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, November 26, 2011

Weekly Overseas Health IT Links - 26th November, 2011.

Note: Each link is followed by a title and few paragraphs. 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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Patients Have Security Concerns On Data Sharing

New report by PwC reveals what consumers think about data sharing, privacy and security, online consultations, social media in healthcare, and more.
By Marianne Kolbasuk McGee,  InformationWeek
November 17, 2011
Consumers are concerned about the privacy and security of their health data, but most are comfortable having their health information shared among healthcare providers if doing so would improve their care, according to a new report.
In a recent PwC Health Research Institute online survey of 1,000 consumers, when asked to select the purposes for which they would be comfortable having their health data shared among healthcare organizations, 60% said for improving coordination of their care; 54% said for supporting real-time decisions in their care; 36% said to support analysis of doctors' performance; and 29% said to provide data to identify groups or patients at risk for health issues.
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4 keys to the cost of health IT

November 17, 2011 | Michelle McNickle, Web Content Producer
We know health IT saves money and streamlines workflow, and when used properly, its benefits are widespread and long lasting. But within the past decade or so, the revolution of health IT has also sparked some interesting talk about the cost. 
“First of all, investment firms that normally stayed on the sidelines are going all in," said Lisa Suennen, managing member at Psilos Group and author of the blog Venture Valkyrie. “Three years ago, if you told a roomful of venture capitalists that healthcare IT would boom like the Internet once did, they would have laughed you out of the room. Today they are trying to figure out how to get in on the action.” 
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One-third of nation's primary care providers enrolled in health IT extension centers

November 17, 2011 | Mary Mosquera
Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule.
And 70 percent of all primary care providers in small practices in rural areas around the country are working with the extension centers, and in some states, it’s practically 100 percent, said Dr. Farzad Mostashari, the national health IT coordinator.
Those are among the efforts through which the Office of the National Coordinator for Health IT’s toolbox has established a beachhead, he said at a Nov. 17 summit spotlighting the progress of the extension centers, health information exchange, and beacon or model health IT communities to help to transform health care.
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Don't Regulate EHRs Like Cars

In the interest of patient safety, the Institute of Medicine recommends that health IT be more tightly regulated, much like the auto industry. But are the two industries comparable?
By Paul Cerrato,  InformationWeek
November 16, 2011
It's hard to argue against safety. And in our lawsuit-crazy society, not taking all reasonable measures to keep the public safe is an invitation to bankruptcy. But there are two complicating issues to keep in mind when considering whether to apply an auto industry regulatory approach to medical informatics.
One is the fact that IT systems are a lot like sex. And we all know there's no such thing a safe sex, only safer sex. My point is, there's no completely safe technology, so we have to decide how safe is safe enough, and are we willing to spend the millions of dollars required to reach that level of safety?
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AHIMA, Forbes Sound Off on AMA's ICD-10 Stance

HDM Breaking News, November 17, 2011
Among reaction to the American Medical Association's vow to fight implementation of ICD-10, the American Health Information Management Association and Forbes magazine take decidedly different views.
AHIMA officials expressed disappointment in the AMA's position. CEO Lynne Thomas Gordon said the industry must move its disease classification system toward international standards and align it with the meaningful use program and value-based reimbursement, which requires a more contemporary and detailed coding system.
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Birmingham Women's pauses Lorenzo

17 November 2011   Shanna Crispin
Birmingham Women’s NHS Foundation Trust has ‘paused’ implementation of Lorenzo as it re-assesses the system’s benefits.
The trust was the third ‘early adopter’ to take the iSoft electronic patient record software from CSC as part of the National Programme for IT in the NHS, and went live with the care management and clinical documents modules in 2010.
A trust spokesperson has now told eHealth Insider it is delaying implementation of the requests and results module. “We have taken a short pause on requests and results to re-evaluate the benefits of the product.”
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EHR safety: IOM report a good start, but more can be done

November 17, 2011 — 9:44am ET | By Marla Durben Hirsch - Contributing Editor
There's been a lot of fanfare about the Institute of Medicine's (IOM) recent report calling for a new federal watchdog agency to oversee the safety of health information technology (HIT) and investigate adverse events related to HIT. While IOM acknowledges that some components of HIT have improved the quality of healthcare and reduced medical errors, patient safety overall has not improved to the extent that the organization had hoped for. Moreover, new patient safety issues are emerging that are directly attributable to HIT.
And while the report notes that the safety incidents involve a variety of HIT tools--such as personal health records, patient portals, and health information exchanges--there's no denying that the bulk of IOM's emphasis is on electronic health records.   
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Canada Health Infoway, Trillium Health Centre and PatientOrderSets.com collaborate to benefit seniors care

New project will improve safety and quality of care for residents of long-term and complex continuing care facilities in Ontario
November 16, 2011 (Mississauga/West Toronto, ON) - Patient care for seniors in long-term or complex continuing care facilities will benefit from a new library of evidence-based information and clinical protocols that will be created as part of a $1 million investment Canada Health Infoway is making with Trillium Health Centre, announced Trillium President and CEO Janet Davidson, O.C.
Trillium, supported by PatientOrderSets.com, will develop and provide the library to benefit those living in more than 500 long-term care and complex continuing care beds in the Mississauga-Halton region.
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PwC predicts top 10 issues in 'seminal year' for healthcare

November 16, 2011 | Mike Miliard, Managing Editor
NEW YORK – PwC's Health Research Institute has predicted the top 10 issues facing healthcare in the coming year. Health informatics, privacy and security, new reporting requirements and social media, among others, promise to be at the fore.
All these will continue to evolve against a backdrop of political and economic uncertainty in the United States, according to PwC. In response, the firm predicts that diverse healthcare organizations will "join forces in new collaborative business arrangements," and gird themselves with contingency plans for "legislative wildcards."
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NHS IT market set to defy NPfIT gloom

7 November 2011   Jon Hoeksma
In spite of negative comment about the abandoned National Programme for IT in the NHS and general gloom in the public sector, England’s hospitals are set to increase their spend on IT over the next three years.
The first Market Forecast Report, published by EHI Intelligence, calculates that local NHS trust spending on information technology is set to rise by 3.7% CAGR (compound annual growth rate) over the next three years.
This will take the total size of the locally-determined English NHS hospital and mental health trust IT market to £883m by 2014-15.
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6 golden rules of EMR implementation

November 15, 2011 | Michelle McNickle, Web Content Producer
A few months ago, we chronicled the 7 most deadly sins of EMR implementation. From ignoring nurses to declining help, these offenses can be hard to make right. 
But, in an effort to help big and small practices alike avoid the most common EMR faux pas, we followed up with Rosemarie Nelson, principal of the MGMA Consulting Group, and asked for her opinion on the best practices for implementing an EMR system.
Here are Nelson’s six golden rules of EMR implementation:
1. Include nursing staff.  When we first asked Nelson about the sins associated with implementation, the most detrimental, according to her, was forgetting about your nurses. And now, Nelson stands by that mantra and believes the EMR isn’t all about the physician. “Physicians are the owners, or the leaders, or the key decision makers, but they are not the exclusive users of the EMR,” she said. She mentioned nurses account for almost 75 percent of the use of the chart, and physicians, 25 percent. “A successful EMR implementation focuses on how the nurses can assist the physician in the integration of the EMR into clinical workflow,” she said. “Too often, an EMR committee is created in a medical practice, and there’s no nursing representative. Bring in the nurses.”
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OMB: 'Aggressive' use of IT cuts $17.6 billion in waste, fraud, and abuse

November 15, 2011 | Diana Manos, Healthcare IT News
The Office of Management and Budget (OMB) announced Tuesday that the Administration has cut wasteful improper payments by $17.6 billion dollars in 2011. The cuts included those paid for Medicare, Medicaid, Pell Grants, and Food Stamps.
The government-wide error rate for Medicare and Medicaid dropped to 4.7 percent, down from the 2010 error rate of 5.3 percent and the 2009 error rate of 5.42 percent, according to the OMB. Also, the Medicare fee-for-service error rate fell from 9.1 percent in 2010 to 8.6 percent in 2011.
OMB Director Jack Lew said the cuts are due to the effective and agressive use of technology. In 2010, the president announced that by the end of 2012, the Administration would avoid $50 billion in improper payments, cut Medicare fee-for-service errors in half, and recapture $2 billion in overpayments to contractors. The Administration is on track to meet or exceed those goals, the OMB said.
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HHS Earmarks $1B for Healthcare Jobs, Innovation

Margaret Dick Tocknell, for HealthLeaders Media , November 15, 2011

The healthcare industry got a $1 billion shot in the arm Monday when the Department of Health and Human Services announced a competition to spark "innovative healthcare delivery models." Preference will be given "to projects that rapidly hire, train and deploy healthcare workers."
Most of the department heavyweights were on hand for the afternoon press conference: Secretary Kathleen Sebelius, Don Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, and Richard Gilfillan, MD, acting director of the Center for Medicare & Medicaid Innovation.
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8 lessons from a Beacon Community

November 14, 2011 | Michelle McNickle, Web Content Producer
BANGOR, ME – About a year and a half ago, the Bangor Beacon Community, in Bangor, Maine, was chosen as one of 17 national sites to receive a three-year federal grant. The Office of the National Coordinator awarded the organization $12.75 million with the hopes Bangor would use IT to improve the health of the population it serves.
Today, the Bangor Beacon Community, which comprises 12 partners throughout the state, has made noteworthy strides in improving quality and population health. So much so, in fact, that it’s easy to see where similar efforts can extend into non-Beacon Communities and improve the role of health IT nation wide.
Cathy Bruno, executive sponsor at Bangor Beacon Community, offers eight valuable lessons she and her team learned (and are still learning) while acting as a Beacon Community. 
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Standards panel seeks advice on data exchange

November 14, 2011 | Mary Mosquera, Government Health IT
WASHINGTON – The federal advisory Health IT Standards Committee is asking for feedback from individuals and organizations experienced in deploying specifications developed for the nationwide health information network (NwHIN) Exchange.
The group also wants to learn about first-hand practice and observations of individuals involved in setting up the required infrastructure and operational use of the NwHIN Exchange specifications or technical descriptions of the requirements.
The NwHIN Exchange is composed of federal agencies and predominantly large organizations that have contracted with the federal government. ONC is seeking a foundation to expand participation in the exchange, which follows comprehensive standards and services to securely share health information through the Internet.
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CHIME releases info exchange guide for CIOs

Posted: November 15, 2011 - 12:30 pm ET
The College of Healthcare Information Management Executives and the eHealth Initiative have jointly released The HIE Guide for CIOs to educate healthcare information technology leaders about technical requirements and other issues involving health information exchanges.
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AMA opposes ICD-10

Posted: November 15, 2011 - 12:15 pm ET
UPDATED: 1:45 p.m.
The American Medical Association's House of Delegates voted today "to work vigorously to stop implementation" of the International Classification of Diseases 10th Revision family of diagnostic and procedural codes, citing the healthcare industry's already full plate for changes and reforms, including the federal push for physicians to adopt electronic health-record systems.
"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," AMA President Dr. Peter W. Carmel said in a news release from the association's four-day policy meeting in New Orleans.
"At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions," Carmel said. "The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be—on their patients."
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Darlington first to finish SCR roll-out

10 November 2011   Rebecca Todd
More than 98% of patients in NHS Darlington now have a Summary Care Record, making it the first primary care trust to roll out the programme to its entire patient population.
All the GP practices in the area have created SCRs for patients who want them, with 1.66% of people having opted out of the scheme.
Clinical pharmacists on medical and acute admissions wards at County Durham’s two major hospitals have been viewing the records with patient consent since a pilot project was launched in July.
The hope is to extend SCR access to after-hours doctors within six months and ultimately to A&E physicians.
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No Security for Health Information

Health Data Management Blogs, November 14, 2011
The daily stories of personal health information being stolen or lost cannot be a surprise to anyone by now.  And PHI in EHRs or health information exchanges will continue to be released unauthorized, or stolen, because there's no real enterprise-class information management architecture in any of the HIE or EHR products that we know of.
In fact, the health care I.T. industry is riddled with very poorly designed systems from an information management and security perspective compared with, say, the world of finance.  Relatively speaking, we read about almost no leakage of financial information compared with health information, especially if you compare the relative value of financial information vs. health information.
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Tuesday, November 15, 2011

Health IT Saves a Life in Memphis

A medical data-sharing program saved at least $2 million and gave doctors crucial insight about a pregnant woman's complications.
A new study has found that a medical-information exchange system that is considered a model for health-care reform efforts saved significant amounts of money and led to better care for patients—including a woman who probably would have died without the system.
The woman was bleeding from her uterus when she came to the emergency room of Saint Francis Hospital in Memphis, Tennessee, in 2009. If her medical records had been unavailable, doctors probably would have ordered an ultrasound, incurring some delay in treatment. But because of the city's digital information-sharing program—a rarity among U.S. hospitals with different owners—the doctors learned that an ultrasound done days earlier at another facility had detected that the woman had an ectopic pregnancy, in which the embryo becomes implanted outside the uterus. (It's not clear whether the first institution had failed to follow up or whether the patient refused treatment there.)
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EHR vendor cooperation vital to interoperability workgroup

November 11, 2011 — 5:17pm ET | By Ken Terry
The agreement by seven states, eight electronic health record vendors, and three health information exchange vendors on an initial set of standards for exchanging health data is a major step toward the interoperability that has so long defied the best efforts of technologists and policymakers.
The achievement of the EHR/HIE Interoperability Workgroup is important for several reasons. First, standardization will decrease the cost and accelerate the process of connecting EHRs to HIEs, be they statewide or local. Second, insofar as the workgroup hews to national standards, it will lay the groundwork for connecting HIEs to the Nationwide Health Information Network (NwHIN). And third, this initiative has the potential to break down the barriers between disparate EHRs.
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Epic to add 900 new jobs

November 14, 2011 | Bernie Monegain, Editor
VERONA, WI – Epic Systems plans to add 900 new jobs to its campus in Verona, Wis., according to the newspaper of the University of Wisconsin-Madison, The Badger Herald.
The newspaper reported that Epic also planned to add three new office buildings to house the new employees.
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ECRI names top 10 healthcare tech dangers

November 14, 2011 | Bernie Monegain, Editor
PLYMOUTH MEETING, PA – Hazards from clinical alarms top the list of 10 technology hazards for 2012, according to the ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care.
Now in its fifth year of publication, ECRI Institute bills its annual Top 10 hazard list as a comprehensive report designed to raise awareness of the potential dangers associated with the use of medical devices and systems. Most significantly, the report includes action-oriented recommendations on addressing these risks.
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ECRI Unveils Top 10 Health Technology Hazards

John Commins, for HealthLeaders Media , November 14, 2011

The incessant beeping, chirping, whirring, flashing and whooping of any number of patient monitors continues to be a top hazard in hospitals, as bedside providers either struggle to prioritize the noisy demands of the machines, or tune them out completely.
That's according to a study, Top 10 Health Technology Hazards for 2012, from the nonprofit ECRI Institute.  The organization is designated an Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality.
The report notes that bedside providers increasingly are showing signs of "alarm fatigue" as they deal with the constant demands of ventilators, infusion pumps, physiologic monitors, dialysis units, and other technology.
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HL7 and Regenstrief Institute connect on standards

November 14, 2011 | Diana Manos, Senior Editor
ANN ARBOR, MI – Health Level Seven (HL7) International and the Regenstrief Institute, Inc. announced on Monday an agreement to create a complementary process to develop and extend comprehensive standards in the healthcare industry.
“This agreement further solidifies and extends the wonderful relationship HL7 has enjoyed with Regenstrief for many years,” said Bob Dolin, chair of HL7 Board of Directors.“HL7 is committed to working with Regenstrief and other standards bodies to advance the delivery of safe and effective patient care.”
Logical Observation Identifiers Names and Codes (LOINC) is a universal code system developed by the Regenstrief Institute for identifying laboratory and clinical observations. When used in conjunction with the data exchange standards developed by HL7, LOINC’s universal observation identifiers make it possible to combine test results, measurements, and other observations from many independent sources. Together, they facilitate exchange and pooling of health data for clinical care, research, outcomes management, and other purposes.
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DH pilot finds mixed mobile benefits

8 November 2011   Shanna Crispin
The Department of Health’s clinical lead on mobile solutions has warned NHS trusts not to expect immediate results from mobile working.
Kathy Drayton presented the results of a DH project focussed on assessing the benefits of mobile working in community settings at EHI Live 2011.
The National Mobile Health Worker project trialled mobile working at 11 sites across the country for a period of eight weeks.
Drayton said the results had led to overall efficiencies within trusts, but their experience was mixed to start with.
The City and Hackney Primary Care Trust, for example, saw a decrease in the number of patients being visited when it first introduced a mobile system, and Drayton said this was not uncommon.
“What we do know is that before you get a significant increase, there’s usually a decrease in productivity as people get used to the technology.
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Monday, November 14, 2011

Data Could Be King in Reformed Health Care System

Laura Landry can tell you exactly why health information matters.
Landry, the interim CEO of Cal eConnect, California's newly created entity to oversee health information exchange, had a story to tell during the organization's annual stakeholder summit last week in Sacramento.
"It's not my government background that qualifies me for this job," Landry said. "It's not my tech background. And it's not my policy background." What qualifies her for the job, she said, is much simpler.
"I went blind in my left eye," Landry said.
About 10 years ago, Landry had vision problems during a weekend. "All of my health information was all locked up," she said. So Landry went through a battery of tests she'd already had, she said.
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Survey: Most U.S. community hospitals embrace EMRs

Written by Luke Gale
November 14, 2011
According to the results of a survey of community hospitals, a considerable majority of community hospitals, those with fewer than 300 beds, have already implemented or are in the process of implementing an EMR system.
The survey’s results were based on questionnaires completed by representatives from 74 community hospitals and returned to Anthelio Healthcare Solutions, a Texas-based health IT services company.
Of the 74 respondents, 23 percent are operating full-functioning EMRs, 69 percent have begun implementing EMRs and only 8 percent have yet to begin implementing or don’t plan to implement EMRs.
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After EHR Frenzy: Health IT's Next Priorities

Healthcare providers are looking beyond electronic health records to find tools to tackle ICD-10 and accountable care organizations, says Allscripts CEO.
By Nicole Lewis,  InformationWeek
November 10, 2011
Although most healthcare organizations are now focused on getting their electronic health records (EHR) systems running properly, many are also setting their sights on the technology needed to meet ICD-10 compliance, support accountable care organizations (ACOs), and maintain systems that will reduce hospital readmissions, according to Glen Tullman, CEO of Allscripts.
Giving his assessment of the healthcare IT market during Allscripts' Nov. 3 third-quarter financials conference call, Tullman said technology has taken center stage as an important tool that can address challenges facing the healthcare sector.
"While Meaningful Use is on everyone's mind today, attention is beginning to shift to the required adoption of ICD-10 in 2013," Tullman said. "Another influential factor is the significant revision to reimbursement underway at the federal level fostering the move to a value-based system of care."
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Federal panel begins work on Stage 3 meaningful use

November 10, 2011 | Diana Manos, Senior Editor
WASHINGTON – Some members of the Health IT Policy Committee on Wednesday cautioned against making the measures required under Stage 3 meaningful use too burdensome. The panel also began to focus on medical specialties.
Committee member Gayle Harrell, a Florida state legislator said, “We’re learning things every single day. We have an opportunity now to get Stage 3 right.”
Harrell said the committee is on an evolutionary path, learning from Stages 1 and 2. “We really want to get our bang for the buck,” she said.
She also cautioned that specialists be taken into account when developing Stage 3. “We want to use this opportunity wisely and make sure we move forward on a specialist level,” she said. “Seventy-five percent of the cost of care is provided by specialists. We need to make sure we’re not going to go down a track that would not allow every specialty the ability to qualify.”
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Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

Published In: Annals of family medicine, v. 9, no. 5, Sept./Oct. 2011, p. 392-397
PURPOSE: Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques.
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Monday, November 14, 2011

Aetna Hopes Games Will Make People Healthier

The health-care industry is using games to encourage better choices.
By this January, some people who are insured by Aetna will have a new tool to help them keep New Year's resolutions: the Life Game, an interactive platform that helps users formulate health goals and stay motivated to achieve them.
About 70 to 80 percent of health-care costs in the United States stem from chronic conditions that are largely preventable or manageable, such as hypertension, diabetes, and heart disease. Those three conditions alone cost U.S. employers nearly $500 billion in lost productivity, according to the Milken Institute, a nonprofit economic think tank. But effective prevention strategies have proved elusive; simply educating people about the benefits of eating better and exercising has had little effect.
Aetna and other health-care companies, such as Humana, hope the features that have made games so addictive will motivate people to adopt healthier lives. A crop of startups are integrating social networking and behavioral economics with games toward that end. Although Aetna declined to provide estimates, even a modest change for the better could have a big impact on an insurer's bottom line if the results were sufficiently widespread.
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Enjoy!
David.

Friday, November 25, 2011

Where Health IT Is Seen As Making A Real Difference. Assisting Providers To Do Better Is What Matters First!

The following report of an interesting study appeared a few days ago.

Booz Allen identifies 9 ways IT is transforming healthcare

By Bernie Monegain, Editor
Created 11/16/2011
MCLEAN, VA – As healthcare moves into a new era of efficiency, effectiveness and improved patient outcomes through health information technology, consulting firm Booz Allen Hamilton has identified the top nine ways health IT is transforming healthcare. Among the changes with the greatest impact are reduced medical errors and faster emergency care.
"Good healthcare is no longer about just good doctors and good hospitals; it's about connectivity, it's about data, it's about information, it's about speed to treatment and health IT enables each of those," said Robert M. Pearl, MD, the executive director and CEO of The Permanente Medical Group.
"Many people associate health IT simply with the electronic storage of health records," said Kristine Martin Anderson, a senior vice president in Booz Allen Hamilton's healthcare market. "In reality, health IT is much more transformative. It's a strong collection of technologies, analytics and process innovations that are already revolutionizing the way people receive and manage their care in communities across the nation."

The Booz Allen Hamilton report noted that health IT has tremendous potential to make the healthcare system patient-centered. Today, through new mobile technology, doctors can receive real-time information about a patient's condition. Now, a firefighter who has heart attack symptoms on the job can be diagnosed before he reaches the hospital, allowing him to receive treatment within 30 minutes of noticing symptoms – not hours. Remote monitoring technology and video conferencing allow caregivers to monitor a patient's vitals and discuss their current condition without the patient even leaving home.
Top 9 ways health IT is transforming healthcare

The following list was developed from research by Booz Allen, which works with leading federal, nonprofit and commercial healthcare clients to understand how to effectively utilize health IT, such as existing and emerging data from electronic health records, claims, and laboratory data, to implement payment reform, comparative effectiveness, quality measurement and improvement, research and development, and translational research.
  1. Reduces medical errors.
  2. Improves collaboration throughout the healthcare system.
  3. Ensures better patient-care transition.
  4. Enables faster, better emergency care.
  5. Empowers patients and their families to participate in care decisions.
  6. Makes care more convenient for patients.
  7. Helps care for the warfighter.
  8. Enhances ability to respond to public health emergencies and disasters.
  9. Enables discovery in new medical breakthroughs and provides a platform for innovation.
More here (with a description of each of the points listed above):
As you read the list what becomes clear is that the flow of benefits actually comes from improving the information access for health care providers so they can do their work more safely and effectively rather than provision of information to patients. Both are crucial but where you get the most ‘bang for your buck’ in the first instance is provider enablement and provider decision support.
Sadly DoHA and NEHTA are just in denial of this basic fact. Silly them!
David.

Thursday, November 24, 2011

Another Two Examples Of Just How Thoroughness and Care Is Required To Get E-Health Implementation Right!

I came across this abstract a few days ago.

Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

Published In:
Annals of Family Medicine, v. 9, no. 5, Sept./Oct. 2011, p. 392-397

Abstract

PURPOSE: Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques.
METHODS: We conducted a multimethod qualitative case study of 5 ambulatory primary care practices identified as exemplars of effective e-prescribing. The practices were identified by a group of e-prescribing experts. Field researchers conducted in-depth interviews and observed prescription-related workflow in these practices.
RESULTS: In these exemplar practices, successful use of e-prescribing required practice transformation. Practice members reported extensive efforts to redesign work processes to take advantage of e-prescribing capabilities and to create specific e-prescribing protocols to distribute prescription-related work among practice team members. These practices had substantial resources to support e-prescribing use, including local physician champions, ongoing training for practice members, and continuous on-site technical support. Practices faced considerable challenges during use of e-prescribing, however, deriving from problems coordinating new work processes with pharmacies and ineffective health information exchange that required workarounds to ensure the completeness of patient medical records.
CONCLUSIONS: More widespread implementation and effective use of e-prescribing in ambulatory care settings will require practice transformation efforts that focus on work process redesign while being attentive to effects on patient and pharmacy involvement in prescribing. Improved health information exchange is required to fully realize expected quality, safety, and efficiency gains of e-prescribing.
More here:
This editorial below also led me to a second abstract from the same issue of the journal:

A Diabetes Dashboard and Physician Efficiency and Accuracy in Accessing Data Needed for High-Quality Diabetes Care

  1. Richelle J. Koopman, MD, MS1,
  2. Karl M. Kochendorfer, MD1,2,
  3. Joi L. Moore, PhD3,
  4. David R. Mehr, MD, MS1,
  5. Douglas S. Wakefield, PhD2,4,
  6. Borchuluun Yadamsuren, PhD3,
  7. Jared S. Coberly, BS1,
  8. Robin L. Kruse, PhD, MSPH1,
  9. Bonnie J. Wakefield, PhD, RN5 and
  10. Jeffery L. Belden, MD1,3
CORRESPONDING AUTHOR: Richelle J. Koopman, MD, MS, Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306N Medical Sciences Building, DC032.00, Columbia, MO 65212, koopmanr@health.missouri.edu

Abstract

PURPOSE We compared use of a new diabetes dashboard screen with use of a conventional approach of viewing multiple electronic health record (EHR) screens to find data needed for ambulatory diabetes care.
METHODS We performed a usability study, including a quantitative time study and qualitative analysis of information-seeking behaviors. While being recorded with Morae Recorder software and “think-aloud” interview methods, 10 primary care physicians first searched their EHR for 10 diabetes data elements using a conventional approach for a simulated patient, and then using a new diabetes dashboard for another. We measured time, number of mouse clicks, and accuracy. Two coders analyzed think-aloud and interview data using grounded theory methodology.
RESULTS The mean time needed to find all data elements was 5.5 minutes using the conventional approach vs 1.3 minutes using the diabetes dashboard (P <.001). Physicians correctly identified 94% of the data requested using the conventional method, vs 100% with the dashboard (P <.01). The mean number of mouse clicks was 60 for conventional searching vs 3 clicks with the diabetes dashboard (P <.001). A common theme was that in everyday practice, if physicians had to spend too much time searching for data, they would either continue without it or order a test again.
CONCLUSIONS Using a patient-specific diabetes dashboard improves both the efficiency and accuracy of acquiring data needed for high-quality diabetes care. Usability analysis tools can provide important insights into the value of optimizing physician use of health information technologies.
Full text also available from the site (free).
These article is accompanied by an excellent editorial. Here are the first few paragraphs:

Successful Health Information Technology Implementation Requires Practice and Health Care System Transformation

Carlos Roberto Jaén, MD, PhD, FAAFP
CORRESPONDING AUTHOR: Carlos Roberto Jaén, MD, PhD, FAAFP, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, jaen@uthscsa.edu
The complexity of primary care is increasingly recognized and documented.1
The inputs and outputs of primary care encounters require considerable additional time beyond the face-to-face time of patient encounters.2
The promises of health information technology (HIT), meaningful use, electronic prescribing, and other policy approaches are thwarted by current incentives built into primary care reimbursement, particularly the fee-for-service–only structure and its practical implementation in most practices.
Most electronic health records (EHRs) are not built to support clinical operations, particularly higher-level primary care functions that involve integrating, personalizing, and prioritizing care across a broad spectrum of opportunities that range from patients’ acute concerns, management of (often multiple) chronic illnesses, prevention, mental health, family care, and often undifferentiated problems of daily living.3,4
Plug and play is not an option.5 A system that grafts on the current paper-based operations of primary care is a fantasy.
Management of chronic diseases requires timely and accurate information to guide action. Most EHRs are designed to optimize documentation of the current encounter and improve billing efficiency, not the integrated, personalized, longitudinal care of chronic illnesses or clinical operations in general. Having discrete disease data available in an EHR is necessary but not sufficient to improve care of chronic diseases. Trolling for important data necessary to optimize delivery of care is often a major barrier to delivery of quality of care. The data need to be converted to useful information.
The full text (free) is here:
There are tips about workflow impact and modification and clinician efficiency here that simply can’t be ignored if we are to get the levels of use and interaction with EHR systems we seek.
Two very valuable and interesting studies I reckon.
David.

Another Fascinating Study On How Information Can Improve Care. We Need All The Help We Can Get To Save Lives!

This very interesting article appeared a few days ago.

Not by quality metrics alone

November 07, 2011 | John Morrissey
Even the most robust technology itself cannot improve healthcare outcomes, as Vanderbilt University Medical center discovered on its way to lowering ventilator-associated pneumonia rates – saving money
During the last decade, Vanderbilt University Medical Center built into its operations the attention to clinical quality that now figures prominently in health reform, using a level of digital documentation and decision support that anyone seeking meaningful use of health IT would love to have.
The problem: All that effort was falling flat where it really counted.
“We had all of the technology anybody’s talking about,” said William Stead, the Nashville-based medical center’s chief strategy and information officer. “We could show that the percentage of the time we did what we wanted to do with decision support went from, say, 10-30 percent up to 40-60 percent – major improvement. But even so, our performance on summative quality measures such as observed to expected mortality were average or actually below average.”
It wasn’t until informatics pros and clinicians figured out how to calculate and graphically present a spectrum of clinical status measures for immediate action that quality measures became worthwhile and patient-care results dramatically improved.
The lessons learned are relevant for hospitals nationwide as they incorporate into clinical settings the quality metrics typical of the federal value-based purchasing and meaningful-use programs now underway.
Most notably, Vanderbilt found that these standard quality metrics by themselves won’t give front-line clinicians the focused information that’s useful in improving clinical results and increasing healthcare value. Measuring and reporting constitute only the first half of the quality-improvement equation. What’s further needed is a sound way to “force” a set of expeditious responses to feedback that, if done well, leads to improved metrics while lowering clinical costs and preventing inpatient deaths.
The method is in place to prevent certain types of infections in high-risk areas, and Vanderbilt is expanding that to target other patient threats in the hospital environment.
Homing in on a serious risk
Few hospital situations are more life-threatening than a critically ill patient, put on a ventilator in an intensive-care unit, who develops pneumonia. Mortality rates discussed in medical literature vary from 20 percent to more than 50 percent.
With six adult ICUs for burn care, trauma, neurological, cardiovascular, post-surgical and general critical care – combining for about 160 beds – Vanderbilt annually had many hundreds of patients who were spending, collectively, tens of thousands of hours on ventilators in settings that were nearly always full.
Ventilator-associated pneumonia (VAP) rates in the mid-2000s at Vanderbilt were running in some cases two to three times above the national benchmark for inpatient populations, said Devin Carr, administrative director of the surgery and trauma patient care center. In 2004, for example, the rate of VAP per 1,000 ventilator days was 29.3.
In the wake of a national campaign by the Institute for Healthcare Improvement to reduce VAP through consistent ventilator management, Vanderbilt organized a multidisciplinary team of physicians, nurses, pharmacists, respiratory therapists and other clinicians in 2007 to develop a “bundle” of care elements proven to reduce the incidence of pneumonia. Then came the challenge of keeping track of how clinicians were juggling the seven elements of necessary care.
Clinical IT provided the electronic means to document what nurses and others did for patients and assemble quality metrics for such actions as elevating a patient’s head to prevent aspirating back into the lungs, appropriate oral care to prevent a buildup of bacteria, and frequently evaluating whether the patient was ready to breathe independently and get off the ventilator.
But for all the advances in IT at Vanderbilt, the VAP improvement team identified some significant shortcomings, Carr said. For example, various ICU medical teams documented differently in separate areas of the IT system according to how they worked, which complicated the task of drawing out and standardizing the metrics in ways that could be brought together and posted in a timely manner.
There also was no alerting function in the documentation system itself.
Due to the broad range of people and clinical roles that come into daily contact with a patient, Stead said, alerts affecting all those roles would be overwhelming in an already-intense environment.
......
From 18 pneumonia cases per 1,000 ventilator days in calendar 2007, the rate fell to 14 in 2008 and 11 in 2009. But thereafter, it continued falling to 7.5 in 2010 and, in the first three months of 2011, a mere three per 1,000 days.
“What we’re really talking about is how to get people to look at care as a system and use controls and feedback to help you adapt and do the right thing,” Stead said. “If you do that, then you fix the system in a way that will fix many quality indicators.”
More here:
It is interesting that the approach adopted here has two arms. First some excellent systems to record care delivery and second some very easy to understand ways of presenting key summary information that identified where care was falling short of guidelines.
Of course even before this having the systems in place to identify outlier clinical outcomes that need attention is also important! You won’t address problems until you know they exist.
Using a synthetic view of where the patient was situated in terms of required care and then feeding it back to the carers in essentially real time clearly has a dramatic impact on the proportion of needed care that is actually delivered - and guess what the patient outcomes are improved!
It is well worth considering what other problems could be addressed in similar fashion.
David.

Wednesday, November 23, 2011

Submissions On The Draft Legislation for the PCEHR Are Now Published!

See here:
Lots of fun browsing.
There look to be about 50 submissions!
I note the Victorian State Government is not a happy camper!
David.

Health Information Exchange Some Lessons from The Real World and Some Legislative Comments and Legislation on the PCEHR!

It is interesting to read of the barriers faced by others to get Health Information Exchange really humming along!

The Top 5 roadblocks HIEs face

November 14, 2011 | GHIT Staff
Just as young businesses of most any sort must circumvent myriad challenges to succeed, health providers are encountering multiple roadblocks in the implementation of HIEs. At the core of those: financial sustainability. The root of many, perhaps, money is neither the only problem, nor the most trying.
“The most important obstacles facing HIEs depend on the perspective of who is looking at them – the patients, the providers, etc. So as we move forward, we have to make sure to address all these stakeholders,” said Benjamin Stein, MD, president and CEO of HIE Long Island Patient Information eXchange (LIPIX). “There is no one-size-fits-all answer to the problems of HIEs.”
Indeed, many healthcare professionals have raised doubts about HIEs living up to their potential. A survey of healthcare providers, vendors and experts found five issues that constitute the top concerns.
1. Data sharing
The groundwork already in place, with federal incentives for EHRs, HIEs, telemedicine, and related projects available, the goals of HIEs are straightforward: Reduce administrative costs associated with manual data and paper-based systems, reduce costs related to improved information access by decreasing redundant testing, avoidance of unnecessary hospitalizations due to missing information, more efficient visits, improving co-ordination of patient care with timely and accurate information across providers, and more effective medication reconciliation.
That all comes down to actually exchanging health data.
As HIEs now stand, however, much of their operations still occur in narrow sets of silos. Data exchange between EHRs and exchanges through organized state and regional HIEs is decidedly uneven in delivery. Electronic reporting for public and population health measurement is lacking.
2. Patient consent
Patient authorization and consent is often cited as one of the first challenges to HIEs, because authorization is a true test of the ability of EMR systems to work across healthcare and technology platforms as data is exchanged.
At Geisinger Health System, a Danville, Pa.-headquartered provider, Jim Younkin is program director of IT, leading development of the Keystone Health Information Exchange (KeyHIE), a regional HIE.
“Our legal counsel reminds us of the risks, and to make sure we don’t share information with anyone unless we have patient authorization allowing it to be shared,” Younkin said. “So we have increased our efforts in obtaining authorization, but that’s not easy.”
KeyHIE includes 12 hospitals, more than 90 clinics, skilled care, long-term care, and home health organizations. More than 385,000 patients have signed authorizations, allowing their information to be shared for treatment purposes through this exchange. Nonetheless, Yonkin says patient authorization and consent remain a hurdle to further development of HIEs.
“Because we have a large footprint,” Younkin adds, “a lot of doctors see patients who have records from other hospitals, where in some cases the information comes back in faxes. That’s been a difficult issue for us.”
Having started an EMR system in 1996, Geisinger is a seasoned user of technology platforms to facilitate date exchange, and is continuing its search for best practices in patient authorization, Younkin added
Likewise, Patty Dodgen, CEO of Tampa, Fla.-based Hielix, which provides HIE implementation services, sees difficulties in adopting patient authorization on the large scale contemplated by HIEs.
“There is a maze of EHR vendors touting, not an HIE system, but an interface. You have to have functionality that includes a mechanism for verifying and authenticating individuals and a record location service,” Dodgen explained. “You have to build an HIE that includes functionality that can go into a variety of settings and pull information back into the user.”
3. Standards
4. Complexity Costs
5. Competition
More details and a forward view here:
What I find interesting with this is the similarity between the US and here. It is only point five where I think we probably have a good deal less of an issue. Certainly I think there is a level of denial about the Standards and complexity issues.
The following also explores the issues from a different point of view:
Monday, November 14, 2011

Data Could Be King in Reformed Health Care System

Laura Landry can tell you exactly why health information matters.
Landry, the interim CEO of Cal eConnect, California's newly created entity to oversee health information exchange, had a story to tell during the organization's annual stakeholder summit last week in Sacramento.
"It's not my government background that qualifies me for this job," Landry said. "It's not my tech background. And it's not my policy background." What qualifies her for the job, she said, is much simpler.
"I went blind in my left eye," Landry said.
About 10 years ago, Landry had vision problems during a weekend. "All of my health information was all locked up," she said. So Landry went through a battery of tests she'd already had, she said.
"About 12 hours later, after taking all those tests again, they came to me and told me they knew what they were going to do. They said, though, there was only one problem," she said. "They couldn't complete the therapy they wanted to do within the 12-hour window that was most effective for that therapy."
You could call it a moment of vision. When her eyesight was threatened and time was so short and critical, Landry said, it became crystal clear just how important health information exchange can be.
"How can we improve health care?" she asked. "We could make data necessary."
Overlapping Authority
Reliable communication of health data could streamline patient care on both an individual and public health level. Identifying where patients with like conditions are within a geographic area could trigger more services for those conditions where they're most needed and most effective.
But tracking down and using that information can be a nightmare, according to many of the stakeholders at the conference.
"From an HIE perspective, many times we don't know if anyone has direct control over the data, sometimes it's co-hosted, it's not clear who can access it," said Alex Horowitz of Believe Health, a community health consulting group. "It's so hard to sort it out, even just in one county."
The state medical system has been built piecemeal, Horowitz said, like a stack of Jenga blocks. It's hard to pull one piece of information without involving multiple agencies and multiple denials of help.
Horowitz had an idea for Cal eConnect. Building a map of which state agencies control what information would go a long way toward solving real-life health information exchange problems, he said.
"We deal with Stanislaus, Fresno and Kern counties," he said. "But it turns out that 12 of the 13 [sets of data] we need are at the state level, and no one really knows how to get that data. It's just this incredible spider web."
'We Want Ideas'
Dozens of ideas and suggestions were floated at the stakeholder conference.
"Many state agencies need data from health care providers for public health data," Landry said. "And it would make life easier if that data could flow. We want ideas about how to do that. We are pretty sure that we could improve quality of care, reduce duplicative or multiplicative data entry, improve quality of data and reduce reporting time."
Right now, for instance, the state health care system spends money on surveys to help identify health trends and needs in an effort to determine in geographic and financial terms where the state should spend its energy and effort.
If you could track trends over time by using electronic clinical and community indicators, such as tobacco use or body mass index numbers, that would make the whole evaluation process smoother, Landry said.
"The aggregation of data, that's the public health benefit," she said, "and doing that would be saving a lot of money on surveys."
She said there are cost savings and streamlining opportunities throughout California. "Transportability of data allows us to get the data to providers, and public health is just one user of that data," she said.
.....

MORE ON THE WEB

More here:
In this discussion we see the issues of governance and leadership also being made clear!
I really wonder what is going on at DoHA. Submissions on the Draft Legislation closed on October, 28 2011 and we have yet to see either the submissions or the response from government.
Here are the ones I know about so far:
AMA
OAIC
ADA
APHA
NSW Council Of Civil Liberties
AFAO
Medicines Australia
Aged Care Council
Health Information Management Association of Australia (Paper)
Governance gets a serious run in many!
Worth a browse to see what is concerning the various stakeholders!
Late Breaking News:
The legislation has been tabled and the Explanatory Memorandum describing the legislation mentions governance just twice. Again the public seems to have been ignored.
See here.
David.

The Appalling Secrecy Imposed By Australian Government Continues Endlessly It Seems. Pretty Sad!

I found this after the article below was published today.
Media Releases and Communiques

Standing Council on Health - Joint Communique - 11 November 2011

Australian Health Ministers met in Brisbane today and welcomed the passage of world-first legislation for plain packaging of tobacco products that passed in the Senate yesterday.
Ministers noted the historic legislation was yet another measure in a long history of tobacco-control measures over many decades taken by Commonwealth and State and Territory Governments.
Ministers also noted the legislation, combined with State and Territory efforts on tobacco control, would assist in achieving targets committed to by the Commonwealth and State and Territory Governments to reduce the adult daily smoking rate to 10 per cent by 2018, and halving the rate among Aboriginal and Torres Strait Islander people.
Ministers discussed and considered a range of issues, including:
  • eHealth
  • MyHospitals website
  • food labelling
  • rural and remote health
  • aged care reform
  • mental health reform
  • health workforce.
The information is found here:
This is the article the prompted by search.

e-Health authority to live on

THE National e-Health Transition Authority will live on post-June 2012, with the federal and state governments agreeing to continue their joint funding arrangements for the time being.
NeHTA’s immediate future was decided at a meeting of the Standing Council on Health in Brisbane this month, although there is no commitment to a long-term role for the organisation.
No public announcement has been made and the level of funding is yet to be agreed.
Federal Health Minister Nicola Roxon has been slow to commit to further funding for the e-health program beyond the launch of her personally controlled e-health record (PCEHR) system on July 1.
Forward budget allocations for e-health programs drop from $433 million in the current financial year to $35m annually in each of the next three years.
A spokesman for Ms Roxon yesterday said the health ministers were "continuing to consider" NEHTA’s future funding.
Taxpayers have spent more than $1 billion on NeHTA and related activities since the joint federal-state government corporation was established in 2004 by former health minister Tony Abbott.
Around $830m was spent on e-health in the six years to 2010, while NeHTA has received more than $200m in base funding and contracts for its 18-month implementation of the PCEHR.  
NeHTA’s future has been uncertain as it awaited a Council of Australian Governments' decision to renew funding. 
But a survey of state and territory health ministers by The Australian has revealed agreement was reached on November 11 at SCOH, a new COAG council that replaces the former Australian Health Ministers’ Conference.
Comments from many of the Health Ministers follow.
What is interesting are two things.
1. The Federal Health Minister is saying that ministers were “continuing to consider” NEHTA’s future funding.
This confirms what I have been hearing suggesting DoHA has put NEHTA’s funding on a month to month basis because of concerns about NEHTA’s delivery.
2. The comments from all the ministers suggest that the funding of the PCEHR and who contributes when and how much is still very much ‘up in the air’.
That there have not been clear press releases from anyone suggests to me there is still a way to go before finality in all this is reached.
Of course the total absence of any information at all in the communique is just a sick joke! Surely a couple of lines could have been provided on e-Health?
We are living in very strange times indeed!
David.

Tuesday, November 22, 2011

As We Leap Into The Unknown and Untested We Need To Be Very Careful! People May Die Otherwise!

This article appeared a day or so ago.

New Report Echoes Call for National EHR Safety Board

HDM Breaking News, November 21, 2011
A new report published in the Journal of Patient Safety advocates creation of an independent national board to monitor and improve the safety of electronic health records. Among other duties, the board would have the power to implement unannounced, randomly scheduled, on-site EHR safety inspections.
In February 2010, Dean Sittig, PhD, of the University of Texas Health Science Center; and David Classen, M.D., of the University of Utah School of Medicine advocated five ways to improve EHR safety in a commentary published in the Journal of the American Medical Association. A recent report from the Institute of Medicine mirrored two recommendations--mandatory reporting of safety issues and a national safety board.
Now, in the Journal of Patient Safety, Hardeep Singh, M.D., of Houston VA Health Services joins Sittig and Classen in a new report detailing an oversight process for EHRs. They note that the increasing scope and complexity of EHRs, combined with aggressive implementation timelines under the meaningful use incentive payments program, can create a potentially hazardous environment. "At present, it is unclear which single agency is responsible for EHR oversight."
An EHR safety oversight program should include mandatory, standards-based reporting of adverse events and near-misses, and data analysis, according to the new report, "Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards." Both reporting and analyzing "should be overseen by a new independent board specifically charged with ensuring safety of EHRs nationally," the authors recommend.
The EHR safety board could be modeled after the National Transportation Safety Board. To support the new national board, institutional EHR safety committees, including a designated EHR patient safety officer, would investigate and report all known safety incidents in an organization and perform routine safety self-assessments.
.....
The report is available for purchase here for $35.
More here:
http://www.healthdatamanagement.com/news/ehr-electronic-health-records-safety-reporting-43640-1.html
The issue I believe we have here is that we a purporting to be going live with a PCEHR system just 8 months from now and having apparently done none of the things you need to assure any sense of genuine patient safety.
For reasons that utterly elude me we are running these multiple pilots of various parts of a conceptual system (the Wave 1 and 2 Sites) and then expecting that when those components that are working are somehow ‘fused’ into the PCEHR all will be well, it will all hang together seamlessly and Bob will be our uncle! All I can say is dream on!
It just won’t happen and to be doing this at a national level without some testing at a (small) regional level of the whole system is as Sir Humphrey would put it ‘courageous’!
Consider for a moment the risks associated with one minute aspect of the proposed system - the Consolidated View.
Here a whole range of information from diverse sources is planned to be assembled onto a single screen.
The number of ways all this could go wrong is frankly terrifying (think wrong data, old data, lost data etc., etc.). At the very least there needs to be robust testing and validation of not only the information flows but also the information quality. Even if you get that close to right you then have the issue of this view being intended to be used by both clinicians (who won’t be well trained) and consumers who will essentially be untrained. Where is the evidence that consumers will understand and then sensibly use whatever is provided for them on this screen? Answer it does not exist!
If ever there was a time to get into place mechanisms to properly analyse the utility and safety of the PCEHR System proposals in the hands of consumers (as well as clinicians) it is now.
Consider the apparently simple issue of displaying pathology results. Where is the research that demonstrates the ideal to present such information to consumers and is the same approach optimal for clinicians? Someone might let me know if it exists but we all know it doesn’t. Equally is the PCEHR Consolidated View going to be static no matter who is the user, or will it dynamically re-configure depending on user capability. I wonder who has researched how that is best addressed?
To not have answers to all this, and to not fully pilot a complete implementation at small scale for utility and safety, before batting on because of political deadlines is the height of incompetence and stupidity in my view. Not only are lives potentially at risk but so also is the whole viability of e-Health as a publicly acceptable idea.
Part of the non-existent governance mechanisms has the be a Safety Board to review what is happening on behalf of both consumers and clinicians an to have the power and responsibility to call time out when real risk is identified until it is properly and fully addressed.
The madness of all this just seems to roll on towards an inevitable and very sad outcome.
David.