of Cincinnati-based S2 Statistical Solutions--and colleagues conducted an analysis using records from January 1990 through February 2009, courtesy of GE Healthcare's Centricity EMR database. Clinical information for more than 30 million patients throughout the U.S. can be found in the database.

.....

Overall, the EMR database analysis of more than 91,000 U.S. adults demonstrated "no statistically significant increased risk of cancer associated with statins," the authors concluded.

For more information:
- check out the Journal of the American College of Cardiology
study

- read the MedPage Today article

- see the Cardiovascular Business article

More here:

http://www.fierceemr.com/story/emr-data-determines-statin-use-doesnt-lead-cancer/2011-07-28

Just as EMRs were very useful in identifying the issues with Vioxx and heart disease it seems that similar work combining records from many patients is continually adding to knowledge.

Of course similar work is going on with EMIS in the UK and we also now have the use of Google and Twitter in monitoring the spread of infectious diseases.

To date it does not appear the GPs in Australia have found themselves contributing to such initiatives in large numbers, although some efforts of this type have been undertaken by Medical Director over the years. Let me know if you know of similar initiatives here in OZ!

See here:

http://www.racgp.org.au/ehealth

Here is the page on the GP Research Network.

http://www.hcn.com.au/Products/GPRN

Used well this may be a useful initiative but I am not sure I like the idea of information being used to target improved sales efforts from drug reps!

David.

Wednesday, August 03, 2011

This Is Looking Like A Very Sad Story Indeed. Are We Learning Enough From What Has Happened?

The following appeared yesterday.

NHS pulls the plug on its £11bn IT system

After nine years and with billions already spent, doomed computer system is abandoned

By Oliver Wright, Whitehall Editor
Wednesday, 3 August 2011

A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills. Ministers are expected to announce next month that they are scrapping a central part of the much-delayed and hugely controversial 10-year National Programme for IT.

Instead, local health trusts and hospitals will be allowed to develop or buy individual computer systems to suit their needs – with a much smaller central server capable of "interrogating" them to provide centralised information on patient care. News of the Government's plans comes as a damning report from a cross-party committee of MPs concludes that the £11.4bn programme had proved "beyond the capacity of the Department of Health to deliver".

The Commons Public Accounts Committee (PAC) said that, while the intention of creating a centralised database of electronic patient records was a "worthwhile aim", a huge amount of money had been wasted.

"The department has been unable to demonstrate what benefits have been delivered from the £2.7bn spent on the project so far," Margaret Hodge, chair of the PAC, said. "It should now urgently review whether it is worth continuing with the remaining elements of the care-records system. The £4.3bn which the department expects to spend might be better used to buy systems that are proven to work, that are good value for money and which deliver demonstrable benefits to the NHS." A further £4.4bn was expected to be spent on other areas of the vast IT project.

The nine-year-old NHS computer project – the biggest civilian IT scheme ever attempted – has been in disarray since it missed its first deadlines in 2007. The project has been beset by changing specifications, technical challenges and clashes with suppliers, which has left it years behind schedule and way over cost.

Accenture, the largest contractor involved, walked out on contracts worth £2bn in 2006, writing off hundreds of millions of pounds in the process. Months earlier, the US supplier IDX, contracted to provide software in and around London, had also withdrawn from the project, making a $450m (£275m) provision against future losses from the two contracts.

The PAC said part of the problem had been weak leadership in the department. "The department could have avoided some of the pitfalls and waste if they had consulted at the start of the process with health professionals," it said.

Heaps more here:

http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html

NHS should consider abandoning £7bn IT project

The Department of Health should consider abandoning a disastrous £7billion project to computerise all patients’ medical records, according to a powerful group of MPs.

6:15AM BST 03 Aug 2011

The Public Accounts Committee says that although £2.7bn of taxpayers’ money has already gone on the scheme, it is unclear what the benefits have been and so ministers should think about whether the rest of the cash could be better spent elsewhere.

Although the intention was to create a single network that would allow NHS staff across England to access any patients’ details, the report says this will not happen now and the country has been left with a “patchwork” of costly and fragmented IT systems whose future is uncertain because of reforms to the health service.

The chief executive of the NHS, Sir David Nicholson, also comes in for criticism for failing to oversee the project properly while civil servants provided “late, inconsistent and contradictory” information to the MPs’ inquiry.

Margaret Hodge, the committee’s chairman, said: “The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable.

“The Department has been unable to demonstrate what benefits have been delivered from the £2.7 billion spent on the project so far.

“It should now urgently review whether it is worth continuing with the remaining elements of the care records system. The £4.3 billion which the Department expects to spend might be better used to buy systems that are proven to work, that are good value for money and which deliver demonstrable benefits to the NHS.”

The integrated electronic care records system is a central part of Labour’s £11bn National Programme for IT in the NHS, which was set up in 2002 and faced repeated criticism since then over its cost and technical problems, most recently from the National Audit Office.

In a report published on Wednesday, the MPs say the intention to allow rapid sharing of patients’ records was “worthwhile” but the Department of Health has been unable to make it work.

They claim that creating a single system was always a “massive risk” especially as clinicians were not asked for suggestions on its operation.

Again a lot more here:

http://www.telegraph.co.uk/health/healthnews/8677275/NHS-should-consider-abandoning-7bn-IT-project.html

There is a lot to carefully digest here, but it seems the warning for what is planned with the PCEHR needs to be very carefully thought trough.

That many of the companies who were involved in what now seems to be a pretty questionable enterprise in the UK are now apparently wanting to be involved in the PCEHR would have to demand, at the very least, some very careful due diligence as to what was done, what was learnt and how things would go better in Australia.

It seems clear that while some of the peripheral work for the UK NHS has gone well that the key failure has indeed been with the Shared EHR.

I wonder just how full the DoHA/NEHTA understanding is of what caused these problems is? Having one or two people join NEHTA who were involved may not be enough. Who can know. Maybe a published review from NEHTA on the ‘lesson learnt’ and the risk mitigation proposed with the PCEHR might be a useful first step to reassure clinicians and consumers.

David.

Some Useful Pointers on Health IT Errors. What Does This Mean For the PCEHR?

A very interesting article on an article in the Archives of Internal Medicine appeared a few days ago.

Researchers propose method for counting health IT errors

By Joseph Conn

Posted: July 25, 2011 - 6:00 pm ET

A pair of Texas informatics researchers has come up with a classification scheme for categorizing—and ultimately counting—errors involving health information technology.

Their proposal is outlined in a four-page article, "Defining Health Information Technology-Related Errors: New Developments Since 'To Err is Human'" that appears in the July 15 issue of the Archives of Internal Medicine. It references the totemic 1999 study on medical errors, "To Err is Human," by the Institute of Medicine.

The authors of the article are Dean Sittig, a professor in biomedical informatics at the University of Texas Health Science Center, Houston; and Dr. Hardeep Singh, an assistant professor of medicine at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, and Baylor College of Medicine. Sittig is an adjunct associate professor at the Baylor College of Medicine and the founding editor of The Informatics Review, the electronic journal of the Association of Medical Directors of Information Systems. Singh also serves as the chief of the health policy and quality program at the Houston VA's Health Services Research and Development Center of Excellence.

Sittig, in a telephone interview, said the idea for the classification scheme came after he testified about IT-related errors before an IOM panel in December. A fellow witness also spoke about medication errors. Afterward, Sittig said he was approached by an IOM person who asked whether a definition existed for EHR errors. "We decided there really wasn't any," Sittig said, which led to their research and this report.

"There are a lot of people who don't seem to understand when their EHR is responsible for something that happens," he said. "This is what we think constitutes an electronic health-record system error. By creating this definition, people can start to realize we have a problem. We're trying to heighten people's awareness of these things so they come to mind when it happens."

First, Sittig and Singh report as established fact that health IT-linked errors are real, citing 19 types of actual errors—many gleaned from their literature search and others from the authors' own knowledge. The error types are listed in a table that also presents a "sociotechnical model" for health IT evaluation and use that provides "an origin-specific typology for HIT errors."

There is more found here:

http://www.modernhealthcare.com/article/20110725/NEWS/307259891/

There is also coverage here:

How Health IT-Related Errors Hurt Patient Safety

New analysis explains how the occasional glitches with EHRs and related systems can get out of hand.

By Ken Terry, InformationWeek

July 26, 2011

URL: http://www.informationweek.com/news/healthcare/patient/231002617

As an Institute of Medicine (IOM) committee considers how medical errors related to health IT affect patient safety, a new analysis published in the Archives of Internal Medicine defines these errors, breaks down their "sociotechnical" sources, and suggests some fixes.

"These errors, or the decisions that result from them, significantly increase the risks of adverse events and patient harm," write Dean Sittig and Hardeep Singh in the Archives article. The reason, they explain, is that "there are often latent errors that occur at the 'blunt end' of the health care system, potentially affecting large numbers of patients if not corrected."

In an interview with InformationWeek Healthcare, Sittig, a professor at the University of Texas Health Sciences Center in Houston, explained that problems in a health information system are usually caught fairly soon. But, because they may affect an entire hospital or a multi-hospital system, they can cause a lot of harm in a short time, he said.

Here is the formal abstract from the Archives

HEALTH CARE REFORM

Defining Health Information Technology–Related Errors

New Developments Since To Err Is Human

Dean F. Sittig, PhD; Hardeep Singh, MD, MPH

Arch Intern Med. 2011;171(14):1281-1284. doi:10.1001/archinternmed.2011.327

Despite the promise of health information technology (HIT), recent literature has revealed possible safety hazards associated with its use. The Office of the National Coordinator for HIT recently sponsored an Institute of Medicine committee to synthesize evidence and experience from the field on how HIT affects patient safety. To lay the groundwork for defining, measuring, and analyzing HIT-related safety hazards, we propose that HIT-related error occurs anytime HIT is unavailable for use, malfunctions during use, is used incorrectly by someone, or when HIT interacts with another system component incorrectly, resulting in data being lost or incorrectly entered, displayed, or transmitted. These errors, or the decisions that result from them, significantly increase the risk of adverse events and patient harm. We describe how a sociotechnical approach can be used to understand the complex origins of HIT errors, which may have roots in rapidly evolving technological, professional, organizational, and policy initiatives.

This can be found here:

http://archinte.ama-assn.org/cgi/content/abstract/171/14/1281

If you have access via an academic library or CIAP the full text is available from this link.

The last paragraph of the conclusion really says it all.

“In conclusion, rapid advances in HIT development, implementation, and regulation have complicated the landscape of HIT-related safety issues. Erroneous or missing data and the decisions based on them increase the risk of an adverse event and unnecessary costs. Because these errors can and frequently do occur after implementation, simply increasing oversight of HIT vendors' development processes will not address all HIT-related errors. Comprehensive efforts to reduce HIT errors must start with clear definitions and an origin-focused understanding of HIT errors that addresses important sociotechnical aspects of HIT use and implementation. To this end, we provide herein a much needed foundation for coordinating safety initiatives of HIT designers, developers, implementers, users, and policy makers, who must continue to work together to achieve a high-reliability HIT work system for safe patient care.”

It seems to me the bar has been dramatically raised on our expectations of what Health IT can deliver and how well designed and delivered it must be.

Those rushing to deliver the PCEHR should understand - they have been warned that doing what they are attempting is a great deal harder than it might initially appear. It also seems likely that pretty much no-one has got it fully right - or even close - just yet!

David.