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, May 26, 2012

Weekly Overseas Health IT Links - 26th May, 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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National report shows surge in e-prescribing among health practitioners

By Erin McCann, Associate Editor
Created 05/17/2012
ARLINGTON, VA – By the end of 2011, 58 percent of office-based physicians were using e-prescribing, with solo practitioners contributing the most significant growth, according to Surescripts, which released today “The National Progress Report on E-Prescribing and Interoperable Healthcare Year 2011.”
Included in the report is data analysis that documents the prevalence of e-prescribing adoption and use in the United States from 2008 through 2011.
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ONCHIT programs that assess HIT individual competence

Author Name : Stephen C. Burrows, DPM, MBA   |   Date : May 17, 2012
Many health professions have a mechanism for certifying individuals as to their knowledge and competence. While there have been a few to certify individuals in the field of healthcare information technology (HIT), none have dominated the field.
As part of a nationwide strategic plan for advancing the use of healthcare IT, Congress passed the HITECH Act and provided a significant amount of grant money for a number of initiatives. Included is a knowledge assessment program for HIT Professionals known as the Competency Examination Program. According to the ONCHIT, this program will “enable health IT professionals, employers, and other stakeholders to assess their own health IT competency levels or the competency of their health IT staff members, as appropriate.”
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New HL7 program seeks to spur EHR participation

By Erin McCann, Associate Editor
Created 05/17/2012
ANN ARBOR, MI – Health Level Seven International (HL7) announced Wednesday the inception of its pilot membership program and launched a website aimed at increasing caregivers’ participation in the development of electronic health record (EHR) standards.
"For several years, the HL7 leadership has voiced its concerns about the typical first encounter with the standards development process,” said Charles Jaffe, MD, CEO of HL7. However, he added, “Now we are in a better position to translate the practical clinical expertise of these caregivers into tangible improvements in the interaction with the health record technology."
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Experts get creative in protecting patient IDs in audit trails

May 18, 2012 | By Ken Terry
A body that advises the state of Massachusetts about health information exchanges has devised an unusual approach to maintaining the privacy of patient information while allowing the use of audit trails.
In a recent blog post, John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, explained that the technology workgroup of the Massachusetts State HIE Advisory Committee recently grappled with an issue that arises from the use of the Direct secure messaging protocol: When one provider sends a Direct message to another, it is surrounded by an electronic "envelope" that contains key information about senders, receivers and content in the form of metadata. While unauthorized parties cannot access that information, it is also unavailable for audit purposes.
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Hospitals enlist vendors for data analytics help

By Susan D. Hall
Created May 17 2012 - 11:55am
Providers are increasingly turning to big tech companies to help their data mining efforts, according to an article [1] at Bloomberg Businessweek.
Vendors such as Microsoft, SAS, IBM and Oracle are giving mounds of data the once-over in an analytics industry that generated more than $30 billion last year, according to research firm IDC. That figure is expected to grow to $33.6 billion in 2012--and healthcare is a leading customer.
The article gives some enticing examples.
For example, a hospital in Washington, D.C., called in Microsoft to help look at readmission rates--the data helped pinpoint the infected room.
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Google ranks high for health research, but all search engines lacking

By mdhirsch
Created May 17 2012 - 12:04pm
The top four search engines all provide "rich" health and medical information, but none of them stand out as the best, according to a new study [1] published in the Journal of Medical Internet Research.
The researchers, from the University of Missouri and China, compared the top four search engines--Google, Bing, Ask.com and Yahoo!--for usability and search validity. They noted that most people use just one search engine when conducting research on a health-related topic, and then view the websites only on the first page of the search. The researchers wondered if this was the best way to obtain information.
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JAMIA: Why do some providers use HIEs and others not?

Written by Jeff Byers
May 15, 2012
Understanding end users' perspectives towards health information exchange (HIE) technology is crucial to the long-term success of HIE, according to researchers from Vanderbilt University School of Medicine in Nashville, Tenn., who developed an in-depth understanding of HIE usage by applying qualitative methods.
Publishing their findings in the May edition of the Journal of the American Medical Informatics Association, Kim M. Unertl, PhD, department of biomedical informatics at Vanderbilt Implementation Sciences Laboratory, and colleagues conducted an ethnographic qualitative study from January to August 2009 in six emergency departments (EDs) and eight ambulatory clinics in Memphis, Tenn.
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Diabetes mobile app bolsters role of pharmacists in patient adherence

Posted By Stephanie Baum On May 16, 2012 @ 5:48 pm In MedCity News eNewsletter,SYN,  
One of the most significant factors influencing healthcare costs is patient adherence [1]or lack thereof. If diabetes patients don’t take their medications, watch what they eat and monitor their blood-glucose levels, they risk complications that can lead to hospitalization.
A semifinalist in Sanofi US’ (NYSE:SNY) Data Design Diabetes Innovation Challenge [2], iRetainRx [3] believes it can overcome that challenge by providing a cloud-based system to help patients and caregivers connect with pharmacists and providers. Using a mobile device such as a computer, iPad or smartphone, they can get a video link to their pharmacist to get answers to questions and pharmacists can call attention to issues such as risky drug interactions.
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Thursday, May 17, 2012

A Look at Social Media in Health Care -- Two Years Later

by John Sharp
Two years ago I wrote an iHealthBeat Perspective, titled, "Social Media in Health Care: Barriers and Future Trends." Let's take a look at how far we have come and whether my predictions are on target.
Online Communities and e-Patients
Since 2010, pharmaceutical companies have joined startups, patient communities and providers in the social media realm. Many startups, particularly those enabling patient communities, have matured and broadened their scope. PatientsLikeMe has expanded to more than 1,000 conditions, CureTogether has gained the attention of major press outlets and 23andMe is defining personal genomics.
In addition, both PatientsLikeMe and 23andMe have published results in medical journals, bringing further validation to social networks and social media as having legitimate contributions to medicine. A PatientsLikeMe study, titled "Perceived Benefits of Sharing Health Data Between People With Epilepsy on an Online Platform," was published in the journal Epilepsy and Behavior, and a 23andMe study, titled "Efficient Replication of Over 180 Genetic Associations With Self-Reported Medical Data," was published in  PLoS One, as well as the Journal of Medical Internet Research.
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Data-Mining in Doctor's Office Helps Solve Medical Mysteries

By Jordan Robertson on May 15, 2012
When hospitals turn to Microsoft Corp., it's no longer just for the latest office software. Some are asking the technology giant for help in diagnosing their patients.
In one instance, a hospital in Washington, D.C., asked Microsoft to examine its medical records to determine why certain patients were getting sick soon after being discharged. The company crunched the data from MedStar Washington Hospital Center and found something surprising: Patients who stayed in the same room had come down with the same infection.
"There was a bug in the room -- people were getting infected," Scott Charney, vice president of Microsoft's Trustworthy Computing group, said recently at a security conference. Such infections are often caused by bacteria on medical instruments or furniture.
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No 'bubble' for healthcare IT, analysts say

By Larry McClain, Contributing Writer
Created 05/16/2012
NASHVILLE, TN – Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.
In the health IT sector, there’s currently a glut of buyers and not enough companies to acquire. There are many non-healthcare players like Lockheed-Martin wanting to buy healthcare IT companies – and many suitors for a limited number of clinical decision support companies. “There are still a lot of great opportunities for technology-enabled healthcare companies with a demonstrable ROI,” said David Jahns, managing partner at Galen Partners.
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3M Health Data Dictionary Going Open Source

MAY 16, 2012 12:31pm ET
3M Health Information Systems will release a public version of its Healthcare Data Dictionary as open source software, making it free and available worldwide.
Placing the dictionary, called HDD, in the open source market is part of a contract 3M has reached with the Departments of Defense and Veterans Affairs. The departments will use HDD to enable semantic interoperability for its integrated electronic health record initiative.
Semantic interoperability enables the exchange of data with the meaning of data preserved, such as to normalize test results, which vary depending on the lab doing a particular test and the system it uses.
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Barriers to mainstream genetic tests remain

By danb
Created May 16 2012 - 12:22pm
Although genome sequencing has shown promise as a tool for the type of preventive care that will be necessary for successful accountable care, several drawbacks--such as the potential for over-treatment--remain, according to a Wall Street Journal article [1].
In particular, over-treatment could result from unique genetic variations in each patient that could, at first, raise concerns, but ultimately might not cause any disease, Michael Watson, executive director of the American College of Medical Genetics and Genomics, told WSJ.
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Even opt-in doesn't protect data exchange privacy

By danb
Created May 16 2012 - 1:58pm
The healthcare industry still has room for improvement when it comes to health information exchange privacy, even in states that have an opt-in or opt-out option, according to a recent article [1] from Bloomberg News.
Although not all states are required to tell patients if their medical data is being used, even those that do so aren't necessarily doing a good job, according to the article. In New York, for example, a state with an opt-in option for patients, studies published in March by the state's civil liberties union and the Consumers Union [2] determined privacy "rules of the road" to be undefined, patient education efforts to be weak, and the opt-in effort to be too broad. As it stands, a one-time opt-in allows "blanket permission" by providers to release all medical information.
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May 13, 2012

Exploring the Role of Mobile Technology as a Health Care Helper

By STEPHANIE NOVAK
Two decades ago, a woman having a difficult birth in a Ugandan village would have had few options to get life-saving treatment if there was not a nearby health clinic. But today, mobile technology can help her get advice from a doctor in Kampala over the telephone, alert a community health worker about her situation, or even get her to a hospital.
Mobile technology is changing the landscape of health care delivery across the developing world by giving people who live in rural villages the ability to connect with doctors, nurses and other health care workers in major cities.
“Now, a phone call can compress the time that it would have taken before to come to that decision point and get the woman care more often and quickly,” said Dr. Alain Labrique, a professor of International Health and Epidemiology at Johns Hopkins University, in Baltimore.
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Dr. Farzad Mostashari: 5 things government can do to improve health technology

By Chelsea Conaboy

Globe Staff  
May 15, 2012
What is the government’s role in developing new technology? Some would say to stay out of the way. Dr. Farzad Mostashari, the national coordinator for health information technology, said that’s overly cynical.
But, Mostashari said in an interview, government is no longer the major producer of innovative products and services that it once was, creating things for military purposes or space exploration that work their way into the consumer market.
“That’s not the model anymore,” he said. “The investments in research and development that are going on in the consumer technology space are now dwarfing the investment and innovation that are happening in, say, the military.”
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ONC Announces Creation of CMO Role, Office of Consumer eHealth

May 16, 2012
In a blog post by the National Coordinator for Health Information Technology, Farzad Mostashari, M.D., the Office of the National Coordinator for Health IT (ONC) has announced the creation of the Office of the Chief Medical Officer and an Office of Consumer eHealth. The primary function of the Office of the Chief Medical Officer will be to infuse a clinical perspective across ONC on all activities which have clinical implications. The Office of Consumer eHealth will work on consumer engagement.
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Report: HIEs failing at true interoperability

By Mike Miliard, Contributing Editor
While some $560 million in federal health information exchange funding may soon run dry, changing reimbursement models mean market-driven growth will continue, says a new report on HIEs from Chilmark Research.
Profiling 22 HIE vendors, the study, "2012 HIE Market Report: Analysis and Trends," shows a market that's evolving, making the shift toward serving healthcare organizations of all sizes as they position themselves for payment reform, its authors say.
Increasing HIE technology adoption is spurred by two factors, say researchers. First is the need to meet proposed Stage 2 meaningful use requirements, which put a far greater emphasis on data exchange. More crucially, big changes on the horizon with regard to reimbursement means healthcare organizations are implementing HIE technology to support community-wide care coordination.
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Top 9 fraud and abuse areas big data tools can target

By Roger Foster, Senior director, DRC’s high performance technologies group, and advisory board member of the technology management program at George Mason University
Fraud and the abuse of healthcare services in the U.S. cost an estimated $125-175 billion annually. This represents the second largest component of the $600-850 billion surplus in healthcare spending. Healthcare organizations and government agencies must leverage big-data collections of patient records and financial billing to identify and eliminate system abuses.
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Web First: Q&A with Allscripts CEO Glen Tullman

By Bernie Monegain, Editor
Created 05/15/2012
CHICAGO – In real estate, it’s all about location, location, location, they say. In healthcare IT, you might say it’s about integration, integration, integration. Allscripts CEO Glen Tullman is keenly aware of how critical product integration is, he says, and he’s working on it. It’s the difficulties with integration that seem to have led to the EHR company’s recent troubles – at least it’s what Allscripts customers and analysts mention most often. Then came April 25 and the ousting of Allscripts’ board chairman, which triggered three board members to quit in protest, the departure of its CFO (for reasons unrelated, according to the company) and a dismal quarterly report, all of which led to stock price plunging 44 percent.
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Living in a box

Health minister Earl Howe launched South London and Maudsley NHS Foundation Trust’s MyHealthBox project on Tuesday. Reporter Rebecca Todd went along to hear more about the innovative online patient records scheme.
15 May 2012
“Exciting” was the word of the day for speakers at the launch of MyHealthBox. “Innovative” and “empowering” also popped up more than once as people spoke about why patient controlled records are a good idea.
MyHealthBox uses Microsoft’s HealthVault platform to create a patient record for South London and Maudsley NHS Foundation Trust’s service users.
The online portal can pull data from the trust’s Electronic Patient Journey System and from primary care - and patients can contribute to it themselves.
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Maudsley launches HealthVault-based PHR

15 May 2012   Rebecca Todd
South London and Maudsley NHS Foundation Trust is today launching personal online health records for its patients, using Microsoft’s HealthVault platform.
Director of information strategy, Mike Denis, presented on the MyHealthBox project at the Health+In4matics conference in Birmingham last week.
He told attendees the project was a partnership between the trust, the Institute of Psychiatry and service users. It aims to improve patients’ engagement in their care and the use of outcome measurements across the trust.
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Debate: Can mobile apps achieve what pills can't?

By Susan D. Hall
Created May 15 2012 - 12:47pm
In a pair of point-counterpoint articles [1] at Forbes, contributors Dave Chase and David Shaywitz face off on the question of whether mobile apps could someday be more effective than prescription drugs--a response to health app company Happtique's plans to build a platform for physicians to "prescribe" apps to their patients [2].
Chase, the CEO of patient portal and relationship-management company Avado.com, sounds a dire warning [3] that apps pose a huge threat to a lethargic pharma industry. He likens pharma execs to those of the newspaper industry 15 years ago, who saw the landscape changing around them, but did too little to adapt. 
Chase urges pharma execs to get out of the stands and put more skin in the game in terms of money and people.
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New research disputes claims EHRs improve diabetes care

By Susan D. Hall
Created May 15 2012 - 1:24pm
Contrary to previous research, the use of electronic health records failed to improve care for diabetic patients in a study [1] published in the Annals of Family Medicine.
Robert Wood Johnson Medical School at the University of Medicine & Dentistry of New Jersey researchers compared data from 16 practices in the Northeast that used EHRs and 26 practices that did not, assessing the care for 798 patients.
They found, in fact, that patients at clinics using paper records were more likely to meet all of three targets for hemoglobin A1c levels, low-density lipoprotein cholesterol and blood pressure after two years than those in practices that used EHRs.
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Berwick on Analytics: Technology Is Ready, but Doctors Need Help

Scott Mace, for HealthLeaders Media , May 15, 2012

If Marcus Welby, MD, were practicing on TV today, would he be letting data drive his decision-making? I'm on a journey to find the answer to this and related questions. Last week this journey took me to Atlanta for a HealthLeaders Media Roundtable on business intelligence and predictive analytics, and then onward to North Carolina for a conference dedicated to healthcare analytics.
While in North Carolina, I got to sit down with Don Berwick, MD, former administrator at the Centers for Medicare & Medicaid Services, and prior to that, founding CEO of the Institute for Healthcare Improvement. We talked about data analytics, but our discussion ranged far and wide around healthcare IT. Here is a portion of our conversation.
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7 common myths about data encryption

By Michelle McNickle, Web Content Producer
Created 05/14/2012
Although data encryption is becoming a valuable resource to protect against breached PHI, according to a new report by WinMagic Data Security, certain myths and misconceptions about it still exists. 
"IT professionals, at the enterprise level, frequently turn to encryption for protecting data," read the report. "Although encryption is a proven technology that delivers strong, effective data security, common myths and misconceptions about it persist, even among some people who are generally knowledgeable about computers. All too often, the myths surrounding encryption are based on misunderstanding of the technology or outdated concepts."
The report outlines and debunks seven common myths about data encryption. 
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Defense Department outlines joint EHR plans

Posted: May 14, 2012 - 4:00 pm ET
The Defense Department has released an outline of how the proposed joint electronic health-record system for use by the Military Health System and the Veterans Affairs Department's healthcare organization is to be developed.
The 55 page report (PDF), "Department of Defense Enterprise Architecture to Guide the Transition of the DoD Electronic Health Record, and Related Matters," was submitted to Congress by Dr. Jonathan Woodson, assistant secretary of defense for health affairs.
The "envisioned target state" of the joint EHR is "a coordinated, 'best-of-breed' approach that includes a mix of existing SOA (service-oriented architecture)-compliant capabilities, commercial-off-the-shelf, open-source and custom systems." The Defense Department's Manpower Data Center will be the "single identity management source," the report said, while the department's Defense Information Systems Agency will run the EHR's data centers. The EHR will have a common user interface.
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Emphasis on Support in Decision Support

Greg Freeman for HealthLeaders Media , May 14, 2012

This article appears in the May 2012 issue of HealthLeaders magazine.
Computer-based clinical decision-support systems offer great opportunities to improve care and reduce costs, but healthcare leaders have to remember who's ultimately in charge: the human operating the computer. Implementing even the best technology for decision support can become a costly, frustrating failure that ultimately degrades patient care if you don't factor in the human element.
That was one of the lessons learned when Penn Medicine in Philadelphia adopted a computerized physician order entry system. Penn Medicine used the Eclipsys Sunrise Clinical Manager to achieve 100% CPOE in the inpatient setting. In addition, 1,800 physicians actively use the Epic electronic medical record system in the ambulatory setting.
Physicians make about 15 million hits per year in Penn's internally developed physician portal to view patient information and results. All physicians have access to an internally developed data warehouse that maintains 2.4 billion rows of data to help ensure patient safety and quality care, as well as support clinical trials and research.
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ONC taps public for help on nationwide exchange

By Mary Mosquera, Contributing Editor
Created 05/14/2012
WASHINGTON – The Office of the National Coordinator for Health Information Technology is calling for public comment on proposals for rules of the road to govern the nationwide health information network (NwHIN).
ONC will use the comments to help it develop a notice of proposed rulemaking (NPRM), according to a May 11 announcement in the Federal Register preview section. Once it is officially published May 15, the public will have 30 days to offer its views.
ONC seeks help on a range of topics, including the creation of a voluntary program under which entities that enable electronic health information exchange could be validated based on meeting ONC-established “conditions for trusted exchange.” ONC also wants to hear views about the scope and requirements included in the initial conditions for trusted exchange and processes used to revise them over time.
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SaaS EMRs gaining favor, says KLAS

By Mike Miliard, Managing Editor
Created 05/14/2012
OREM, UT – More and more providers are taking software-as-a-service EMRs seriously, according to a new KLAS report. They're intrigued by the systems' lower price and easy maintenance, and reassured by advances in the security of cloud-based data storage.
The study, "SaaS EMR 2012: Is It For You?" assesses the performance of software-as-a-service EMR products from vendors including AdvancedMD, athenahealth, Bizmatics, CureMD, MedPlus/Quest Diagnostics, MIE, OptumInsight, Practice Fusion, Sevocity and Waiting RoomSolutions.
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NHS Direct to pilot GP appointment app

11 May 2012   Chris Thorne
NHS Direct is considering a pilot that will allow patients in Lincolnshire to use a smartphone app to book appointments with their GP.
EHealth Insider understands that negotiations are taking place with some GPs in Lincolnshire to start allowing practice systems to directly interface with NHS Direct, for a trial to start this autumn.
The trial would involve patients using a GP appointment booking smartphone app or the NHS Direct website to book their own appointment, linking directly into the GP system.
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Telemedicine, mHealth will connect with EHRs when providers are motivated

By kterry
Created May 14 2012 - 6:34am
In a discussion at the recent American Telemedicine Association (ATA) conference, panelists bewailed the absence of electronic health record vendors from the meeting, according to a post [1] in NHIN Watch.
"Politically, commercially--it's an issue," said Hon Park, M.D., CEO of Diversinet, which provides secure two-way connectivity for mHealth applications. Pak said that mHealth apps, EHRs, and health information exchanges must be integrated for effective care coordination, according to the post.
Michael Lemnitzer, an executive with Philips Home Healthcare Solutions, said his company is "working aggressively" with EHR vendors to develop interfaces, because 90 percent of Philips' contracts with healthcare providers require connectivity with EHRs. Lemnitzer predicted that by 2015, the majority of EHR companies would have interfaces for telemedicine applications. For that to happen, he said, more interoperability standards would be necessary, according to the post.
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Tablet Use Nearly Doubles Among Doctors Since 2011: Report

2012-05-11

With the Apple iPad the most popular mobile device, doctors have almost doubled their use of tablets in the last year, according to a new report by Manhattan Research.

Doctors have nearly doubled their use of tablets since 2011, a May 10 report by Manhattan Research revealed.
In its annual "Taking the Pulse" study, Manhattan Research found that tablet use by doctors reached 62 percent in 2012, compared with 35 percent of physician tablet adoption in 2011.
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VA's 7 steps to protect VLER data

By Mary Mosquera
The Veterans Affairs Department has described how it will protect the information of veterans and military service members that it shares as part of the virtual lifetime electronic record (VLER) program.
The VLER program enables the electronic sharing of health, benefit, disability determination and administrative data with VA, Defense Department and participants in the nationwide health information network (NwHIN) Exchange.
VA published in the May 11 Federal Register a notice of a Privacy Act System of Records, in which federal agencies detail how they will manage personal information according to federal security requirements. Robust privacy and security safeguards can increase trust and confidence in health information exchange.
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Press Release
May 14, 2012, 8:58 a.m. EDT

InterSystems Launches Next Generation of HealthShare

Strategic Informatics Platform Enables Breakthrough Solutions For Connected Care and Active Analytics

CAMBRIDGE, Mass., May 14, 2012 (BUSINESS WIRE) -- InterSystems Corporation, a global leader in software for connected care, today launched the next generation of its InterSystems HealthShare(TM) strategic informatics platform for interoperability and active analytics. Designed originally for public health information exchanges (HIEs) at regional, state and national levels, HealthShare has been extended and rearchitected to also deliver the advanced technologies needed by integrated delivery networks (IDNs).
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InterSystems' Revamped HIE Platform Mines Patient Data for Patterns

2012-05-15

InterSystems has launched a new version of its HealthSense platform that features data-modeling and enhanced analytics to allow doctors to search through unstructured data.

InterSystems, an IT vendor that powers many state health information exchange (HIE) platforms, has introduced a new version of its HealthSense record-exchange software that adds new data modeling and analytics capabilities.
Announced May 14, the latest version features InterSystems' iKnow technology, which allows doctors to search through unstructured narratives of patient histories. Most clinical data, such as images and text, are unstructured and in multiple file formats.
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Monday, May 14, 2012

Business Partners: A New Risk to Health Data Security?

by John Moore, iHealthBeat Contributing Reporter
Third-party business partners represent a significant security risk to health care providers, who may need several layers of protection to ensure the security of patient data.
The HIPAA Privacy Rule refers to third parties as "business associates" and defines them as individuals or organizations that handle protected health information, or PHI, in the course of working with a covered entity. The category may cover a range of companies, including data processing firms, IT consultants and cloud computing providers. 
HIPAA's Security Rule calls for covered entities to create contracts with business associates to ensure that the partner "will appropriately safeguard" PHI. The HITECH Act of 2009 further strengthened HIPAA's rules regarding business associates and security obligations.
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Stage 2 EHRs Require Meaningful Patient Engagement

Many of the government’s proposed Stage 2 Meaningful Use criteria for e- health records won't be easy to meet. Here's how providers are meeting the challenge.
By Paul Cerrato,  InformationWeek
May 14, 2012
For many healthcare organizations, Stage 2 Meaningful Use feels more like Stage 2 cancer: a threat to life and limb. AdTech Ad
As written, the proposed regulations will require providers to give more than half of patients e-access to their health information; make sure more than 10% view, download, or transmit their health information to a third party; and provide more than 10% with EHR-generated educational resources.
Those are high hurdles, especially for smaller hospitals and practices. Several health IT and clinical stakeholders have taken the Centers for Medicare and Medicaid Services to task on these issues.
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Health Min to scrap electronic health records

ÄŒTK |
14 May 2012
Prague, May 11 (CTK) - The IZIP patients' e-health files project, subsidised by the state-controlled VZP insurer for ten years now and widely criticised as disadvantageous for the state, will be wound up, Prime Minister Petr Necas and Health Minister Leos Heger agreed on Thursday, Heger's spokesman told CTK.
The VZP, the country's biggest health insurer whose board of managers comprises 10 representatives of the government and 20 representatives of parties in parliament, invested 1.8 billion crowns in the IZIP project in the past decade.
Heger's spokesman Vlastimil Srsen said an assessment of the project's hitherto results has shown that the IZIP does not work effectively. That is why the ministry has decided "not to protract the agony," he said.
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Enjoy!
David.

Friday, May 25, 2012

Here Is A Considered And Very Useful View Of the NEHRS (PCEHR) And Its Problems.

I came across this in Pulse+IT a few days ago and Emma Hossack (the author) has told me she is happy if I re-publish her ideas here on this blog.
Over to Emma.

MSIA: The eHealth paradigm and the PCEHR

Written by Emma Hossack on 18 May 2012.
This article first appeared in the May 2012 edition of Pulse+IT Magazine.
The 2008 National eHealth Strategy set out a number of noble aims that were supported by industry and government alike. Industry confidence was at a high when then-Health Minister Nicola Roxon outlined her plans for a national eHealth system. Things have not progressed according to the plan, however, and there are a number of lessons that we can all learn to ensure this doesn’t happen again.
“A healthy population underpins strong economic growth and community prosperity. Australians therefore have a strong incentive to ensure that our health system is operating efficiently and effectively, and continues to deliver a high standard of care that aligns with both community and individual priorities[1]. One of the ways to realise this is through eHealth. The benefits of eHealth are clear[2] and Australia’s current health expenditure is not sustainable if it remains on the current trajectory[3]. Consultations and reports on the need for eHealth in Australia have been persistent and bipartisan since 1994 and many have been calling for an end to all the talk, and for eHealth to begin with more than unsustainable pilot programs.
So why is there so much controversy about the federal government’s $467 million spend on eHealth reform[5]? And just why is it so heavily focused upon the PCEHR? The implementation of any new national system is a huge challenge, and can expect to attract controversy. In the field of health it affects everyone — so opinions abound. At present there is politically fuelled criticism, concern about how well it will serve the Australian health consumer[6], and trepidation about whether the personally controlled electronic health record will be useful, privacy compliant, secure[7], safe[8] or efficient[9].
Probably of greatest concern of all is the theme which eschews all these as unnecessary worries — because, this line of thought goes, there is not any real likelihood that the PCEHR will be used once the pilot sites have achieved the various goals including Healthcare Identifier matching (an interesting imperative in itself).
Yet despite all of this debate, there is an overarching air of genuine optimism in the Medical Software Industry Association about the underlying rationale for the current investment, evincing as it does a clear recognition of the value of eHealth solutions working today, and the willingness of the government to invest in eHealth and reap the benefits of interoperability.
eHealth is a noble cause as health is the most significant barometer of a country’s success. It is also Byzantine in its complexity, which means it captivates a unique array of players, all sharing a desire to see eHealth benefits maximised. As one of the consumer stakeholders has aptly pointed out, eHealth, unlike banking and almost every other industry, is an arena where many systems must communicate seamlessly with many other disparate systems for it to work[10] in the multi-tiered, distributed eHealth space. This is not your average bunch of vendors.
At the April 2012 MSIA CEO Forum[11] one of the most persistent themes was the participants’ pride in the success of eHealth projects with which they were involved in with their clients, inside and outside the current government spending initiatives, and beneficence — the desire to promote the clinical benefits which resulted from the use of information — not simply the technical prowess of the software solutions[12]. Consequently, there is naturally disappointment when things have not gone to plan and a keen desire to help get things back on track[13]. It is in this context that some observations will be made on the comparison between what Australians will have on 1 July 2012, and more importantly, what was promised.
The path to success is rarely swift and straight as indicated by the recent Parliamentary Library paper ‘The ehealth revolution — easier said than done’[14] which provides a useful summary of Australia’s eHealth over the last decade.
The much lauded Deloitte eHealth strategy 2008 was supported both by the National Health and Hospital Reform Commission and the federal government. Apparently it still is — at least in speeches. It proposed that the eHealth reform should:
  • Be a 10-year journey.
  • Build on the success of existing eHealth solutions.
  • Not be prescriptive but focus on strong infrastructure and where possible robust international standards.
  • Be sustainable. Provide incentives for clinicians to take up the eHealth solutions.
  • Have a strong and transparent governance framework to ensure confidence of the industry, clinicians, consumer and governing bodies[15].
The NHHRC endorsed this. It went further in Recommendation 123, which stated that the government should not design, buy or implement eHealth systems. The government endorsed the report, which augured well for Australia. Minister Roxon added to the confidence felt by industry and stakeholders generally when in her launch of the eHealth “revolution” on 30 November 2010[16] she announced that $467m would be spent on “major infrastructure” for a PCEHR[17], and, significantly, she stated:
“We’re getting on to deliver the next steps which will result in empowering patients, linking vital information to make doctors and nurses lives easier. We’re doing this based on the hard work already achieved, not trying to build a one-size-fits-all system from scratch. Let me take you through some examples.”
Whereupon the minister described the first three “Wave” sites of Brisbane North, Melbourne East and Hunter Valley. GPpartners in particular was singled out as “an Australian leader in eHealth for many years”. The sites were tasked to deploy and test eHealth infrastructure and standards, provide evidence-based results, influence change management processes and inform the process for implementations elsewhere. The message on governance was strong: DoHA was to assume ultimate oversight of the project and NEHTA was its contractor to develop and to deliver infrastructure.
“We want the best available expertise and experience so there will be an open approach to the market for key elements of the program. I can confirm to you all that this Government is not looking to run the whole system. Our job is to contract partners to build the infrastructure and the linkages and to set the standards and regulations. It will not be our job to deliver all of the technological advances — that’s what we’re looking for from the innovators in industry.”[18]
In essence we were told that the reform would follow the Deloitte eHealth strategy. However, even on 30 November 2010 the first three Wave sites had been chosen and funded without an open tender process. Tragically for Australian taxpayers, there was no governance around how they would procure eHealth services or manage conflict of interest — be it to continue with existing suppliers following an open tender process, or instead resolve to make an internal selection and start building something new[19]. The appropriate governance emphasised by the minister, and later embedded in the PCEHR Concept of Operations, had been ignored and raised questions about the transparency of NEHTA as manager of the procurement process.
The industry and specifically providers of robust solutions should probably have banged their drums louder about this sleight of hand. This may have prevented unnecessary cost to the Australian taxpayer by trying to reinvent the wheel rather than using, extending and upgrading current systems.
For example, Ms Roxon was shown the HRX system in July 2010 by Dr Richard Kidd, director of GPpartners, just one month before she awarded funding for the Wave 1 sites. A press release[20] issued on the day of the visit stated:
Dr Kidd said he was grateful Ms Roxon had the opportunity to view the HRX first hand as it was necessary at this stage in the health reform process that the government was kept fully informed regarding the system’s extensive capabilities.
“GPpartners is confident that the HRX already provides an effective solution to some of the difficulties health providers face with regard to the sharing of patient medical information across multi-sector, multi-disciplinary care environments,” Dr Kidd said.
The speed of testing for the infrastructure could have been faster, and a more effective use of funds could be made on change management and not software development which the minister had specifically eschewed previously. Sadly, this was a wasted opportunity to get some solid and valuable results for the promotion of eHealth to Australians. It behoves the industry to ensure that in future the funding bodies are crystal clear on the facts relating to procurement of technology so that the taxpayer gets value for money. Fortunately the second Wave projects followed clear procurement guidelines and whilst there were only nine ‘winners’, the procurement methods were appropriate and there was no concern about probity.
The decision to put out tenders for GP clinical information systems was possibly limited. In the health market there and numerous GP desktop systems; some clearly have a market share and others provide more specific needs, such as those for indigenous health practices. As recognised by the RACGP and MSIA in 1995:
Standards in general practice information management contribute significantly to a better practitioner working environment [and] better or more accessible information pertaining to patients and their health problems. [Standards] will work to ensure that components will work appropriately, will work in concert with one another where appropriate, and will perform tasks according to a level of efficiency and reliability that is of assistance and utility to the general practitioner as an individual and the general practice community as a whole[21].
A standard application programming interface (API) requirement for all clinical systems would create immediate value for interoperability. Where these are not provided, there are serious risks that data will not be shared, or will be extracted or uploaded without both parties’ co-operation to ensure that changes and upgrades do not compromise the doctor’s record and thus patient safety where the data is used to inform decisions. The concerns relating to this practice are documented[22].
If instead of selecting a vendor panel, an invitation to apply had been released for the creation or enhancement of APIs for a myriad of other valuable applications, this could have resulted in Australia taking a huge leap ahead in both interoperability, and importantly, realisation of clinical benefits. As it stands, the duplication by many vendors of interfaces to the same system, usually paid for with government funds, create no value after the first interface has been developed — just waste and lack of conformity. Safety risks too, are avoidable. The danger to the market place should not be overlooked either — if your clinical system was not one of the ‘winners’ does that impact on prospective markets?
In the period after the Deloitte eHealth strategy, the NHHRC report and the Wave bids, the Shared Electronic Health Record concept seemed to undergo a metamorphosis into an IEHR, PCEHR and now a National Electronic Health Record System (NEHRS). This is not in line with the broader objectives of an eHealth paradigm or successful overseas experience. Indeed, it was not what the minister signed up for in her very specific 30 November 2010 speech. It can only be assumed that someone else with a Svengalian skill of transformation had quite a different vision, or simply wanted to transplant a system built for a different market and population into Australia.
This created a bewildering and unnecessarily complex national architecture suited specifically to large-one-size fits-all system. It also created quite a different and unexpected role for NEHTA which became deeply involved in the very activities which the NHHRC warned should not be in the government’s remit[23]. The PCEHR Concept of Operations extended some of the original goals beyond recognition and whilst recognising value in the federated conformant repository model[24], the clear mandate of the National Infrastructure Partner was to build a one-size-fits all system, or bring it from overseas, irrespective of well-documented evidence that nowhere else in the world had experienced success this way[25].
However, this work is not easy or necessarily useful, as we know from the UK experience, which had many of the same players. In 2005 the British Medical Journal printed a case study by Sheila Teasdale on the failed early implementation of Kaiser Permanente in Hawaii[26]. The report was written in the vain hope that the English National Programme for IT would learn from these mistakes; namely, to quote Professor Trisha Greenhalgh’s advice to government following her study of the failed UK exercise:
  • There is no ‘tipping point’ for big IT.
  • Don’t try to build systems or write standards.
  • Don’t throw money before you’ve sussed the complexity.
  • Don’t equate knowledge with what is passed up the line.
  • Don’t impose political milestones.
In Australia, now that the 10-year plan proposed by Deloitte has been compressed into 18 months, we have witnessed the inevitable pressure which has resulted in ‘pauses’[27] and questions being raised by a Senate inquiry[28]. Not surprisingly, there has also been a clear campaign to reduce public expectations to little more than a patient sign-in to an empty national database. The medical software industry has been providing healthcare solutions for decades, long before the current PCEHR program, and the HealthConnect one before that. There is no doubt that it will continue to do so. However, it is worth reflecting that if the government is going to spend on eHealth again in the future, it would be great if the medical software industry could be empowered to:
  • Build for real needs not political aspirations.
  • Use local development for local communities.
  • Listen to the healthcare providers, privacy practitioners and software industry to support what is working and build on that to get some concrete health improvements.
Starting the eHealth reform was a bold move and without doubt a well-intentioned one which should be commended. The plan was good, but not followed. The criticism has been public, but at least it has kicked off the requisite debate and public education. The industry remains optimistic that once the political imperatives are removed, the stakeholders’ desires for systems to be useful rather than useless, extensible not expedient and provided amidst a transparent framework, then greater focus can be given to the improved health outcomes possible with the many eHealth tools. Next time around we will surely be given the chance to get a lot more of it right — and from a lot less — and maybe even see some of the magic in it[29].

Author Details

Emma Hossack
B.A. (Hons) Melb, LLB (Melb), L.L.M
Committee member: MSIA
ehossack@extensia.com.au
In addition to being a Medical Software Industry Association committee member, Emma has been CEO of Extensia for several years following her life as a corporate lawyer. Emma is currently vice president of the International Association of Privacy Professionals and is a regular speaker on privacy.

Competing Interests

Emma Hossack is CEO of Extensia, a medical software development company. One of Extensia’s principal products is RecordPoint, a shared electronic health record.
The full article (with references etc. ) is here:
I really have nothing to add - other than to point out that had the 2008 National E-Health Strategy actually been funded and implemented I suspect the rather dysfunctional mess we now have might have been avoided - at least to a large extent and we would not - at the same time - have done so much damage to the small Australian Health IT vendors.
David.

Thursday, May 24, 2012

The Numbers Never Lie. The Federal Commitment To E-Health Seems To Be Weakening.


----- The Following is A Draft Article For a Print Magazine - Comments welcome.

In mid May 2012 we had the most recent Federal Budget released. Along with seeing just how the promised surplus was to be achieved, not surprisingly, my main interest was to see what had been done with e-Health Funding over the next financial and the three out years.

To get a full picture of what is being planned there are a couple of ways it is important to view the announcement(s).

first consider, in isolation what has been announced for the next financial year. Here is the specific e-Health funding for 2013/13 from the Ministerial Press Release:

“eHealth spending in the 2012-13 Budget comprises –
  • $161.6 million to operate the Personally Controlled Electronic Health Record (PCEHR) system for the next two years, including registration and customer support, adoption support and benefits monitoring and evaluation;
  • $4.6 million to maintain safeguards for privacy-related aspects of the PCHER system. This will mean that people can be confident that the privacy of their personal health information is fully protected; and 
  • $67.4 million as the Commonwealth’s share of joint funding with the states and territories for the National E-Health Transition Authority (NEHTA) work program for the next two years. This is to operate and maintain critical services and standards for the secure electronic exchange of health information, including healthcare identifiers, authentication services and eHealth standards.”

This $233.6 million follows the $466.7 million over the previous two years. Interestingly, of the new $233.6 million the cash flow is actually spread over three years.

2011/12 (Present year) $ 33.4 million

2012/13 (Next Year) $ 79.2 million

2013/14 (Year After) $121.0 million

As far as can be determined the specific PCEHR spend is an additional $33.4 million for the year to June 30, 2012 and then a total of $166.2 million for the next 2 years after that. The other $67.4 is spent on NEHTA over two years bring its annual budget to approximately that figure allowing that the funds are spread equally over the two forward years (This is well down from the 2 previous years)

A few other points from the Budget Papers and announcements subsequent that are worth making are:

1. That to date the investments in consumer and practitioner education, GP and specialist software, call-centres and so on which will be needed to actually implement the PCEHR have been very small indeed and indeed pretty late coming.

2. A review of the full 4 year e-Health Program as now budgeted shows that about $20 million has been cut from the 4 year program with major cuts in the Telehealth program in the later years.

3. Yet again there has only been two years of funding committed for both NEHTA and the PCEHR program rather than the traditional 4 years window for continuing programs.

4. Oddly two weeks after the 2012/13 Budget was announced we have had another $50 million added to the e-Health domain.

In summary and to quote the release “Health Minister Tanya Plibersek has announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Australian Government’s new eHealth records system.”

You really have to wonder why this was not included in the Budget?

5. The operational expenditure for the PCEHR and Health Identifier Service have disappeared into the huge bucket for funds ($4 billion +) supporting Medicare Australia and are not dissected as far as I can see.

6. The targeted adoption of the use of the PCEHR appears to be only 25-30% of the population after five years which seems very low. Only the first two years of the program are supported in a budgetary sense so it is hard to know what will happen after that.

7. Despite the apparently rather low adoption targets the Ministerial Press Release announcing the e-Health Budget claims the Government strongly supports e-Health because it will deliver $11.5 billion of savings over 15 years - but then says the supporting evidence for this claim has been used for Cabinet Discussions and so cannot be revealed. A big call I would suggest!

8. In another part of the Budget (under Outcome 10.5.3) there has been a change to the requirements for Practice Incentive Payments (PIP) related to e-Health which imposes quite a high technical barrier to the continuing receipt of these quite significant payments (up to $50,000 p.a. per practice). The AMA and the RACGP have expressed ‘concern’ about this change in the requirements and are clearly not happy.

For those who have an interest in the topic area there is also a very recently published review of this topic which has been prepared by Dr Rhonda Jolly of the Parliamentary Library. This review may be found here:

http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201213/Ehealth

Overall I would describe the Budget as an incoherent and fragmented mess lacking any strategic vision or integrated approach to reaching the goals we all broadly support. e-Health deserves much better leadership and governance than is presently evident.

Enough on the Budget and to follow up on the article from the last quarter’s issue I can now confidently assert that when the PCEHR launches (on July 1, 2012) it will actually be a PC-LES (a Personally Controlled Largely Empty Shell - Jenny O’Neill MSIA.) for which consumers will be able to register and then wait for some useful functionality to be provided at some point in the (distant) future.

All I can suggest at this point is that people keep a watchful eye on the PCEHR Program and consider registering to use it when it is clear there is some value to be had from spending the time to do it. That time may be a good way off.

----- End Draft

David.