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, June 09, 2012

Weekly Overseas Health IT Links - 9th June, 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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Wednesday, May 30, 2012

Big Data Can Save Health Care—But at What Cost to Privacy?

From the opinion: “Although health data are highly sensitive and thus require protection, they are also a public good. The more data that researchers are able to analyze, the better chances they have for detecting patterns that can lead to fewer wasteful (and often painful) procedures and tests, and for finding new causes, treatments, and even cures for diseases. …Ironically,
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State Health Insurance Exchanges Choke On Health IT

Politico: Politics aside, IT could be biggest barrier to 2014 readiness.
By Ken Terry,  InformationWeek
May 31, 2012
State health insurance exchanges (HIX) face technological barriers that could prevent many of them from launching in January 2014--on top of the political and legal challenges they face, says a new article in Politico.
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Houston HIE to connect 130 hospitals via 'network of networks'

By Mike Miliard, Managing Editor
Created 05/31/2012
HOUSTON – Greater Houston Healthconnect announced Thursday that it will partner with Medicity to establish a community-wide health information exchange, connecting more than 130 hospitals and some 14,000 physicians in a 20-county region of Southeast Texas.
Officicials say Healthconnect will bridge existing networks of major health systems, together with independent hospitals and providers to improve care quality and lower costs for 7 million area residents.
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Big Data Reality Check

MAY 29, 2012 2:44pm ET
The promise of business gems from big data may be more of a long-range goal as enterprises work through their own issues with BI systems and unstructured content uses, according to a new report from non-profit information management professionals group, AIIM.
The survey, entitled “Big Data – Extracting Value from Digital Landfills” consisted of more than 400 responses to an AIIM member survey conducted in March and April. Less than 10 percent reported that it is already an “essential capability” for business and about 15 percent expect that it will be essential. On the flip side, nearly 15 percent reported they weren’t really aware of what big data is yet and about 20 percent were merely more than curious about its potential. As far as data analysis, reporting and BI across structured data sets, only 4 percent are developing advanced analytics and big data tools, while most still opt for spreadsheets and ad hoc reports (30 percent) and reports in individual business systems (29 percent).
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Written by Beth Walsh   
May 29, 2012

New clinical informatics subspecialty is a go

The American Board of Medical Specialties (ABMS) has approved the American Board of Preventive Medicine's application for subspecialty certification in clinical informatics.
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Health IT spending flying high, survey says

By Erin McCann, Associate Editor
Created 05/31/2012
CLEARWATER, FL – Healthcare IT spending hasn’t shown signs of slowing down anytime soon. In fact, a Black Book HIE survey released today projects that industry spending will triple by 2014.
Despite these projections, the majority of U.S. hospitals (80 percent) and physicians (97 percent) remain disconnected from HIE technology. The survey’s numbers suggest, however, that the tides are indeed changing. Although only one in 15 provider organizations indicated they are developing strategies to advance them towards HIEs, industry tech executives sang a different tune, with 84 percent saying they are actively taking measures to move towards HIE adoption.
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NEWS

June 1, 2012

Infoway to become more responsive to health system needs, CEO vows

Canada Health Infoway must rapidly reboot, and do so in substantial fashion, if it’s to justify public outlays beyond the billions already spent on developing a national electronic health infrastructure, according to the crown corporation’s CEO.
After years of defending a strategy that favored massive centralized data systems over meaningful use of electronic health data by physicians and patients, Richard Alvarez, Infoway’s top mandarin, told a blue chip audience in Vancouver, British Columbia on Tuesday that the agency must re-prioritize its activities as Canada’s existing approach has left it lagging dismally behind international counterparts such as Australia and New Zealand in achieving improvements in care through the use of electronic technologies.
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By: J. Lester Feder
May 29, 2012 10:28 PM EDT
If state health care exchanges survive the Supreme Court challenge to health care reform, the election and state tea party activists, health policy experts are worried they could still be brought down by a much more mundane problem: information technology.
Even states that are solidly committed to pursuing an exchange are facing major logistical challenges in building the computer systems that will be able to handle enrollment when exchanges open for business in 2014.
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Hypertension study ties EHR data quality to training, management

May 31, 2012 | By Susan D. Hall - Contributing Writer
Data quality remains an issue in electronic health records, according to a West Virginia study of hypertension cases that found use of free text was a common cause of indentification errors. The authors looked at barriers to outcomes research, quality improvement and practice redesign, such as the National Committee for Quality Assurance's Patient-Centered Medical Home program.
The West Virginia researchers imported anonymous EHR data from 11 West Virginia primary care centers into an external system, in this case a public-domain patient registry, in an attempt to search for hypertension cases. Through the EHR data--patient diagnoses, demographics, vitals, laboratory results and services--they could look at coding consistency and completeness, according to a report published in Perspectives in Health Information Management.
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EHR training often rushed, overwhelming

May 30, 2012 | By Marla Durben Hirsch
Some of the problems that hospitals and practices are running into with electronic health record adoption stem from the ways that staff are trained on the systems, Andres Jimenez, CEO of EHR training provider ImplementHIT, told Becker's Hospital Review in a recent interview.
For example, many EHR training programs rush to provide advanced training when physicians are not yet ready, overwhelming them and ultimately lowering retention rates.
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Fierce exclusive: 10 steps for thwarting EHR hackers

May 31, 2012 | By Marla Durben Hirsch
It's bad enough that the number of security breaches of patient protected health information appears to be skyrocketing. But it feels downright creepy when the breach is at the hands of a hacker, as was the recent attack by Eastern European hackers that breached almost 800,000 Medicaid recipients in Utah. 
And while a lot of hackers are attacking EHRs to steal the information within them for personal gain, many of them do it just for the fun of it, attorney Robert Hudock, with Epstein, Becker Green in Washington, D.C., said in an exclusive interview with FierceEMR. "It's very easy to scan for vulnerability and execute an exploit. People are curious," he said.  
Hudock, who is a certified "ethical hacker" as designed by the International Council of e-Commerce Consultants, warns that information security and privacy concerns have become so widespread that providers are increasingly at risk of not being able to defend their EHR and other health IT systems.
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6 tips to mitigate cloud-computing risks

By Michelle McNickle, Web Content Producer
Created 05/30/2012
A recent Healthcare IT News survey found 48 percent of respondents planning to incorporate cloud computing into their health IT endeavors; 33 percent had already taken the plunge. But 19 percent answered with a "no," and according to Rick Kam, president and co-founder of ID Experts, one of their biggest fears could very well be security issues surrounding the cloud. 
"Cloud computing poses great risks for healthcare organizations, providers and entities responsible for safeguarding protected health information (PHI)," said Kam. "Healthcare entities are responsible under Federal HITECH and HIPAA regulations for the security of PHI in the cloud, though they often have little or no control where or how this data is moved, processed, or stored."
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Everything You Need to Know About BYOD

MAY 29, 2012 2:08pm ET
Not that long ago, Michael Roca walked into the breakfast restaurant of a hotel he was staying at for his work as senior vice president of compliance at Jefferies & Co.
Sitting near him was a couple with four phones laid out on their table. Two each, one for business communications, one for personal communications.
Those days are ending, as executives, managers and employees all begin relying increasingly on smartphones that blend Web surfing, entertainment, business and communications of all types, as well as tablets and lightweight computing devices with larger screens for consuming books, reports and interactive media. Devices that they purchase for their own reasons. But quickly want to use for both personal and business purposes.
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Hospital CIOs: Health IT change 'too much, too fast'

May 31, 2012 | By Dan Bowman
Meaningful Use. ICD-10. HIPAA 5010. Separately, all of these implementations, along with many others, represent big changes for hospital executives. Combined, however, they represent a big mess, according to a new healthsystemCIO.com survey.
Roughly 74 percent of CIOs surveyed admitted that all of the various changes being asked of hospitals are starting to become overwhelming. "So often I hear the phrase 'Can you make them stop?' one CIO said in responding to the survey. "In this case, mandates, regulations, financial shakedowns and haircuts, quality pressures, MD affiliations, HCAP scores, the list goes on and on. Organizations need to do a better job at setting priorities, as no outfit can do it all."
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Maine HIE to create 'nation's first' statewide medical image archive

May 31, 2012 | By Susan D. Hall - Contributing Writer
Maine's health information exchange HealthInfoNet is planning a five-month pilot to create a statewide medical imaging archive, which it says will be a nationwide first.
The health exchange decided in 2009 not to include images because they average 50 megabytes each. With the state's providers creating 1.8 million medical images a year, the bandwidth strain would make the system unbearably slow. But clinicians keep asking for the images, not just the text report they have been getting.
The pilot will use 200 terabytes of storage for X-rays, CT scans, MRIs and mammograms, and will involve 56 radiology imaging centers, which produce 80 percent of the state's images, Computerworld reports.
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Freedom of 'best-of-breed' HIT systems costly

May 31, 2012 | By Dan Bowman
While best-of-breed IT systems allow hospitals to be more innovative with their technology implementations, it's not all fun and games, according to Lehigh Valley Health Network Chief Medical Information Officer Donald Levick, M.D., who spoke at an event at Children's Hospital of Philadelphia this week.
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Humber confirms Lorenzo go-live

31 May 2012   Chris Thorne
Humber NHS Foundation Trust has confirmed its successful “go-live” with Lorenzo and issued more details about its implementation of the electronic patient record system.
According to a statement issued to eHealth Insider by the trust, more than 600 staff across 50 sites are now using the system, for which it is now the mental health ‘early adopter’, to record clinical activity.
The statement says that local service provider CSC has provided the trust with “a patient administration system with clinical applications for care management, task management, internal referrals, clinical documentation and letters, ward attenders, document scanning, and access plans to monitor waiting times and care pathways.”
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Don't let meaningful use dictate EMR choices, IDC tells small practices

By Mike Miliard, Managing Editor
Created 05/30/2012
FRAMINGHAM, MA – A new report from IDC Health Insights rates the best EMR vendors for small physician practices -- and warns that the short-term incentives of meaningful use shouldn't overshadow those offices' long-term care strategies.
The study, "IDC MarketScape: U.S. Ambulatory EMR/EHR for Small Practices 2012 Vendor Assessment" assesses 11 products from nine vendors aimed at helping small physician practices qualify for meaningful use incentive money. In its report, IDC weighs in on which vendors are well-positioned today through current capabilities – and which are best positioned to gain market share over the next one to four years.
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May 29, 2012

Gottlieb and Kleinke: There's a Medical App for That---Or Not

By SCOTT GOTTLIEB AND J.D. KLEINKE

Even the most ideologically opposed politicians agree: Health care is choking on paperwork, and medicine is prone to errors of handwriting, lost information and guesswork. That's why the promotion of health information technology is one of the only demilitarized zones in Washington—consistently attracting bipartisan support since the Bush administration began funding ways to standardize and computerize health-care records a decade ago.
Despite such broad political support—plus that of health insurers, providers, drug companies and patient groups—the Food and Drug Administration (FDA) unfortunately has rushed in to play bureaucratic spoiler just as this new engine of innovation was leaving the station.
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Denmark Selects InterSystems HealthShare For Countrywide Health Information Exchange

CAMBRIDGE, Mass.—February 2, 2012—InterSystems Corporation, a global leader in software for connected care, today announced that InterSystems HealthShare™ has been chosen to support health information exchange (HIE) throughout Denmark.
The Danish NSI (Nationalt Sundheds-IT), an agency operating under the Ministry of Health, is beginning development of a new service to link healthcare information systems used within Danish regions on a national level. The new HealthShare-based initiative enables the sharing of patient information between healthcare providers and government agencies countrywide.
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Pennsylvania closes in on health IT network

May 27, 2012 12:00 am
By Bill Toland / Pittsburgh Post-Gazette
Within two years, Pennsylvania should have in place a first-generation, Internet-based communications network that allows for the exchange of patient health data among doctors, hospitals, pharmacies, insurers and, eventually, the federal government.
It will be -- according to its advocates -- one of the great nonclinical medical advances of our age, carrying with it lofty expectations that it will improve outcomes and save money for the U.S. health care system.
"It's a huge deal," said Martin Ciccocioppo, vice president of research at the Hospital and Healthsystem Association of Pennsylvania. It will begin "an amazing evolution for the delivery of health care," said Pam Clarke, vice president of health care finance and managed care at the Delaware Valley Healthcare Council.
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Grow Your Own Health Information Exchange

While many healthcare organizations turn to private vendors to set up HIEs, others get good results by building their own.
By Paul Cerrato,  InformationWeek
May 29, 2012
Once upon a time, many health IT stakeholders hoped to develop a massive, public health information exchange (HIE) that would eventually let hospitals and practices share patient data nationwide. That hope is beginning to look more like a pipe dream.
A recent report from Chilmark Research for instance, shows that while the HIE market grew more than 40% in the past year, most of that growth came in privately sponsored, enterprise health information exchanges, rather than in public health information exchanges that seek to connect providers across regions and states. AdTech Ad
Chilmark CEO John Moore offered his take on the growth in private HIEs in a recent InformationWeek Healthcare interview: "Everybody realizes they're going to have to tie their systems together with their affiliates if they're going to have any hope of surviving payment reform."
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X-rays and iPads: The network healthcare evolution

Network technology is changing the nature of healthcare—slowly.

by Sean Gallagher - May 30 2012, 2:00am AUSEST
At the rate technology has changed everything else in our lives, by now we should have the equivalent of tricorders in our smartphones—instant access to our health statistics collected by sensors in our clothes and pulled into our individual health history in the cloud. We should be able to Skype our physician, text our pharmacist, and get both a blood sugar measurement and an MRI at Starbucks while waiting for a grande latte.
Except for the MRI part, all of that is doable today. Thanks to the big stick provided by the Affordable Care Act in the US, some healthcare organizations are pushing more aggressive use of network bandwidth and cloud technology:
  • Monitoring patients’ health more proactively with networked devices, ranging from wirelessly networked medicine bottle lids to worn or embedded sensors that report back on vital signs;
  • Coordinating care with the help of analytic tools in the cloud and a wealth of individual and collective patient data; and
  • Connecting physicians directly with patients over PCs or mobile devices for between-appointment follow-ups.
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6 reasons today's heath IT systems don't integrate well

By Michelle McNickle, Web Content Producer
Created 05/29/2012
Although the healthcare community has been clamoring for integration of its IT systems for decades, the industry is still in a rather elementary stage when it comes to useful and practical systems integration, according to Shahid Shah, software analyst and author of the blog The Health IT Guy.
"Our problem in the industry is not that engineers don’t know how to create the right technology solutions or that somehow we have a big governance problem," he said. "[Although] those are certainly issues in certain settings, the real cross-industry issue is much bigger – our approach to integration is decades old [and] opaque, and [it] rewards closed systems."
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A Status Check on the Government’s HIT Training Programs

MAY 30, 2012 12:04pm ET
After being laid off from a private sector technology job, Linda Gebaroof directed her energies toward starting a career in health I.T. Having worked as licensed practical nurse many years ago, and with an associate's degree in computer science, she figured moving into health care I.T. wasn't much of stretch.
And to increase her marketability, she enrolled in and completed an HIT training program at a nearby community college, a program funded by the Office of the National Coordinator of Health Information Technology's Community College Consortia program, designed to train more than 10,500 new HIT professionals a year.
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Patient-reported data key to 'big data' success

May 30, 2012 | By Ken Terry
Researchers from technology companies and universities are trying to figure out how to apply analytic tools to a wide range of information to improve healthcare and find new cures for diseases. Most of these "big data" efforts involve the use of clinical records. But an article in the Atlantic says researchers could achieve more by analyzing data from patient surveys and other sources than by scouring electronic medical records.
Author Robert Litan, vice president for research and policy at the Ewing Marion Kauffman Foundation, which recently issued a report on big data, admits that lab and test results might be useful in this kind of research. But other data that could be important--on patients' health behavior, life and job histories, and genomic makeup, for example--is either not included in clinical records or is inaccessible because it is locked up in physician notes, he writes.
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Electronic Records Foster Glucose Control

By Chris Kaiser, Cardiology Editor, MedPage Today
Published: May 29, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
PHILADELPHIA -- The use of electronic medical records (EMRs) for insulin order sets can improve glycemic control in hospitalized diabetes patients, researchers said here.
The rate of hypoglycemia pre-EMR subcutaneous insulin order sets was 9.6%, which dropped to 3.8% after the adoption of an EMR, according to Karla M. Arce, MD, from the Cleveland Clinic Florida in Weston, Fla., and colleagues.
The difference was significant at P=0.03 (95% CI 0.27 to 0.51), Arce said here at the American Association of Clinical Endocrinologists (AACE) meeting.
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E-prescribing sign-up highest among small practices

The nation’s largest e-prescribing network finds solo practices experienced the highest growth in adoption.

By Pamela Lewis Dolan, amednews staff. Posted May 28, 2012.
Government incentives aimed at e-prescribing and electronic health record use had the intended effect, as they are considered the primary reasons for the great interest in e-prescribing among small practices.
The 2011 “National Progress Report on e-Prescribing and Interoperable Health Care” by Surescripts, the largest e-prescribing network, found that 58% of office-based physicians are using e-prescribing systems and the highest use — and largest growth — has been among small practices. Solo practices saw the most significant growth from 2010 to 2011.
When broken down by practice size, the report found that practices with six to 10 physicians have the highest adoption rate at 55%, up from 44% in 2010, followed by two- to five-physician practices, whose adoption rate of 53% was up from 42% in 2010. From 2010 to 2011, e-prescribing in solo practices rose from 31% to 46%.
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6 reasons physicians need to be on social media

By Michelle McNickle, Web Content Producer
Created 05/21/2012
NEW YORK – Live tweeting, ukulele playing and numerous discussions swirling around social media and healthcare were to had throughout the Connecting Healthcare + Social Media Conference, produced by NYC Health Business Leaders, this past week in New York. During the latter half of the day Thursday, Mike Sevilla, M.D., family physician and blogger at Family Medicine Rocks, took the stage to present not only his own social media story, but to convince other physicians why they, too, need to be on social media. 
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Tablet adoption by docs soars

By Bernie Monegain, Editor
Created 05/22/2012
NEW YORK – Physicians' use of devices and digital technology is evolving much faster than anticipated, especially when it comes to tablets, where adoption nearly doubled since 2011, according to a new study from healthcare market research and advisory firm Manhattan Research.
The study surveyed 3,015 U.S. practicing physicians online in Q1 2012 across more than 25 specialties.
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ONC chief pushes for HIE 'rules of the road'

By Mary Mosquera, Contributing Editor
Created 05/29/2012
WASHINGTON – Healthcare providers need health information exchange to be fully automated and easy to do in order to scale up sharing of patient data to improve care, according to Farzad Mostashari, MD, the national coordinator for health information technology.
Some steps for preparing data for exchange are still often almost hand-coded, such as vocabulary mapping, value sets and quality measures, he said.
The development of rules of the road to govern the nationwide health information network (NwHIN) could promote that automation by detailing the policies and technical standards that organizations that want to perform exchange activities would meet to foster trust in their services.
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The Price of I.T. Progress?

APR 30, 2012
Three years ago, independent physicians ruled the roost at Medical Center Health System, a 403-bed community hospital in Odessa, Texas. At that point, the health system employed only half a dozen physicians, mostly primary care docs who doubled as hospitalists. Today, the employed medical staff numbers 30, encompassing both radiology and anesthesiology. And the number is going to keep growing, says Gary Barnes, CIO. "When we're recruiting medical staff, we try to bring in private physicians first, but more and more, they want to be hospital-employed," he says.
The reason? For Barnes, the answer boils down to one simple fact: Running a private group practice, of whatever size, is increasingly a difficult undertaking, one that fewer and fewer physicians are keen on doing. "If you come in as an employed physician, we can take care of the billing and the medical records, and you can practice medicine instead of trying to manage a business and make a profit."
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Cash contests alone won't make EHRs work for specialists

May 29, 2012 | By Ken Terry
A new contest announced by the Office of the National Coordinator for Health IT (ONC) offers cash prizes for applications that integrate ophthalmologists' examination devices with their electronic health records. If one or more parties came up with apps that met all of ONC's criteria by Nov. 9, the contest deadline, that could be a step forward for eye doctors. But it would still address only a portion of their health IT needs.
Here's what ONC requires of the winning application: it must warehouse data from many different devices; convert the data from proprietary formats to a single, vendor-neutral format; enable clinicians to manipulate data and images; and interface with existing EHR systems (presumably, just the top dozen or so).
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Video gaming more than just child's play

May 29, 2012 | By Sara Jackson
University of Pittsburgh researchers say video games as a powerful tool for improving patient health, according to a study just published in the American Journal of Preventive Medicine.
It's not a comprehensive endorsement--the study finds there are too few clinical-level studies on the topic, and some drawbacks to video gaming overall--but video games can substantially improve outcomes in physical therapy (69%), psychological therapy (59%), getting patients more active (42%) and pain management (42%), the study found.
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EMIS relaunches EMIS Access

28 May 2012   Rebecca Todd
EMIS is re-launching EMIS Access through patient.co.uk, with an "easy to use" interface for patients who will also be able to log-in without their practice-issued password.
Group chief executive Sean Riddell spoke at the iLinks event in Liverpool last week about work to make the patient access portal more attractive to both GPs and patients.
The news follows a firm commitment in the NHS information strategy, released last week, that all GPs should be offering patients online access to transactional services and their medical record by 2015.
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EHI PC survey: show us the money

GPs leading the government’s commissioning reforms have high hopes for IT; but wonder where the leadership and money is going to come from. Fiona Barr reports.
28 May 2012
Clinical commissioning groups have one big priority and one big problem when it comes to IT and information.
The priority is to enable better information sharing across the health economy. The problem is that they do not know where the funding will come from to enable them to do that. Or who is going to be responsible for the infrastructure, services and systems that will be needed to do it.
Joined up
Last month, EHI Primary Care conducted an exclusive survey of GPs, CCG chairs, board members, IM&T leads, and others involved in commissioning. It found that 82% hope that IT will help them to provide better clinical information to GPs over the next three to five years.
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EHI PC survey reveals funding fears

29 May 2012   Fiona Barr
Uncertainty about future funding for NHS IT and the future direction of NHS informatics are the biggest IT concerns for clinical commissioning groups, according to an exclusive survey by EHI Primary Care.
Nearly a third of those who took part in the poll (29%) said future funding for NHS IT as a whole was their major concern, 19% were worried about uncertainty over the future direction of NHS informatics, and 12% said they were mainly concerned about funding for GP systems.
On respondent said “the NHS must make a decision about where IT will sit along with its resources” and another said their greatest concern was that “responsibility to fund GP IT national initiatives will be passed to local organisations without any additional funding.”
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The Power of Plugged-In Physicians

Philip Betbeze, for HealthLeaders Media , May 25, 2012

Hospital and health system senior executives are continually searching for ways to engage their physician staff. Some are doing it through an employment strategy. Some are creating a variety of economic incentives for physicians to help them achieve the goal of fewer readmissions, meet quality targets, and agree on treatment protocols that fit evidence on cost and quality. They're working to educate physicians on the downstream effects of their decisions on the entire organization.
Those are all valid and important initiatives to attempt in an industry hungry for transparency, cost control, and better quality. But to hear many CEOs speak, it's a tricky business to encourage physician engagement, and they search for the right combination of incentives to get the job done. They fail at their career peril.
I have found that most execs have trouble defining what exactly physician engagement or alignment really looks like.
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Pill Mill Crackdown Endangers Telepsych Program

Scott Mace, for HealthLeaders Media , May 29, 2012

It is far too easy in this country to set up and run a pill mill. Recently I attended a session on healthcare fraud and abuse detection where a former regulator noted that in the state of Florida, all that was required to set up an online pharmacy was to prove one was 19 years or older.
Now here come federal lawmakers, trying to solve a problem that may in large part belong to the states. And one such effort, unless amended, uses such broad brush strokes that it threatens to choke off a very good technology-based healthcare program.
Mission Hospital in Asheville, North Carolina is the tertiary hospital serving the 18 counties of western North Carolina. Rural primary and secondary hospitals there are isolated and lack many specialists. Psychiatrists and neurologists are in particularly short supply.
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3 Solutions to Improve EHR Training, Outcomes

Written by Kathleen Roney | May 25, 2012
When hospitals purchase expensive electronic health record systems, they are hoping to benefit from advanced features, which produce cost-savings, increased efficiency and patient care benefits. However, training sessions for complex EHR systems can be overwhelming and time consuming. According to Andres Jimenez, MD, CEO of ImplementHIT, many hospitals may not receive optimal outcomes from EHRs because hospital staff and physicians are not trained effectively. "One of the basic tenets of education is that individuals, especially adult learners, must find training immediately relevant need to be engaged in learning in order to retain information. With physicians, if the information is not relevant, it is not only harder for the individuals to learn, it will often completely disrupt learning, which reduces engagement and any possibility of meaningful learning from that point forward," says Dr. Jimenez. For healthcare, relevance applies to EHR training in both content and pace, at which intermediate and advanced topics are introduced. According to Dr. Jimenez, physicians and hospital staff need to undergo gradual EHR training that is set to their individual pace and tailored to their specialty and proficiency level. Not many EHR training sessions are individualized or specialized, which is causing problems for hospital EHR implementation.
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Dictation Degrades EHR Accuracy

By John Pulley
May 23, 2012
Patient care is “significantly worse” when doctors dictate their notes into electronic health records compared with two other common forms of documenting care, according to a study published online this week by the Journal of the American Medical Informatics Association.
The findings suggested that doctors “who more intensely interact” with EHRs based on their style of documentation “may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality care,” according to the article abstract.
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Tuesday, May 29, 2012

Integrated Health Systems Lead the Pack on Mobile Health

by Rebecca Vesely, iHealthBeat Contributing Reporter
Rob Carnahan lives in rural Oregon, about 80 miles from the nearest Kaiser Permanente facility. But the 63-year-old checks his personal health records, emails his doctor, receives lab results and makes appointments from out in his fields.
He's even refilled a prescription from atop his tractor.
Carnahan is an avid iPhone user and is on his third generation of the popular smartphone. He accesses the Kaiser Permanente website through the device to keep on top of his health care needs, and he rarely uses a laptop or desktop computer to do so.
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Enjoy!
David.

Friday, June 08, 2012

The UK National Health Service (NHS) Announces A New Information Strategy. Different Horses for Different Courses.

Big news for the UK NHS a few weeks ago.

New NHS information strategy unveiled

21 May 2012   Jon Hoeksma
The new NHS information strategy, published today, urges health and social care services to make full use of online technologies to put patients in control of their health and health records.
The strategy puts a particular emphasis on the creation of portals for patients, health professionals, commissioners and researchers, in a series of moves that health secretary Andrew Lansley says will free up the "power" of information.
A national ‘portal’ will be created as the definitive source of trusted information on health and social care by 2013. The NHS portal will inform patients’ decisions on selecting treatments and providers.
This fits with the central theme of shifting to a presumption of sharing information within and between health and social care providers, and capturing data just once at the point of care.
"These proposals will ensure that the NHS will become easier to understand, easier to access and will drive up standards of care,” said Lansley.
A new commitment is given to make it far easier for the life sciences industry to access anonymised patient records, with the lead role to be provided by the Health and Social Care Information Centre.
An ambition is also outlined to develop integrated health and social care records, and provide patient access, “once technology permits."
The long-awaited strategy, developed after extensive consultation, is titled ‘The power of information of information: Putting us all in control of the health and care information we need.'
The strategy is big on ambition – nothing less than the previously promised 'information revolution' – but only offers a sketchy map of how to get there.
.....
No specific financial commitments are given, other than a brief statement that there will be some funding from capital investment for patients administration systems for hospitals that didn't receive them from NPfIT. (DM Note: Remind You Of Anywhere Else?)
Link
Here is a news report:

Patient access to GP records by 2015

21 May 2012   Rebecca Todd
Providing patients access to their online records by 2015 is one of the few specific commitments in the government’s newly released NHS information strategy.
Many GPs remain unconvinced of the benefits of giving people access to their records, and are concerned that this will create more work for practices when patients ring up to question what they have read online.
However, the strategy predicts just a “modest” time investment by GP practices that will lead to significant increases in productivity that “far outweigh the initial investment."
The government has committed to all patients having secure online access to their GP record by the end of this parliament.
The information strategy says this means that by 2015, all general practices will be expected to provide electronic booking and cancelling of appointments, ordering of repeat prescriptions, electronic communication with the practice and online access to their record to anyone who wants it.
Although more half of GPs in England have systems which can provide electronic access to records, fewer than 1% offer the service.
The uptake for offering transactional services is much higher, with 70% of GPs using a system that offers it - and 30% using the functionality.
More here:
Here is a summary of some reactions.

Power plays

GPs and GP system suppliers are glad to see the NHS information strategy published, but they are concerned about some of its commitments and the lack of detail on how to achieve them. Rebecca Todd reports.
22 May 2012
The strategy makes much of its ‘vision’ for moving the NHS towards a ‘digital first’ service, and giving researchers, commissioners, clinicians and patients the information they need to make informed choices about health and care.
But it sets out little by way of targets or milestones and is virtually silent on what organisations will be put in place to support the vision – or where the money will come from.
Reaction to the strategy has been muted in the GP community, with doctors and suppliers welcoming the commitment to more transactional services for patients, but raising practical questions about giving patients online access to their GP records by 2015.
Commenters have also raised concerns that the strategy is silent on such pressing issues as what will happen to GP IT support and systems as primary care trusts are abolished and GPSoC comes to an end in 2013.
BMA and RCGP joint IT committee chair - Dr Paul Cundy
“[The strategy] is largely fairly sensible. [It talks about] online booking of appointments and prescription requests; but a lot of us are doing that already, so it’s a non-issue.
“There’s no problem with [patients] having access to their records, but there are issues which will have to be sorted out first, not the least of which is knowing it is the patient who is accessing the record.
“Also, it has long been my personal view that the records I hold on my computer systems are not the patient’s records. They are my records, and the patient element is a component of them.
“There’s an enormous danger in letting patients believe that they can edit the tools I use to treat them. Yet the message from politicians is that ‘it’s your record and you can write it’.”
BCS Primary Healthcare Specialist Group chair – Roz Foad
“The call for a reduction in face to face consultations as a means of saving money is something that should only be introduced with patients involved in the implementation.
“Some will welcome the idea of telephone and, no doubt later, video consultations as a way of saving time. But the heaviest users of the NHS - the elderly with chronic conditions - will most likely see this as another reduction in service.
“What GPs have been crying out for since before the National Programme for IT in the NHS is the introduction of an electronic discharge summary direct into their records, in a form which provides the right, relevant, correctly coded information – where is that an actual target in the new strategy? It is flagged up as a good pilot scheme example, but it should be a priority target, not just an ‘encouragement’.
“What I have not found in the strategy generally is the specifics; such as who is responsible for GP IT system commissioning and support after March 2013, which is less than a year away. What is the replacement for the National Information Governance Board? Information governance will be ever more critical, and I see no independent, credible, replacement.
“Indeed, I very concerned about the consent issues around sharing confidential medical records with outside bodies. Obviously, there are great benefits to research organisations, to public health and so on in doing this, but patients must be fully informed about where their data is going, and have the opportunity to opt out if they so wish.”
Chairman of the BMA’s GPs Committee - Dr Laurence Buckman
“There are GP surgeries which have been pioneering online booking and repeat prescriptions for a while now, so we would support the wider implementation of this, as long as it doesn’t impact on patients without IT access who [will need to be able to] continue to book appointments in the usual way.
“However, we would caution against the potential use of email for consultations, because compared to a telephone or face-to-face consultation, it is difficult for GPs to assess someone quickly and safely this way.
“When it comes to patients being able to view their records online, we believe patients should have access to their health records but we’d want to be satisfied that their records would remain secure before this was implemented.”
GP and EHI Primary Care columnist - Dr Neil Paul
“My reaction is: records access by 2015 – do we need that long? The government should be more ambitious. Most of what is in the strategy is doable now.
“And I don’t think it goes far enough. We need better, secure communications with patients rather than email. We need something like the banks have, so we can send messages to patients safely and confidentially.
“We need to be publishing more performance data. For example, hospitals often take months or weeks to let patients know what their CT scan results are, when I know they are reported on the same day. Publishing some of this data would force secondary care to invest in IT more.
“We need to do more than just share data. We need better tools to analyse data and we need open access to clinical systems to allow custom built modules that don't rely on big monopolies to dictate what we can and can't
Lots more reactions here - especially from the GP system vendors:
Here is some Ministerial Comment.

Ten years to digital first NHS: Earl Howe

Health minister, the Earl Howe, tells eHealth Insider editor Jon Hoeksma that the NHS needs to become ‘digital first’ in the next ten years, and the finally just-published NHS information strategy will help to get it there.
21 May 2012
The seventh Earl Howe is an unlikely revolutionary, yet he hopes his department’s new information strategy - ‘The Power of Information’ - will set in train a far-reaching upheaval in the way healthcare services are delivered.
The parliamentary under secretary of state, who has a background in banking, says the strategy is “deliberately bold and consciously so.”
It is intended to create a culture shift among health professionals and patients that will enable a “digital first” NHS to be built from the ground up over the next decade.
In an exclusive interview with eHealth Insider, the minister said the strategy is framed to set the ambition of a digital health service, which promises to be as transformative as the information revolutions that have re-shaped other sectors.
“Our task is to give a sense to patients and the public of how transformative this technology can be to their own lives.”
The strategy also aims to catalyse action by providing “a series of ideas on how this could be done, and already is in places being achieved.” But it is not intended to prescribe how the health services, or individual organisations, should get there.
Quality underpinned by information
A key theme in the strategy is for the government to step back and create the conditions that will enable quality information, local innovation and best practice to flourish and spread only intervening where necessary. Or as Earl Howe put it: “The role of the centre is to facilitate the process.”
The role of the centre is to set the direction of travel and create the conditions for local innovation, together with core infrastructure “including standards.” Use of the NHS Number and pushing adoption of SNOMED CT are the two mentioned by the strategy.
Heaps more here:
All in all fascinating stuff - and it will be interesting to see how it evolves without specific funding. We all know what happened with the NON-FUNDED National E-Health Strategy in Australia.
David.

Thursday, June 07, 2012

This Is A Piece Of News That Should Not Be Taken Lightly. This Can Stop The NEHRS Dead In Its Tracks.

The following report appeared a few days ago.

Litigation warning on eve of e-Health

FOUR weeks before the introduction of a $1 billion e-Health scheme, key medical indemnity insurers are warning GPs not to participate as they could be exposed to a new wave of litigation.
There is concern doctors could be sued if patients are harmed because records are not kept up to date or clinical information is omitted. They are also worried by the ability of patients to restrict access to parts of the record.
Insurers are advising doctors not to use the e-Health records until the issues are settled.
President of Medical Defence Australia Julian Rait said his organisation had serious concerns about the legal liabilities doctors would face if they used the Personally Controlled e-Health Record (PCEHR) and would "advise members not to participate until these problems are properly addressed".
David Nathan, Avant Mutual Group Limited chief executive, said his organisation was concerned that key elements of the initiative, including the potential risks assumed by healthcare professionals in accessing the PCEHR, were yet to be finalised, and "they may determine our advice to members as to the risks of signing up to the initiative".
Lots more here:
And if you really want to scare people away this will do it.

Premiums may skyrocket due to e-health

5th Jun 2012
AS THE government continues to bargain with GP groups over the conditions practices must agree to when using the national e-health record system, experts have warned the legal liabilities attached to the records could push premiums up.
The first draft of the agreement caused outrage across the profession by requiring practices to assume all legal liability for the system and grant health department officials unrestricted access to their premises and records.
Department officials were due to meet RACGP representatives today to discuss the latest draft of the agreement, which sources said was the fourth so far, but MO understands the major GP organisations are still unhappy with many of the conditions.
MDA National president Associate Professor Julian Rait said the contentious “search and seizure” powers had been removed from the latest draft but GPs should still treat the system with “extreme caution”.
Lots more here:
What needs to be appreciated here is the power of the Medical Indemnity Insurers. If they say to their members we would advise you to leave the NEHRS / PCEHR alone until we are sure there are essentially zero risks as far as your contributing to and using the NEHRS you can be sure they will be taken very seriously indeed.
To practice all doctors need this sort of insurance - essentially to cover their defence costs where they are wrongly accused and to compensate those patients who have been wronged - and costs can range from a few thousand a year to tens of thousands depending on your risk profile.
The Indemnity insurers are ‘not for profit’ and so if they see an additional risk / possible liability their actuaries will cost it in and adjust premiums accordingly - as well as warn about getting involved - or maybe charge a higher premium if you say you plan to use the NEHRS system. There is lots of precedent for extra premiums depending on the nature and scope of practice.
At present there seem to be two areas of concern. The first is around the conditions the Department wants to put in their agreement with doctors to contribute to / be the custodian of the Shared Record. Right now the AMA and RACGP are not at all happy and a third draft is apparently being prepared - the first two having been rejected.
The second area is around accountability for the use of a NEHRS record and possible liability that may flow from wrong treatment or care based on information found in a NEHRS record. Clearly there have to be clear rules and clear ‘good faith’ use exemptions or the risk of use just will not be worth it.
I guess the Government will be grateful, with the delayed start - to have some more time to sort all this out. If they don’t you can be sure clinical use of the system will approximate zero.
David.

This Is Just Beyond Belief. What An Unremitting Fiasco. We Need An Audit of the NEHRS Pronto!

The following appeared today.

Health minister Lawrence Springborg reveals cost of fixing QH payroll issue will top at least $1.2 billion

THE cost of Queensland's disastrous health payroll system is set to top $1.2 billion by 2017.
But Health Minister Lawrence Springborg has warned that estimate is a "bare-bones price" that does not include any contingency funding should anything go wrong.
Contingency provisions for repairs could add an extra 30 per cent to the $1.253 billion cost.
It also fails to include the impacts of Fringe Benefits Tax payable on wage overpayments, which could be as high as $110.4 million.
Even more concerning, the Workbrain and SAP systems will no longer be supported from 2014-15 and the former Bligh government failed to set aside any cash for the needed upgrade or re-implementation.
That cost has not yet even been quantified.
The shocking cost is detailed in a wide-ranging audit tabled in State Parliament this afternoon which has, for the first time, given the true picture of the bill taxpayers face to ensure health workers are paid properly.
Since March 2010, Queensland Health's payroll fiasco, one of the Bligh government's biggest disasters, left thousands of health workers underpaid, overpaid or unpaid, often for weeks on end.
The system was originally expected to cost about $40 million to implement.
Lots more with links to other articles here:
I am sorry - this debacle really does leave me just open-mouthed in amazement!
The cost blowout has clearly meant health services in Queensland have been curtailed as a result of the vast an inexcusable overspend. I know setting up a payroll system in a complex Health Bureaucracy can be hard - but surely not this hard.
As far as the NEHRS is concerned what is shown is just how useful a proper Audit can be to sort out what is what and just how exposed everyone is.
If ever there was a program in need of the same sort of review it is the NEHRS!
David.

Wednesday, June 06, 2012

Given We Will Only Get A Number To Call Come July 1 - Rather Than A Working NEHRS - Can We Get Some Money Back?

In the last couple of days, indeed since Senate Estimates last week., we have been learning just how limited the scope of the July 1, kick-off of the NEHRS / PCERH will be.
Here is a typical report.

Just another day in the e-health evolution

05/06/2012
Emma Connors
Anyone hoping for fireworks when a new $467 million-plus e-health system goes live next month is going to be disappointed.
In recent weeks, Health Minister Tanya Plibersek has been hosing down expectations. Last week, it was the turn of the Health Department secretary Jane Halton.
“One July is the beginning, not the end point,” Ms Halton told a Senate estimates committee hearing last week.
“We do not expect everyone to be registered on that date and we did not expect all the capability to be available on that date.”
In some respects the launch will be more remarkable for what is not there than what is.
Amazingly, the official website might have to redirect those who want to sign up for an electronic health record. Health Department officials can’t say for certain if the online registration capability will be available on July 1. If not, enthusiastic consumers will have to get off the internet and head for a Medicare shop front or ring a call centre instead.
So, it’s clear that as far as system launches go, this one is going to be more of a damp squib than a jaw-dropping display of new technology.
The government argues this is not so important. These new records have been more than a decade in the making so how they function in the health system in the medium to long term is more important than what happens next month.
There is a great deal of discussion and reaction that follows here:
Reading all the commentary through one does rather get the sense of a slightly disorganised and not all that well planned and executed mess.
That brought me to think about all the funds that had been spent in readiness for the July 1, 2012 start-up and I wonder what it means for all the service providers?
We have a range of consortiums who have been allocated funds for delivery. These include:
The infrastructure partner consortium - Accenture, Orion, Oracle and others - $77 million
The change and adoption partner consortium - McKinsey, PWC, Ocean Informatics and others -  $29.9 million
The benefits realization and evaluation consortium - PWC, McKinsey Trilogy and others -  $5.8 million
NASH - IBM - $23 million
External delivery assurance advisor $990,000 + extra a bit later (As the external assurance adviser, Ernst &Young will have ongoing oversight of the project and provide independent advice on progress) This one especially seems to have a good deal of work yet to do.
And of course there are millions that have gone to NEHTA as ‘managing agent’
There is a lot of useful information aggregated here:
A detailed analysis of all the various bits is also found here:

Labor's Personally Controlled Electronic Health Record system blows out to $760m

SPENDING on Labor's Personally Controlled Electronic Health Record system has blown out to $760 million, almost $300m more than the $466.7m budget.
The National E-Health Transition Authority has swallowed the original allocation almost whole -- it has received $466m in taxpayers' money since the PCEHR was announced by former health minister Nicola Roxon in 2010.
The $760m price tag to date has been uncovered by The Australian in a detailed analysis of statutory records available from the federal Health Department, AusTender, the Senate Community Affairs committee and the Council of Australian Governments.
COAG allocated $218m in base funding for NEHTA for a three-year period from July 2009 until the PCEHR's promised operational start on July 1 this year.
Half of this funding came from the commonwealth while state and territory governments contributed the other half.
The Health Department gave NEHTA another $136m to develop specifications for the infrastructure and related software and systems, from July 09-12.
The latest departmental records show NEHTA recently received a $21m top-up on funding to $110m, for the provision of services related to the PCEHR's introduction from January last year.
Heaps more detail here:
Given we actually don’t have change managed, any benefits to evaluate and much in the way of operational technology what happens next.
Do the partners just plug on until what is meant to be delivered is at no extra charge of do the taxpayers get to stump up some more.
Enquiring minds and maybe the next Senate Estimates should be asking.
David.