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 23, 2012

Weekly Overseas Health IT Links - 23rd 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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10 Experts Give Tips to Combat Mobile Device Threats to Healthcare

Written by Kathleen Roney | June 13, 2012
Mobile devices offer a great deal of convenience as well as nearly unlimited applicability to patients, physicians and medical professionals. Mobile devices improve ease and efficiency of communicating with patients, collaborating with physicians, ordering prescriptions or drugs and inputting patient data during visits. In addition, many patients have been using mobile technology to access their medical information, refill prescriptions or make appointments.
Unfortunately, there is also a downside to mobile devices in healthcare — a greater vulnerability to data breaches. According to the report "Attack Surface: Healthcare and Public Health Sector," by the Department of Homeland Security, mobile devices face security threats such as spyware and malicious software, loss of treatment records or test results and theft of patient data. The portability of mobile devices also means they are easy to lose or steal.
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11 technologies pegged as best to tackle chronic disease

By Rene Letourneau, Editor, Healthcare Finance News
Created 06/13/2012
CAMBRIDGE, MA – Health policy institute NEHI has identified 11 emerging technologies that have the potential to improve care and lower costs for chronic disease patients, especially those in at-risk populations.
Each of the technologies are profiled in NEHI’s new report, “Getting to Value: Eleven Chronic Disease Technologies to Watch,” published with support from the California HealthCare Foundation. The report also identifies lessons learned about the role of technology in creating value and offers an overview of some of the barriers to adoption.
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Health IT, telehealth overlap

By Patty Enrado, Special Projects Editor
Created 06/12/2012
Insiders call for breaking down silos
SAN JOSE, CA – The telemedicine and health IT camps need to overcome their traditional way of operating in silos and develop partnerships to make a significant impact on improving the quality of care in the healthcare system.
If anyone is reaching out, however, it’s the telemedicine side, according to four industry executive panelists who spoke recently at the American Telemedicine Association 2012 Conference and Exhibition in San Jose, Calif.
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NY Accelerates State Health Information Exchange

Regional health information exchanges team up with IBM and other IT vendors to build the massive Statewide Health Information Network of New York.
In a bid to ramp up its statewide health information exchange, New York has corralled three Regional Health Information Organizations (RHIOs) and three health IT vendors to participate in the Statewide Health Information Network of New York (SHIN-NY).
As an increasing number of N.Y.-based private practices, nursing homes, clinics, and hospitals are using electronic health records (EHRs), many have connected their systems to RHIOs in their part of the state. These RHIOs collect health record data from the healthcare providers in their area, and, with patient consent, allow this information to be shared securely with other providers in the region.
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EHR design: A mold in need of breaking

June 13, 2012 | By Marla Durben Hirsch
Apparently I struck a nerve with last week's commentary on making the transition to electronic health records. The editorial generated quite a few comments, and every one of them were against EHRs.  They're expensive, become a crutch for the lazy or less-trained, and deter from direct patient-physician communication.  
There also was a recurring theme in the comments, which were thought-provoking and insightful: EHRs are designed poorly. Here are a few:   
"EMRs are plagued by problems and inefficiencies that harm [patient] care and potentially, security and privacy--some day when they are perfected and work the way physicians work, we will flock to them. That time is not now! Data access can be more convenient, but data entry is terrible."
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More docs questioning benefits of ACA, EHRs

By Erin McCann, Associate Editor
Created 06/14/2012
WATERTOWN, MA – Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years. 
The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based athenahealth and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practices sizes. 
This year's PSI tells a story of over-burdened physicians who are deeply concerned about where the healthcare industry is headed. The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices. 
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Consumer groups step up pressure on HIE security

June 13, 2012 | By Ken Terry
Consumers want the benefits of health information exchange, but they also wish to be assured that their personal health information (PHI) will remain private and secure, notes a new issue brief by Consumers Union and the Center for Democracy and Technology (CDT). The report, which was sponsored by the California Healthcare Foundation, recommends several ways to strike an appropriate balance between these objectives and also calls for stricter laws to protect PHI in health information exchanges (HIEs).
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Study: Computer Can Predict Drug Side Effects, Save Billions

June 11, 2012
Recent research has determined that a set of computer models can predict the negative side effects in hundreds of current drugs, based on the similarity between their chemical structures and those molecules known to cause side effects. The conclusion was driven by researchers at the University of California at San Francisco, and will appear in a paper in the journal Nature.
Led by researchers in the UCSF School of Pharmacy, Novartis Institutes for BioMedical Research (NIBR), and SeaChange Pharmaceuticals, Inc., it looked at how a computer model could help researchers eliminate risky drug prospects by identifying which ones were most likely to have adverse side effects. The researchers focused on 656 drugs that are currently prescribed, with known safety records or side effects. They were able to predict such undesirable targets — and thus potential side effects — half of the time.
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Telepsychiatry for Children Improved Symptoms, Halved ED Visits

A pilot telepsychiatry program for children significantly improved symptoms and cut emergency department visits in half, based on data from more than 8,000 patients over 2 years.
Health care costs will continue to rise, so new mechanisms are needed to combat the shortfalls in primary care medicine – including the limited number of child psychiatrists, said Alexander Vo, Ph.D., who presented the results in a webinar June 12.
"Telemedicine is the use of technology to deliver health care from a distance," said Dr. Vo of the University of Texas Medical Branch at Galveston. Faced with a shortage of pediatric psychiatrists in Texas and given a mandate to provide access to quality mental health and medical care, the University of Texas received a grant to develop pediatric psychiatry clinics for telemedicine.
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ONC to offer mobile device security tips

By Mary Mosquera
WASHINGTON – The Office of the National Coordinator for Health IT (ONC) will help small providers who use smart phones and other mobile devices learn how to easily secure them using simple steps explained in plain language.
Research shows that about 81 percent of physicians use smart phones or tablet devices. The small size of these devices make them easy to lose on subways and airplanes or stolen. Yet very few safeguard them, such as using encryption, making it easy for unauthorized users to access information.
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Thursday, June 14, 2012

Portals Hold Promise for Patient Engagement but Challenges Remain

Many believe that granting patients access to their medical information will lead to better quality and coordination of care. They contend that the easiest and most efficient way to provide this access is through portals. However, as in other areas involving health IT, there are challenges and fears.
Some challenges involve adopting and implementing technology or reconfiguring workflows to optimize benefits from portals. Other issues surround managing clinicians' concerns and expectations to gain support for this new way of communicating with patients.
Fears surrounding portals include the concern that patients will be slow to use them and that those who could benefit from better access to information won't take advantage. That worries IT executives, who fear that their ability to meet one proposed objective of Stage 2 of the meaningful use program lies outside their direct control.
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Thursday, June 14, 2012

Portals Hold Promise for Patient Engagement but Challenges Remain

Many believe that granting patients access to their medical information will lead to better quality and coordination of care. They contend that the easiest and most efficient way to provide this access is through portals. However, as in other areas involving health IT, there are challenges and fears.
Some challenges involve adopting and implementing technology or reconfiguring workflows to optimize benefits from portals. Other issues surround managing clinicians' concerns and expectations to gain support for this new way of communicating with patients.
Fears surrounding portals include the concern that patients will be slow to use them and that those who could benefit from better access to information won't take advantage. That worries IT executives, who fear that their ability to meet one proposed objective of Stage 2 of the meaningful use program lies outside their direct control.
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Discovery debuts e-health record app

By Admire Moyo, ITWeb's portals writer.
Johannesburg, 14 Jun 2012
Discovery Health has rolled out HealthID, the first electronic health record application of its kind in SA.
The company says the new app puts patients' health records in their doctors' hands, adding that electronic health records are at the heart of the application, where clinical information derived from claims data and pathology laboratories is stored.
With HealthID, doctors are able to access their patients' data and details of their previous doctors and hospital visits. Doctors can also view previously prescribed medicines, blood test results and patients' health measures such as body mass index and blood pressure.
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Centralizing healthcare big data in the cloud

June 12, 2012 11:44 AM EDT
Can the medical community make better use of big data, government regulations and the cloud to improve service and save lives? 
There is a lot of buzz going around about big data and cloud computing, but there is also a lot of confusion about how to incorporate them for an advantage. Cloud computing is all about providing services over the network, and big data is all about analyzing lots of data to gain insights and find trends. Government regulations are all about protecting the data and forcing the owners of the data to save it, just in case.
The problem is many folks are afraid of cloud-based solutions because they feel the data may not be secure, and sometimes big data may really just contain useless or redundant (what I call fat data), and regulations are just a pain to accommodate. There needs to be a better way.
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Tips to Improve Mobile Device Security

JUN 13, 2012 9:01am ET
ID Experts, a data breach prevention and remediation firm, talked with 13 experts and got 13 tips for managing mobile device threats in health care:
* Install USB locks on computers and devices to prevent unauthorized uploads and downloads;
* Consider software that can track and locate a device or wipe (erase) its data;
* Consider “brick” software that disables a missing device;
* Encrypt;
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New app maps patients' health risks

By Erin McCann, Associate Editor
Created 06/13/2012
WASHINGTON – IndiGO, an application developed by San Francisco-based Archimedes Inc., uses a patient's EHR and advanced algorithms to generate graphical analyses of that individual's health risks. The app brought its game face to last week's Health Data Initiative (HDI) in Washington, D.C., eventually walking away with a win.
IndiGO was presented with the "Best of Care Applications" award at the HDI event earlier this month for its ability to provide a graphical representation of a patient’s heart attack or stroke risk, chance of developing diabetes and the predicted impact of interventions, such as lifestyle changes and medications that are most effective at reducing these risks.
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Roundtable forecasts big changes for state HIEs

By Mike Miliard, Managing Editor
Created 06/13/2012
WASHINGTON – A new report from the HIMSS State Advisory Roundtable argues that state HIEs will need to adapt to changing approaches to reimbursement, evolving their mission and business models from "information exchange" to "coordination facilitation."
Convened about this time last year, the HIMSS State Advisory Roundtable comprises experts and advocates from state and federal governments, regional extension centers, health information exchanges and more. It seeks to target health IT issues that transcend state boundaries, helping enable different states advance their health IT programs.
Its inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.
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9 dos and don'ts of cloud computing

By Michelle McNickle, Web Content Producer
Created 06/12/2012
At this point, the trend toward cloud-computing is strong, even though some are still skeptical of its "chaotic" use and its ability to meet the needs of health IT professionals. Mariano Maluf, CTO at Atlanta-based GNAX, says now is the time to strongly consider the cloud – while keeping some basic tips in mind.
"The shifting IT landscape is prompting more and more questions around cloud computing models and their immediate value proposition," said Maluf. "Changes in work style and device formats, coupled with new application platforms and delivery methods, all coalesce to challenge the IT status quo."
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Telehealth, mobile systems among promising chronic care technologies

June 13, 2012 | By Dan Bowman
Home telehealth and extended care eVisit systems are among some of the more promising, available technologies, geared to fighting chronic care, according to a new report from the New England Healthcare Institute, a health policy research organization that focuses on enabling innovation in healthcare. The report highlights a total of 11 underused technologies that have the potential to lower costs and improve care quality for chronic care patients.
The technologies also are divided into four separate classes, with those that are on the edge of widespread adoption (home telehealth, extended care eVisits and tele-stroke) in Class I, and those that are promising but lack research to support clinical or financial benefit (in-care telemedicine, social media and mobile cardiovascular tools) in Class IV.
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June 12, 2012

Evolution in the C-Suite and the Evolving Role of the CMIO

A driving force in the evolutionary process is the need to adapt to new environments and changing situations. Healthcare is facing such an evolutionary process today and this change is reflected in C-suite transitions. While there is a great deal of change underway through healthcare reform and differing opinions on how to manage it, one thing seems clear—executive support for healthcare IT is here to stay.
Achieving meaningful use of electronic health records (EHRs) as part of the mission to improve outcomes has become one of the top strategic missions of most health systems. The increasing importance of healthcare technology in the strategic landscape is changing the manner in which hospitals operate. It also has accelerated the demand for a clinical IT skill set and physician IT leadership.
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Demographics, not practice setting, predict doctor tech use

While 81% of doctors go online, a report found which are most likely to use the most Internet communication strategies.

By Bob Cook, amednews staff. Posted June 11, 2012.
To find which physicians are most active on social media and other places online, one study says don’t look at the doctor’s specialty or practice setting.
The most consistent predictors of whether physicians used seven Internet-based communication technologies was whether the doctors were young, male and had teaching hospital privileges, according to a study posted online May 25 on the website of the Journal of the American Medical Informatics Association.
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Kalorama Tracks Mobile Medical App Market

JUN 12, 2012 5:25pm ET
The market for mobile medical applications was about $150 million in 2011, but that number will grow 25 percent annually for the next five years, according to market research firm Kalorama Information.
At best, medical apps top out at about 2 percent of the total app market, but the medical segment is growing a little faster than the 23 percent annual rate for the overall application market. Clinicians increasingly are using smartphones to perform some of the work previously done on a desktop or laptop computer, according to the firm.
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Catholic Health Initiatives to build enterprise HIE

By Patty Enrado, Special Projects Editor
Created 06/12/2012
ENGLEWOOD, CO – Catholic Health Initiatives is partnering with Orion Health to build an enterprise-wide HIE that will enable physicians and clinicians to access patient records across its 100 facilities in 19 states. Once connected, CHI plans to link to statewide HIEs in states where its 76 hospitals are located.
The second largest Catholic healthcare system in the U.S. will deploy Orion Health HIE to support its $1.5 billion OneCare program, which will create a shared, universal patient record documenting its more than 400,000 hospital admissions and nearly five million physician office visits annually.
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Health Care: A Not Too Distant Future

JUN 12, 2012 11:20am ET
Over my six-month hiatus from this blog, many things have changed in the health care industry. Two of the most significant have been the delay of the ICD-10 implementation and the Supreme Court’s review of the Affordable Care Act.
But one thing has stayed constant: We still seem to be struggling with two divergent views on how to improve health care in this country. Vested interests and ideologies are as deeply ingrained as they were six months ago, and the numerous studies and counter-studies may not have done much to shift opinion one way or another.
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Disruption, Not Destruction Will Save Medicine

Scott Mace, for HealthLeaders Media , June 12, 2012

No contemporary discussion about healthcare and tech is complete without addressing the work currently sitting on top of Amazon's Health Care Delivery bestseller list.
The book by Eric Topol, MD, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, published in January, supposes that a combination of patient activism and sheer technological innovation can largely get us out of our current healthcare mess.
I respect Topol's long track record in medicine, and his ability to crank out an entire, fact-filled book about the revolutionary changes technology is bringing to healthcare. But I'm leery of going as far as he does. As a book title from another bestselling  author on disruptive innovation suggests, healthcare definitely needs to be disrupted. But I would stop short of creatively destroying it.
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Data for GP comparison scores published

7 June 2012   Rebecca Todd
Data published today by the NHS Information Centre will be used to rank GP surgeries, which will be given an overall score out of ten based on patient experience.
The Department of Health says the information will help patients choose the right GP surgery and “help GPs and the NHS to make improvements to the way they do things.”
However, a BMA spokesperson says the rating system fails to take into account the different challenges that individual GP practices may face.
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Yorkshire e-consultation scheme extended

8 June 2012   Chris Thorne
An e-consultation system that helps specialists to decide whether GPs should refer a patient for hospital care is being extended.
Since 2007, Bradford and Airedale GPs using TPP’s SystmOne have been able to use the e-consultation service to seek advice from consultant nephrologists at Bradford Teaching Hospitals NHS Trust about patients with chronic kidney disease.
The service has since been expanded to GPs working across the NHS Airedale, Bradford and Leeds Primary Care Trust Cluster, and to a further five specialisms, with rheumatology joining the e-consultations catalogue imminently.
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Study links HIE use to less imaging in the ER

June 12, 2012 | By Susan D. Hall - Contributing Writer
Use of a health information exchange helped curb repeat imaging tests for headache patients who went to Memphis emergency departments, but didn't cut overall costs, according to a recent study.
Researchers from the University of Tennessee Health Science Center studied 1,252 adults who made at least two visits to Memphis ERs between 2007 and 2009. Patient records were shared through an HIE connecting 15 major hospitals and two regional clinic systems. Cases in which HIE records were used were compared with those that were not and the use of neuroimaging tests including CT, CT angiography, MRI or MRI angiography.
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Drug tracking database law passes in New York

June 12, 2012 | By Dan Bowman
Doctors in New York will be required to issue electronic prescriptions for painkillers within three years and will have to check patient records online before doing so after state legislators unanimously passed the Internet System for Tracking Over-Prescribing Act (I-STOP) yesterday. The bill establishes the creation of the real-time database, and also requires pharmacists to report when they fill such prescriptions, according to an announcement from state Attorney General Eric Schneiderman, who proposed the legislation in June 2011.
"With I-STOP, we are creating a national model for smart, coordinated communication between healthcare providers and pharmacists to better serve patients, stop prescription drug trafficking, and provide treatment to those who need help," Schneiderman said in a statement.
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U.S. Lags in Bettering Value of Healthcare

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: June 10, 2012
The U.S. faces major obstacles in the effort to document variations in health outcomes and improve clinical practice through value-based healthcare, according to a report from industry consultants.
While the U.S. health system has the highest per capita cost of the 12 nations studied -- spending 17.6% of its gross domestic product on healthcare -- it ranked at the bottom in terms of readiness to implement a value-based care system. The fragmented nature of the healthcare system has severely limited the collection and use of national health-outcome data.
In a value-based health system, variations in health outcomes are documented, leading to potential changes in clinical practice. "Making the data available allows clinicians to identify best practices and helps steer resources toward the clinical centers and specific clinical interventions that achieve the best results," according to a statement from the Boston Consulting Group that issued the report.
The report assessed the national health systems of 12 countries -- Australia, Austria, Canada, Germany, Hungary, Japan, the Netherlands, New Zealand, Singapore, Sweden, the U.K., and the U.S -- by the country's infrastructure to support value-based care and its ability to link health outcomes with costs.
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June 11, 2012

The App as Health Aide

By JULIE WEED
Travelers with chronic ailments like diabetes or high blood pressure have long struggled to remember when to take their pills as they cross time zones. Or they may have had a hard time finding emergency care in a foreign country or communicating about complicated health conditions.
But there are now a rapidly growing number of mobile health and medical apps that aim to deal with those types of situations.
Travelers can tap into technology before the trip begins, by storing information that can help ensure the right care is delivered if health issues crop up. Some put their medical history, latest EKG, chest X-ray or list of allergies and medications on a flash drive marked with a red cross, and attach it to a necklace, bracelet or keychain. Those who have had cardiac or other surgery may create a simple image using the free app drawMD for iPad devices that shows the exact location of a stent, for example, or an implant or bypass. For travelers who prefer a traditional method of communicating, a laminated card lists important information and physician contacts.
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mHealth: Embraced by developing world, resisted by developed countries

By Eric Wicklund, Contributing Editor
Created 06/08/2012
NEW YORK – A new study of the global mHealth market finds that consumers and developing countries are driving its growth, while physicians are reluctant to adapt.
Those are some of the conclusions drawn from “Emerging Health: Paths for Growth,” published by PricewaterhouseCoopers. The 48-page report, based on two separate surveys conducted by the Economist Intelligence Unit and analyzing 10 nations, indicates developing nations are quicker to accept and adopt telehealth because it’s seen as a way to increase access to healthcare, while developed nations like the United States are being dogged down by regulatory hurdles and a resistance to change among providers.
“Consumers are demanding and payers are willing to pay, but providers aren’t willing to provide,” said Christopher Wasden, PwC’s global healthcare innovation leader. “What we are going to need to do is get providers to think and act differently.”
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Blog Explores Immediate Chaos of Overturned Reform Law

JUN 11, 2012 11:50am ET
A posting on the KevinMD.com blog gives a sobering look at the challenges facing physicians--as clinicians, patient advocates and parents--if the Supreme Court rules the entire reform law unconstitutional.
The blog, from Bob Doherty, senior vice president of government affairs at the American College of Physicians, looks at provisions in the law that clinicians and patients take for granted now just two years after enactment.
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Another view: Neil Paul

A phone company has developed a smartphone that calls for help if its user collapses. That is just the start, says GP Dr Neil Paul.
29 May 2012
I recently saw a press release for a phone company that had developed a service that meant that if a person collapsed their phone would ring for help. I guess it works by utilising an accelerometer? A sudden bang and the program activates.
Combined with a GPS it sounds like a good way of alerting people. I can see it being useful for patients with strokes and epilepsy and, perhaps, for some people who are just frail and elderly and who want peace of mind.
I thought it was a clever idea and wondered what else could be done? At this point, I have to declare an interest, because I have thought about this before.
With a couple of colleagues I helped developed an iPhone app called iTennisElbow that we give away free. It’s meant to help you do your exercises for tennis elbow.
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Public health's 5 big data hurdles

By Kate Spies, Contributing Writer
Public health entities are inevitably sitting on massive data sets. Growing archives of stored patient records, population reports, and lab results are thrusting data volume measures into the petabyte scale.
Agencies, on average, currently store data that could require more than “20 million four-drawer filing cabinets filled with text,” according to MeriTalk’s recent report, ‘The Big Data Gap.”
The copiousness of big data doesn’t need any clarification, but the significance of it does – as health entities work to implement EHRs, convert to ICD-10, and reach meaningful use, the importance of grappling with big data needs to be defined.
Amongst the growing projects issued to the public health sector, what are big data’s challenges and what are its benefits?
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Debate over EHR value in patient care misses key point

June 10, 2012 | By Ken Terry
As more and more physicians adopt electronic health records, the debate over whether electronic health records actually improve the quality of care has risen to a new crescendo. Yet the discussion is not shedding much light on the key issues.
In the latest tit for tat, a new study in the Annals of Family Medicine found that type 2 diabetes patients in practices using paper records achieved better intermediate outcomes than did patients in practices with EHRs. In contrast, a recent paper in the New England Journal of Medicine showed that EHR-based practices provided better treatment and produced better outcomes for diabetes patients than did paper-based practices. And a paper presented at the recent American Association of Clinical Endocrinology meeting found that the use of an insulin order set in a hospital EHR improved glycemic control for hospitalized patients with diabetes.
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Diabetes registry has data on 1.1 million

Posted: June 8, 2012 - 3:15 pm ET
Researchers analyzing 15.8 million electronic health records contributed by 11 integrated health plans identified nearly 1.1 million people as having diabetes, and these patients' de-identified information is now part of a diabetes registry created by the plans.

The registry is the focus of an
article in the latest issue of the Centers for Disease Control and Prevention's Preventing Chronic Disease journal.
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OCR tells patients to use legal right to health data access

By Mary Mosquera
WASHINGTON – The administration’s top enforcer of health information privacy and security has issued an official reminder that patients have a legal right to access their medical records, and they should use it.
Patients can also print the single-page memo to take with them when they visit their provider to support their request.
Leon Rodriguez, director of the Office of Civil Rights, released the right to access memorandum to educate consumers on their legal right to obtain a copy of their health information. OCR enforces the Health Insurance Portability and Accountability Act (HIPAA) and oversees health information privacy in the Health and Human Services Department. 
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History's answer to increasing the use of computerized diagnostics

Joseph Conn
The year the dot-com bubble burst, 2001, the three largest pharmacy benefit management companies launched RxHub, an electronic prescribing network, and the two main pharmacy associations created its rival, Surescripts.
While the two exchanges battled for supremacy, both promoted the common cause, e-prescribing, as a patient-safety issue and funded a grind-it-out marketing campaign that cost millions of dollars to sustain.
I had lunch the other day with physician information technology leader Dr. Harry Greenspun, who recalled those days, saying, for years "you couldn't swing a dead cat" in health IT circles without hitting Kevin Hutchinson, Surescripts' then-omnipresent CEO.
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Monday, June 11, 2012

Electronic Quality Reporting Poses Major Challenges

One of the biggest barriers to meeting the Stage 1 meaningful use criteria for government electronic health record incentives has been the collection of data for clinical quality measures (CQMs). And, to judge by the statements of organizations representing health care providers and EHR vendors, electronic quality reporting and the software rewriting it requires may be even more difficult in Stage 2.
In its comments on the proposed rule for meaningful use Stage 2, the American Hospital Association told CMS that hospitals had encountered "significant difficulty" in using EHRs to do quality reporting in Stage 1. Citing "inaccurate e-specifications" for the electronic measures and "unworkable, but certified, vendor products," AHA asked CMS not to add any additional measures in Stage 2, but to help providers and vendors "get it right" on quality reporting.
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Tuesday, June 12, 2012
Patients' health records, containing the most sensitive of details, may be accessed by public and private doctors under a voluntary e-health scheme set to roll out in 2014.
This was confirmed yesterday by Secretary for Food and Health York Chow Yat-ngok.
Chow was addressing the Legislative Council health panel where results of a two-month public consultation on the voluntary Electronic Health Record Sharing Scheme were discussed.
"The information can only be accessed by medical staff who will protect the patients' privacy," Chow said. "It's a voluntary scheme in which patients can decide whether they want to join."
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Enjoy!
David.

Friday, June 22, 2012

Hansard From House of Representatives Where We Have Final Approval Of The NEHRS / PCEHR and Some Other Views.

Most of the Comments from the Minister - Made on 21 June, 2012 - cover the amendments. The Opposition takes a slightly broader view.
Here is the transcript.
Ms PLIBERSEK (SydneyMinister for Health) (11:20): I move:
That the amendments be agreed to.
The amendments to this legislation, the PCEHR bills, reflect recommendations by the Senate Community Affairs Committee, address issues raised through consultation and make other small clarifications and corrections. Some of the key amendments will ensure the system operator can cancel or suspend a consumer's registration if continued registration poses a risk to the personally controlled e-health records system. The amendments strengthen consumer consent arrangements; clarify the extent of the Australian Information Commissioner's powers in respect of the PCEHR system; clarify the use of de-identified data for research and public health purposes and provide for requirements to be made for this function; support the use of participation agreements by the system operator; improve the transparency of the future review of the legislation; improve the consultation undertaken on the making of PCEHR rules; and they reflect the evolving design of the PCEHR system.
This is a once-in-a-generation opportunity to deliver these important reforms. The PCEHR bills and these amendments are part of the government's bold health reform agenda, reforms that will make it easier for consumers to receive the right care when and where they need it. I want to thank members opposite for their cooperation in relation to this legislation and I commend these amendments to the House.
Dr SOUTHCOTT (Boothby) (11:22): Time is of the essence here, because it is only 10 days until the personally controlled electronic health record launches on 1 July. The amendments under discussion arise out of the Senate inquiry, which the opposition moved for, into the PCEHR legislation. The amendments are sensible, and the opposition does not oppose them. I have a few brief points to make on the PCEHR and the government's implementation of it.
Right from the beginning—from the first grand announcement by the member for Griffith, the then Prime Minister, about the personally controlled electronic health record—the government has struggled to meet its own deadlines. We are now 10 days from the launch of the PCEHR, and the parliament is still considering the important issues around governance, security and privacy in the legislation which is needed for the system to operate. We now know that the National Authentication System for Health, NASH, will not be ready for the launch on 1 July and that Medicare will be required to provide an interim system until the NASH is ready.
I understand that there has been some dispute about how much has been spent on the e-health record and NEHTA. On my figuring, though I am very happy for the minister to correct me if I am wrong, since 2010, $846.7 million has been allocated by the Commonwealth to NEHTA and the personally controlled electronic health record. This sum is made up of $467 million for the e-health record in the 2010 budget, a $109 million contribution to NEHTA which was part of the COAG agreement in 2010, $233.7 million in the 2012 budget, and $37 million in the most recent Tasmania bailout . When the contribution from the states, which is another $109 million, is included, almost $1 billion—$955.7 million—has been spent on NEHTA and the e-health record. Since almost $1 billion has been spent, we would expect to see something on 1 July; instead, we hear that the electronic health record will not allow electronic or online registration when it launches. So there is the farcical situation of an electronic health record which cannot be signed up to electronically.
Senate estimates recently heard that the GP practice management software will not be ready to interface with the electronic health record until September this year—that is, three months after the launch of the electronic health record on 1 July. It remains to be seen what will be available on 1 July—that is, in 10 days’ time—after almost $1 billion has been spent by state and Commonwealth governments on NEHTA and, more specifically, the electronic health record project. The opposition believes that the government should have listened to its own national e-health strategy, which recommended a gradual and incremental approach focused on building quick wins—such as electronic prescriptions, discharge summaries and pathology results—which practitioners and health professionals would find useful. The coalition would have tackled it that way.
We do not oppose the amendments, and we did not oppose the original legislation; however, we will be keeping a close watch on the continued roll-out of this $846.7 million of Commonwealth money on NEHTA and the e-health record.
Question agreed to.
----- End Hansard.
So there you have it - done and dusted and awaiting Royal Assent.
It is clear that the Opposition simply does not agree with the strategy being adopted by the Government and I am sure all who read here will be aware I have a very similar view.
I am not the only one who thinks this is a mess: From the Drum on the ABC and written by two academics researching experience here and overseas with Shared E-Health Records.

E-Health: are we ready for this brave new world?

On July 1, Australia is going to "change the world", "dive in the sand" and "realise the dream".
The date represents "our big chance to make a difference", and apparently we have to compare it to "putting a man on the moon". Exciting, isn't it? Surely we are finally going to Mars, initiate world peace or establish brotherhood amongst men? Or not, of course.
When Peter Fleming uttered these inspirational words last August, he was unfortunately not talking about finding a cure for cancer, but about the start of a national electronic health system in Australia.
It is understandable that the CEO of the National E-Health Transition Authority (NEHTA) is thrilled that E-Health is finally ready to go; in its embryonic phase the idea has been in existence since 1991, and 21 years is a long time in politics. The fact that it has survived is a major feat. The only question now is whether we are really ready for this brave new world?
The most important part of the government's E-Health package, and the element that goes online on July 1, is the Personally Controlled Electronic Health Record (PCEHR). From this date, Australians who 'opt into' the system will be given their own personal health-page, where their medical history, demographic details, allergies, medicines and clinical records will be stored.
If they choose to be involved, they have to nominate a provider, usually their GP, 'who', according to NEHTA, 'will supply basic verified data for a shared health summary'. Patients can limit who has access to specific data, but not to this shared health summary, and access restrictions 'can be overridden in case of an emergency'.
The idea behind this PCEHR is that all doctors who are engaged in treating a patient know all the information they need to do this and that they can share this information between them. The patient, in the mean time, is 'in control' and 'empowered', because he or she can access this information from any computer in Australia and decide who gets access to this information. This will, the government writes on its website, 'improve the quality and safety of our healthcare system'.
..... Lots omitted but needing to be read.
So why do it? Especially now, when even NEHTA says that most of the problems have not been solved yet? Maybe the language that talks about putting a man on the moon gives some idea. The promise of the internet is a powerfully seductive dream and politicians want to believe in technology as the solution for every complex problem. It is the lure of modernity, a type of utopian discourse, similar to the claims made during the advent of the telegraph. Then enthusiasts declared that this new technology would make war obsolete, because world leaders would be able to communicate more easily.
Unfortunately, this did not happen, and we think that launching a system without solving its problems first (and not during, as NEHTA wants to do) is about as safe as stepping into a car without knowing whether the engine will work or the tires are securely fastened. With or without the magic 'personal control', this is an accident waiting to happen.
The full article and a zillion comments are here:
The last 2 paragraphs say it all.
I wonder when it will be when we see the project plan covering all this for the next few years. Right now it is really a ‘pig in a poke’.
David.

Thursday, June 21, 2012

Just A Little Note On The Benefits Claimed By The Pollies For E-Health. They Don’t Know What They Don’t Know.

I have been impressed to see how quickly the politicians have leapt on the $11.5 billion figure for PCEHR benefits over the next 15 years
Here is an example of what we heard in the Senate:
Senator EGGLESTON (Lib) (Western Australia)
“It has been forecast that by 2020 e-health capabilities could save up to $7.6 billion a year in health costs by reducing duplication and errors, by improving productivity and by providing better adherence to best practice principles. The government's own numbers suggest that the benefits of e-health records alone in Australia would be $11.5 billion saved by the year 2025. That is an incredibly large figure which in itself justifies completely the introduction of the system.”
Surely this needs to be followed by something like ‘if you think you can really believe it”!
Now I am as keen as the next person to see all that benefit - but I really think we need to just conduct a small sanity check.
A simple one is to compare today with 15 years ago (the benefits period cited). Back then - say 1997 - we had no Broadband to speak of, no digital radio, DVD’s were utterly new fangle (the format was launched in March 1997), Apple was almost broke and Windows was back at the amazingly unstable Win95 version. The level of change that one sees in 15 years is just amazing!
Frankly, no one can know what world and technology let alone healthcare IT, will look like in 15 years and what value e-health might, or might not, be offering then.
And it you want even more of a giggle a new report from a different team working for the Government refers to benefits and, I quote, ‘disbenefits’. They used to be costs when I was a boy. Additionally, but hardly surprisingly they come up with different numbers.
In the recent draft they say for Benefits out to 2020.

“Theoretical potential value

At a national level, with full adoption, the total gross annual direct benefit potential of eHealth including the PCEHR in Australia estimated to be $8.2 billion in 2012-13 (annual potential assuming full adoption and technical capabilities). Including disbenefits of $5.2 billion, net benefits are expected to be $2.9 billion annually. Note that current net benefit value refers to the monetary value of benefits less the value of disbenefits (including capital investment from the Commonwealth Government, jurisdictions and individual providers as well as time-costed effort).”
I suspect one cost that may not have been really fully addressed is the impact of the 1-2 mins spent looking at and updating an extra system in addition to the usual GP System.
With 4 consults per hour (2 mins of time for each update) over a 6 hour working day that is 48 mins (if always used) per day. That is 4 lost 10 minute consultations per day. Call it 20 per week and you can see the potential productivity impact and cost to GPs.
Each short consultation is paid at about $50. That means the GP loses $1000 per week or $50,000 p.a. doing all this. The Practice Incentive Program is up to $50,000 per practice (not per GP) so you can see why some are a little concerned, if this is really to get used, about the cost and productivity hit.
It is not only me who is pretty sceptical of these figures
Here are the results of a poll on this blog a few weeks ago:
The question was:

Do You Believe The DoHA Estimates Of the Benefits That Will Flow From The PCEHR are Realistic?

Yes
-  4 (10%)
No
- 32 (84%)
I Can't Tell
-  2 (5%)
Votes 38
Here is the link:
The Government issues a revised Budget figure every 6 months (MYEFO) and it does this to keep things credible. Even to get a handle over the next 2-3 years is pushing it a little and beyond that it is just pointing a finger in the air and hoping. It is all perfectly well intentioned but I wonder do such estimates come with enough disclaimers as to the possible level of error?
Let’s be clear - I know Governments need to justify investments (as does the private sector) - but surely they might at least be honest enough to make it clear what is expected and trustworthy and what is little more than wish laden estimates.
David.

For Information The NEHRS / PCEHR Legislation Has Passed The Parliament.

I will have a close look at Hansard to see if there was anything said that might be of interest.

Again it seems the Opposition is saying they are going to keep a 'close eye' on it!

David.