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, January 14, 2012

Weekly Overseas Health IT Links - 14th January, 2012.

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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How CIOs Cope When the Going Gets Tough

Edward Prewitt, for HealthLeaders Media , January 3, 2012

Healthcare IT is subordinate to the medical mission. Information technology in hospitals and healthcare systems operates in the service of executives, medical staff, and especially patients, and healthcare CIOs tend to focus on industry-specific issues such as meaningful use, healthcare information exchanges, and EMRs/EHRs/PHRs. The professional organizations for healthcare CIOs, CHIME and HIMSS, speak to the specific issues of their members.
Yet I am struck by how similar the healthcare CIO's job is becoming to that of CIOs across other industries. John Halamka, CIO of Beth Israel Deaconess Medical Center and Harvard Medical School and a noted blogger, recently penned a column titled "The modern healthcare CIO job: It's becoming a Mission Impossible." He recounts a host of difficulties, including "compliance burdens, overwhelming demands, and impossible expectations."
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The telehealth year in review

December 29, 2011 | Government Health IT Staff
It is hard to imagine a more interesting time in the healthcare industry than today. The realm is undergoing unprecedented change, and all segments are converging on a common set of goals to leverage innovation and technology to provide quality care, improved outcomes, and cost-efficiency.
Five years from now 2011 may be looked at as a pivotal time in the evolution of Telehealth. We saw a continued trend of federal funding that provides direct incentives for the use of Telehealth technology, and promising results from major pilots in the field. But most importantly, there were significant developments in the regulation of Telehealth technology and coverage of Telehealth-enabled care. These game-changers will lower the barriers to entry and accelerate the adoption of Telehealth.
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Less than 1 percent of hospitals fully use tablets

By: Chris Gullo | Jan 2, 2012
Less than one percent of US hospitals have fully functional tablet systems, according to Jonathan Mack, director of clinical research and development at the West Wireless Health Institute. Despite financial incentives from the government, US hospitals are still slow to adopt EMRs, Mack told Kaiser Health News in a recent interview. Those that do might not have access to a native tablet application from the EMR developer, and even then, the app might include only read-only functionality. To circumvent this, virtualization programs such as Citrix are used on EMRs designed for keyboard input, making for a slow and frustrating usage experience.
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Diabetic Tester That Talks to iPhones and Doctors

·         By WALTER S. MOSSBERG

While consumer technology advances by leaps and bounds, the devices patients use to manage diseases often seem stuck in the past. A glaring example is the glucometer, the instrument diabetics use to measure the sugar in their blood—information they use to adjust their diet, exercise and medication.
These meters, which analyze drops of blood drawn from fingertips, typically resemble crude PDAs from 10 or 15 years ago. They offer little feedback and can't connect to the Internet to show results to caregivers. Most diabetics who use them log their readings on paper, which they hand doctors weeks or months later.
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Microsoft researcher: Passwords aren't dead but they need fixing

  • Tim Greene (Network World)
  • 05 January, 2012 08:29
Password use needs an overhaul that is driven not by guesswork but by actually understanding the real damage that can be done when password security is compromised, according to a Microsoft researcher.
While many call for replacing passwords altogether with something else, they may be doing so based on little or no hard evidence, says Cormac Herley, a principal researcher at Microsoft Research.
Keystroke logging, brute force attacks, phishing and session hijacking are all used to get around passwords, but it would be impossible to draw a pie chart of how much each method was used because nobody knows, he says in a paper on the subject. "We don't know the slice sizes — not even approximately," he says.
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FDA's approach to clinical decision support software: A brief summary

By bthompson
Created Dec 28 2011 - 9:53am
We wrote this paper for those who have little experience with U.S. Food and Drug Administration regulation of clinical decision support (CDS) software. Our goal is to provide background for those who want to participate in FDA's ongoing efforts to clarify its regulatory approach to CDS. In 2011, FDA announced plans to publish a new guidance document that will define which types of CDS it will regulate. To gather the information needed to write the guidance, the agency held a hearing in September 2011, and we anticipate FDA will propose its guidance document perhaps early in 2012.
While the topic is very complicated, in this paper we try to distill it down to the fundamentals, and probably risk oversimplifying in the process.
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App challenge winners harness public data for cancer treatment

January 05, 2012 | Mike Miliard, Managing Editor
HONOLULU – Two new winners of a Department of Health and Human Services (HHS) innovation challenge have created health IT applications that use public data and to help patients and healthcare professionals prevent, detect, diagnose and treat cancer.
The winning apps, which were presented this week at the Hawaii International Conference on Systems Sciences, were each awarded $20,000 by the Office for the National Coordinator for Health Information Technology (ONC).
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Microsoft's PHR goes mobile with iTriage

December 30, 2011 | Bernie Monegain, Editor
DENVER – The consumer healthcare technology platform iTriage will integrate its iPhone mobile application with the Microsoft HealthVault personal healthcare record (PHR).
The connection will enable iTriage users to view and access their records stored within Microsoft HealthVault, via the iPhone.
More than three million people have used iTriage to view information on symptoms, diseases, procedures, medications, and to access a nationwide directory of medical providers, according to iTriage executives, who note that iTriage has been touted by ABC News as the one-stop app that allows patients to not only know what’s wrong with them, but also know where to go for treatment.
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Riding the Revolution

JAN 1, 2012
Intermountain Healthcare is equally renowned for cutting-edge information technology and health care quality improvement. Though it hasn't formally attested for meaningful use (mainly because its homegrown EHR system has to be certified first), health informatics pioneers were using computers for decision support at Intermountain's flagship LDS Hospital as early as the 1950s, and it has had electronic medical records in some form since the 1970s.
It's currently developing a new EHR system in collaboration with GE Healthcare; modules are expected to start reaching the market sometime later this year. Using its advanced I.T. capabilities, Intermountain conducted some of the first formal studies on health care quality, utilization and efficiency in the mid-1980s. The Intermountain Institute for Health Care Delivery Research, founded in 1990, routinely breaks new ground in finding ways to make care more efficient and effective.
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Federal health IT market poised for growth

December 29, 2011 | Bernie Monegain, Editor
HERNDON, VA – Investments in health IT systems and services by federal government agencies will increase from $4.5 billion in 2011 to $6.5 billion in 2016 at a compound annual growth rate of 7.5 percent, according to a new GovWin report from research firm Deltek.
“Federal Health Information Technology Market, 2011-2016” explores the federal health IT market environment and future trends and their anticipated impact on vendors, VARS, systems integrators, and federal contractors over the next five years.
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Building One Big Pipe

Elizabeth Gardner
Health Data Management Magazine, 01/01/2012
Thanks to smartphones, the Internet, and streaming Netflix, the general public no longer draws the traditional distinctions among data, voice and video. They're all just one big stream of information and communication-a stream that users expect to be able to tap at will from wherever they are, with whatever gadget is handy. And hospital CIOs are scrambling to meet that expectation, not only for their clinicians but for the many devices that generate data, images and alerts for those clinicians to use in patient care.
"Our doctors look like Batman with a utility belt" because they're carrying multiple cell phones and pagers to connect with the people and data they need, says Chuck Christian, CIO of Good Samaritan Hospital, Vincennes, Ind. "We would like one device to take the place of all those things, and then to create a single conduit for communications."
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Halamka to test ways to reduce mobile device distraction

By: Neil Versel | Dec 22, 2011
Perhaps the best-known hospital CIO in the country loves the potential of mobile devices to improve care, but he cautions that healthcare organizations had better understand and act to mitigate the risks mobility can introduce.
Writing on the Agency for Healthcare Research & Quality’s Web M&M online journal, Dr. John Halamka, CIO of CareGroup Healthcare System in Boston, discusses his experience with mobile devices at Beth Israel Deaconess Medical Center. Halamka suggests hospitals need to develop best practices for employing mobile devices in clinical settings.
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Hackers Target Patient Records on Mobile Devices

By Janet Maragioglio | Wed Dec 21, 2011 11:34 am
Patient data breaches are surging as mobile device use increases among healthcare personnel, underscoring a need for greater privacy protection.
According to the Ponemon Institute, data breaches in healthcare rose more than 30 percent this year, with 96 percent of healthcare organizations reporting at least one breach involving patient information over the past two years.
The rise in medical data breaches parallels the increase in mobile device use in healthcare, becoming one of the industry's biggest challenges as more hospitals and physicians' offices digitize patient records.
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The 7 Deadly Sins of EMR implementation

By Michelle McNickle, Web Content Producer
Created 09/07/2011
Congratulations! You've committed to an EMR, which is an accomplishment in itself. But the hardest part is still to come: getting it to work.
From failing to plan to skipping out on training, many mistakes can be made during the implementation process. And although they may not be as juicy as wrath, envy or lust, the Seven Deadly Sins of EMR implementation could wreak just as much havoc.
Steve Waldren, MD, director of the American Academy of Family Physicians' Center for Health IT, and Rosemarie Nelson, principal of the MGMA Consulting Group, gave us the worst sins providers can commit during EMR implementation.
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Health IT Tools Reduce Readmissions At Philadelphia Hospitals

With the help of health information technology, more than 400 patients avoided being rehospitalized and 18 facilities saved a total of $4 million in one quarter.
By Nicole Lewis,  InformationWeek
December 22, 2011
A survey of 29 Philadelphia-based hospitals has found that the 18 facilities that submitted patient readmissions data saw a 7% drop in their 30-day same-hospital readmission rates. The figures represent more than 400 patients who avoided being re-hospitalized and $4 million in savings for the third quarter of 2011.
How did they accomplish these goals? According to the Transitions of Care Survey Summary Report, recently released by The Health Care Improvement Foundation, hospitals participating in the 18-month Preventing Avoidable Episodes (PAVE) Project improved upon strategies that enhance transitions of care and prevent hospital readmissions. Those strategies could not have happened without electronic health records (EHRs) and related health information technology tools.
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Year in review: Top 10 trends in healthcare data privacy and security

December 22, 2011 | Rick Kam, President and CEO, ID Experts and Christine Arevalo, director of healthcare identity management, ID Experts
Forget the hospital dramas on TV. Our top 10 list of this year’s trends in healthcare privacy and security has excitement to rival any show. 2011 has been the year of the policing of the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) police, mobile technology and massive-scale data breaches:
1. More policing, more penalties, OCR-style.
The OCR has entered a new phase of increased enforcement and fines that are stiffer than an overstarched lab coat. In February,
Cignet Health was fined $4.3 million for denying patients access to their medical records. At about the same time, Massachusetts General agreed to pay $1 million for the loss of 192 patients’ PHI.
2. Increase in healthcare data breaches.
Despite increased enforcement of federal regulations, the frequency of healthcare data breaches are on the rise, up 32 percent, according to
a new benchmark study by the Ponemon Institute. Data breaches have become a when, not if, reality in the lives of healthcare professionals. The Ponemon study found that hospitals and healthcare providers are averaging four data breaches a year. These data breaches are costing the healthcare industry an estimated $6.5 billion annually, according to the study.
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Computer Sciences Warns of $1.5 Billion Write-Down

By MATT JARZEMSKY

Computer Sciences Corp. warned it might write off the $1.5 billion value of a disputed contract with the U.K.'s state-run health service, the latest in a string of setbacks for the technology-services company.
CSC has been negotiating with Britain's National Health Service since mid-November over the scope of an electronic patient-records system the company is helping to develop. Uncertainty over the deal's value, along with struggles in CSC's core business and a regulatory investigation of its accounting, have dimmed investors' view of the Falls Church, Va., company.
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ONC’s Five-Step Process for Adopting EHRs

HDM Breaking News, December 22, 2011
Provider organizations still mulling over whether or when to adopt electronic health records can get help from a five-step implementation program on the Web site of the Office of the National Coordinator for Health Information Technology.
The program walks through assessing practice readiness, planning your approach, selecting or upgrading to a certified EHR, training and implementation, and achieving meaningful use and quality improvement.
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December 18, 2011

Digital Data on Patients Raises Risk of Breaches

By NICOLE PERLROTH
One afternoon last spring, Micky Tripathi received a panicked call from an employee. Someone had broken into his car and stolen his briefcase and company laptop along with it.
So began a nightmare that cost Mr. Tripathi’s small nonprofit health consultancy nearly $300,000 in legal, private investigation, credit monitoring and media consultancy fees. Not to mention 600 hours dealing with the fallout and the intangible cost of repairing the reputational damage that followed.
Mr. Tripathi’s nonprofit, the Massachusetts eHealth Collaborative in Waltham, Mass., works with doctors and hospitals to help digitize their patient records. His employee’s stolen laptop contained unencrypted records for some 13,687 patients — each record containing some combination of a patient’s name, Social Security number, birth date, contact information and insurance information — an identity theft gold mine.
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IBM's Watson computer to aid Cedars-Sinai cancer center

The artificial-intelligence computer will guide doctors at the Samuel Oschin Comprehensive Cancer Institute on diagnosis and treatment.

By Ricardo Lopez, Los Angeles Times
December 17, 2011
IBM's Watson supercomputer may be best known for handily beating "Jeopardy!" game show champs.
Now it's being harnessed to help doctors at Cedars-Sinai's cancer clinic in Los Angeles stay up-to-date on medical breakthroughs and treatments.
Doctors at the Samuel Oschin Comprehensive Cancer Institute will be the first to use the technology, IBM said, and they will help the computer company make tweaks to the system — the first commercial application of the computer since its "Jeopardy!" debut early this year.
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Federal health IT market set to grow to $6.5B by 2016

December 20, 2011 | Mike Miliard, Managing Editor
HERNDON, VA – Federal spending on healthcare IT will reach $6.5 billion by 2016, according to a new survey from Deltek, Inc. That represents a compound annual growth rate of 7.5 percent -- outpacing forecasted growth of just 1.1 percent for overall federal non-health IT spending for the same period.
Federal health IT spending includes funding for payment systems, technology used to deliver healthcare services including electronic health records (EHR) systems, and IT to support federally-funded health research and promotion, according to the survey, conducted by Deltek, which develops IT for professional firms and government contractors.
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Interoperability should be top priority for NHS, report says

November 28, 2011 | Jamie Thompson, Web Editor
The Interoperability Toolkit (ITK), a set of standards and guidelines intended to help the NHS across England to connect health IT systems, is touted as an important resource in bringing about interoperability in the region. A new report co-authored by Paul Cooper, IMS MAXIMS Head of Research, titled We Should Talk: Interoperability and the NHS, delves into this topic.
The report recognizes the benefits of the ITK, such as its ability to ensure results at a local level. But it recommends that more needs to be done to engage suppliers and that many people still need to be persuaded to accept interoperability.
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Year-end: 3 security threats and 4 tips for protecting health data

December 16, 2011 | Moti Rafalin, CEO, WatchDox
This year, we witnessed several trends that have major implications when it comes to the security of our most precious resource – our documents. And document leaks are on the rise. The Ponemon Institute recently released a study showing a 32 percent increase in data breaches in the healthcare field. Also, 96 percent of healthcare organizations indicated they had suffered from a data breach in the last two years. The combined cost of such data breaches is estimated to be $6.5 billion annually.
So what are the trends that are causing this increase? This article will review the major trends changing the world and the way people consume information, as well as the effect these trends have on document security.
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Ohio first state to use Direct messaging across state lines

December 16, 2011 | Diana Manos, Senior Editor
COLUMBUS, OH – Ohio is the first state in the nation to successfully send and receive health information across state lines, using Direct secure messaging, through its statewide health information exchange, CliniSync, according to the Ohio Health Information Partnership (OHIP). The OHIP, a Medicity client, is the state-designated HIE for Ohio.
Medicity announced Friday that it has helped OHIP to conduct live messages between one physician's office in Lima, Ohio and another in Biloxi, Miss. Mississippi's state-designated HIE, the Mississippi Health Information Network (MS-HIN), is also a Medicity client. The partnership also performed live instances of Direct messaging within the state of Ohio. 
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VA's Blue Button expanding nationwide and beyond

December 19, 2011 | Diana Manos, Senior Editor
WASHINGTON – In 2010, the Veterans Administration launched the Blue Button, a standards format that allows simple exchange of a patient's personal health data. Initially designed for use by veterans, the idea has taken off in the private sector and has been supported by at least one major care provider overseas.
According to VA’s chief technology officer and Blue Button’s developer Peter Levin, Blue Button is expanding much more than your average American is aware of. With regard to the future, “this changes everything,” Levin said. “Blue Button really is on the vanguard of changing the clinical encounter. Patients now have access to their record.  It's all there, all organized.”
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Consumer group lists top 6 data breaches of 2011

December 19, 2011 | Stephanie Bouchard, Contributing Editor
SAN DIEGO – Of the six most significant data breaches in 2011, three were in the healthcare industry, according to the Privacy Rights Clearinghouse, a nonprofit consumer protection and advocacy organization.
Breaches at Sutter Physicians Services/Sutter Medical Foundation ranked third on the list, Health Net came in fifth and Tricare Management Activity/Science Applications International Corporation came in sixth.
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Implementation support needed for small practice EHR adoption to take off in 2012

December 18, 2011 — 6:06pm ET | By Ken Terry
Long ignored by leading electronic health record vendors because of the high cost of selling to them, small practices finally are getting the spotlight. Motivated by the government's EHR incentive program, Dell and Costco recently launched campaigns to market EHRs to these small businesses, which have adopted the technology at a far slower rate than have medium-sized and large groups.
Dell is selling a package of computer hardware, software and services to physicians in small practices through a network of 30 value-added resellers (VARs) that eventually will grow to as many as 150 firms. Physicians can choose among a dozen well-known EHRs, including those of Allscripts, Cerner, eClinicalWorks, e-MDs, Epic, Greenway, Ingenix, NextGen, Practice Fusion, McKesson, and MEDITECH.
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Enjoy!
David.

Friday, January 13, 2012

The Recently Departed Health Of US Health IT Provides Some Perspectives On What is Happening There. It Is Serious Stuff!

As a special from the New England Journal of Medicine, which is celebrating its 200th year this year we have a 2 parter from the just departed head of the Office of the National Co-ordinator for Health IT in the US.
Given Dr Blumenthal is from the Boston / Harvard Medical School axis where better than the NEJM for this to appear?

Wiring the Health System — Origins and Provisions of a New Federal Program

David Blumenthal, M.D., M.P.P.
N Engl J Med 2011; 365:2323-2329 December 15, 2011
PART ONE OF TWO
Presented as the 36th annual Joseph Garland Lecture of the Boston Medical Library on October 25, 2011. Dr. Garland was editor-in-chief of the Journal from 1947 through 1967.
In February 2009, the U.S. government launched an unprecedented effort to reengineer the way the country collects, stores, and uses health information. This effort was embodied in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of a much larger piece of legislation, the so-called stimulus bill. The purpose of the stimulus bill, also known as the American Recovery and Reinvestment Act of 2009 (ARRA), was to stimulate the economy and prevent one of the worst economic recessions in modern history from becoming a full-fledged depression. Congress and the Obama administration took advantage of the crisis to enact programs that might spur short-term economic growth as well as promote scientific and technical advances with potential long-term benefits for the American people. In the health field, one such program involved a commitment to digitizing the U.S. health information system. The HITECH Act set aside up to $29 billion over 10 years to support the adoption and “meaningful use” of electronic health records (EHRs) (i.e., use intended to improve health and health care) and other types of health information technology.
Such large, targeted public investments in any particular type of health technology are rare in U.S. history. Indeed, it is difficult to think of a precedent for the HITECH Act, which encourages millions of health professionals and thousands of health care institutions to adopt and use health information technology. Now that more than 2 years have passed since this historic program began, a review of its original rationale, its accomplishments, and its considerable challenges seems timely. This report discusses the original justification for the HITECH Act, its major provisions, and some of the early challenges associated with its implementation. In interpreting this report, readers should be aware that I served as national coordinator for health information technology in the Obama administration from April 2009 until April 2011.

Arguments for HITECH

Two basic arguments justified intervention by the federal government in 2009 to promote the adoption and meaningful use of health information technology. The first was a conviction that information technology could improve health and health care for the American people. The second was that major problems inhibit the spread of health information technology in ways that create the need for government remedies.

Value of Health Information Technology

As the first decade of the 21st century came to a close, a variety of considerations appeared to support the expanded use of new forms of information technology in health care. One rationale was intuitive. Information technology was revolutionizing every aspect of human affairs, but U.S. health care seemed peculiarly immune. As of 2008, only 17% of physicians and 12% of hospitals had basic or fully functional electronic health records.1,2 This level of use contrasted with widespread adoption of EHRs in many other industrialized nations, including the United Kingdom, the Netherlands, Scandinavia, Australia, and New Zealand.3 Surely, the U.S. health care system — by far the most expensive in the world — should be capitalizing on one of the most fundamental technological breakthroughs in human history.
Theoretical arguments offered a further rationale for the use of health information technology. Experts agreed that the U.S. health care system was not realizing value for the money invested.4-6 The health system's waste and inefficiency weighed particularly heavily on policymakers, who contemplated the effects of relentlessly increasing health care costs on the U.S. economy and federal deficits.6 But eliminating waste and improving quality are difficult if health professionals are uninformed about the care their patients are receiving elsewhere in the health care system. Better coordination of care lies at the heart of improved performance of the health system, but coordination implies sharing information, and information sharing is difficult in a paper-based world. Electronic health information systems thus seemed a necessary foundation for realizing many other short-term and long-term health policy goals.7
Still another rationale was empirical. Experience was demonstrating the ability of health information technology to improve the quality and efficiency of care, especially in the large health systems that were early adopters of this technology. Relying heavily on health information technology, the Veterans Health Administration transformed itself in the 1990s from a much-disparaged health care organization to one of the best in the United States.8 The Kaiser Permanente Health Plan was making major strides in improving the care of patients with chronic illness using its systemwide electronic health records.9,10 Ninety percent of physicians using EHRs in 2008 reported that they were satisfied or very satisfied with them, and large majorities could point to specific quality benefits.1 After a review of the existing evidence, the Institute of Medicine called repeatedly for increased use of health information technology in health care.11,12 Studies were not uniformly positive. Some showed possible safety problems associated with health information technology.13-17 Others raised questions in particular about whether the benefits realized by early adopters and large institutions with self-developed EHRs were generalizable to commercially developed products and later adopters and smaller institutions.18 But, on balance, studies provided support for the wider adoption and use of health information technology.19

Barriers to Adoption and Use of Health Information Technology

Despite the attractions of health information technology, at least four barriers have slowed the dissemination of EHRs and other electronic information systems. The first barrier is economic.1,2,20,21 The fee-for-service payment system in the United States does not financially reward the improved quality and efficiency that health information technology makes possible. When such benefits occur, they accrue to patients and payers as much as or more than to the health professionals and institutions that bear the often considerable costs of installing EHRs and other forms of information technology. Thus, left to their own devices, private U.S. health markets are unlikely to take full advantage of health information technology. Economists generally agree that when markets fail in this way, government has a legitimate role in helping to correct those market failures.22
A second barrier to the adoption and use of health information technology is logistical and technical. EHRs in particular are complex products that are difficult to evaluate and understand. The market's diverse offerings vary enormously in capability and usability, and new products are burgeoning. Lacking resources and expertise, providers are legitimately concerned about making big investments in systems that may not meet their needs.1 They also face technical hurdles in installing, maintaining, and upgrading EHRs over time. These concerns can reinforce the natural reluctance of health professionals to make the major changes in their daily work that new health information systems often require. Such logistical and technical barriers suggest that many providers may need assistance in adopting and using health information technology, and a successful effort to propagate EHRs in New York City indicated that government can facilitate such assistance.23
Problems with the exchange of health information create a third obstacle to the dissemination and use of health information technology. The ability to effectively transfer electronic health information between different information systems in various institutions and practices is underdeveloped in the United States at this time.24,25 Thus, providers are appropriately concerned that their electronic health information systems may not be able to exchange health information about their patients with other caretakers. This concern creates a rationale to wait until some uncertain future time when systems for exchange are working well. However, with thousands of health information technology products and hundreds of thousands of users of health information technology, developing such exchange solutions and getting them to work seamlessly are huge challenges. Overcoming these challenges requires collaboration among vendors and users of health information technology, but these organizations are often fierce competitors in local and national markets; so collaboration is unlikely to occur naturally. This lack of collaboration creates a rationale for government to be an honest broker in facilitating technical and policy approaches to the exchange of health information.
Still a fourth problem inhibiting the adoption and use of health information technology is concern about the privacy and security of digital health information. Paper-based systems are not completely private or secure,26 but digital systems create new challenges. The media report almost daily breaches in public and private electronic information systems, both health- and non–health-related.27 Entire new industries have arisen using personal health information for purposes that were never anticipated by existing privacy statutes, and these uses are not currently regulated. An example is the growing personal health record industry, which is not currently regulated under the Health Insurance Portability and Accountability Act (HIPAA). Public fears about the loss or misuse of personal health information could undermine efforts to disseminate health information technology.
Taken together, the case for more rapid adoption and use of health information technology, the considerable barriers to its spread, and the rationale for government intervention to overcome those barriers created the justification for federal legislation to promote electronic health information systems. Congress had made several bipartisan attempts to pass such legislation during the administration of President George W. Bush, but the political will for a major federal investment in health information technology did not exist at that time. The economic crisis of 2008 broke the logjam, and the HITECH Act emerged.
The much longer full free article is here:
Here is the beginning of Part 2
Special Report

Implementation of the Federal Health Information Technology Initiative

David Blumenthal, M.D., M.P.P.
N Engl J Med 2011; 365:2426-2431 December 22, 2011
PART TWO OF TWO
Presented as the 36th annual Joseph Garland Lecture of the Boston Medical Library on October 25, 2011. Dr. Garland was editor-in-chief of the Journal from 1947 through 1967.
In the spring of 2009, the Department of Health and Human Services (DHHS) faced a daunting project: to lead the creation of a nationwide, interoperable, private, and secure electronic health information system. The DHHS and its two key agencies that were responsible for this task — the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) — were in many ways unprepared to undertake it.1 But, as national coordinator for health information technology at the time, neither I nor my CMS colleagues had any choice. The Health Information Technology for Economic and Clinical Health (HITECH) Act was the law of the land. This report reviews how the DHHS responded to the challenges it faced in implementing the HITECH Act, what has been accomplished to date, and some of the major issues that remain to be addressed.

Responding to the Challenges of the Hitech Act

The very size and scope of the HITECH Act mandate could have proved paralyzing if the DHHS had tried to address all its goals and requirements at the outset. However, the legislation itself helped to avoid this outcome. Its ambitious, congressionally determined deadlines made clear that the CMS and ONC had to act quickly. They should start by defining the “meaningful use” of electronic health records (EHRs) (the level of use that providers would have to attain to qualify for incentive payments under the HITECH Act). They should also set standards, define implementation specifications and certification criteria for EHRs that would support meaningful use, and build a national infrastructure to help willing providers attain meaningful use by January 2011, or as soon thereafter as possible. Tight time frames also made it unrealistic and unwise to specify a final, permanent definition of meaningful use and associated technical requirements in the few months that Congress had allowed. The only practical strategy was to do so in stages; this would permit continuing consultation with stakeholders and learning from experience.
The limited administrative resources of the ONC and CMS and the sheer complexity of the policies that they had to develop also argued for assembling the best minds in the nation to assist with defining and implementing the HITECH Act. However, consultation with outside experts poses surprising challenges in the federal government. Federal officials must conform to the Federal Advisory Committee Act, which requires that they obtain nongovernmental input through an open and transparent process that is accessible to the public. Here again, the ONC and CMS were fortunate that the HITECH Act created two new federal committees to advise them: a Health Information Technology Policy Committee (HITPC) and a Health Information Technology Standards Committee (HITSC). The former was to provide general policy advice, and the latter to help with developing standards, implementation specifications, and certification criteria for EHRs. In hundreds of open meetings of the HITSC, the HITPC, and its many working groups, scores of experts contributed tens of thousands of free hours to helping DHHS make the HITECH Act work.
In still another way, the HITECH Act helped the DHHS make critical early choices about implementation. The law provided the ONC with $2 billion to support development of a nationwide electronic health information system. The ONC had wide discretion concerning how to allocate these funds, but the statute provided important guidance. First, it said that whatever else the ONC decided to do, it had to fund regional extension centers for health information technology, programs for states to organize the exchange of health information within their boundaries, and training programs for health information technology professionals.2-7 Second, the HITECH Act created a clear unspoken requirement to put supports in place well before providers became eligible for meaningful-use payments on January 1, 2011, so that the programs could assist the first wave of potential users. For both legal and practical reasons, therefore, it made sense to get these three mandated congressional initiatives up and running as soon as possible.
The early pragmatic focus of the DHHS on meaningful use and on having the ONC fund particular initiatives did not obviate the need to develop a broader strategic vision and a more extensive set of programs for achieving the overarching goals of the HITECH Act. The ONC produced a first installment for such a vision in the summer of 2009.8

The Record to Date

Meaningful Use

On December 31, 2009, under the leadership of CMS, the federal government produced a proposed rule defining meaningful use and its associated incentive programs. A number of provider groups commented that they found the proposed rule too demanding and inflexible. CMS published a revised final rule on July 13, 2010. Described in detail elsewhere,9,10 the final rule was generally better received by providers, although some still warned that small practices and health care institutions would be unable to meet its demands. The rule defined stage 1 of meaningful use, and it promised that additional stages would be specified in 2013 and 2015. Stage 1 focused on defining the data that should be collected electronically in EHRs. Later stages of meaningful use would be more demanding and would emphasize the uses of EHRs that would improve processes of care (stage 2) and outcomes (stage 3).
In the final analysis, the meaningful-use program will be successful if it improves the quality and efficiency of health care services and the health of Americans. However, these are long-term goals that will be challenging to measure and will be influenced by a host of factors, including the implementation of the Affordable Care Act (which the HITECH Act is supposed to support). In the short term, the success of the meaningful-use provisions will be judged at least in part by whether or not sufficient numbers of providers are adopting and using EHRs in a manner consistent with meaningful-use criteria. What constitutes “sufficient numbers” at any point in time will always be open to interpretation. On the one hand, if 100% of providers met the meaningful-use standard in 2011, the rule could be fairly criticized for having set the bar too low. On the other hand, if only a few providers qualified for payments during stage 1, the regulation will be considered excessively demanding.
Stage 1 of meaningful use lasts through 2012 (although the secretary of health and human services has suggested extending it), and the program as a whole extends through 2018 for Medicare and through 2021 for Medicaid. It is far too early, therefore, to reach any definitive judgment about the regulation's success. On the positive side, providers are clearly aware of and responding to the availability of incentives. Internal CMS surveys show that as of April 2011, 78% of physicians and 96% of hospital executives were aware of the meaningful-use program (Trudel K: personal communication). As Figure 1 (Figure 1Provider Registrations for Meaningful-Use Payments) shows, more than 114,000 eligible providers, or 21%, had registered for meaningful-use payments by the end of September 2011.11 Registration is the first step in qualifying for meaningful-use payments. Providers must then complete a second step by attesting to their fulfillment of meaningful-use criteria. The pace of registrations remains strong at approximately 10,000 providers per month. CMS internal surveys have shown that 90% of unregistered hospitals intend to register. Less positive is that only 31% of unregistered physicians said they intended to register (Trudel K: personal communication).
Through September 2011, a relatively modest 3880 providers had successfully attested to meaningful use under Medicare, receiving a total of $357 million. An additional 6767 had received more than $514 million from state Medicaid programs, which do not require attesting to meaningful use in the first year.11
On a much more positive note, the HITECH Act may have spurred a rapid increase in the adoption of EHRs, an essential precondition to their meaningful use. Data released by the DHHS at the end of November showed that between 2009 and 2011, the proportion of U.S. physicians reporting that they had at least a basic EHR had increased from 22 to 34%. The percentage of primary care physicians with a basic EHR had increased from 20 to 39%, or almost doubled, during that period.12
..... (much more fascinating material omitted on what has happened in 2 years.)

Looking Forward

Beyond these three challenges to achieving the vision of the HITECH Act, many others remain. Nevertheless, over the long term, the success of the HITECH program seems inevitable, in part because its failure is unimaginable.
Information is the cornerstone of good clinical care and vital to all the objectives of our health care system. It is inconceivable that the health system in the United States will indefinitely resist a force that is transforming modern civilization and that offers almost infinite promise for improved and more efficient care. But perhaps the most convincing reason for the inevitability of the vision of the HITECH Act is that the next generation of clinicians, weaned on the Internet, Twitter, Facebook, the iPad, and the iPhone, will insist that the United States find its way to an interoperable, private, secure, and modern electronic health information system.

Source Information

From the Departments of Medicine and Health Care Policy, Harvard Medical School, Boston.
The second part is here:
What we have here, in my view, is the insider’s view of what has happened when funds, leadership, political will and governance come together. Sure Dr Blumenthal is talking his own book and legacy to a degree but I invite comparison with the capability and competence of what we are seeing in Australia.
I fear it is really pretty sad indeed. Do read the two articles - they are free and need to be read by all.
David

Thursday, January 12, 2012

More Perspectives Appear On Health IT Safety. I Don’t Think NEHTA is Paying Attention. They Should Be!

Some interesting articles appeared on Health IT safety around the time I published a link to an article in the Australian.
That Australian article is linked from here:
In chronological order we have:

New Institute of Medicine Report on Health IT and Patient Safety

POSTED BY: Robert Charette  /  Mon, November 14, 2011
Last week, the Committee on Patient Safety and Health Information Technology at the Institute of Medicine released a very interesting report concerning its investigation into health IT and improving patient safety. The title of the 197-page study, appropriately called "Health IT and Patient Safety: Building Safer Systems for Better Care," is focused on assessing "... some of the important issues surrounding health IT and its introduction and to indicate the activities most likely to bring the potential value of health IT to the U.S. health care system."
The IOM study was necessarily narrow in scope, and therefore the Committee did not look at issues such as "... whether health IT should be implemented, access to health IT products, medical liability, privacy, security, and standards." The Committee recognizes these critical issues need to be addressed, but its mission was to examine "..the aspects of health IT directly pertaining to safety."
A great deal more here:
I referred to this article in my Senate Enquiry Submission here:
Then we have a much later and very comprehensive effort from iHealthBeat.
Wednesday, December 21, 2011

Gov't Seeks To Ensure Patient Safety While Promoting Health IT

One of the most sacred maxims in health care is "first, do no harm." Following this principle, the federal government has taken a number of steps to balance patient safety with its promotion of widespread adoption of health IT to improve care.
As part of this effort, the Office of the National Coordinator for Health IT asked the Institute of Medicine to explore the effect of health IT on patient safety and to define the roles of the public and private sectors in ensuring safe and effective health IT use. On Nov. 8, IOM released its recommendations in a report titled, "Health IT and Patient Safety: Building Safer Systems for Better Care." 
Background
How best to protect patients from health IT-related harm is an important policy issue that has been the subject of considerable debate. Unlike pharmaceuticals and medical devices, health IT tools are not currently subject to comprehensive safety review.
Some have suggested that ONC -- which is responsible for coordinating the development of a national health IT infrastructure and promoting use of health IT -- should oversee health IT safety. Others have suggested that FDA is best suited to ensure health IT safety.
As the IOM report acknowledged, the level of safety risk associated with health IT tools is unclear, although case reports suggest that poorly designed health IT tools can create new hazards in the delivery of care, such as the loss or corruption of vital patient data.
However, there is industry concern that FDA regulation could slow health IT innovation. The IOM report noted that the "current FDA framework is oriented toward conventional, out-of-the-box, turnkey devices. However, health IT has multiple different characteristics, suggesting that a more flexible regulatory framework will be needed in this area to achieve the goals of product quality and safety without unduly constraining market innovation." 
IOM did not take a definitive position on the question of whether health IT tools should be subject to comprehensive, FDA-type regulation. Instead, IOM recommended that Congress create an independent federal entity to investigate patient safety deaths, serious injuries or potentially unsafe conditions associated with health IT and that FDA exert its regulatory authority only if HHS determines that progress toward safety and reliability is insufficient.
Major Themes From IOM Recommendations
ONC asked IOM to examine a variety of patient safety topics, including how to reduce health IT-related safety concerns, as well as the role of private-sector groups (e.g., accreditation bodies and professional societies) and federal government agencies in ensuring health IT safety. IOM's recommendations apply to electronic health records, patient engagement tools, such as personal health records and patient portals, and health information exchanges.
In general, IOM noted that because health IT is not used in isolation and instead is part of a larger "sociotechnical" system that also includes people, organizations and processes, safety emerges from the interactions of these factors. Thus, safety analyses should not look for a single "root cause" of problems but should consider the system as a whole; health IT vendors, users, government and the private sector all have roles to play.
While IOM made 10 recommendations, four main themes emerge. First, fostering a system-based approach is key. According to IOM, creating safer systems begins with user-centered design principles and includes adequate testing and quality assurance conducted in real or simulated clinical environments. Designers and users of health IT should work together to develop, implement, optimize and maintain health IT tools.
Second, health IT vendors and users must be able to freely share safety information. The ability to generate, develop and share details of safety risks is essential for health care providers to choose health IT tools that best suit their needs. Non-disclosure clauses in health IT vendor contracts can discourage users from sharing information and should be limited. Comparative user experiences with health IT should be publicly available.
Third, standards, measures and criteria for safe use of health IT are necessary. Without them, it is difficult to reliably assess the current state of health IT safety and to monitor improvements.
Finally, transparency and accountability can help turn errors into lessons learned. There should be a government-run mechanism for reporting health IT-related deaths, serious injuries or unsafe conditions. This will help quantify patient safety risk and enable vendors and users to act on the information.
.....

MORE ON THE WEB

The full article is here:
The latest - after Christmas is here:

Unintended - but Predicted - Consequences of Electronic Health Record Usage Grows

POSTED BY: Robert Charette  /  Tue, December 27, 2011
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced that nearly $2 billion has been paid out in electronic health record (EHR) adoption incentives as of the end of November. In 2009, the US government, as part of the American Recovery and Reinvestment Act of 2009, set aside nearly $30 billion to support EHR adoption in the US. Eligible Medicaid professionals can get up to $63,750 over six years (eligible Medicare professionals up to $44,000 over five years) in incentive payments if they can meet certain technological certification as well as healthcare practice criteria called "meaningful use."
"... 115,093 physicians and hospitals are [currently registered] in the Medicare incentive program; 39,503 physicians and hospitals are in the Medicaid program; and 2,634 hospitals are registered for both the Medicare and Medicaid programs."
As more physicians and hospitals adopt EHRs, the more operational risk issues surface. In mid-December, the RAND Corporation in cooperation with the University of Pennsylvania School of Medicine, Kaiser Permanente-Colorado and the American Health Information Management Association Foundation released an EHR "Unintended Consequences Guide" which is available from the US Agency for Healthcare Research and Quality web site.
The guide, says RAND, is aimed at helping "... hospitals and other health care organizations anticipate, avoid and address problems that can occur when adopting and using electronic health records." Some common unintended consequences the guide addresses are:
  • More work for clinicians
  • Unfavorable workflow changes
  • Never-ending demands for system changes
  • Conflicts between electronic and paper-based systems
  • Unfavorable changes in communication patterns and practices
  • Negative user emotions
  • Generation of new kinds of errors
  • Unexpected and unintended changes in institutional power structure
  • Over-dependence on technology
I must admit that I am a bit mystified by what qualifies to be an "unintended consequence" of EHRs since all of the above issues have been discussed for years in the medical as well as computer literature, including by myself here in IEEE Spectrum as a direct consequence of EHR implementation and use. What is interesting is that other issues, e.g., like protecting the security/privacy of electronic health records, do not seem to be mentioned in the guide at all. I'll return to this subject in a few moments.
Another so-called "unintended consequence" missing from the list is "doctoring while distracted," i.e., doctors and other healthcare professionals paying too much attention to their EHR system or other digital devices and not enough to their patients. Sometimes it has to do with doctors having to futz with inputting information into the EHR system, and losing eye contact with their patients (PDF).
Other times, it's being tempted to just forget the patient is there are all. There was an article in the New York Times just two weeks ago about distracted doctors and other health care workers that contained some troubling examples. For instance:
"A peer-reviewed survey of 439 medical technicians published this year in Perfusion, a journal about cardio-pulmonary bypass surgery, found that 55 percent of technicians who monitor bypass machines acknowledged to researchers that they had talked on cell phones during heart surgery. Half said they had texted while in surgery."
Lots more here:
The bottom line in all this is that we have to have a structured, co-ordinated and learning approach to the development, implementation and post implementation of health systems to ensure that we are obeying the first rule of medicine - “First, do no harm”.
I look forward to being told that NEHTA is changing their ways - and until then I will keep banging on about the issue!
David.

Wednesday, January 11, 2012

This Is A Very Interesting Study of Patient Attitudes To EHR Information Access. Changes Are Coming and The PCEHR is The Wrong Way To Be Going!

The following very interesting report appeared very late last year.

Patients, doctors at odds about sharing medical notes

December 20, 2011 | Bernie Monegain, Editor
BOSTON – Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests.
In a study published in the Dec. 20 issue of the Annals of Internal Medicine, patient and doctor attitudes were surveyed extensively prior to the launch of the OpenNotes trial in which patients at BIDMC, Geisinger Health System of Danville, Pa., and Harborview Medical Center in Seattle were offered online access to their doctors’ notes written after office visits. Such notes have long been primarily within the doctors’ domain, even though patients have the legal right to obtain them. 
 “Doctors were divided in many of their expectations, and the issues we highlight have important consequences for both their work life and quality of care,” writes lead author Jan Walker, a nurse with an MBA, who works at BIDMC’s Division of General Medicine and Primary Care.
While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried.
“The enthusiasm of patients exceeded our expectations,” wrote Walker. “Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics.”
More here:
Here is the Abstract from the Annals of Internal Medicine:

Patient Interest in Sharing Personal Health Record Information

A Web-Based Survey

  1. Donna M. Zulman, MD, MS;
  2. Kim M. Nazi, MA;
  3. Carolyn L. Turvey, PhD, MS;
  4. Todd H. Wagner, PhD;
  5. Susan S. Woods, MD, MPH; and
  6. Larry C. An, MD

Abstract

Background: Electronic personal health record (PHR) systems are proliferating but largely have not realized their potential for enhancing communication among patients and their network of care providers.
Objective: To explore preferences about sharing electronic health information among users of the U.S. Department of Veterans Affairs (VA) PHR system, My HealtheVet.
Design: Web-based survey of a convenience sample.
Setting: My HealtheVet Web site from 7 July through 4 October 2010.
Participants: 18 471 users of My HealtheVet.
Measurements: Interest in shared PHR access and preferences about who would receive access, the information that would be shared, and the activities that users would delegate.
Results: Survey respondents were predominantly men (92%) and aged 50 to 64 years (51%) or 65 years or older (39%); approximately 39% reported poor or fair health status. Almost 4 of 5 respondents (79%) were interested in sharing access to their PHR with someone outside of their health system (62% with a spouse or partner, 23% with a child, 15% with another family member, and 25% with a non-VA health care provider). Among those who selected a family member other than a spouse or partner, 47% lived apart from the specified person. Preferences about degree of access varied on the basis of the type of information being shared, the type of activity being performed, and the respondent's relationship with the selected person.
Limitations: The survey completion rate was 40.8%. Results might not be generalizable to all My HealtheVet users.
Conclusion: In a large survey of PHR users in the VA system, most respondents were interested in sharing access to their electronic health information with caregivers and non-VA providers. Existing and evolving PHR systems should explore secure mechanisms for shared PHR access to improve information exchange among patients and the multiple persons involved in their health care.
Primary Funding Source: Veterans Health Administration and The Robert Wood Johnson Foundation Clinical Scholars Program.
The full paper is linked from here (.pdf is free):
There is also an editorial found here:
Again the .pdf of the full text is free.
The writers of the editorial have some experience in their own organisation over a number of years doing a similar thing with generally very positive results.
It is important to note the large number questions raised by the editorial. Issues of access, interpretation, understanding and use are all open. They also make it clear that this is at the beginning of a long journey.
This type of information access is, of course, the direction I have been pushing for a good while now, with the provider providing access for their patients to their records. It is worth remembering a number of GP Practices in the UK are doing very similar things.
This trend has also been made quite clear by an article appearing in E-Health Insider yesterday.

Future Forum calls for access plan

10 January 2012   Rebecca Todd
The NHS Future Forum has said the government needs to develop a plan to deliver on its commitment to give patients access to their online records by 2015.
The forum’s summary report – second phase was due to be released onto the Department of Health website at midnight.
Hints of what it contained led to a flurry of media interest in the issue of patient records access in the days before Christmas.
NHS Future Forum chairman Professor Steve Field says in the report that citizens should be equal partners in their care, rather than passive consumers, and that a key part of this is patient ownership of their data.
The government has already made a number of commitments to giving patients access to records and other data.
It’s ‘Information Revolution’ consultation on a new NHS information strategy said patient access to records should start with GP records and then extend to hospital and other medical records.
In his Autumn Statement, Chancellor George Osborne said that all patients should have access to their online GP records by the end of this Parliament – 2015.
The NHS Future Forum supports that commitment and says the information strategy must clearly set out how this will be achieved, “recognising that there is both a financial and time burden to GP practices and by providing meaningful help and support to them.”
Professor Field says the Royal College of General Practitioners, in partnership with the British Medical Association, NHS Commissioning Board and relevant patient organisations, should be invited by the Department of Health to “develop a plan that delivers the roll-out of access to patient records by 2015.”
“Switching on patient access alone is not enough, and potentially detrimental if appropriate support structures are not in place for patients so that they understand and know how to use the information,” he says.
“The planned rollout of patient access to electronic records by the government must acknowledge this and ensure that a support structure is in place, including a proper consent process.”
More here:
So what we are seeing is a move in the US and UK to provision of access to provider records directly in consultation with that provider and with direct interaction with the consumer
This is just not what the planned PCEHR will enable and will mean the patient cannot build a direct relationship with the EHR managed, curated and delivered by their provider and be supported by them.
I think this is a major directional change and has the possibility to improve clinician / patient engagement and the quality of care. Only time and further experience will tell.
The PCEHR is just a dead end on this path and the concept is just obsolete.
David.

Tuesday, January 10, 2012

A Press Release That Conceals A Rather Large Problem. The Dominant GP System Provider Is Apparently Not Engaged With The PCEHR!

The following release appeared late last year.

iSOFT Demonstrates Progress at the NEHTA GP Desktop Vendor Panel

Monday, December 19, 2011 - iSOFT a CSC Company
Presenting at the NEHTA GP Desktop Vendor Panel on 6 December 2011, iSOFT demonstrated progress in preparing the practiX software to communicate health information according to the new NEHTA eHealth specifications.
Sydney, NSW – Earlier this month, iSOFT, a CSC company, presented at the National E-Health Transition Authority (NEHTA) GP Desktop Vendors Panel in Sydney. The purpose of the meeting was to review the progress of the six vendors participating in the project to prepare GP practice management software to communicate with hospital and specialist systems as part of the Federal Government’s PCEHR project. The first milestones in the project are to enable the applications to look up Individual Health Identifiers (IHI), accept discharge information and specialist letters – foundational elements of the Australian Government’s eHealth agenda.
Presenting along with iSOFT at the NEHTA panel were GP desktop vendors; Best Practice, Communicare, Genie, Medtech and Zedmed. Vendors demonstrated or explained the work they had been doing to enable their GP desktop systems to communicate health information according to the NEHTA specifications.
Each vendor showed evidence of progress against NEHTA’s milestones in preparation for implementation at the first GP sites early in 2012.
“As our eHealth solutions span primary, community, aged and tertiary care, we felt it was important to take an open and health system wide approach to meeting the NEHTA specifications. Using our iSOFT HIE Suite we are building interoperable components, that can work across iSOFT solutions and that are available to any application following the same NEHTA specifications,” explained James Rice, iSOFT APAC Managing Director.
“This open approach is of great advantage to state governments looking to implement Individual Healthcare Identifiers (IHI) across a health care system. Using iSOFT’s open Health Information Exchange (HIE) architecture, state departments of health will be able to identify and manage patients across multiple eHealth systems.”
Talking about the wider effort at iSOFT to achieve connectivity between applications, iSOFT’s Rice said, “Most recently we have used our HIE Suite to also enable our widely implemented Patient Management System (i.PM) for the HI without the need for customers to upgrade the core product. This is another example of the agility such a solution provides iSOFT and our customers.”
All vendors have now met the Wave I Release 1 requirements for use of healthcare identifiers. In addition to identifiers, iSOFT has achieved CCA conformance testing for the Secure Message Delivery (SMD) functionality. The SMD capability is part of the Release 2 functionality due 31 January, 2012.
iSOFT demonstrated the practiX GP desktop software interacting with the Medicare Individual Healthcare Identifier (IHI) database to retrieve a new 16-digit IHI number and associate it with a specific patient record. This functionality is the basis for the national eHealth reforms as it enables the secure sharing of health data across health care sectors.
The full release is here:
What is interesting in this release is this list.
Here are the vendors who were involved.
·         Best Practice (BP)
·         Communicare
·         Genie
·         Medtech
·         Zedmed
·         and iSoft themselves.
The reason this is important is what is missing - Medical Director is not there!
In terms of market share I believe BP is now up to a little over 20% of the market and that the others are a good deal lower - please correct me if I am wrong.
Figures from a year or so back - and they are pretty hard to come by for obvious commercial reasons suggest - roughly the following:
MD (Version 2 and 3) - 35-45%
Pracsoft - Around 20-30% (MD Financials etc)
Best Practice - Around 20%
Medtech - Around 5%
Genie - Around 7-15%
ZedMed - Around 5%
Practix - Around 10%
Let me know if any of these figures are off!
The bottom line is that MD is at least 40% and probably closer to 50% so to not have them involved is just commercial stupidity on the part of NEHTA and DoHA.
I wonder just what is going on behind the scenes here?
David.

AusHealthIT Poll Number 103 – Results – 10th January, 2012.

The question was:
How Well Do You Think The PCEHR Program is Being Managed / Delivered?
Just Fabulously
- 1 (4%)
Sort of OK
-  0 (0%)
Not Very Well
- 6 (25%)
Just Awfully
-  17 (70%)
Votes 24
It appears that all except one reader thinks things are dreadful - hopeless that!.
Again, many thanks to those that voted!
David.

Monday, January 09, 2012

Submissions to The Senate PCEHR Enquiry Are Beginning To Be Made Public!

The following page is now active.

Personally Controlled Electronic Health Records Bill 2011 and one related bill

Submissions received by the Committee

The following link is useful to keep a close eye on what is being published.
I note - as of 10pm 09/01/2012 - we already have material from the following to be browsed.

Sub No.

1               National Rural Health Alliance (PDF 56KB) 
2               National E-Health Transition Authority (PDF 750KB) 
3               Associate Professor Terry Hannan (PDF 170KB) 
4               CSC Healthcare (PDF 517KB) 
5               HealthLink Ltd (PDF 674KB) 
6               The Royal Australian and New Zealand College of Radiologists (PDF 113KB) 
I am sure more will follow in coming days. May be even mine! There is already some good reading.
Submission close on 12/01/2012 so not much time is left to have your say.
Enjoy checking back regularly.
David.