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, November 10, 2012

Weekly Overseas Health IT Links - 10th November, 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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Insight: Crunching the numbers to boost odds against cancer

Thu, Nov 1 2012
FRANKFURT (Reuters) - Software engineers are moving to the fore in the war on cancer, designing programmes that sift genetic sequencing data at lightning speed and minimal cost to identify patterns in tumors that could lead to the next medical breakthrough.
Their analysis aims to pinpoint the mutations in our genetic code that drive cancers as diverse as breast, ovarian and bowel. The more precise their work is, the better the chance of developing an effective new drug.
Ever since James Watson and Francis Crick discovered the structure of DNA in 1953, scientists have been puzzling over how genes make us who we are. The confluence of computing and medicine is accelerating the pace of genetic research.
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In Sandy's wake, hospitals share stories of success, survival

By Erin McCann, Associate Editor
Created 11/02/2012
With the support of health information technology, astute preparation by staff and, yes, even some good old-fashioned luck, hospitals and health systems along Hurricane Sandy’s path emerged from the storm relatively unscathed.
Officials at Atlanticare, one of New Jersey’s largest healthcare systems, based in Galloway and Atlantic City, N.J., cite early preparation among IT and safety staff as key to surviving this kind of storm. 
“I had actually been tracking the weather the week prior,” Debra Fox, chief safety office at Atlanticare, tells Healthcare IT News. “Thursday is actually when we initiated our planning and communication to the leadership around beginning to put their operational preparedness plans in place,” she adds. This included topping off generator fuel and ensuring that the facility is able to withstand a loss of power.
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Romney or Obama? How either election outcome will affect health IT

November 2, 2012 | By Dan Bowman
Right in the thick of this year's presidential election season, the House of Representatives and the Senate have raised questions about the effectiveness of the Meaningful Use incentive program. The former went so far as to call the program "weak" and "a waste of taxpayer dollars," in a letter sent to U.S. Department of Health & Human Services Secretary Kathleen Sebelius on Oct. 4.
To that end, we at FierceHealthIT wonder how the election will impact the industry once the dust settles next Wednesday (assuming the dust does settle by then). We asked our FierceHealthIT Advisory Board members to share their thoughts on how the election results--either way--will impact health technology professionals.
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Health IT Holds Key To Better Care Integration

IT-enabled care coordination is a key component of patient safety. Healthcare organizations must invest in technology infrastructure to enable complex medical care.
Although a new report on improving and accelerating the coordination of care does not explicitly say so, a former head of Kaiser Permanente who helped draft the paper believes that it is nearly impossible to achieve the goals of care integration in the absence of well-designed IT systems.
"IT is a substantial enabler," Dr. David M. Lawrence, retired chairman and CEO of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, told InformationWeek Healthcare. "You almost cannot do complex medical care without that kind of connectivity." AdTech Ad
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6 ways to improve safety of medication administration and delivery

November 2, 2012 | By Gienna Shaw
Six measures to improve the safety of medication administration and delivery could cut healthcare costs nearly half a trillion dollars, according to the IMS Institute for Healthcare Informatics.
Among the recommendations: do a better job of engaging and educating patients about their medication, ensure timely delivery of medication and prevent errors along the continuum of care. 
Technology can help providers adopt these guidelines. One recent study, for example, found that electronic health records reduced medical errors 93 percent in hospitalized HIV patients, who are at risk for medication errors when clinical staff are unfamiliar with their complex drug regimens. Most frequent errors involved hospital personnel altering medication timing and the frequency of dosages.
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EHR market projected to grow 6.6% annually in Europe

October 28, 2012 | By Marla Durben Hirsch
The next wave of opportunity for electronic health record vendors may be in Europe, according to a recently published report from Kalorama Information.
EHR adoption varies considerably in Europe. The Nordic countries have been using the technology for more than 10 years, but adoption in the U.K., Germany, France and Spain is "on course" with adoption in the U.S., according to the report.
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http://www.healthcareitnews.com/news/rochester-rhio-reaping-dividends-image-sharing

Rochester RHIO reaping dividends from image sharing

By Patty Enrado, Special Projects Editor
Created 11/01/2012
ROCHESTER, NY – When the Rochester RHIO was established in 2006 to improve the quality and efficiency of care in the greater Rochester, NY, area, one of the requirements from a local matching grant was to enable diagnostic-image sharing among healthcare providers.
Since July 2009, the nonprofit, community-run organization has offered this service, first receiving images from a few and then expanding to include 11 participating radiology practices.
In 2013, Rochester RHIO expects to complete studies it has been conducting on changes in clinical care based on HIE access to images.
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Health IT could help with medication adherence, saving billions, study finds

By Diana Manos, Senior Editor
Created 11/01/2012
PARSIPPANY, NJ – A new global study by the IMS Institute for Healthcare Informatics shows that the use of healthcare IT to increase medication adherence could be a key factor in saving some $500 billion in healthcare spending worldwide.
Murray Aitken, executive director of the IMS Institute says the study shows that policies and practices that govern the use of medication are an essential and under-appreciated piece of the global healthcare puzzle.
 “Harnessing available information to set priorities, monitor progress and support behavior change among healthcare stakeholders – including policymakers, payers, clinicians, nurses, pharmacists and patients – is a vital first step,” he said.
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Mining physicians’ notes for medical insights

A new approach to algorithmically distinguishing words with multiple possible meanings could help find useful data in electronic medical records.
Larry Hardesty, MIT News Office
October 31, 2012
In the last 10 years, it’s become far more common for physicians to keep records electronically. Those records could contain a wealth of medically useful data: hidden correlations between symptoms, treatments and outcomes, for instance, or indications that patients are promising candidates for trials of new drugs.
Much of that data, however, is buried in physicians’ freeform notes. One of the difficulties in extracting data from unstructured text is what computer scientists call word-sense disambiguation. In a physician’s notes, the word “discharge,” for instance, could refer to a bodily secretion — but it could also refer to release from a hospital. The ability to infer words’ intended meanings makes it much easier for computers to find useful patterns in mountains of data.
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AHIMA releases core clinical documentation guidelines for coding

November 1, 2012 | By Julie Bird
The American Health Information Management Association has outlined core clinical documentation guidelines for coding medical diagnoses and procedures in 2013 and 2014.
In a new white paper, AHIMA says healthcare providers should have a "high integrity" coding compliance policy that should be updated at least once a year. The paper provides guidance on identifying source documents as a designated clinical documentation set.
Although AHIMA has issued guidance for compiling a coding compliance document, it has not previously defined what core medical record documents or clinical documentation should be used, according to the paper.
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Cleveland Clinic: Top 10 Innovations announced

Published: Wednesday, October 31, 2012, 6:01 AM     Updated: Wednesday, October 31, 2012, 6:11 AM

CLEVELAND, Ohio -- Bariatric surgery to control diabetes has been selected as the No. 1 innovation by doctors at the Cleveland Clinic.
The Top 10 medical innovations for 2013 will be announced this afternoon at the Clinic's 10th annual Medical Innovation summit. They were selected from 150 nominations of emerging technologies, gathered from more than 110 Clinic experts. The innovations had to have a high probability of commercial success. 
"Our list gives you the flavor of where health care is going," says Chris Coburn, executive director of Cleveland Clinic Innovations. It is the Clinic's corporate arm, responsible for creating companies using the health system's research in medical technology.
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Study: Wikis Help Patients Participate in Creating Clinical Practice Guidelines

October 31, 2012
According to a new study published in the Journal of Medical Internet Research, wikis would be an effective participatory tool for patients in the development of a clinical practice guideline. Wikis, which are user-friendly websites that allow readers to put in their own modifications of content with a simple text editor, were tested by researchers looking to create clinical guidelines for infertility treatment.
The researchers wanted to see how many people would visit the wiki, what the benefits would be, and what helped and hurt adoption. In order to create the initial wiki, the Netherlands-based researchers interviewed 12 patients and created 90 recommendations onto a wiki.
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NHS 111 fails to deliver benefits

29 October 2012   Rebecca Todd
NHS 111 has not improved efficiency in the NHS and has a low probability of cost savings to the emergency and urgent care system, an independent evaluation report says.
However, a “simplistic economic analysis” concludes that national roll-out of the urgent care telephone number "could potentially" save the NHS money.
NHS 111 has dealt with more than 1m calls since its introduction in August 2010 and is live in 13 sites across England.
The University of Sheffield has published its ‘Evaluation of NHS 111 pilot sites’ report into the first four sites to go live.
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In disasters such as Sandy, HIE is 'as critical as having roads, as having fire hydrants'

By Mike Miliard, Managing Editor
Created 10/31/2012
NEW YORK – The Statewide Health Information Network of New York (SHIN-NY) sees itself as a "public utility" as much as an HIE. In the wake of Hurricane Sandy, as patients bounce between hospitals (and as other public utilities, such as electricity and transportation, are compromised), it has enabled critical continuity of care.
The images of dozens of red-flashing ambulances, evacuating as many as 200 patients – some of them in critical condition, some of them infants – from NYU Langone Medical Center, whose backup generator had failed, to hospitals such as Sloan-Kettering and NewYork-Presbyterian, will be some of the most enduring images from the super storm.
The harrowing process was made much smoother by the fact that those patients' electronic health records were secure and readily accessible at the hospitals to which they were transported, thanks to New York's statewide HIE.
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ONC Challenge: Make EHRs More Readable

OCT 31, 2012 12:11pm ET
The Office of the National Coordinator for Health Information Technology has a new challenge for software developers: ONC is calling on graphic designers to figure out ways to make electronic health records more “readable.”
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Top 10 Takeaways From Silicon Valley Healthcare CEOs

Scott Mace, for HealthLeaders Media , October 30, 2012

I've been a part of some great healthcare technology discussions while at HealthLeaders Media, but perhaps none covered more ground and got to the heart of more issues in less time than a meeting last week between some of Silicon Valley's top healthcare entrepreneurs and four top executives—three of them CEOs—representing healthcare providers with a Valley presence.
Hosted by the University of California, San Francisco, this 100-minute meeting of minds got right to the promise and the pitfalls of technology in healthcare, and highlighted just what an inflection point we've reached as 2012 draws to a close.
For one thing, I was struck by how many hospitals are taking selected tech startups under their wing, offering business advice and intimate glimpses for a lucky few developers into their particular workflow challenges.
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eHealth Ontario back on track

Published on Wednesday October 31, 2012
Greg Reed
There will be no “big bang” in 2015 when 13 million Ontarians’ electronic health records are all suddenly turned on. It’s happening now, each and every day. More than 9 million Ontarians already have an electronic health record.
Three years ago this month the auditor general of Ontario issued a report highly critical of eHealth Ontario’s progress, spending, and lack of strategy. Since then, a new management team and board of directors have been working to turn around the agency and deliver real progress.
Here’s what we’ve achieved:
 • Today two out of three Ontarians have an electronic health record.
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AHRQ to study effect of health IT on workflow

October 31, 2012 | By Susan D. Hall
The Agency for Healthcare Research and Quality is launching a study to better understand how implementation of health IT affects clinical workflow, reports HealthData Management.
"The goal of the project is to understand the impact of implementing health IT-enabled care coordination on workflow within small community-based primary-care clinics in various stages of practice redesign," it says in a notice published Wednesday in the Federal Register.
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MIT algorithm designed to clear up confusion in healthcare NLP

October 31, 2012 | By Susan D. Hall
Massachusetts Institute of Technology researchers are working on algorithms to better distinguish the meaning of words that might be used in multiple ways--a common occurrence in healthcare, reports MIT News.
Since so much data is buried in physician notes, for instance, the implications for advancing natural language processing are huge. The problem lies in "word-sense disambiguation"--determining, for example, whether  "discharge" refers to a bodily secretion or release from a hospital.
The researchers, from MIT's Computer Science and Artificial Intelligence Laboratory, will present their new system next week at the American Medical Informatics Association's annual symposium in Chicago.
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Senate Panel Takes Aim at Prescription Drug Abuse

  • by Maurice Chammah
  • October 30, 2012
Speaking Tuesday at a Senate panel hearing on prescription drug abuse, doctors and law enforcement officials touted the importance of agencies sharing information to more effectively look for pharmacies and doctors involved in the usage of prescription drugs outside of medically sanctioned purposes.
Despite the recent passage of tougher penalties, prescription drug abuse has continued to be a problem, speakers said Tuesday. But doctors told lawmakers that many involved in prescription drug abuse are not drug dealers but addicts who first got a prescription for legitimate pain.
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Liaison launches cloud-based MPI geared towards MU, HIE

By Anthony Brino, Associate Editor
Liaison Healthcare, a division of the Atlanta-based data management firm Liaison, is launching a cloud-based Master Person Index (MPI) platform that helps providers with meaningful use and health information exchange use cases.
The cloud-based MPI solves several problems that have been a drag on the pursuit of interoperability, Liaison Healthcare's VP of healthcare solutions Gary Palgon said in a press release. With some MPIs still using legacy processes for patient and provider identifications, some providers have been struggling with data system integration and information exchange, resulting in inefficiencies like duplication, Palgon said.
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EHR Data Entry on Mobile Devices Challenges Clinicians

Robert Lowes
 Oct 29, 2012
Here's a news flash that might cool down physicians' fever for the new iPad mini from Apple, which slips inside the pocket of a white lab coat: Clinicians in 70% of healthcare organizations look up electronic health records (EHRs) on smartphones and tablet computers, but they find it hard to enter data on the small screens of these hot devices, according to a new report from the research firm KLAS.
"Our physicians are accessing [the EHR] largely to view data," a representative of one organization told KLAS in a survey on mobile devices. "When the [iPad] keyboard pops up, it covers two thirds of the screen and makes it nearly impossible to efficiently document."
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HIMSS: The intangibles of HIT employee retention

By David S. Finn, Health IT Officer, Symantec
There is clearly no doubt that healthcare and IT jobs are the fastest-growing in the market.  When you combine those categories into health IT jobs, fastest-growing actually means shortage – for managers that means hard-to-find and hard-to-keep good people.
How is it that some leaders seem to have a revolving door, and some are able to keep employees over an entire career?
The people will vary, but leaders need to look at themselves – they are the constant in the retention equation.  One theory is that leaders are “emotionally contagious” – if you are happy and like your job, well, then, your people will be happy and like their jobs.
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7 steps to help safeguard against breaches

By Steff Deschenes, New Media Producer
Created 10/29/2012
At the same time the government is encouraging healthcare providers, doctors and insurance companies to digitize healthcare information, the landscape for attacking that info is increasing dramatically. Data beaches occur routinely, but data security experts warn about the vastly higher cost of waiting until a breach occurs, than doing the upfront work to prevent it.
"A security breach is an incredibly expensive problem," said Danny Creedon, managing director at Kroll Advisory Solutions, a company that deals in risk mitigation and response. "There's significant cost surrounding investigation, notification, remediating what occurred and putting in to place services like credit monitoring and identify theft service monitoring that have a monthly cost per person and remain in effect for some time.
"Unfortunately," he added, "most healthcare organizations don't take data security seriously until there's a breach," continued Creedon. "They never seem to have funds available to appropriately support a data security program until they actually have a breach. Then the funds seem endless."
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Cleveland Clinic taps IBM's Watson for med school

October 30, 2012 | By Julie Bird
The Supercomputer known as Watson will help medical students at Cleveland Clinic to analyze medical problems and develop evidence-based solutions.
The IBM natural language processor, meanwhile, will be building its base of medical knowledge and improving its Deep Question Answering Technology, making it a more valuable partner to future physicians, according to an announcement from IBM. Another goal will be using Watson to process an electronic medical record "based on a deep semantic understanding of the content within an EMR," the computer-maker says.
You might remember Watson as the computer that beat two Jeopardy! champions last year, sorting through its reams of knowledge to respond to oral questions from host Alex Trebek. Watson wasn't perfect: It responded "Toronto" to a Final Jeopardy! question about U.S. cities with airports named after World War II heroes.
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'Troubling disconnect' between mobile security threats and protections in place

By Mike Miliard, Managing Editor
Created 10/29/2012
DALLAS – Even as nearly everyone is using smartphones and tablets for critical information, few organizations have taken steps to keep the devices safe from cyber threats, according to a new survey from the Polytechnic Institute of New York University and AT&T.
A full 90 percent of respondents allowed employees to access work email via mobile devices, and 41 percent say they allow their employees to access important files via mobile devices, according to the study.
But just 65 percent reported that information and data security of wireless devices was a concern – even as 91 percent of respondents said they were concerned about computer and online data security. Fewer than one-third (29 percent) have installed anti-virus software on smartphones.
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Web info on prostate cancer tough to understand

Thu, Oct 25 2012
NEW YORK (Reuters Health) - There's no shortage of websites with information on prostate cancer treatment, but they may be well beyond the average person's comprehension, a new study finds.
The study, of 62 such websites, found that only three had treatment information written below a 9th-grade reading level. Most often, sites aimed for the reading level of a high school senior - far beyond the reading skills of many Americans.
That's a worry, researchers say, because there is a range of treatment options for prostate cancer. And if men are going to make good choices, they need to understand the information out there.
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3 health IT must-haves for natural disaster preparedness

By Benjamin Harris, New Media Producer
Created 10/29/2012
Responding to disasters is something every healthcare institution needs to be ready for. From hurricanes to snowstorms to wildfires, having a plan in place and technology to back it up is critical to an effective response.
During these times of crisis many simple things, such as contacting relatives of patients or ordering crucial supplies can become major headaches if an adequate plan is not arranged beforehand. As many healthcare centers employ a higher than average concentration of IT equipment, there are certain ways they can leverage them to cope with disasters- and things they must do to safeguard their technology as well.
Mike Detjen of Arcadia Solutions speaks about some of the must-haves for HIT in disaster scenarios – ways it can be useful and things to be concerned about.
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Indian Health Service Readies a PHR

OCT 29, 2012 11:19am ET
The Indian Health Services is building a first-generation personal health records system to serve more than 2 million beneficiaries.
The PHR will be populated with data from HIS’ existing clinical, administrative and billing information systems. Patients will have the ability to access via the Web and print a subset of their health information.
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Monday, October 29, 2012

Going Virtual To Improve Patient Safety

by Bonnie Darves, iHealthBeat Contributing Reporter
Jazz buffs might readily recognize Duke, Ella, Thelonius and Billie as the names of four of the all-time greats in that musical sector. But those monikers are also the names of the members of a virtual family -- two adults and two children -- being used by FDA to potentially improve the safety of devices and drugs before they hit the market.
These virtual patients are basically high-resolution, magnetic-resonance images of healthy volunteers, complete with organs, bones and other tissue. Created using computer-aided design to comprise  FDA's "Virtual Family Tool," the models are being used to assess the safety and efficacy of medical implants and devices, and radiologic imaging.  
"The virtual physiological patient is our model for taking this work forward to come up with a coherent set of models for key organ systems that can be used to design devices, and eventually tailor therapies to individual patients so that their physiology can be plugged into these models," Michelle McMurry-Heath -- associate director for science in FDA's Center for Devices and Radiological Health -- said.
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Due diligence is key when it comes to EHRs and malpractice

By Madelyn Kearns, Contributing editor
Created 10/29/2012
SAN ANTONIO – It’s not what you say that matters — it’s what you do and how you use it.
So goes the motto blanketing all professions and endeavors, from campaign trails on down to the compassionate acts of ideal citizenry, where the candidate meets an elderly woman and a passerby helps her across the street. In the healthcare technology world, this pay-it-forward mantra demands amplification; it must remain constant and pressing, it must take-it-forward. There is no time to fumble around for the correct change.
Instances of EHR transitions have a tendency to muddle such advancement, plateauing some practices and putting them at risk for fraud investigations and medical liability issues. The reins often get tossed and the practice inevitably loses itself where it could easily thrive.
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Wikis allow patients to help develop clinical practice guidelines

October 29, 2012 | By Julie Bird
Patients can play a key role in developing clinical practice guidelines (CPG) through a specialized wiki, a group of Dutch researchers report in the current issue of the Journal of Medical Internet Research.
The researchers tested their theory by developing a wiki about infertility treatment, according to the article, "Feasibility of a Wiki as a Participatory Tool for Patients in Clinical Guideline Development."
Initial content of 90 recommendations was developed following in-depth interviews with 12 patients.  Over a seven-month period, additional patients were invited to participate in the wiki, resulting in 298 unique visitors to the website and 289 recommendations. The recommendations were winnowed down, with a guideline development group assessing their value.
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Dossia Launches Consumer Social Network

OCT 26, 2012 5:10pm ET
Dossia, a vendor of personal health records and related tools for large corporations that offer the technology to employees, has introduced an online health consumer social network and resource center that is free to everyone.
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CMS posts clinical quality measures for 2014 MU

By Mike Miliard, Managing Editor
Created 10/26/2012
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has published the final 2014 clinical quality measures (CQMs) for eligible professionals and eligible hospitals seeking to attest for meaningful use.
Beginning in 2014, the reporting of clinical quality measures will change for all providers. Electronic health record (EHR) technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria.
Eligible professionals (EPs), eligible hospitals and critical access hospitals will report using their respective new 2014 criteria – regardless of whether they're taking part in participating in Stage 1 or Stage 2 meaningful use.
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NHS 24 takes new approach to telehealth

16 October 2012   Jon Hoeksma
NHS 24 has committed to launch all telehealth solutions on three channels - smartphones, tablets and digital TV.
NHS Scotland’s online and telephone-based advice service has also committed  to only launch telehealth solutions that are able to support multiple conditions.
“Scotland won’t deploy any solution that manages just one condition on telehealth,” NHS 24 medical director Professor George Crooks told the Healthcare Efficiency through Technology conference in London last week.
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Enjoy!
David.

Friday, November 09, 2012

Struth I Hope They Sort This Out and Quick. The Perfect Murder?

This turned up a few days ago.

Death by defibrillator: FDA called to address hacking risk

By Brian Alexander, NBC News Contributor
It sounds like a scenario out of a James Bond movie: a villain spots his quarry and uses a small device to hack into the official’s heart defibrillator, sending a signal for mayhem. There’s chest grabbing, and a collapse, and alarms, but the bad guy walks free because there’s no gun, knife, poison dart -- no evidence at all a murder has been committed.
According to a recent report by the Government Accountability Office (GAO), a non-partisan agency that works for Congress, not only is such a scenario possible, there’s a growing danger that grandpa’s heart rhythm device, or, say, a child’s insulin pump – any implantable device that can be accessed remotely --  could be susceptible to hacking.
But the GAO report suggests that the Food and Drug Administration, which approves and regulates such devices, has been behind the curve when it comes to security and now is calling for the agency to set guidelines for manufacturers to help combat the threat of hacking.
According to the report, which had been requested by members of Congress in light of tests by researchers revealing the vulnerability of the medical technology, “there have been four separate demonstrations in controlled settings showing that the intentional exploitation of vulnerabilities in certain medical devices is possible.” The report stressed that there have been no proven cases of anybody actually doing this for nefarious purposes.
Still, when he released the GAO report, Congressman Edward J. Markey (D-Mass.), one of the requesting legislators, issued a statement saying that  “wireless medical devices are susceptible to increasingly advanced hacking techniques that could threaten patient health.”
The susceptibility stems largely from their wireless communications abilities, explained Nathanael Paul, chief scientist at the Center for Trustworthy Embedded Systems at Oak Ridge National Laboratory. In 2010, Paul and a colleague demonstrated they could hack into an insulin pump, like the one Paul himself wears to treat his Type 1 diabetes.
Thanks to wireless communication, doctors can download diagnostic information and health status from the device to a computer and make changes in the performance of a device without surgery. For example, defibrillators can be programmed using a wand that communicates with the device inside a patient’s chest.
Lots more here.
Oh dear, oh dear!
Good to know all this has apparently not happened yet...as far as we know!
Sort this one out guys - and fast.
David.

Thursday, November 08, 2012

The Melbourne Institute Attempts To Take A Hard Look At Health Reform - And Skates Over the Surface.

This session was held on November 1, 2012 as part of the Melbourne Institutes

2012 Economic and Social Outlook Conference

Session 4B: Health
Will health reform work? This year has seen major changes to hospital funding and performance management. How will these reforms affect service delivery and deal with the costs? Is there more that needs to be done?
Chair: Professor James Angus AO, Dean, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne
Speakers:
Professor Stephen Leeder AO, Professor of Public Health and Community Medicine, School of Public Health and Director, Menzies Centre for Health Policy, The University of Sydney - View presentation
Professor Anthony Scott, Professorial Research Fellow, Melbourne Institute - View presentation
Dr Tony Sherbon, Acting Chief Executive Officer, Independent Hospital Pricing Authority - View presentation
The program for the whole conference can be found here:
The Government’s plans for E-Health as a ‘Reform’ were very briefly mentioned by Professor Leeder but there was no detail or focus on the topic as far as I could see.
Professor Scott pointed out that the evidence as still out on the utility of incentive payments at the hospital level - when hospital management gets the money and it is those at the coal face who decide what is actually done - which really determines cost.
Last Dr Tony Sherbon told is that the ‘efficient price’ had been determined to be $4,808. There is now a thing called a National Weighted Activity Unit (NWAU) which then gets the rebate for each service. e.g. a limb amputation gets 4.8387 NWAU and a Medical Outpatient Visit 0.0588 NWAU.
The flaw in all this - in my view is found here in a FAQ on this reform. (See Page 6)

“How will activity based funding contribute to more efficiency in public hospitals?

Activity based funding will contribute to the efficiency of public hospitals through the development of an independently determined efficient price per service, based on the actual cost of service delivery in a range of hospitals.
Activity based funding will empower those working in the health sector to drive continuous improvement and value for money in the delivery of public hospital services.”
There is no evidence that the stressed out workers at the front lines of our health system have much interest in making the services they offer provide more ‘value for money’. They want to provide the service as best they can and what it costs is a ninth order issue for most of them.
Worse most hospitals do not have the computer systems or the capacity to properly understand which services are too expensive and which are funding winners. Real Activity Based Costing (ABC) is a very complex undertaking and takes years to properly implement - especially in organisations which are not ‘for profit’ - as the Government Health Sector is.
I would argue it is just impossible to determine an efficient price for a service that will be reasonable for a large hospital on the north side and another on the south side of Sydney - let alone more broadly. For cost information to be useful in managing it has to be believed by those involved i.e. the local clinicians and I would argue the approach being adopted is compromised severely by not having really localised cost inputs.
While I could be proved wrong I suspect this is going to be a huge mess which will not have the desired efficiency and cost outcomes.
We will all have to wait and see.
In the meantime browsing all the submissions from the stakeholders that is found on the Pricing Authority web site certainly shows a range of levels of concern and many outstanding issues.
See here:
This is probably an initiative that needed a fair bit of initial piloting before national introduction.
David.