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, December 03, 2011

Weekly Overseas Health IT Links - 3rd December, 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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National electronic health records network gets closer

By David Goldman @CNNMoneyTech November 18, 2011: 8:27 AM ET
NEW YORK (CNNMoney) -- The ambitious goal of setting up a nationwide, interconnected, private and secure electronic health records system isn't yet a reality -- but we're getting closer.
The 2009 Recovery Act, better known as the stimulus bill, set aside more than $20 billion for incentives to health care providers that deploy and meaningfully use certified electronic health records systems in their offices or hospitals. The first incentives are set to go out in the form of $22,000 Medicaid payments to early adopters within the next six months.
Since we're still in the early phases, it's hard to get clear numbers for adoption rates. Prior to the bill, just 17% of physicians' offices and 12% of hospitals had implemented some kind of electronic health records system.
Now, according to the Office of the National Coordinator for Health Information Technology (ONCHIT), the agency tasked with organizing the electronic health records project, 74% of hospitals have responded to surveys saying they are planning on investing in health information exchange services. ONCHIT presented the update at a Washington conference of health IT professionals on Thursday.
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EHR security: Are providers better off going to the cloud?

November 23, 2011 — 9:36am ET | By Marla Durben Hirsch - Contributing Editor
The jury is still out as to whether using cloud-based technology for an electronic health record system is better than systems that store data on-site. Cloud computing raises unique issues that providers need to be aware of, especially since it is becoming more common, according to attorney Chanley Howell of Jacksonville, Fla.-based law firm of Foley & Lardner.
"An EHR module, the whole EHR system or some component of the software could be in the cloud," Howell said during a webinar last week that focused on key legal issues raised by EHRs.
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Report: Physician practice adoption of EHRs to reach 80% by 2016

November 23, 2011 — 9:35am ET | By Marla Durben Hirsch - Contributing Editor
Physician practices will move from a 25 percent adoption rate of electronic health record technology in 2009 to more than 80 percent adoption by 2016, according to a new report from IDC Health Insights.
The report provides a guide to help practices assess EHR vendors, and measures 10 products from eight leading vendors that target large and mid-size physician practices. It also offers advice for practices seeing assistance in selecting a vendor, using 48 criteria that measure, among other things:
  • The breadth of functionality and usability of different products;
  • Vendors' attention to regulatory changes and communication of them to customers;
  • Financial stability of vendors;
  • Compatibility of products to mobile devices and different delivery models.
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Expect These Unexpected EHR Challenges

By Tracy Welsh, vice president at Hayes Management Consulting
HDM Breaking News, November 23, 2011
We all know the expected challenges of implementing an electronic health record -- not having enough time, money or resources to go around. However, unexpected challenges are more likely to throw a wrench in your EHR implementation timeline and budget. The following four challenges are common, but usually unexpected.
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Tool lets hospitals compare meds use

21 November 2011  
A system that allows hospital pharmacies to compare their medicine use with that of other trusts has been developed by Rx-info.
The product, called Define, will come onto the market in spring 2012 after successful trials in hospital clusters across the West Midlands and the South West.
Royal Wolverhampton Hospitals NHS Trust clinical director of pharmacy Professor Ray Fitzpatrick has been trialling the system, after working on its design with Rx-info.
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EHI interview: Chai Chuah

New Zealand is looking to IT to transform healthcare. Rebecca Todd talks to the country’s head of IT about its plans.
17 November 2011
Health IT should be an “agent of change” rather than something that tries to “drive change in itself,” says Chai Chuah.
“The conventional view is that health IT can play a significant role in terms of assisting the health system to transform itself into a different place - and that’s true. The challenge, for both the health system and health IT, is the implementation of that raw principle.
“One of the main things in New Zealand driving the mission is saying that health IT needs to be seen as an agent of change, but it shouldn’t drive change in itself.”
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Doctors Slow To Embrace Telemedicine, Cloud Computing

Tablets, smartphone, and mobile EHRs gain ground in healthcare, but cloud computing and videoconferencing lag, finds CompTIA study.
By Nicole Lewis,  InformationWeek
November 21, 2011
One out of four healthcare providers are now using tablets in their practice, with another 21% expecting to do so in the next 12 months, and more than half are using a smartphone at work.
These findings are part of CompTIA's 3rd Annual Healthcare IT Insights and Opportunities Study, which relied on separate online surveys with 350 doctors, dentists, and other healthcare providers or administrators and 400 IT firms with healthcare IT practices. CompTIA conducted the interviews in late July and early August.
While adoption rates for tablets are increasing at a fast clip, IT teams continue to face challenges integrating these devices into the healthcare enterprise. The most pressing tablet challenges center around security, integrating workflow, and optimizing legacy applications to run on the devices.
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Wednesday, November 23, 2011

Exposing the Cost of Health Care

Most Americans don't know what medical procedures cost until after the fact. One startup aims to change that.
It's easy to compare prices on cameras, vacations, and homes. But in the United States, patients fly blind when paying for health care. People typically don't find out how much any given medical procedure costs until well after they receive treatment, be it a blood draw or major surgery.
This lack of transparency has contributed to huge disparities in the cost of procedures. According to Castlight Health, a startup based in San Francisco, a colonoscopy costs anywhere from $563 to $3,967 within a single zip code. EKGs can range from $27 to $143, while the price for a set of three spinal x-rays varies from as little as $38 to as high as $162.
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Global Hospital Information Systems Market to Reach US$17 Billion by 2017, According to New Report by Global Industry Analysts, Inc.

GIA announces the release of a comprehensive global report on Hospital Information Systems (HIS) market. The global market for Hospital Information Systems (HIS) is projected to reach US$17 billion by the year 2017, primarily driven by the need to upgrade legacy healthcare IT systems with advanced automated systems, financial incentives being provided by governments for adopting technology based innovations and improvements in healthcare, and opportunities from huge underserved market. Robust demand from developing markets, especially Asia-Pacific, also augurs well for the market.
San Jose, California (PRWEB) November 22, 2011
Adoption of IT is not new to hospital industry with several IT tools already proving their worth in billing and administrative functions. Use of IT in clinical environment however has been restricted over the years, given the sensitive nature of patient information, medical procedures and treatment regimes, all of which can be vulnerable against data losses, or misuse. However, with growing realization of benefits, and rapid developments in technology, IT is slowly making its way even into the clinical set up, especially for capturing and storing patient records, and managing imaging, testing and surgical room procedures.
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eRx worthwhile, but still problematic for docs, pharmacies

November 22, 2011 | Mike Miliard, Managing Editor
ROCKVILLE, MD – A new study by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality finds that physician practices and pharmacies are both keen on e-prescribing's ability to improve safety and save time – but that both groups face barriers to realizing its full benefit.
The study, published online in the Journal of the American Medical Informatics Association, focuses on the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed. It finds that e-prescribing helps reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.
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AMA launches patient Rx app

Posted: November 22, 2011 - 2:30 pm ET
The American Medical Association has unveiled "My Medications," a new smartphone application created to help patients store and share their health information.
The app, which is available for 99 cents through iTunes, allows users to store data about their current medications, drug allergies and immunizations. Also, the app's functionality lets patients e-mail medical information and store healthcare providers' contact information.
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Hurdles remain for e-prescribing: study

Posted: November 21, 2011 - 3:00 pm ET
Historically, the last mile in electronic prescribing has been the connection between physicians and other prescribers and the next handoff in the chain—either pharmacies or mail-order pharmacy benefits managers.
A study by the Center for Studying Health System Change indicates that a bit of roadwork remains along that last mile before e-prescribing will be bump-free from end to end.
A nine-page report, Transmitting and Processing Electronic Prescriptions: Experiences of Physician Practices and Pharmacies (PDF), based on the study and published in the Journal of the American Medical Informatics Association, concludes that improvements are needed to the structure of the national e-prescribing design targeting mail-order pharmacy connectivity and technical standards. Additional training of physicians and pharmacists may also be needed to improve e-prescribing use.
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By Joseph Conn

Health records group vows to meet deadlines

If the current deadlines hold for both the ICD-10 code sets and the Version 5010 data standards, there are 46 companies in the Electronic Health Record Association that will be ready, according to Charlie Jarvis, the trade association's co-chairman.
The American Medical Association's House of Delegates voted to place the AMA in opposition to the Oct. 1, 2013, compliance deadline for the International Classification of Diseases 10th Revision. Meanwhile, the CMS announced it would hold off for 90 days on enforcing the Jan. 1, 2012, compliance deadline for the ASC X12 Version 5010 upgrade.
Both changes are federally mandated under the Health Insurance Portability and Accountability Act of 1996.
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Privacy is Easy

Health Data Management Blogs, November 21, 2011
Insuring patient privacy is easy.  Well, easier than information security. 
Information security is about preventing unauthorized access to information.  Information privacy is partially about security, but there is more to it. Privacy is not just about insuring all access is technically authorized.  Information privacy is also protecting against technically authorized, but inappropriate access.  Information privacy is also about giving the subject of the information some say over how the information is used and shared.  And it is also about notifying them when something is amiss.
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EHI PC survey identifies CCG IT plans

21 November 2011   Fiona Barr
Clinical commissioning groups have identified tools to compare GP practice data and to share data with secondary care as priorities for IT investment.
An exclusive survey conducted by EHI Primary Care, which attracted 64 responses, equal to almost 25% of the emerging groups in England, found that more than 75% believed that IT would be vital to the delivery of their goals.
More than two-thirds of respondents reported that they expected to invest in GP practice comparison data tools (67%) and tools to share information with secondary care (66%) over the next three years, while 67% expected to invest in GP clinical systems.
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Working group to consider SCR add-ons

17 November 2011   Rebecca Todd
A working group is being arranged to consider how additional information will be added to Summary Care Record via GP systems.
A Department of Health SCR Programme Update for October says 73% of out-of-hours doctors using the records feel they have increased patient safety.
But 74% also say that having additional information on the record would increase their ability to make informed decisions.
The update, included in the minutes of a British Medical Association and Royal College of GPs joint IT sub-committee meeting , says a working group is being put together to consider how additional information could be added.
“A working group is being arranged to consider and set a direction of travel for how additional information will be added and maintained via GP practice systems,” it says.
“It is essential that this work has input from the professional bodies and patient groups and that a way forward is jointly agreed by all parties. An initial meeting is being scheduled for November 2011.”
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Tuesday, November 22, 2011

Getting Health Data from Inside Your Body

Hugo Campos believes that patients with implanted medical devices deserve access to the data they collect.
Hugo Campos is a man on a mission. He wants access to the data being collected inside his body by an implanted cardiac defibrillator. He believes that having this information could help him take control of his health—for example, by helping him figure out what triggers his frequent attacks of abnormal heart rhythms. While not life-threatening, they cause dizziness, fainting, and chest pain. But he says device makers are reluctant to make that information available, mostly for commercial reasons.
"I have this complex little computer implanted in my body, but I have no access to it," says Campos. "The best that patients can do is get a printout of the report given to the doctor, and that's designed for doctors, not patients. Patients are left in the dark."
Campos's goal is a new twist on the concept of open access, one that has emerged as implanted medical devices become more common and patients increasingly use wireless devices and smart-phone tools to track their health and take control of their care.
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EHRs are inevitable, experts say

November 21, 2011 | Diana Manos, Senior Editor
WASHINGTON – Electronic health records will become the norm, sooner than later, experts said at a summit hosted Friday by the Office of the National Coordinator for Health IT (ONC).
The bottom line, said many of the speakers at ONC's Grantee and Stakeholder Summit, is that consumers are demanding EHRs. The government is helping with adoption, but this is not nearly as influential as the healthcare consumer's pressure on providers.
National Coordinator for Health IT Farzad Mostashari, MD, said the patient is not just "a ticket holder crammed into economy."
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Todd Park: More can, should be done to capture unique EHR safety issues

November 17, 2011 — 11:20pm ET | By Dan Bowman
As Chief Technology Officer at the U.S. Department of Health & Human Services, it's Todd Park's job to be excited about innovation. And, as anyone who's seen him speak live can attest, he takes his job very seriously.
"There has never been a better time to be an innovator at the intersection of IT, data, and health care improvement," Park tells FierceHealthIT in an exclusive interview. "Market incentives are beginning to change in the direction of rewarding innovations that improve health, quality, and efficiency, and information is being liberated at multiple levels to help power these innovations. Over the past 18 months, I've talked with literally hundreds of innovators across America who are doing incredible things with data and IT to improve health and care. Many of them aren't yet broadly known--but many will be soon. To paraphrase William Gibson, the future is here, it's just not ubiquitous yet."
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Analyzing the Sharp End of Health Care

HDM Breaking News, November 16, 2011
Perioperative services account for a huge chunk of hospital revenue, but they also account for a sizable slice of costs and medical errors. At the University of California–Irvine Medical Center, perioperative and anesthesia services were managed with rudimentary information technologies when Zeev Kain, M.D., came on board in 2008 as chairman of anesthesiology and perioperative care.
“We were basically at a horse and carriages stage with the I.T.—you had an OR environment where everything was state-of-the art but anesthesiologists were still using pen and paper to record what they did, and due to various workflow disruptions there was very little correlation between what they wrote down and what actually occurred,” Kain says. “To manage the OR we had to rely on green boards and mix of data that really didn’t provide insights into how to manage surgeries efficiently and ensure patient safety processes were being followed.”
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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.
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Written by Luke Gale
November 21, 2011

Three EU hospitals tap into HIMSS to assess health IT progress

Three European hospitals have recently reached Stage 6 on the EMR Adoption Model (EMRAM) scale, the Healthcare Information and Management Systems Society’s (HIMSS) rating system to track the progress of healthcare facilities’ efforts to implement new health IT programs.
According to HIMSS Analytics Europe CEO Uwe Buddrus, “For a hospital to achieve Stage 6 on the EMRAM scale means that it has successfully tackled some key challenges in the adoption of EMRs.”
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CHIME, eHI Issue HIE Guide

Posted by Anthony Guerra on November 16th, 2011
To help CIOs make complex decisions involving how to achieve HIE with other providers, CHIME and the eHealth Initiative have released, The HIE Guide for CIOs.”
The Web-based guide offers chapters on:
• Assessing the local landscape for HIE
• Considerations in forming an Enterprise Health Information Organization
• Selecting an external Health Information Organization
• Technical requirements for HIE
• Assessing service offerings
• Ensuring privacy and confidentiality
• National HIE initiatives
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Physicians using tablets to treat patients

Remote access to e-health records a top priority

Lucas Mearian
November 17, 2011 (Computerworld)
Within the next year, almost half of all doctors will be using tablets and other mobile devices to perform everyday tasks, such as accessing patient information in electronic medical records (EMRs), according to the survey by the Computing Technology Industry Association (CompTIA), a nonprofit group.
Today, a quarter of healthcare providers surveyed say they're using tablets in their practice. Another 21% indicated they expect to do so within a year.
CompTIA's Third Annual Healthcare IT Insights and Opportunities study was based on two separate online surveys: One focused on 350 doctors, dentists and other healthcare providers or administrators; the other polled 400 IT firms with healthcare IT practices. Both were conducted in late July and early August.
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Monday, November 21, 2011

Health Care IT Leaders Still Optimistic and Now Realistic

Earlier this year, a hospital CIO described hospitals' efforts to achieve meaningful use of electronic health records as thinking you're running in a 5K but finding out it's a marathon, and the finish line is moving further away with each step.
It's true that marathon runners experience a rush of adrenaline when they start, and everything looks rosy that first mile. Likewise, hospital CIOs were optimistic a year ago about their organizations' chances of receiving federal stimulus funding under the HITECH portion of the American Recovery and Reinvestment Act.
CIOs now are discovering they are in the midst of a long-term effort that will present a variety of challenges. While their timelines have been readjusted, most are cautiously confident as they move ahead with plans to implement EHRs.
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Healthcare Providers Continue to Move Toward Electronic Medical Records

By Ashley Cloninger
November 20 2011
A nationwide health care records network is getting closer to becoming reality. In 2009 the US Government set up a system of incentives as part of the Recovery Act to encourage health care providers to convert to electronic medical records systems. The first of those incentive payments will be issued within the next six months and we will find out just how effective the Act has been in converting health care providers to electronic means of documentation.
Prior to the Recovery Act, just 17% of health care providers and 12% of hospitals were on electronic systems. The problems with paper records were many, including susceptibility to loss or damage, lack of ability to transfer information between providers, and incorrect prescriptions being written. The new digital system proposed by the government would rid the medical system of all of these issues and hopefully help medical staff to be more efficient.
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Enjoy!
David.

Friday, December 02, 2011

All One Can Say Is - “Only In America”! I Wonder What Is Happening Here?

I was alerted to this article a few days ago.

Stimulus funds helped some stocks soar

By Tim Mullaney, Special for USA TODAY
As Congress and the White House launch investigations into renewable-energy loan guarantees made to companies such as Solyndra under the 2009 stimulus bill and related legislation, a USA TODAY analysis shows that a series of public companies that got help have soundly beaten the stock market and most venture-capital funds raised in 2008.
With debate raging in Washington about whether government can effectively pick winners and losers in a fast-changing economy, the data shed light on how well the Obama administration did the two major jobs that venture capital performs in a high-tech economy — helping investors make money and bringing new technology to market. Skeptics have pointed to former Obama economics adviser Lawrence Summers' comment in a 2009 e-mail that "government is a crappy VC" to argue that the $787 billion stimulus measure was packed with waste.
About $100 billion of stimulus funding was earmarked for technology spending, according to tech consulting firm International Data Corp. Two-thirds was for energy technology, and most of the rest will subsidize doctors' adoption of electronic medical-records (EMR) software. At USA TODAY's request, IDC identified major beneficiaries of that spending to examine whether the money helped companies grow and bring technologies to market.
The analysis covered more than 45 companies that are public or have registered for initial public offerings, including most leading makers of electronic medical-records software and electric cars, and a small selection of the 5,000-plus companies and local government agencies that got clean-energy stimulus grants. Separately, USA TODAY looked at the recipients of all 38 completed or pending loan guarantees under the Energy Department's three major financing programs, including well-known public companies such as Ford, Southern Cos. and NRG, not on IDC's list. In all, the included companies, or their customers, are to receive more than two-thirds of the technology funding.
So far, the legislation has sparked adoption of electronic medical-records software and nurtured an electric-car industry that will sell at least 20,000 cars this year. At least 19 companies have gone public or filed for IPOs after getting stimulus money, from Solazyme's $21.8 million grant to build a pilot biofuels refinery to a $1.6 billion loan guarantee letting BrightSource Energy build the world's biggest solar-generation plant of its kind, according to securities-disclosure filings.
.....
Healthy gains
The clearest connection between the stimulus and the economy might be in health care software, in which the boost in companies' value far exceeds the amount spent so far in a five-year program costing up to $30 billion. Together, the gain in value of companies such as McKesson, Cerner and Athenahealth since the stimulus bill was proposed is at least $20 billion.
The stimulus has paid about $100 million so far to clients of Cerner, the largest maker of electronic medical-records (EMR) software, said Piper Jaffray analyst Sean Wieland. Given Cerner's 20% market share, that translates into $500 million in extra annual sales for the industry, which may double as lower Medicare reimbursements, also part of the stimulus law, kick in for doctors who don't use EMRs by 2015, he said.
"This really did accelerate adoption," said Jeff Townsend, chief of staff at Kansas City, Mo.-based Cerner, whose stock-price value is up 194% or $6.5 billion, since January 2009. Cerner's new-software sales rose 26% in the first nine months of 2011 vs. 2010's pace of 16%. He said extra spending will add to growth, as doctors upgrade their systems and connect them to each other.
That spending has lifted nearly all health information technology stocks. Allscripts Healthcare Solutions, an EMR company whose CEO Glen Tullman raised money for Obama in 2008, has seen shares rise 134%. Rival Athenahealth, which supplies Internet-based medical-billing and EMR services as a cheaper alternative to software, has doubled since mid-2010.
The question is whether the spending was efficient, says Athenahealth CEO Jonathan Bush, who has donated to Mitt Romney's presidential campaigns and is former president George W. Bush's cousin. He says Washington could have spurred adoption of cheaper, more flexible technology such as his through regulatory changes without subsidizing software.
"We're a beneficiary of stimulus spending, but we'd be doing even better without it," said Bush, whose company benefitted from the administration's decision to have Medicare reimburse doctors for regularly using EMRs, favoring pay-as-you-go Internet business models such as Athena's, rather than paying for software purchases up front. "What you really needed was hundreds of cloud-based companies innovating."
By government standards, the health care stimulus was fairly disciplined, Townsend contends. Doctors aren't reimbursed for software until they show they're routinely using it for work such as prescribing medications, he said. While knitting together networks owned by different doctors and hospitals will take time, data-sharing is essential to contain overall health care spending, he said.
More here:
At the bottom of the article there is a table summarising the outcomes for a range of listed US companies.
iHealthBeat had an E-Health focussed take:
Monday, November 21, 2011

Stimulus Package Helped Boost Value of Health IT Stocks by 82%

The 2009 federal economic stimulus package helped to increase the stock value of 11 health IT-related companies by an average of 82%, according to an analysis by USA Today and consulting firm International Data Corporation, USA Today reports.
For the analysis, USA Today and IDC examined more than 45 companies that benefited from the stimulus package, including many leading manufacturers of electronic health record systems. All of the analyzed companies either are public or have registered for initial public offerings.
Health IT-Related Findings
According to the analysis, the value of the 11 health IT-related companies -- which include athenahealth, Cerner and McKesson -- has increased by a combined total of at least $20 billion since the stimulus package passed.
The analysis notes that the companies' gains exceed the amount that the federal government has spent so far to encourage EHR adoption through an incentive program that will cost up to $30 billion over five years. Under the stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
The analysis found that since the stimulus package passed, the stock value of health IT-related companies has increased by:
  • 194% for Cerner;
  • 134% for Allscripts Healthcare Solutions;
  • 105% for Computer Programs and Systems;
  • 105% for McKesson;
  • 96% for Siemens;
  • 89% for UnitedHealth Group;
  • 83% for Accenture;
  • 55% for athenahealth;
  • 51% for Dell; and
  • 34% for General Electric.
More here:
Some of the names we know well in Australia. It would be really interesting to know who much of the $467 Million we are spending on the PCEHR is going overseas and how much is actually ‘trickling down’ to Australian entities.
Sadly I doubt we will ever know. At least there has been considerable flow on to Australian based staff from DoHA and NEHTA especially for which we possibly should be grateful.
Sadly what I hear from a range of local providers is that demand has actually shrunk and that the concentration of skills in NEHTA and DoHA has ‘hollowed out’ the local industry to rather worrying levels.
This sentiment seems to have been expressed  here by the immediate past president of the Medical Software Industry Association.

MSIA: Things I should have said...

I wish I had kept a diary for the past two years during my time as the Medical Software Industry Association President (MSIA). The things I have seen, heard and read have generated all sorts of emotional responses: surprise; laughter; disappointment; frustration; sadness; anger; and humility. Health at the best of times is a hot topic. Throw an “e” at the start of Health and all sorts of “emotional” responses are brought forward. Throughout this roller-coaster ride of ups and downs, where often you only have a narrow window to get a point across, there are a number of things that, with the benefit of hindsight, I wish I had said.
The current politicians’ need both better advisors and to make public servants actually responsible for their actions if they want to progress change. The political process is a short-term cycle and the objective seems to be simply to stay in power. We should accept this as a fact of how politics works. It is not as complicated as they would want us to believe. More time (and money it seems), is spent on spin doctoring rather than calling to account the people or organisations that money is provided to.
.....
It is what happens next that really matters. We have all had experiences in our past that we would like to forget. While there are things that I should have said, I am sure there are things I should not have. Despite the frenetic pace that the eHealth agenda is facing and its potential derailment in many eyes, it is not too late to look at what can be achieved if we effectively work together to deliver the building blocks of eHealth. It is still possible if we harness the good will and the money that has been allocated to the eHealth agenda. Industry can help if they are helped. It has to be a constructive and effective action-generating outcomes. It is a hard task before us at best, so let us not make it harder than it already is. Simple, simple, simple steps is all that is needed. These steps will have lasting effects and stimulate innovation and creativity in the market place.
In conclusion: “Where is the rest of the $467 million that is not accounted for?” Any simple calculation of announced funding seems to have $10’s of millions, if not a lazy $100 million, unaccounted for. Why can’t that money be used to assist industry broadly to get the foundation pieces in place, like Health Identifiers, terminology and secure messaging across all sectors? This will deliver greater benefits and improve the effectiveness and efficiency in health and healthcare delivery than a Personally Controlled Electronic Health Record (PCEHR) system alone. Furthermore, it will enhance the PCEHRs that are already in existence and support the uptake of existing ones. This will be a lost opportunity if this money is not wisely spent with the broader industry to bring them to the table to deliver change. If we don’t engage the wider industry now, they will wander off and pursue things that really matter. eHealth dreams will be remembered as lost opportunities, good money after bad again, like the ghosts of eHealth past.
Dr Geoffrey Sayer
BSc(Psychol), MCH, PhD
Immediate Past President, MSIA
president@msia.com.au
Lots more here:
There is a serious warning here for those who will listen!
David.

Thursday, December 01, 2011

Electronic Prescribing and Prescription Transmission Seems To Be Working In the US. A Bit Different Here I Suspect.

This interesting report appeared a little while ago.

eRx worthwhile, but still problematic for docs, pharmacies

November 22, 2011 | Mike Miliard, Managing Editor
ROCKVILLE, MD – A new study by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality finds that physician practices and pharmacies are both keen on e-prescribing's ability to improve safety and save time – but that both groups face barriers to realizing its full benefit.
The study, published online in the Journal of the American Medical Informatics Association, focuses on the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed. It finds that e-prescribing helps reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.
Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. But prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists – particularly drug name, dosage form, quantity, and patient instructions – continue to pose problems.
"Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, MD. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."
Researchers at the Center for Studying Health System Change in Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies.
Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than 25 percent of the community pharmacies reported they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.
Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.
.....
The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," is available at jamia.bmj.com.
Lots more here:
Here is the abstract:
J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000515
  • Research and applications

Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies

  1. Joy M Grossman,
  2. Dori A Cross,
  3. Ellyn R Boukus,
  4. Genna R Cohen
  • Received 29 July 2011
  • Accepted 15 October 2011
  • Published Online First 18 November 2011

Abstract

Objective A core feature of e-prescribing is the electronic exchange of prescription data between physician practices and pharmacies, which can potentially improve the efficiency of the prescribing process and reduce medication errors. Barriers to implementing this feature exist, but they are not well understood. This study's objectives were to explore recent physician practice and pharmacy experiences with electronic transmission of new prescriptions and renewals, and identify facilitators of and barriers to effective electronic transmission and pharmacy e-prescription processing.
Design Qualitative analysis of 114 telephone interviews conducted with representatives from 97 organizations between February and September 2010, including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions via Surescripts.
Results Practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions.
Conclusions Electronic transmission of new prescriptions has matured. Changes in technical standards and system design and more targeted physician and pharmacy training may be needed to address barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions.
The full paper is here (free).
It is interesting to note that as of a few weeks ago over 50% of use physicians were using electronic prescribing and prescription transmission.
See here:
It really seems the US has their act together in this area - while we still seem to be trying to sort out Standards and have a couple of presently non-interoperable prescription transmission providers.
This is an area where the leadership from DoHA has been just woeful to say the least.
This from DoHA in June 2008 says it all!

KPMG CONSULTANCY IN ELECTRONIC PRESCRIBING AND DISPENSING

JUNE 2008

DEPARTMENT OF HEALTH AND AGEING RESPONSE

The Department of Health and Ageing considers electronic prescribing (ePrescribing) to be an important element of the national eHealth strategy and one that has the support of a large range of stakeholders.
The development of technical and business process standards for ePrescribing and dispensing of medications will serve as building blocks for broader opportunities arising from developments in medication management systems and individual electronic health records.
A number of amendments to State and Federal legislation have already been enacted across jurisdictions to enable ePrescribing systems to be implemented.
It is in this context that the Department of Health and Ageing in December 2007 contracted KPMG to undertake a research and consultation process to develop a national ePrescribing framework.
The KPMG report titled “Consultancy in Electronic Prescribing and Dispensing of Medicines (ePrescribing)”, finalised in June 2008, identifies strategic, technical and operational perspectives for developing ePrescribing across the various prescribing settings, namely: general community, private and public hospitals and the aged care sector.
The report provides an overview of the emerging issues in Australia, considers past experiences, international developments and broad stakeholder views in formulating a guide to the development of standards and guidelines for nationally consistent ePrescribing systems.
The process undertaken by KPMG was robust and importantly included substantial stakeholder consultation and investigation of the key issues.
The report identifies a number of implementation steps to support a nationally consistent ePrescribing systems environment.
The four key recommendations made in the report (page 6) are accepted by the Department of Health and Ageing and will be progressed in conjunction with broader eHealth initiatives.
A full copy of the KPMG report can be found at  www.health.gov.au
----- End Release
Almost 3.5 years later just where are we? We have the Pharmacy Guild and Medisecure / RACGP competing for the market and the Commonwealth incentive funds.
The Australian Standards are still in draft and contentious and progress is less than optimal!
This really could have been done just so much better!
David.

Wednesday, November 30, 2011

This Incompetent Piecemeal Approach Really Annoys Me. Just Hopeless.

The following appeared a few days ago.

DoHA seeks Web portal to combat chronic disease among indigenous Australians

The portal will build upon a pilot portal, built by HP on the Microsoft SharePoint platform
The Department of Health and Ageing (DoHA) is on the hunt for a provider to develop and host a Web portal with the aim of better managing and preventing chronic disease among indigenous Australians.
The Indigenous Web Based Primary Health Care Resource (IWBPHCR) will be a Web portal which integrates with clinical systems and enables healthcare staff to access materials relating to the prevention and management of chronic illness among indigenous Australians.
“The IWBPHCR collates and presents in a single resource existing tools, guides and other online information that promotes best practice in the prevention, identification and management of chronic disease in indigenous Australians,” the documents reads. “It covers the key chronic diseases contributing to the burden of disease including cardiovascular disease, diabetes mellitus type 2, chronic respiratory disease, chronic kidney disease and cancer.”
More here:
It seems to me this is archetypical ‘reverse discrimination’. If there is a business case to create a provider portal for 2.2% of the population (the Indigenous Population according to Wikipedia) then the case for a National Portal for all professional healthcare providers must be utterly overwhelming.
Pure and simple siloed and ignorant policy development and implementation in my view. The same sort of dreadful policy development quality that cuts the incentives for students to study science and maths in the Budget Update. Both are utterly appalling and prejudice our future.
David.

Here Is A List DoHA and NEHTA Ought To Think Carefully About.

The following appeared overnight.

GAO's 9 common critical success factors of federal IT projects

November 22, 2011 | Tom Sullivan, Editor
Knowing which tactics make for smooth, investment-worthy IT efforts can be as tricky as the projects themselves. Looking to shed some light on the matter, the Government Accountability Office (GAO) compiled a list of best practices based on interviews with CIOs and other acquisitions and procurement officials.
Using as a basis seven government IT projects – one of those being the VA’s Occupation Health Record-keeping System – the GAO boiled that list down to the “common factors that were critical to the success of three or more of the seven investments.”
Those are:
  1. Program officials were actively engaged with stakeholders
  2. Program staff had the necessary knowledge and skills
  3. Senior department and agency executives supported the programs
  4. End users and stakeholders were involved in the development of requirements
  5. End users participated in testing of system functionality prior to formal end user acceptance testing
  6. Government and contractor staff were stable and consistent
  7. Program staff prioritized requirements
  8. Program officials maintained regular communication with the prime contractor
  9. Programs received sufficient funding
In the report, titled "Critical Factors underlying successful major acquisitions," the GAO also listed its top seven projects – so judged because they “best achieved their respective cost, schedule, scope and performance goals.”
More here:
With a ridiculous testing time table, low levels of stakeholder engagement, specifications dreamt up in a vacuum I leave it as to reader exercise to score NEHTA / DoHA out of 9!
Won’t be high I suspect.
David.

Tuesday, November 29, 2011

This May Be The One And Only Opportunity You Get To Save E-Health In Australia. Take It!

The following report appeared in the Australian today.

Performance of NEHTA to go under Senate spotlight

THE performance of the National E-Health Transition Authority will be scrutinised in a Senate inquiry into the Gillard government's e-health record legislation.
The Community Affairs committee has been instructed to examine the design and capability of the $500 million personally controlled electronic health record system, including its expected functionality on the July 1 launch date next year.
Health Minister Nicola Roxon tabled her PCEHR bill and companion regulations in the lower house last Wednesday.
She needs to shepherd the legislation through parliament quickly to meet her political deadline.
Victorian Liberal senator Mitch Fifield has immediately referred it for a broad-ranging public inquiry.
Its scope includes "any other issues the committee considers appropriate".
The committee will consider the security arrangements, risks to patient privacy, the likelihood of data breaches and the proposed penalties.
It has also been instructed to examine NEHTA's use of consultants, contractors and the tendering process during the development of the PCEHR.
In particular, it will look at the products that NEHTA has designed, made, tested and certified for use in the system.
The Medical Software Industry Association has repeatedly warned that unresolved technical and clinical issues could put patients' safety at risk.
It said the Healthcare Identifiers service -- designed by NEHTA with little industry input -- was flawed and could result in duplicate individual identifiers, while there was no means of correcting operator or system errors in users' downstream systems.
Meanwhile, privacy and consumer advocates have complained about NEHTA's lack of consultation over key concerns.
Lots more here:
You can read the terms of reference for the enquiry.
The details are found in Appendix Six.
While it is very good that the topics cited above are being reviewed my major concern relates to the need to have the appropriate leadership for the whole e-Health program and to have the sort of governance frameworks in place that will ensure there is a sensible balance of all stakeholder’s interests as we move forward.
It goes without saying that for me this involves a fundamental review of the evidence for and business case supporting the PCEHR and a root and branch review and audit of just what NEHTA has been doing over the last 5+ years.
I will be preparing a submission on my own account to try and push the Senate Committee to ask the really hard questions and to not be fobbed off as they can be in a short Senate Estimates hearing.
These two paragraphs found later in the article make it utterly clear that big change is needed.
“Mr Fleming said last month that he was "committed to resolving the matter to the satisfaction of both organisations".
But in a second letter to Dr Clarke last week, he said NEHTA could not "accept a situation" where Dr Clarke continued to use "firm and direct communications" as he saw fit.”
You can read the full letter here:
Mr Fleming, it seems, is not at all comfortable with a little assertiveness on the part of a pretty well respected privacy advocate (Chair of the Australian Privacy Foundation at present) whose job it is to be just that!  He apparently does not agree with the views expressed and he (or his staff) seem to be trying to suppress these views by denying attendance at forums.
It is just this sort of issue that properly a designed governance framework and sensibly respectful leadership would swiftly address and save us all from a great deal of toing and froing.
Indeed in the letter Mr Fleming makes it clear he needs and wants respectful communication and co-operation. This is clearly vital on both sides  - especially when matters are seriously contested in the public space. Again a proper governance framework can assist greatly in getting the right outcome. The bottom line to me is that both sides in a disagreement like this actually need to really listen to each other and understand what is being communicated in terms of concerns and issues.
You can read all the correspondence here:
For this and a whole host of other reasons leadership and governance are top of my list for the enquiry. Bureaucrats need to remember they are ‘public servants’ and we are all the public!
Another point I also intend to make is around the frequently stated fiction from DoHA and NEHTA that implementing the PCEHR is implementing the National E-Health Strategy of 2008. This is just plainly and simply NOT true!
Lastly, on the governance issue, we have this claim from Minister Roxon on the legislation.

E-records legislation to be investigated

29th Nov 2011
THE Senate will investigate new legislation intended to create Australia’s personally controlled e-health record (PCEHR) system after the two relevant bills were referred to the Senate Standing Committees on Community Affairs last week.
The legislation, which includes provision for the merging of MBS and PBS information for the first time, was tabled in the lower house by Health Minister Nicola Roxon last week before being referred to the committee in the Senate on Friday.
.....
Ms Roxon told parliament on Wednesday the legislation was developed through two rounds of public consultation and a draft version of the bill.
“The central theme of our system and this bill is that any Australian will be able to register for an e-health record, and they will be able to choose the settings for who can access their record and the extent of that access,” Ms Roxon said.
.....
Full article here:
With decent governance we would have a digest that shows how the Government responded to the submissions mentioned above and what changes were made. Of course we don’t have a clue and no one knows if their time was utterly wasted in responding!
The details of how to make a submission to the Senate Enquiry are found in this post.
The closing date is January 12, 2012 - so get thinking and writing if we are to see some better e-Health in the years to come!
Feel free to indicate in comments areas you think need to be addressed by the enquiry.
David.