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, August 18, 2012

Weekly Overseas Health IT Links - 18th August, 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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Dozens of hospitals, including St. Jude and Le Bonheur, temporarily lost access to patient records

From Our Press Services
Wednesday, August 8, 2012
LOS ANGELES — Dozens of hospitals across the country, including St. Jude Children's Research Hospital and Le Bonheur in Memphis, lost access to crucial electronic medical records for about five hours during a major computer outage last month, raising fresh concerns about whether poorly designed technology can compromise patient care.
Cerner Corp., a leading supplier of electronic health records to hospitals and doctors, said "human error" caused the outage July 23 that it said affected an unspecified number of hospitals that rely on the Kansas City, Mo., company to remotely store their medical information.
Doctors and nurses use these complex computer systems for nearly every task within a hospital, such as recording patient notes, ordering medical tests and drugs, and communicating with one another about lab results and changes in a patient's condition. Adventist Health, which runs White Memorial Medical Center in Los Angeles and 18 other hospitals, and St. Jude were among those affected by the outage.
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5 security vulnerabilities that could mean trouble

By Michelle McNickle, New Media Producer
Created 08/09/2012
At this point, the benefits of EHRs are well known - the reduction of paperwork, relief of administrative burdens and substantial cost savings. But, according to Lynda Martel, director of privacy compliance communications at DriveSavers, the presence of an EHR in a care setting also dramatically increases the risk of a data breach.
“Not all organizations entrusted with protected health information (PHI) are putting the security protocols in place to assure the confidentiality and integrity of PHI content,” said Martel. “If healthcare organizations ignore the security vulnerabilities in their healthcare environment, both internally and externally, costly data breaches may be the result.”
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Epic, Cerner Top EMR Vendors in 200-Plus Bed Market

August 9, 2012
According to a new report from the Orem, Utah-based research firm, KLAS, Epic and Cerner have moved into first and second place, respectively, in the 200-plus bed EMR market thanks to strong integration options. The KLAS study, Clinical Market Share 2012: Meaningful Use Momentum Continues, looks at the clinical vendor market share across 1,470 U.S. hospitals and 151 Canadian hospitals.
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Report: EHR Vendors with Better Integration Gaining Market Share

AUG 10, 2012 11:25am ET
Allscripts, McKesson, Meditech and Siemens are losing market share in hospitals with more than 200 beds, as the better integrated product lines of Epic and Cerner lead the pack, according to vendor research firm KLAS Enterprises.
A study of market share across 1,470 U.S. hospitals and 151 in Canada shows larger hospitals favoring higher levels of integration and clinical functionality, with Epic the leader, followed by Cerner.
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'Wall of Shame' exposes 21M medical record breaches

Notification, reporting part of new rules under the Health Information Technology for Economic and Clinical Health Act

Lucas Mearian
August 7, 2012 (Computerworld)
Over the past three years, about 21 million patients have had their medical records exposed in data security breaches that were big enough to require they be reported to the federal government.
Since Sept. 2009, 477 breaches affecting 500 people or more each have been reported to the Office for Civil Rights (OCR) under the U.S. Department of Health and Human Services. In total, the health records of 20,970,222 people have been compromised, the OCR said.
The Office for Civil Rights has been updating a list of the breaches on its website. The list is known to the health care industry as "The Wall of Shame," according to the OCR.
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Should patients have immediate access to test results?

4:50 PM, Aug 7, 2012
A patient once blamed me for causing him considerable anxiety because he had to wait several weeks before receiving the results of a lab test, which I had ordered.
Many patients commonly have to wait days, if not weeks, before getting lab results from their doctor. The delay can affect patients’ health negatively.
For instance, one study looked at women who underwent a breast biopsy for possible cancer. It took one to six days for these patients to obtain their results. Those who had to wait longer had abnormal biochemical stress levels, which can potentially affect their healing times from the biopsy.
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Survey: Physician adoption of EHRs continues to climb

August 6, 2012 | By Marla Durben Hirsch
Physician adoption of electronic health record systems continues to increase at a steady pace, with about half of all physicians overall using one, according to SK&A's latest survey of physician practices.
The number of physicians in the U.S. using EHRs has jumped to 49.6 percent, up from 45.6 percent in January. Perhaps not surprisingly, larger practices were more likely to have adopted an EHR system, with 78.8 percent of groups of 26 or more physician going electronic, compared to solo practitioners, of whom 41.8 adopted.
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Study: Make access control workable to improve security, privacy

August 9, 2012 | By Susan D. Hall
Setting access controls for electronic health records--determining who can get in and what they can do there--isn't that easy. And once set, such policies can devolve into an "unmanageable spaghetti" of shared passwords, Post-It notes and other circumvention, note Dartmouth College researchers who set out to explore how hospital workers feel about access controls.
Their work was presented at the 3rd Usenix Workshop on Health Security and Privacy earlier this week.
A policy that's too loose might allow inappropriate access, while one that's too strict could encourage circumvention, which might carry regulatory and legal consequences.
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EHRs help docs to reduce unnecessary prescriptions

August 7, 2012 | By Dan Bowman
Electronic health records could greatly reduce unnecessarily antibiotics prescriptions, a study published this week in the Annals of Internal Medicine found.
In retrospective research of more than 28,000 patient EHRs between 2006 and 2011, doctors were found to have prescribed antibiotics for patients presenting with a fever or cold-like symptoms 45 percent of the time, according to Reuters.
What's more, the range of prescribing among physicians varied from 18 percent to 84 percent, with physicians more likely to prescribe antibiotics to patients during seasonal periods than pandemic periods. Hence, the more cases a doctor had for context of an illness, the less likely he or she was to assume that a prescription was the right course of action.
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Research Firm: mHealth Will Continue to Soar

AUG 8, 2012 5:26pm ET
The global market value for mHealth, the use of mobile software and devices for health care purposes, is set to explode over the next half-decade, according to data analytics and research firm Global Data, which serves multiple industries.
The firm estimates the global mHealth was worth $1.2 billion in 2011, and projects a compound annual growth rate of 39 percent will bring the market value to $11.8 billion by 2018. The compound annual growth rate is the year-over-year growth rate of an investment over a specified period of time, according to the Investopedia Web site.
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Geisinger develops electronic record sharing without EHRs

August 9, 2012 | By Dan Bowman
Providers now can share patient health information across a regional health information exchange, even if their facility doesn't have an electronic health record, thanks to a collaborative effort between the health IT team at the Keystone Beacon Community and GE-Microsoft joint healthcare company Caradigm. The health IT team at Keystone, which is a Geisinger-led initiative, developed a system that transforms patient care data into a Continuity-of-Care Document. The system is the basis for a MDS (minimum data set)-to-CCD Transformer created by Caradigm.
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Electronic records blamed for rising ER waits

By Associated Press
Posted: August 8, 2012 - 1:15 pm ET
Patients' lengths of stay in Columbus (Ind.) Regional Hospital's emergency department doubled in late June during a switch to an electronic health-record system, and times are still longer than usual despite improvements, hospital officials said.
The emergency department, which had used a paper system for recording patient information, switched to an electronic system the week of June 24. The hospital, as a whole, is switching to a new electronic health records system to meet the requirements of the 2009 economic stimulus legislation, which provided incentives for using electronic health records.
The benefit of electronic health records is that patient information has to be entered only once and can be shared by the various departments of the hospital, said Ron Latta, the hospital's information services director.
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Thursday, August 09, 2012

Feds Raising Awareness of Patient Rights on Accessing Health Data

Increasing patient engagement is a critical element of the ongoing efforts to improve the quality and reduce the cost of health care in the U.S. However, many patients remain unaware of their rights to access their health information, let alone of their opportunities to use that information to improve the care they receive.
Recognizing this, the federal government recently has taken a number of steps to make patients more aware of their rights to access their health information and to enable them to engage more actively in their care.
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The 3 phases of HIE in Massachusetts

By Micky Tripathi, CEO, Massachusetts eHealth Collaborative
Massachusetts has made significant progress in its statewide HIE in recent months. As recently as August 2011, the statewide HIE effort was proceeding slowly. After two years of planning, relatively little progress had been made to turn strategies into production systems. Today, a mere 10 months later, the Commonwealth is poised to go live on October 15, 2012, with a statewide HIE service available to all providers and health plans in the Commonwealth. What accounted for such rapid acceleration? What lessons are suggested for others in similar circumstances?
There is a long history of HIE in MA. The New England Health Exchange Network (NEHEN), which was founded in 1998, now has more than 60 dues-paying members and manages hundreds of millions of administrative and clinical transactions per year. It remains one of the few credibly self-sustaining HIEs in the country, which to this day has never been supported by state or federal government funds. In 2008, the state of Massachusetts allocated $25 million for statewide EHR and HIE programs.
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Carts Push for a Seat at the Automation Table

AUG 1, 2012
When it comes to devices, Al Campanella says generosity is the best approach.
"We never want the lack of a computing device to be an impediment to care," says Campanella, vice president and CIO at Virtua, a four-hospital delivery system based in Marlton, N.J. Thus, across Virtua, caregivers use a combination of carts, wall-mounted devices and conventional desktop workstations, in addition to tablet computers.
The inventory of 1,200-plus devices includes some 400 workstations on wheels, assigned to nurses who use them for a variety of documentation chores, including medication administration.
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Study raises issues with GP2GP records

1 August 2012   Fiona Barr
GP practices have reported that a considerably higher proportion of their own records are accurate, complete and useful than those they have received via GP2GP electronic record transfer, in the first published study on the quality of GP2GP records.
A paper in the Informatics in Primary Care journal reports that GPs value GP2GP, but identify issues with record quality.
The researchers ran an online survey that attracted 147 respondents from 146 GP practices receiving records via the electronic record transfer system.
They found there was no significant differences between different GP systems and concluded that difficulties in mapping data structures between systems might underlie some of the perceived issues.
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Fit notes finally go electronic

7 August 2012   Rebecca Todd
Computer-generated 'fit notes' are being rolled out to GPs by clinical systems suppliers from this month, starting with EMIS practices.
At the moment, medical certificates have to be hand written by GPs. However, following a successful trial, EMIS is rolling out electronic medical certificate software across all three of its systems – EMIS Web, PCS and LV.
This will allow GPs to automatically generate, record and print Med3 certificates for patients.
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Virtual patients designed to interact with therapy trainees

August 6, 2012 | By Susan D. Hall
A California researcher has developed virtual humans with symptoms of clinical psychological disorders to help train a new generation of therapists.
Albert Rizzo, a research scientist at the University of Southern California Institute for Creative Technologies, presented the interactive virtual humans at the American Psychological Association's 120th Annual Convention, the APA announced.
Rizzo showed videos of psychiatry trainees interacting with virtual humans Justin, 16, who has a conduct disorder and whose parents are forcing him to undergo therapy; and Justina, a sexual assault victim with symptoms of post-traumatic stress disorder.
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5 reasons HIEs are critical to the success of ACOs

By Michelle McNickle, New Media Producer
Created 08/07/2012
For hospitals looking to transform into accountable care organizations (ACOs), the transition can be overwhelming. So much so, said Brent Dover, president at HIE technology company Medicity, that it's basically like becoming a mini insurance company.
"And they need to do it overnight -- it's kind of a scary and daunting thing," he said. "Right now, hospitals and doctors are paid on a fee-for-service model, and a fundamental element of an ACO is saying 'we're not going to pay you on that model anymore. We're going to pay you to take care of the overall health of this population. The more proactive you are, and the better quality you deliver, we will share that savings with you."
"And so, I don't care how you swipe it, but in essence, you're asking hospitals and doctors to take on risk and share in that risk," Dover continued. "And if they need to do a good job of managing that risk and paying for that risk. It sounds a lot to me like they're being asked to become truly managed care organizations, or more like health insurance companies."
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BUSINESS

Medical ID theft: Double danger for doctors

The sooner medical identity theft is discovered, the more likely damage can be minimized. Physicians, patients, insurers and the government all can help detect it.

By Pamela Lewis Dolan, amednews staff. Posted Aug. 6, 2012.
When Anne Peters, MD, a Los Angeles-based internist, started receiving phone calls in 2006 from patients who were not hers about medical procedures she didn’t perform or even offer at her practice, she figured out pretty quickly that she had become a victim of medical identity theft.
When Dr. Peters sought advice on how to resolve the situation, she not only came up empty-handed, but she soon started feeling like a criminal herself. She was visited by federal agents, she received notices from the Internal Revenue Service regarding back taxes on $750,000 she never earned, and she was even detained once at the airport for more than an hour when she returned from a trip abroad. Meanwhile, Medicare stopped sending her payments for legitimate claims.
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Half of medical practice EHR shoppers not first-time buyers

The number of practices looking for replacement EHRs has grown, although most small practices are adopting systems for the first time, according to a new survey.

By Pamela Lewis Dolan, amednews staff. Posted Aug. 6, 2012.
As competition heats up in the electronic health record market, practices fed up with poor customer service or systems that only meet a fraction of the practices’ needs are recognizing an opportunity to jump ship and find a new vendor. Others are leaving their old systems to join forces with other health care organizations and form information-sharing networks built on matching EHR systems.
A report published in July by EHR market research firm KLAS found that about half of the 300 surveyed practices in the market for an ambulatory EHR system were not first-time buyers. The number of practices shopping for a replacement EHR jumped from 30% in 2011 to 50% in 2012.
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Research: mHealth Industry to Reach $11.8 billion

August 6, 2012
According to a new report from healthcare industry analysts GlobalData, the mobile health (mHealth) industry is poised for a huge jump in value over the coming decade thanks to a spike in apps, going from its worth in 2011 of $1.2 billion to a value of $11.8 billion by 2018. The industry, GlobalData says, will grow at annual compounded rate of 39 percent.
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Smartphone apps now playing doctor

By Laura Ruane, USA TODAY

We don't use our smartphones for talking as much as we once did, but we are and will increasingly use them to detect and monitor health risks, from ear infections to E. coli bacteria in drinking water, industry experts say.
Health app developers initially focused on consumer diet and exercise, said Brian Dolan, editor of Boston-based MobiHealthNews.com, which tracks advances in mobile health and medical technology. "Now we're seeing them look into more serious health conditions where there's a real need for innovation."
Glen Stream, president of the American Academy of Family Physicians, sees an "explosion" of mobile medical apps, and gives the trend a qualified endorsement. He's an "iPhone guy" who uses about 20 medical or health-oriented apps.
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Humana promises numbers will show power of telehealth

By Eric Wicklund, Contributing Editor
Created 08/06/2012
ST. PETERSBURG, FL – Advocates and critics alike talk about finding the data to back up claims that telehealth can be successful. Officials at Humana and Intel-GE Care Innovations say they'll have those numbers shortly, thanks to a nationwide collaboration.
Humana Cares, the St. Petersburg, Fla.-based complex and chronic care management division of the national insurer, is wrapping up a 34-state project, launched last January, in which 1,000 members with congestive heart failure were given the Intel-GE Care Innovations Guide, a home-based telehealth device that connects the user with a wide variety of resources and care providers.
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Telemedicine Starts with the Doctor's Voice

Scott Mace, for HealthLeaders Media , August 7, 2012

You've heard of manufacturers adopting just-in-time-inventory strategies? Well, healthcare providers should adopt just-enough-technology strategies.
Keep that in mind before diving deep into telemedicine. The term telemedicine is one of the vaguest technology buzzwords in this business, and it covers a multitude of approaches, everything from picking up the telephone to creating a "virtual ICU."
Now that all user-facing technology is going mobile, the demands of wireless networking and the demand for every provider to have an "mHealth" strategy mean more infrastructure, more planning, and more cost when crafting a telemedicine strategy.
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Google search no guarantee for health data accuracy

By Erin McCann, Associate Editor
Created 08/06/2012
CINCINNATI, OH – Google is arguably the closest to achieving divine status and world domain-ation as a corporation can get, but even the idolized Internet giant reveals traces of its humanity from time to time, as a recent study on pediatrics suggests. 
The study, published in a July issue of The Journal of Pediatrics, appears to have Google mapped the search engine’s Achilles heel, and it is pinpointed on the imperfections of Web site data regarding safe infant sleep recommendations. 
Researchers entered 13 key phrases pertaining to infant sleep safety, and then analyzed a total of 1,300 Web sites found through Google search. Less than half  (43.5 percent) of the sites listed contained infant sleep safety information that reflects American Academy of Pediatrics (AAP) recommendations. 
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Kaiser PHR sees 4 million sign on, most active portal to date

By Erin McCann, Associate Editor
Created 08/06/2012
OAKLAND, CA – Four million members are now engaging in their health through Kaiser Permanente's My Health Manager, the organization’s Web-based personal health record, Kaiser officials announced Monday.
Officials say the burgeoning number of active users -- approximately 63 percent of Kaiser’s eligible members -- demonstrates that consumers find the organization's personal health record (PHR) to be an effective and convenient way to manage their health.
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The Obama Administration’s Timid Approach to Security

AUG 6, 2012 12:08pm ET
Meaningful use of electronic health records means meaningful protection of the data in electronic health records. Unless you work in the Obama administration, where, except for national security, timidity is the rule on issue after issue.
As of Aug. 3, it has been 1,264 days since the HITECH Act, which broadly expanded the use of EHRs. The act touted enhanced protections for health information, but contained no mandate for data encryption. Stage 1 of meaningful use didn’t require encryption. The final Stage 2 meaningful use rule has been written and should soon be issued; the proposed rule’s language on encryption can charitably be called timid.
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Drug databases suffer lack of funding, participation

August 6, 2012 | By Gienna Shaw
There's a growing trend toward harnessing data to prevent prescription abuse--Texas is the latest state to adopt an online drug monitoring program that gives law enforcement and healthcare professionals access to a real-time database of dispensed controlled substances that includes statewide patient data going back one year, the Associated Press reported today. Until now, it could take days or more to access the data.
But some states have found that there's something standing in the way of these programs: Doctors.
In Mississippi, for example, an online prescription drug monitoring program can alert physicians when a patient is "doctor-shopping" or abusing medications. But more than two-thirds of physicians don't use the system, which is not mandatory, according to the Clarion-Ledger.
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If you think telemedicine is about technology, think again

August 2, 2012 10:25 am by Deanna Pogorelc 
 “It’s about what you do with technology,” much of which has existed for years, American Telemedicine Association CEO Jon Linkous said at the Health Policy Institute of Ohio’s telehealth event last week. “It’s not health IT — it’s about people.”
Which is why it’s important not only to get healthcare stakeholders on board, but to have people in the right places to make regulatory changes that will enable telemedicine to break through challenges with licensure and the regulation of Internet prescribing.
Here are six reasons why telemedicine will make strides over the next few years, according to Linkous.
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Meaningful use programs expected to promote better care, outcomes for diabetes

  • August 3, 2012
INDIANAPOLIS — In 2010, the Centers for Medicare and Medicaid Services established that all health facilities must implement electronic health records to receive proper reimbursement. Carol Rasmussen, APRN, CDE, FAADE, discussed the meaningful use behind this new venture and its impact on the diabetes field with Endocrine Today at the American Association of Diabetes Educators annual meeting. 
 “The Centers for Medicare and Medicaid Services want to encourage providers to use electronic medical records and follow certain guidelines through three stages to promote better care, better outcomes, and make things better for the patients,” Rasmussen told Endocrine Today.
“The ultimate goal is to have this running smoothly, and if people aren’t on-task and haven’t gotten stage one done by the end of 2013, I don’t know that they’re going to be ready. Then, Medicare will start cutting their payments by a percentage. Medicaid is giving people until 2015, and then they’re going to start doing that. It’s a money reimbursement issue. We’ve had some interesting times with this.”
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IT policy committee gets Stage 3 recommendations

Posted: August 3, 2012 - 2:30 pm ET
A federal health information technology advisory panel has received a draft of criteria that hospitals and physicians would need to meet to qualify for the third round of federal meaningful-use incentive payments.
Recommendations on the Stage 3 meaningful-use criteria were presented to the Health IT Policy Committee this week by the committee's meaningful-use work group.
The recommendations included many new proposed criteria.
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Monday, August 06, 2012

Telehealth To Benefit From SCOTUS Ruling, but Barriers Remain

The Supreme Court's 5-4 decision upholding the federal health reform law paves the way for wider adoption of telemedicine, experts said. Still, roadblocks remain that are preventing the technology from becoming truly mainstream.
Those roadblocks include adequate payment mechanisms, provider credentialing and support for fostering innovation in the sector.
"The Supreme Court decision opens a door to more creative and more accepted uses of telemedicine," Neal Neuberger -- executive director of the Institute for e-Health Policy -- said, adding, "The whole goal of the Patient Protection and Affordable Care Act is to reform the way health care is delivered and improve access. We are pretty sure that telehealth will have a serious impact there."
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Enjoy!
David.

Friday, August 17, 2012

More On Getting a Handle On How Well Or Not EHRs Are Working. And The Australian Approach.

The following editorial appeared a few days ago - showing how the EHR defect issue continues to be top of mind.

Providers need recourse regarding EHR defects

August 8, 2012 | By Marla Durben Hirsch
It's always great to read about the successful implementation of an electronic health record system, like this story published last week in Inside Tucson Business. After all, transitioning to an EHR is expensive and time consuming. If you're going to adopt an EHR--and that is the direction the healthcare industry appears to be moving in--the process should be as smooth as possible.
It's equally disheartening, however, to read the opposite kind of story. Blogger Rich Just posted this week about his practice's struggles with its EHR system: a glitch causes notes to disappear, sometimes to another section of the chart, sometimes into oblivion. According to Just, the practice discovered that the glitch occurred when physicians started the note before entering the vital signs, so now they can avoid the glitch. Still, despite vendor support, it can't be removed. 
It's bad enough that EHRs have design flaws such as usability problems, or backfiring features that impede workflow and functionality. But software glitches that lose data, cause the system to go down regularly and create other havoc really are inexcusable. They're also apparently rather common.
A Google search of "EHR horror stories" came back with a whopping 51,800 results. Granted, not every horror involved "glitches", but that's still a huge number. And those are just the ones reported on the Internet.   
So what's a hospital or physician to do?
There are some precautions that providers can take to avoid buying a problematic EHR system, of course. For instance, they can check out the KLAS rankings on EHR products, conduct research online, confer with colleagues, ask a vendor for a satisfaction and money back guarantee, and the like.
None of those, though, can assure that an EHR will be glitch-free--or that a glitch won't develop, such as during an upgrade; and all EHRs will need to be upgraded to be able to meet the upcoming Stage 2 of Meaningful Use.
So why not resurrect two concepts that have been discussed for years but never implemented?
Read Marla’s suggestions here:
After seeing the US suggestions it is important to recognise that there is some activity on the same area in OZ.

Welcome to the website for the TechWatch Study

We are tracking computer problems that affect the safety of Australian general practice
The TechWatch Study is the world’s first study of critical incidents specifically involving information technology and patient safety in general practice. Information technology has many benefits for clinical medicine. But problems with computer use can introduce new errors that affect the safety and quality of clinical care and may risk patient harm.
General practitioners from across Australia have been invited to join the TechWatch Study and help identify and track safety and quality issues arising from the use of computers in general practice.
Information collected though the TechWatch Study will be used by researchers to gain a better understanding of how to improve the safety of using computers in clinical practice. Our findings will guide the safe design and use of information technology in general practice.
The site with contacts etc. is found here:
For background:
“The TechWatch Study is being jointly led by Farah Magrabi, Michael Kidd, Teng Liaw and Enrico Coiera from the University of New South Wales and Flinders University and is funded by National Health and Medical Research Council (NHMRC) Project Grant 630583.”
I would encourage all GP’s to get involved so we can get a good feel for the situation in Australia.
David.

Thursday, August 16, 2012

The Patient Portal Looks To Have a Real Place. Not Quite What DoHA Thinks However.

The following appeared a little while ago.
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.
Even so, as reform changes the incentives in health care, portals are expected to be a key conduit for engaging patients in their care and getting them important health care information as quickly as possible.
Portals enable health care professionals to interact differently with their patients, and patients increasingly want access to and control of their health care online. These dynamics are new and exciting to many, yet technically challenging and problematic for others. Migrating to an interactive health care delivery system that functions outside the walls of a physical building offers possibilities for improved population health. When caregivers have the ability to access daily logs of patient activities, such as diet, exercise and medication management, they will be more capable of intervening with more effective treatment options.
"I think they're going to be very widely used," Albert Oriol, CIO at Rady Children's Hospital-San Diego, said. "We're trying to engage our patients and their families in their own health and health care, and the portal will be integral to achieving that."
Still, getting past the challenges and fears will be crucial to moving these portals into mainstream use.
Rising Needs for Patient Data
Meaningful use objectives are raising the need to share information with patients. Stage 1 required eligible professionals to "provide more than 10% of all unique patients with timely electronic access to their health information." Proposed Stage 2 objectives, as they now stand, would push more hospitals to offer portals to meet the requirement, as it would require them to demonstrate that "more than 10% of patients and families view and have some ability to download information about a hospital admission" within 36 hours of discharge.
Portal approaches in health care are not new; some pioneers in the field have offered patients access to their health care records for at least 10 years. Typically, portals give patients secure, Web-based access to some portions of their medical records and enable patients to facilitate interactions with providers, such as communication, scheduling, bill payment and other functions.
Use of the portals has grown slowly over the last 10 years, as consumers increasingly have become comfortable with using the Internet for shopping and banking. Providers also have learned a lot in the interim and increasingly see how portals can help them with reform approaches such as accountable care.
For example, Rady Children's Hospital had about 13,000 unique patients active on its portal this April, compared with only 3,000 accounts a year ago. "As of April, we're averaging over 10,000 visits a month," Oriol said. "Stickiness has jumped up as we introduced medical history and other types of questionnaires."
In many organizations, physicians will play an important role in encouraging their patients to use portals. That's helped Partners Healthcare increase patients' use of its portal, Cynthia Bero, IT corporate director of clinical performance management, said. "We launched a production version of our portal in 2002. Since 2007, we've been pushing it more aggressively. We started asking our physicians to engage with it. In the last three years, we've seen year-over-year doubling in usage (by patients)."
Bero says patients are responding to the convenience that portals provide, "to interact asynchronously with physicians' offices. They really appreciate the ability to access portions of their medical record, particularly lab results."
The portal for NorthShore University HealthSystem has experienced steady growth over its eight years of existence, Steven Smith, CIO for the Evanston, Ill.-based system, said. Some 170,000 patients can use NorthShore Connect to send and receive messages from physicians, schedule appointments, refill prescriptions, pay bills, and access medical records, lab results and educational material.
One-on-one discussions with patients, often in the physician office, have proven to be the most effective way to get patients engaged with the portal, Smith said. "It's the best way to explain the benefits of signing up with NorthShore Connect," although other marketing approaches also bear results.
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MORE ON THE WEB

The full (much longer) article is found here:
It is interesting that the article makes it clear the major issue is patient engagement and just how hard that can be - even when providing services such as prescription repeats and appointmenting.
It is also good to see that the authors recognise just what a potential issue the ‘digital divide’ can be, and how, problematically, many who suffer from this divide form part of the target demographic.
The links to other resources are also really useful and worth a browse as is the full paper.
As a reflection of just how successful USEFUL portals can be we have the following report:

Kaiser PHR sees 4 million sign on, most active portal to date

By Erin McCann, Associate Editor
Created 08/06/2012
OAKLAND, CA – Four million members are now engaging in their health through Kaiser Permanente's My Health Manager, the organization’s Web-based personal health record, Kaiser officials announced Monday.
Officials say the burgeoning number of active users -- approximately 63 percent of Kaiser’s eligible members -- demonstrates that consumers find the organization's personal health record (PHR) to be an effective and convenient way to manage their health.
"My Health Manager empowers members to take charge of their health, and our data show that they are doing just that," said George Halvorson, chairman and chief executive officer of Kaiser Permanente. "In the last six months, 67 percent of registered members signed on to My Health Manager two or more times. By revisiting the website, our members are getting a complete picture of their health past, so they can make the best health choices in the future."
My Health Manager allows members to access medical records, email their providers, view lab test results, order prescription refills, and manage appointments from their computers or mobile devices. 
In 2011 members signed on to My Health Manager more than 74 million times and utilized website features in record numbers, officials say:
  • 29.7 million lab results viewed online
  • 12.2 million emails sent to providers
  • 10 million prescriptions refilled
  • 2.7 million appointments scheduled
Lots more here:
The success is obvious and note just how much of what patients are using with Kaiser is simply not part of the agenda for the NEHRS.
It is clear there is more to come in this area.
David.

Some Thoughts On The Way The NEHRS Is Being Undertaken.

As reported below I was able to log on to my record and then notice a legion of problems. Later I was alerted to the fact that the system was in a System Maintenance window.

That I got into the system with no warning reveals utter incompetence on the part of those undertaking the project.

Further what sort of clinical system just goes off-line without some fall back procedures being in place? If there is not a secondary backup system - in some form - then the concept of a system for use in emergent situations is clearly not being catered for. A national system of this type is meant to offer virtually 100% availability and I have accidentally found 2 periods of over 5 hours in one week when it was off line.

Why provide emergency access to a system that may not be available and takes ages to log on to?

Clearly there are no responsible adults - let alone clinicians - defining how this system should resourced and behave.

Utterly hopeless.

David.

Note @8:50am 16/8/2012. The System seems to be back to its normal and pretty useless and empty state.