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."

Sunday, March 18, 2012

Is Detailed Clinical Modelling Actually A Hopeless Cause? It Seems It Might Just Be The Case.

Grahame Grieve published an interesting blog a few days ago.

CIMI at the Crossroads

Posted on March 15, 2012 by Grahame Grieve
The Clinical Information Modelling Initiative (CIMI, see here, and here) is
“an international collaboration that is dedicated to providing a common format for detailed specifications for the representation of health information content so that semantically interoperable information may be created and shared in health records, messages and documents”
CIMI is one of a number of efforts that have been started to try and define a common format for such specifications; all the previous efforts (mostly going by the name of DCM, “detailed clinical models”) have gotten bogged down in methodology questions and political games of various sorts, and they’ve failed to produce something that people might actually use.
CIMI shows every sign of following the same trail to the same dead end.
From the beginning, the CIMI initiative sought to produce a different outcome from previous efforts by trying to be agnostic on the tribal and political issues that have bedeviled the previous efforts. In particular:
  • The membership of CIMI included all the significant players in the space, not only some of them
  • The charter always included CIMI providing the capability to express the clinical models in a series of different formalisms (i.e. XML, Java, HL7 v2, EN13606, CDA, openEHR etc) by the provision of some “compiler”
The membership point was really new – and for the first time there was real hope that something might come from this. The first task for CIMI was to choose an internal methodology that would be used as the primary expression of the models. The initiative held a meeting in London in Nov 2011 to choose between the following candidate approaches:
  • UML/OCL and associated OMG standards
  • 13606-2/ADL 1.4
  • ADL 1.5 (http://www.openEHR.org)
  • Semantic Web technology (OWL, RDF, Protégé, and associated tools and standards)
  •  HL7 v3 approach (MIF, HL7 RIM, static models and associated artifacts and tools)
The full blog and comments are found here:
The blog goes on to point out a seeming lack of progress and agreement and some indecision on the part of many on just is the right way forward.
This area excited me ages ago but sadly I have rather gone off the boil as I waited for perceptible progress to emerge.
Here are a few blogs on related areas.

Saturday, December 02, 2006

Health IT – What is in the Way of Progress?

In the last few weeks I have been ruminating on what is in the way, and what are the roadblocks, to improved Health IT deployment and use in Australia.

There is no doubt that this is a multi-factorial issue that involves human, technical and financial aspects. If we consider the current situation there are some clear facts.

1. It is possible to build, deploy and have used computer systems that can assist with the operations, efficiency, safety and quality of hospitals. Suitable systems both from here and overseas are available to suit most of the patient management, clinical and administrative operations of both small, medium and large hospitals. The same can also be said systems to operate diagnostic laboratory and imaging services.

2. The same is true in the provision of support for General Practice and Specialist Office Practice with the market beginning to mature and evidence of significant contestability of system selection emerging. (Medical Director’s market share is no longer more than 2/3 of the market with IBA, Genie and Best Practice making some headway). Recent changes in the Commonwealth Practice Incentive Program is also ensuring more of the available functionality is actually being used.

3. Messaging of pathology and radiology results is being widely deployed via a number of providers (Argus, Medical Objects, HealthLink, Promedicus etc). Referrals to specialists are also gradually beginning to happen electronically – albeit as yet in pretty un-standardised form by and large. At present there is a great deal of prescription printing but very little, if any, in the way of prescription transmission electronically.

4. There has been considerable investment on development of a range of Standards which have facilitated the communication of pathology results at the individual test level using HL7 V2 which has made these results more usable. At present, however, a majority of results are still transmitted using the PIT format.
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and here:

Sunday, January 21, 2007

Archetypically Stupid!

Recently (December 1, 2006) the Health Informatics Technical Committee of the International Standards Organisation (ISO) released a draft Standard entitled Health informatics — Electronic health record communication — Part 2: Part 2: Archetype interchange specification. The closing date for comments is in March, 2007.

The draft document is on its way through the various ISO and CEN processes towards being approved as one of the five parts of the TC 215 Standard on Electronic Record Communication. (pr13606).

Overall the Standard – if approved - aims to define how extracts of patient records can be safely and reliably moved between two EHR systems which are compliant with the Standard once approved.

Key to the success of the approach being adopted is the use of an information construct called an Archetype which defines how clinical content within the record is to be laid out and interpreted.
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Last here:

Sunday, January 28, 2007

Archetypes, Standards and All That Jazz – Part 2.

Well it has been an interesting week since I published my short article on archetypes. Sadly the conversation has gone on in a number of places (for quite sensible reasons) but it is hard to form an overview – much less try to distil what I have learnt and heard from all the discussion.

Before reading further I suggest those interested visit the openEHR site and review the “aus health it” thread, starting at the 21 January, 2007 entry. It can be found at:
http://www.openehr.org/advice/openehr-clinical/maillist.html

Initially, for some reason my e-mail is deferred and then rejected at the site (since I am not a registered member) so following some of the conversation can be a little difficult.
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Well after at least 5 years it seems pretty hard to discern just what practical and usable progress has been made.
A browse of the last six months this blog shows Dr Heather Leslie and openEHR has been also noticing some areas are more than a little tricky:
See here:
This post is really quite useful in getting to grips with where things are:

Are we there yet?

Posted on
No, but we are definitely moving in the right direction… Conversations are happening that were uncommon generally, and downright rare in the US only 18 months ago.
I’ve been rabbiting on for some time about the need for a ‘universal health record – an application-independent core of shared and standardised health information into which a variety of ‘enlightened’ applications can ‘plug & play’; thus breaking down the hold of the proprietary and ‘not invented here’ approach of proprietary clinical applications with which we battle most everywhere today.
So it was pleasing to see Margalit Gur-Arie’s recent blog post on Arguments for a Universal Health Record. While I’m not convinced about the reality a single database (see my comments at the end of Margalit’s post), I wholeheartedly endorse the principle of having a single approach to defining the data – this is a very powerful concept, and one that may well become a pivotal enabler to health IT innovation.
In addition, Kevin Coonan has started blogging in recent days – see his Summary of DCMs regarding principles of Detailed Clinical Models (aka DCMs). Now I know that Kevin’s vision for an implementable HL7 DCM is totally different to the openEHR DCMs (=archetypes) that I work with. But we do agree on the basic principles about the basic attributes of these models that he has outlined in his blog post – it is quite a good summary, please read it.
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As far as I can discern the core issue with CIMI and DCMs, and why getting a really workable outcome is proving so difficult is due to the very nature of clinical information and how it is used.
Clinical records, by their very nature, are subtle, filtered, complex, incomplete and always only a partial reflection of the thought processes that have led to their creation.
By their very nature a clinical record is more like a novel or a work of art than a bank record and as such is intrinsically very much harder to make computable.
It seems to me the approach we should be adopting is one which goes from the very simple agreed basics and then moves up to the more complex rather than trying to essentially go top down with frameworks and the like which really just seem to magnify the complexity. I am reminded a little of needed to avoid “Boiling the Ocean” with such endeavours and somehow it seems like that is what is being attempted.
As I recall HL7 has been working for close to two decades on their Reference Information Model (RIM) and openEHR has been at the same task for as long I suspect. I have to say that, given the brainpower and skill applied to the whole area, that major decisive progress and agreement has not emerged after this long suggests the whole problem might just be ‘too hard’ or that we are somehow asking the wrong question.
As a pretty smart mate of mine once said - or quoted someone who said - “some models are useful, but all are incomplete”. I am not at all sure attempting to model clinical intuition and insight is at all helpful and I wonder if, in the interests of making at least some progress, we should re-define the problem to something more doable?
Discussion welcome - hate-mail > null.
David.

Saturday, March 17, 2012

Weekly Overseas Health IT Links - 17th March, 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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Monday, March 05, 2012

A Closer Look at the Stage 2 Meaningful Use Proposed Rule

On Feb. 23, CMS released the much anticipated proposed rule on the Stage 2 requirements that health care providers must meet to achieve "meaningful use" of certified electronic health records under the Medicare and Medicaid EHR Incentive Programs. 
The proposed rule covers a broad array of issues, including:
  • Revisions to Stage 1 objectives and measures;
  • New measures for Stage 2;
  • Expanded clinical quality measures and reporting options;
  • Medicare payment adjustments for health care providers who fail to demonstrate meaningful use;
  • Details on meaningful use audit appeals;
  • Guidance for states on their Medicaid EHR Incentive Programs; and
  • Technical corrections. 
One Year Delay for Stage 2 for Providers Who Were Meaningful Users in 2011 Formalized
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12 integration capabilities EHRs will need to have

By Michelle McNickle, Web Content Producer
Created 03/06/2012
With Stage 2 waiting in the wings, the focus is now shifting onto the electronic capture of health information and fostering data exchange at points of care transitions, said Shahid Shah, software analyst and author of the blog, The Healthcare IT Guy. And unlike meaningful use Stage 1, Stage 2 is looking to "raise the bar" and require true interoperability. 
"Current generation EHRs already do some, if not most, of the requirements recommended for Stage 2," he said. "But the reason they won’t meet or exceed the requirements of modern interoperability is [because] next-generation EHRs need far more sophisticated integration capabilities, not just basic interoperability between systems as suggested by the MU Stage 2 NPRM." 
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Study: Physician mergers, private networks won't hurt HIEs

By mdhirsch
Created Mar 7 2012 - 1:18pm
Public community and state health information exchanges (HIEs) will still be useful even if physicians and other providers to merge into larger, more private networks.
That's the conclusion of a new study [1] of care transition data from 10 Massachusetts communities conducted by the Rand Corporation, the Massachusetts Institute of Technology and others, published this week in Health Affairs. The researchers speculated that the pressure to join accountable care organizations may cause physician groups to merge and support private data sharing networks, rather than public HIEs, which focus on the exchange of patient data among independent providers.
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Health IT at 'tipping point' says CDW survey

By Mike Miliard, Managing Editor
Created 03/07/2012
VERNON HILLS, IL – A new survey sponsored by CDW Healthcare shows 84 percent of providers reporting their care delivery has improved with help from health IT. Moreover, they say the IT systems themselves are also improving.
The "CDW Healthcare IT Tipping Point Report" polled 200 IT professionals and more than 200 caregivers at large hospitals, officials say. Its findings indicate an increasingly sanguine view of health information technology systems and their capabilities.
Doctors and nurses polled cite the availability of better information (85 percent), the accuracy of care delivered to patients (72 percent), and the ability to track follow-up care (68 percent) as the technology's top benefits.
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Thursday, March 08, 2012

Private-Sector Insurers Tap Health IT To Support Accountable Care

Health IT is a key enabler of new payment models that pay for health care value, rather than for each incidence of care.
Accountable care has been an important topic of conversation lately. But even before the federal government launched several accountable care organization programs, ACO-style payment arrangements already had been adopted by private insurers.
Health plans and large employers have tried for some time to direct patients to preferred providers as a way to control costs. This has become even more important as mounting evidence shows that high costs do not necessarily signal high quality. HMOs directed patients to particular providers by using closed networks in the mid-1990s, and some have said that ACOs are just the same old pig in a new dress.
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3 Solutions for Major Telemedicine Barriers

Written by Kathleen Roney | March 06, 2012
A recently published study in Telemedicine and e-Health found that despite numerous benefits there are three major barriers to telemedicine implementation and use that need to be addressed.
Telemedicine has and will continue to change care delivery and patient outcomes. Based on this study's survey responses alone, healthcare professionals see the following benefits of teletechnology: immediate patient access, reduced service gaps, improved quality, additional clinical support, better patient satisfaction and improved adherence to care standards.
Telemedicine itself is an established technology; it has existed for over 40 years. However, the advent of powerful computer technology making real-time audiovisual communication feasible — the ability of a physician to remotely consult with a patient via a robot and LCD screen — has transformed care facilitations.
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Patients getting short shrift in EHR privacy and access

By Greg Goth
Created Mar 8 2012 - 11:15am
Healthcare providers and health information exchanges must do a better job of protecting patients' privacy, allowing them to access their own healthcare data, and developing consistent "rules of the road" to safeguard information, according to studies published by the New York Civil Liberties Union [1] and Consumers Union [2].
The Consumers Union study, conducted by University of California-San Francisco professor Robert H. Miller, examined the performance of five California-based provider organizations in meeting nine principles--intended to simultaneously increase provider access to data and protect patients' privacy--adopted by state patient and consumer groups in 2010.
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NHS strikes new deal with CSC for Lorenzo rollouts to continue

Department of Health and CSC sign agreement that will pave the way for deployments of electronic patient records systems at additional trusts
CSC and the Department of Health (DH) look to have concluded negotiations around the future of its Lorenzo system in the NHS.
A revised deal announced by CSC will see the US-based firm deliver additional implementations of the Lorenzo electronic patient records system beyond the 10 have already been rolled out, with "options for more where demand materialises".
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DH secures £1 billion savings from CSC

5 March 2012   Exclusive by Jon Hoeksma
CSC has announced a revised deal with the Department of Health that will secure savings of £1 billion from its disputed £3.1 billion deal for the North, Midlands and East of England.
EHealth Insider understands that the new deal draws a line under DH contractual liabilities as well as securing the savings.
The savings are twice those announced in 2011 when the government first announced that it would be 'scrapping' the National Programme for IT in the NHS.
The deal will also ensure that CSC is paid for past work done and for maintaining existing systems. But the extent to which it commits the NHS to further implementations from CSC is unclear.  
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End in sight for Lorenzo at Bury

8 March 2012   Chris Thorne
Pennine Care NHS Foundation Trust has given the strongest indication yet that it will switch off Lorenzo at Bury's community services.
In April last year, Pennine incorporated the community services arm of NHS Bury, which was the first ‘early adopter’ of Lorenzo; the IT system that CSC has been trying to install across the North, Midlands and East.
Pennine Care was itself supposed to be the fourth early adopter of the system. But it threw the National Programme for IT in the NHS into turmoil when it pulled out of the project last April, despite spending £3.2m preparing for the project.
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Experts: Meaningful Use Stage 2 could put an end to patient data-hoarding

By mdhirsch
Created Mar 8 2012 - 8:48am
Stage 2 of Meaningful Use may do more than spur the adoption of EHRs and the growth of health information exchange (HIE). It could change the way that providers regard their patient records, a panel of experts said during a roundtable discussion hosted by the National e-health Collaborative, a public-private partnership established by a grant from the Office of the National Coordinator (ONC) to foster national HIE.
The proposed rule for Stage 2 of Meaningful Use requires, among other things, that 10 percent of transitions of care and referrals be conducted electronically across vendor and provider boundaries. That means that providers must sending patient data to unrelated entities that may use a different EHR system, said Claudia Williams, director of ONC's state HIE program. Stage 2 also increases providers' obligations to provide patients with on line access to their health information.
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EHRs should include patient-reported data

By mdhirsch
Created Mar 8 2012 - 8:17am
Electronic health records would be more useful if they contained self-reported data from patients, according to a new analysis [1] published in the March issue of Health Affairs
EHRs should include patient-reported information about such topics as their health habits, psychosocial functioning and patient preferences in decision making. The authors, from the National Cancer Institute, Harvard University and the University of North Carolina at Chapel Hill, expressed concern that capturing data from only providers and payers but not patients themselves was insufficient for optimizing patients' health.
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Promoting Your Hospital's HIT Capabilities, Creatively

Marianne Aiello, for HealthLeaders Media , March 7, 2012

Promoting your facility's health information technology capabilities to the general public can be daunting. Without a deft touch, HIT marketing can come off as complicated, stuffy, and confusing. For these reasons, a lot of healthcare marketers don't want to touch it.
But don't be intimidated. There are some real benefits to promoting HIT, specifically electronic health records.  EHR can be a real market differentiator and a way to solidify your organization as a cutting-edge hospital in the minds of consumers. 
Kaiser Permanente's "Thrive" campaign may be one of the reasons healthcare marketers are so intimidated of advertising HIT. Anyone who has seen the sleek "Connected" ad with its high production quality and special effects will agree: Who can compete with that?
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ONC expects 'really rapid progress' on HIE

By Mary Mosquera
Created 2012-03-08 15:32
The Office of the National Coordinator for Health IT hopes to see “really rapid progress” this year on the building blocks that will promote health information exchange, such as provider directories, certificates to assure identification and rules of the road for the nationwide health information (NwHIN) Exchange.
Health information exchange (HIE) will need a variety of models to be able to scale up sharing among physicians, hospitals, and patients and across care settings as called for in the meaningful use stage 2 proposed rule. Over the years, ONC has considered a national architecture of regional health information organizations (RHIOs) and most recently a large role by single statewide HIEs.
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11 stages of the iPad's history in healthcare

By Michelle McNickle, Web Content Producer
Created 03/08/2012
The release of the "new iPad," aka the iPad 3, on March 16th, has health IT folks drooling over the tool's increased screen resolution, its iSight camera – complete with full HD 1080p video recording capabilities – and its voice dictation features. 
"I think it’s no secret that the healthcare industry right now is, to some degree, in love with this tablet," said Jennifer Dennard, social marketing director at Billan's HealthDATA/Porter Research/HITR.com. "Sure, there are the naysayers, but at least half the conversations I had at HIMSS with EMR vendors and HIT folks included at least one mention of 'Apple' or 'iPad.'" 
The past year has been eventful for the tech giant, which lost Chairman Steve Jobs to cancer in October 2011, just days before the public release of its iCloud solution for cloud computing. In anticipation of the release of the third-generation iPad, we look back through the device's history in healthcare and the ways physicians, patients, and IT professionals have used it. 
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Study: Incentive payments, not patient care, driving EHR adoption

By mdhirsch
Created Mar 9 2012 - 8:38am
Most hospitals that don't qualify for the electronic health record Meaningful Use incentive program haven't bothered to implement EHRs, suggesting that the incentive payments, not factors such as improved patient care, are the real drivers behind EHR adoption.
In a new study of long term acute, rehabilitation and psychiatric hospitals published in the March issue of Health Affairs, researchers found that these "ineligible" hospitals have "dismally low" rates of EHR adoption; while 12 percent of short term acute care hospitals had at least a basic EHR system, only 6 percent of long term acute care, 4 percent of rehabilitation and 2 percent of psychiatric hospitals did so.
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Just Enough Technology Should Be Your Goal

Scott Mace, for HealthLeaders Media , March 6, 2012

You can never be too rich or too thin, but you can have too much technology.
Walking around the show floor of the HIMSS conference a couple of weeks ago, just as I started with HealthLeaders Media, I was reminded of that again and again. The technology on display at HIMSS was an impressive summary of all that's been done in the past 20 or so years to use IT to solve some of healthcare's problems.
But at booth after booth, I saw software that boggled my mind in its complexity. One theme I've heard repeatedly as I've come up to speed on the challenges of the meaningful use of healthcare IT is how software can't do it all. How antiquated workflow routines in the clinic and at the bedside get in the way of quality care. How people and politics are the stumbling blocks to breaking apart those antiquated workflows and reassembling them with cost efficiency and patient satisfaction in mind.
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Experts: National HIE strategy evolving

By mdhirsch
Created Mar 6 2012 - 9:32am
There's consensus that the architecture of a nationwide health information network (NwHIN) is shifting. But there's less agreement as to whether this change is a favorable development.
That's the upshot of a panel of experts, addressing the issue in a roundtable discussion held this week by the National e-health Collaborative, a public-private partnership established by a grant from the Office of the National Coordinator for Health IT (ONC) to foster national health information exchange (HIE).
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Home telemonitoring needs health reform, more research to become widespread

By kterry
Created Mar 5 2012 - 9:40am
Several recent reports have predicted a rapid rise [1] in the use of remote patient monitoring. So far, however, it appears that only a small minority [2] of consumers are using these applications and that even fewer people have heard about them from their physicians. Moreover, the use of wellness and fitness apps on mobile devices--which does not require professional involvement--is taking precedence over monitoring of people with chronic diseases.
One reason is that most physicians are not yet organized or incentivized to participate in home or mobile telemonitoring. While healthcare systems and large physician groups employ an increasing number of doctors, the vast majority of physicians still work in small private practices. These practices are not set up for non-visit care management, nor can they afford the staff to keep tabs on telemonitoring data.
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Measures: Surprising HIT opportunities in Obama's federal budget

By Andrea Falciani, Research Analyst, Suss Consulting
Created 2012-03-05 08:18
The recent release of the President’s 2013 federal budget indicates a robust market for industry in the health IT marketplace.
The 2013 budget request is estimated at $11.8B, for instance, a slight increase from the 2012 levels of $11.6B. This boost in funding demonstrates the important role health IT provides in advancing our nation’s healthcare system.
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PwC study spotlights key role for clinical informatics

By Mike Miliard, Managing Editor
Created 03/02/2012
NEW YORK – A new report from PwC US Health Research Institute (HRI) shows how clinical informatics could be a crucial tool to fostering better population health and reducing healthcare costs.
Key to those benefits is for providers to use informatics to engage patients in managing their own health, the study found.
The report also suggests that health organizations view clinical informatics – the integration of information technology into healthcare – as paramount to their financial success and ability to effectively and affordably manage patient care and wellness.
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Report Assesses the Cost of PHI Breaches

MAR 5, 2012 12:12pm ET
A new report examines the financial impact of breaches of protected health information and ways to develop a business case for enhanced protection of the information.
The free report is a collaborative effort of the American National Standards Institute, consultancy The Santa Fe Group, and the Internet Security Alliance, with input from more than 100 members of 70 organizations.
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Report spotlights data-breach costs, concerns

Posted: March 5, 2012 - 12:30 pm ET
A new report by a task force of data privacy and security experts warns that although federal health information technology incentive payment programs have promoted the use of electronic health-record systems, efforts to promote digital security and maintain data integrity have not kept pace.
The 67-page report, "The Financial Impact of Breached Protected Health Information: A Business Case for Enhanced PHI Security," was released Monday morning. It is a product of the PHI Project—a coalition led by the American National Standards Institute and its Identity Theft Prevention and Identity Management Standards Panel, consultant Santa Fe Group and the Internet Security Alliance, an industry trade association. -----

Health IT lawyer decries 'epidemic' of privacy breaches

Posted: March 5, 2012 - 5:15 pm ET
The U.S. healthcare system faces an "untenable situation" as less than half of the country's providers and practitioners use electronic health information systems but there exists an "epidemic" of electronic privacy breaches, according to a member of the team that produced The Financial Impact of Breached Protected Health Information, a report from the American National Standards Institute.
The U.S. healthcare system faces an "untenable situation" as less than half of the country's providers and practitioners use electronic health information systems but there exists an "epidemic" of electronic privacy breaches, according to a member of the team that produced The Financial Impact of Breached Protected Health Information, a report from the American National Standards Institute.
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Electronic health records enabled better management of obesity among children

Electronic health records and embedded tools improved the identification, diagnosis and counseling for overweight or obese children, according to study findings recently published online.
To evaluate the effect of computer-assisted decision tools intended to standardize pediatric weight management in an integrated health care system, researchers conducted a large-scale implementation study documenting the effect of the Kaiser Permanente Southern California Pediatric Weight Management Initiative.
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AHRQ: 'Disappointing results' often seen in health IT deployment

Posted: March 9, 2012 - 12:15 pm ET
Citing "disappointing results" observed often in implementing health information technology, HHS' Agency for Healthcare Research and Quality is looking to evaluate the work-flow toolkit it created for clinical practices to solve problems related to health IT deployment.
AHRQ funded development of the Workflow Assessment for Health IT Toolkit in 2008. The kit is designed to promote a better understanding of how health IT issues affect workflow in ambulatory care at several stages of health IT adoption: determining system requirements, selecting a vendor, preparing for implementation, and using the newly implemented technology. The goal of AHRQ's newly proposed project is to find out how useful clinical practices find the toolkit.
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Mobile Technology Ready to Aid Health Care Worldwide: Report

Pilot projects show success for mobile technology in health care, according to a new report The Boston Consulting Group and Telenor presented at the Mobile World Congress in Barcelona, Spain.

As users are expected to have 7.4 billion mobile subscriptions by 2015, mobile technology is proving it can bring tangible improvement in health care, according to a new report by The Boston Consulting Group (BCG) and Telenor Group, a mobile operator based in Norway.
The companies presented the results of the survey on Feb. 28 at the Mobile World Congress in Barcelona, Spain.
For the study, "Socio-Economic Impact of mHealth," researchers examined the potential of mobile health projects in 12 countries, including Thailand, India and Norway.
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Social media an “ethical duty” for docs

29 February 2012   Jon Hoeksma
Doctors have an “ethical duty” to use the communication channels used by their patients to provide them with good medical advice beyond the occasional ten minute consultation.
This was the impassioned rallying call given by inspirational American paediatrician, mum and blogger Dr Wendy Swanson at HIMSS12 last week in Las Vegas.
Dr Swanson told her audience that people have moved en-masse online, with many now effectively living their lives within social networks, but healthcare professionals have yet to follow.
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France awards grants to 14 e-health R&D projects

Monday 5 March 2012 | 10:49 CET
 The French government has selected 14 R&D projects out of 45 candidates in the first round of its e-health call for projects. The winners will receive a total of EUR 9 million of state funding, with individual projects receiving between EUR 170,000 and EUR 1.7 million. Three-quarters of the support will go to SMEs.
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Docs with e-access to results order more tests: study

Posted: March 5, 2012 - 5:15 pm ET
Physicians who have computerized access to patients' test results are actually more likely to order additional lab and imaging tests, according to a study published in Health Affairs.
The study's findings, which point to a 40% to 70% increase in testing among doctors with computerized access to test results, could shed doubt on long-held beliefs about health information technology’s potential to reduce healthcare spending and inefficiency, the authors said.
"Our findings should at a minimum raise questions about the whole idea that computerization decreases test ordering and therefore costs in the real world of outpatient practice," lead author Dr. Danny McCormick, assistant professor of medicine at Harvard Medical School, Boston, said in an e-mailed news release. "As with many other things, if you make things easier to do, people will do them more often."
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Study: E-Health Records Don’t Deter Testing, Spending

By Jenny Gold
March 5th, 2012, 4:00 PM
Electronic health records have long been touted by Democrats and Republicans alike as a sure-fire way to lower health spending. When doctors have easy electronic access to a patient’s records, advocates argue, they are less likely to order the duplicative and unnecessary tests that drive up the cost of health care in America.
But that assertion is not necessarily proving to be true. Doctors who use EHRs may actually order more diagnostic testing, and therefore make health care even more expensive, according to a study published in the the journal Health Affairs.
Researchers found that office-based physicians were actually 40 to 70 percent more likely to order an imaging test if they had access to computerized imaging results. The study is based on data from the 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to 1,187 physicians.
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Electronic Health Records: A Study and Perspective

By STEVE LOHR
| March 6, 2012, 4:00 pm
I wrote an article in Tuesday’s New York Times, which was based on a study published Monday in the journal Health Affairs that casts doubt on the widespread claim that computerized patient records will cut health care spending.
The study found that doctors who were able to electronically track a patient’s recent imaging tests, like X-rays and MRIs, were more likely to order new imaging tests than doctors with paper records. That is sobering news for advocates of electronic health records, whose adoption is getting a big push from federal incentive payments to physicians.
But the study is another piece of evidence, among many, in the debate surrounding electronic health records. And it’s worth keeping in mind that the debate is really about the best way to adopt the technology, and at what pace — not whether moving from paper records to the computer age makes sense.
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Mostashari: Study on e-access and medical imaging doesn't get all the facts

By danb
Created Mar 7 2012 - 11:44am
National Coordinator for Health IT Farzad Mostashari, M.D., wrote a scathing post [1] Tuesday on the Health IT Buzz blog in response to the study published this week in Health Affairs [2] that concluded that electronic access to medical imaging and lab results led doctors to order more imaging and blood tests.
In addition to pointing out that the study failed to take into account the medical necessity of the tests ordered, Mostashari also said that the authors did not consider clinical decision support or the ability to exchange information electronically--both of which, he added, have been shown to reduce duplicate tests.
"While such interpretations may make for attention-getting headlines, it's important to get the facts," Mostashari wrote. "There are several reasons why [lead author Danny] McCormick's study ultimately tells us little about the ability of electronic health records to reduce costs, and why it tells us nothing about the impact of EHRs on improving care."
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Negative report on electronic medical records disputed by West Michigan health leaders

Published: Thursday, March 08, 2012, 7:15 AM
By Maria Amante | mamante@mlive.com
GRAND RAPIDS -- West Michigan leaders dispute the findings of a nationwide study that showed digital medical records don’t necessarily result in savings.
Research published in the journal Health Affairs said that digital medical records are unlikely to cut costs.
Lody Zwarensteyn, president of the Alliance for Health, said saving and cost cutting from electronic medical records all depend on how long they have been in use.
“Everything depends on the period in which you … pay off your cost,” Zwarensteyn said. “If you say, ‘Look, is it going to give us back our investment in the first year?’ the answer is no.”
Electronic medical records were promised to generate massive savings, as much as $80 billion a year, according to the New York Times report. 
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Mostashari Disputes Study Questioning Savings from Meaningful Use

Farzad Mostashari, national coordinator for health information technology, is taking issue with a new study in the March issue of Health Affairs that concludes having electronic access to medical imaging and lab test results increases the ordering of additional tests.
Authors noted that policy-based incentives for providers to adopt health information technologies, including the HITECH Act’s electronic health records meaningful use program, “are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money.”
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Enjoy!
David.

Friday, March 16, 2012

This Blog Raises Some Interesting And Challenging Questions For Australian E-Health .

The following was posted a few days ago.

Authority is given, not taken

Posted on March 9, 2012 by Grahame Grieve
Real authority is not something that you can take, that you can purchase, that you can steal. It’s something that other people give you freely of their own accord. There’s no other way to get it. It’s important to distinguish power from authority – power is only ever taken, and never given. The two things are closely related – having authority in a sub-group (i.e. the armed forces, or the engineering department) can help you acquire power in a wider sphere. Authority is better than power, because having authority means that people want to do what you tell them.
In New Zealand, where I grew up, this notion is wonderfully captured in the word “mana”, borrowed and adapted from Maori:
“mana”, taken from the Maori, refers to a person or organization of people of great personal prestige and character. Sir Edmund Hillary, is considered to have great mana both because of his accomplishments and of how he gave his life to service. Perceived egotism can diminish mana…
In Australian culture, some of the few people who have attained “mana” in general society are Sirs Don Bradman, Fred Hollows, and Weary Dunlop. Politicians are generally not eligible.
Obviously there’s all sorts of applications of this concept in society, and in politics. For instance, governments that have power without authority will eventually fall, democracy or no (the longer it takes, the more people will die as it falls).
I’m interested here in this blog on how that affects standards. And what I’ve seen is that it doesn’t matter how much power is applied to get a standard to be adopted, if the standard doesn’t have any authority, it won’t make any difference. I’m not saying that power doesn’t make a difference – it does. But power is only useful to the degree that the standard itself has authority.
Lots more here (with comments):
For what it is worth my take is that there is earned and positional authority. Positional is easy - think Prime Minister or Premiers. By virtue of their office and their elected status that have a level of authority - which can ebb or grow depending on performance. Earned authority comes from leadership, demonstrated results, good communication with stakeholders etc. ( Think successful army generals etc.).
In e-Health the lack of authority that resides in DoHA and NEHTA is made clear by the number if Health IT providers and academics who simply do not accept that NEHTA and DoHA have demonstrated the leadership and results to be given any authority. They have also done a pretty dreadful job of building trust by being open and transparent with their initiatives and really overdoing the use of slick PR in documents like the Annual Report. The one from late last year is a doozy from a glitzy spun point of view!
See here:
In a blog ages ago I raised the question of what official authority NEHTA had and had 16 comments follow.
You can browse the blog and comments here.
As I said at the time it might be the time to just ‘move on’. There are a good few in the e-health space who are just a trifle tired of being bludgeoned into submission.
David.