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."

Monday, December 05, 2011

AusHealthIT Poll Number 99 – Results – 5th December, 2011.

The question was:
What Do You Think Will Be The Outcome Of PCEHR 3 Years From Now?
It Will Be Declared A Huge Success
-  11 (22%)
It Will Still Be Limping Along
-  21 (42%)
It Will Have Been Abandoned
- 16 (32%)
I Have No Idea
-  1 (2%)
Votes so far: 49
It appears that over 70% of readers think it will either be dead or be just limping along three years from now. Hardly much of a vote of confidence.
Again, many thanks to those that voted!
David.

Sunday, December 04, 2011

NEHTA's Unreality Just Seems To Roll On And On. This Will Take Years. What Planet Are They On?

The following announcement appeared last week

NEHTA licenses CSIRO software for e-health rollout

The software will aid the transition to a standardised dictionary of clinical terms
The National E-Health Transition Authority (NEHTA) has licensed software from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to aid the move to a standardised dictionary of clinical terms as part of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project.
The $467 million project involves the establishment of a PCEHR system that encompasses patient health summaries which both patients and their healthcare providers can access by 1 July 2012.
Australian e-Health Research Centre (AEHRC) chief executive, David Hansen, told Computerworld Australia that the Department of Health and Ageing (DoHA) and NEHTA would soon require healthcare software vendors to make the transition to SNOMED CT, a clinical terminology which encompasses a group of terms that would underpin the PCEHR going forward.
“Whenever there’s a problem, a diagnosis or a clinical description that’s needed to be put in our electronic health records, clinicians, whether they know it or not because it’s in the software, will be picking a term from the SNOMED CT vocabulary,” Hansen said.
NEHTA adopted SNOMED CT about five years ago when they started standardising electronic health information, but usage is still quite low, Hansen said.
CSIRO will provide a free download of the software, called Snapper, which was developed at the AEHRC – a joint venture between CSIRO and the Queensland Government – from November 2011 until 30 June 2013 to support software companies and healthcare providers in making the move.
“Most existing electronic systems do not use the SNOMED CT dictionary, but a mix of existing standard and local data dictionaries. The Snapper tool will help to translate terms in the existing system to terms from SNOMED CT,” Hansen said.
“The Snapper tool will enable information captured in an emergency department computer system to be understood by the computer systems used for hospital in-patients, and again by GP computer systems once the patient has been discharged.
“It will also help with the maintenance as SNOMED is released every six months and help them know which terms they might want to add and so on.”
The Java-based software, compatible with PCs, Macs and Linux, is standalone and while SNOMED CT comes as part of the package, Hansen said, users will be able to update automatically in the future.
More here:
Being curious I thought I would see just what Snapper was.

Snapper

Developed at the Australian e-Health Research Centre, CSIRO’s Snapper incorporates rich semantic feedback to produce the most fully-featured and easiest to use tool for creating mappings from existing term lists or value sets to SNOMED CT and AMT. These semantic mappings enable the meaning of terms in existing clinical terminologies to be described using concepts or expressions from SNOMED CT.
In addition, the intuitive graphical interface allows quick and easy generation and maintenance of customised term lists (Reference Sets) that can then be exported into current software or accessed via an RF2-conformant terminology server.
  • All-in-one: Map your existing terminology to SNOMED CT or build SNOMED CT compliant Reference Sets without needing to fiddle around with browsers and a spreadsheet.
  • Easy to use: Snapper provides a full browsing experience to enable users to understand the SNOMED CT and AMT content.
  • Time-saving: Snapper imports a list of source terms for mapping each term to SNOMED CT and provides an automap feature to provide a "first pass" mapping.
  • Fully featured: Snapper supports the full semantics of SNOMED CT and AMT. Full support is given for creation and syntactic and semantic checking of SNOMED CT’s post-coordination expression syntax, where required.
  • Intuitive GUI: Snapper has unique visualisation features, such as the interactive ontology visualiser and the expression editor. Drag and drop functionality provides for a modern user interface experience.
  • Full lifecycle: Ongoing maintenance of Reference Sets is supported through the use of RF2-based timestamps and timestamp-aware comparison algorithms.
More information, necessary licenses and downloads are here:
So, in summary what Snapper is, is a terminology mapping tool  to allow systems that have an embedded terminology that is presently used for coding information to convert their present term set to a SNOMED-CT set of associations.
I assume what this means is that if you have an existing set of say drug names or say ICPC codes these can be converted to the SNOMED equivalent in a partially automated way - because - as it made clear, the automap feature only provides a “first pass” map.
A few things occur to me with all this:
A review of the Information Requirements for the PCEHR’s Shared Health Summary (SHS) shows that while SNOMED-CT is preferred, free text is still going to be OK. It is going to be a good while before most software that might create a SHS will be SNOMED-CT compliant.
Any mapping that is done will inevitably introduce all sorts of problems that will need to be manually reviewed and resolved. Any errors could have some rather nasty consequences.
Third if SNOMED-CT is the be used - and it is really the only kid on the block at present - would it not be more sensible to use it directly and not via a map. If terms are going to be applied to text I would feel a direct use would be appropriate - remembering there is a need to minimise user effort by using focussed sub-sets etc. Really it is vital that the clinician is the one that attaches the meaning to a code and this is best done using a direct interaction with the SNOMED hierarchy I would think. This becomes especially relevant if clinical decision support is to be driven from the codes.
This really means provider software need to be configured and tailored to use the terminology from the ground up in an ideal world!
I am also reminded of the comments of Prof. Alan Rector (who really understands this stuff like few in the world) that are found here:
“Until comprehensive quality assurance has been undertaken, anyone using, or mandating, SNOMED should be aware that the hierarchies contain serious anomalies. Should a ‘Reference terminology’ classify diabetes as a disease of the abdomen; fail to classify myocardial infarction as ischemic heart disease; place the arteries of the foot in the abdomen?
Without further quality assurance, clinicians may not realize the implications of what they are saying; researchers may not realize what their queries should retrieve, and post-coordination cannot be expected to be reliable. Interoperability, and therefore meaningful use, will be limited.”
I also note the arrangement only goes until 2013. I suspect that with most involved in e-Health in Australia rather pre-occupied with PCEHR related activities the focus on SNOMED may not be very intense at this stage.
It also seems a little odd that there was not some form of procurement process undertaken for software and services to support SNOMED implementation. There are companies like Healthlanguage and (http://www.healthlanguage.com/)  and Apelon (http://www.apelon.com/) out there who do this work globally.
Interestingly Apelon have just won a contract to help Canada with a similar program.
See here:
Somehow, while being very pleased we have Australian effort and expertise in the area, I feel this is another NEHTA  initiative which may not lead very far in terms of real clinical outcomes in the short or even medium term.
Recognising the limited progress in the five years since SNOMED-CT was adopted I fear we may be waiting another few before some real clinical benefits flow.
To speed things up things some real funds and support need to be provided along with things like Snapper. To date it is not clear that is the plan - to say the least! As of now the expectations of rapid adoption are really pretty unreal - pressure from NEHTA and DoHA or not!
Bottom line. This is not a solution to an urgent problem. We need a total reboot of governance and leadership in Australian E-Health to get us back on the rails.
For those who can access it (at the NETHA Vendor Portal) the NEHTA Version 2.0 Blueprint reveals all sorts of reality checks on time-lines and delivery which really need serious public discussion. Dream on David!
David.

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.