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."

Friday, January 18, 2013

Overseas Health IT Links - Archive From Over Holiday Period.

Here are a few I have come across over the break and seemed worth sharing.
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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The Future of Medicine Is Now

From cancer treatments to new devices to gene therapy, a look at six medical innovations that are poised to transform the way we fight disease

Reporter Ron Winslow talks to WSJ weekend Review editor Gary Rosen about astonishing medical advances that are finally moving from research and prototypes to practical treatments.
In our era of instant gratification, the world of medicine seems like an outlier. The path from a promising discovery to an effective treatment often takes a decade or more.
But from that process—of fits and starts, progress and setbacks and finally more progress—grow the insights and advances that change the course of medicine.
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A Sobering Look at Data Threats in 2013

DEC 24, 2012 12:24pm ET
A cyber security forecast for 2013 by security firm Kroll Advisory Solutions covers four scenarios that organizations aren’t expecting to deal with in the coming year but very likely could confront. These are the issues not being talked about, but must be, the company contends:
1. Vampire Data: Organizations Get Bitten by the Data They Never Knew They Had
Data exists in myriad locations and in a multitude of formats within an organization, and we’ve seen too many instances where clients just didn’t know the data existed until they experienced an attack. We call this vampire data – basically, any data that can’t seem to be killed, but comes back to drain the life out of the organization. Examples include backup tapes and archiving that go back decades (even though they were scheduled to be destroyed); emails that should be destroyed after 90 days but exist indefinitely on employees’ desktops; and material that has been copied to portable or cloud storage without the organization’s consent or knowledge. While it may not be a sanctioned copy of data, it may still be a discoverable one, and it can certainly be stolen or lost, causing a data breach that just shouldn’t have happened.
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ONC looking to 17 Beacon communities for HIT evidence database

By Mary Mosquera, Senior Editor
Created 01/04/2013
The Office of the National Coordinator for Health IT (ONC) is looking to 17 Beacon communities nationwide to gain an evidence database from the beacons’ experience to inform its policies and to share with other providers and organizations, according to Janhavi Kirtane, director of ONC’s clinical transformation and dissemination.
The 17 communities that have brought providers together within regions to use health IT and clinical interventions to elicit better patient care have each demonstrated measureable improvements, including for outcomes around chronic disease and preventive screenings.
These health IT model communities, which the Office of the National Coordinator for Health IT (ONC) has funded, will wrap up their grant status in 2013. 
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ONC hopes cash will spur health info exchange best practices

Posted: December 27, 2012 - 3:45 pm ET
While no federal regulations for a nationwide health information network are forthcoming, HHS' health information technology office announced that is offering financial awards to groups already working to develop health information exchange "rules of the road."
Instead of federal rule-making, the Office of the National Coordinator for Health Information Technology "is establishing a robust framework of leadership, guidance, engagement, listening and learning and monitoring," according to a funding opportunities announcement. "We will identify and shine light on good practices that support robust, secure and interoperable exchange."
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Health IT investments on rise in Europe, says Frost & Sullivan

By Mike Miliard, Managing Editor
Created 12/27/2012
The market for health IT professional services is on the rise in Europe, according to a new report from Frost & Sullivan, driven by providers trying to improve care delivery and lower costs. Still, adoption levels aren't what they could be, thanks to tight budgets.
Exploring changes across the pond such as consolidation and the adoption of inorganic growth models, Frost & Sullivan's "Analysis of the European Healthcare IT Professional Services Market" finds that the European market saw revenues of $1.58 billion in 2011 and should reach $1.93 billion by 2017.
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ONC, AHRQ target patient safety

By Mary Mosquera, Senior Editor
Created 12/27/2012
The Office of the National Coordinator for Health IT wants to use electronic health record certification criteria to make it easier for physicians to report patient safety events, which provide critical raw data for developers, healthcare providers, researchers and policymakers to improve the safety of health IT and make care safer.
The Agency for Healthcare Research and Quality will encourage providers to report adverse events to patient safety organizations (PSOs) and to use AHRQ’s Common Formats, a tool which offers common definitions and reporting formats to improve how they gather, review and report adverse event data, near misses and unsafe conditions.
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Health-care sector vulnerable to hackers, researchers say

By Robert O’Harrow Jr.,

As the health-care industry rushed onto the Internet in search of efficiencies and improved care in recent years, it has exposed a wide array of vulnerable hospital computers and medical devices to hacking, according to documents and interviews.
Security researchers warn that intruders could exploit known gaps to steal patients’ records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems.
A year-long examination of cybersecurity by The Washington Post has found that health care is among the most vulnerable industries in the country, in part because it lags behind in addressing known problems.
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ONC Releases its Health I.T. Safety Action Plan for Public Comment

DEC 24, 2012 9:48am ET
The Department of Health and Human Services has released the “Health IT Patient Safety Action and Surveillance Plan” for public comment. The comment period closes Feb. 4, at 11:59 pm EST.
The patient safety action plan is the response by the Office of the National Coordinator for Health Information Technology about the growing potential of health I.T. to be a contributor to medical errors. The ONC commissioned a study by the Institute of Medicine about how to identify and mitigate those risks; the action plan is based on that study and its recommendations.
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4 health IT predictions for 2013

By Benjamin Harris, New Media Producer
It's that time again. There's snow on the ground (in some places, at least), fir trees have been sawn down and adorned with bright flashing lights and people are beginning to make their predictions for the year ahead.
The healthcare IT industry being just like any other in that respect, practitioners, providers and pundits alike are sounding off on what 2012 was all about, and what the next rapidly approaching year has in store. In addition to providing a reading list of some of the best (and most out of the box) year in review and predictions lists, we've compiled a list of our own here.
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2012: The year meaningful use took hold

By Mary Mosquera, Senior Editor
Created 01/04/2013
The year 2012 was the year when data showed its muscle, whether in the presidential elections or in demonstrating how deeply entrenched the adoption and meaningful use of electronic health records had become.
Health information exchange and patient engagement tools, such as the Blue Button feature to download personal health data, also made headway toward becoming a reality, paving the way for meaningful use Stage 2.
Across the Medicare and Medicaid meaningful use programs, 82 percent of hospitals, or 4,193, have registered for meaningful use, while the majority of hospitals have received payments under the health IT incentive program, according to Farzad Mostashari, MD the national health IT coordinator.
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December 29, 2012

Sure, Big Data Is Great. But So Is Intuition.

By STEVE LOHR
It was the bold title of a conference this month at the Massachusetts Institute of Technology, and of a widely read article in The Harvard Business Review last October: “Big Data: The Management Revolution.”
Andrew McAfee, principal research scientist at the M.I.T. Center for Digital Business, led off the conference by saying that Big Data would be “the next big chapter of our business history.” Next on stage was Erik Brynjolfsson, a professor and director of the M.I.T. center and a co-author of the article with Dr. McAfee. Big Data, said Professor Brynjolfsson, will “replace ideas, paradigms, organizations and ways of thinking about the world.”
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EHRs not convenient for communicating lab results to patients, docs say

January 2, 2013 | By Marla Durben Hirsch
Physicians often fail to notify patients of test results, even when electronic health records seemingly make it easier to receive them, according to a recently published study in the Journal of the American Medical Informatics Association.
Failure to tell patients their test results, particularly abnormal test results, is a major safety concern. The researchers, from the Veteran's Administration Medical Center in Houston and elsewhere, conducted a survey of 2,590 primary care physicians nationally in the VA system to determine whether their EHR result notification system--called "View Alert"--helped them then transmit the information to their patients.
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MU Stage 2 sparks patient portal market

By Mary Mosquera, Senior Editor
Created 01/02/2013
The federal incentive program for adoption of electronic health records is on the verge of driving a growth spike in patient portals, as meaningful use stage 2 requires that physicians engage with their patients and share more information.
Providers feel a sense of urgency to put in place online tools through which patients can view and download their health information, such as test results and medications. This will help them meet criteria for meaningful use and accountable care models, according to a report released Jan. 2 by the research firm KLAS.
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GP IT faces anxious start to 2013

2 January 2013  
Primary care IT leaders have expressed concern about the late decisions that are being made on who will be responsible for GP IT in the future.
Asked to reflect on 2012 and to look ahead to 2013, Chaand Nagpaul, negotiator for the BMA’s General Practitioner Committee, said: “The key event in primary care IT was the decision by the NHS Commissioning Board to delegate responsibility for the operational management of GP IT and associated funding to clinical commissioning groups at a late stage.”
“Unfortunately, there is no clarity about the additional resources that CCGs will need to discharge this responsibility, for which CCGs have been given inadequate time to prepare.”
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Look back, move forward

EHealth Insider asked NHS IT directors, GPs, opinion formers and a patient to look at the state of NHS IT at the end of 2012, and at what 2013 is likely to hold.
18 December 2012
As 2012 draws to a close, there is a sense that the unfinished business of the National Programme for IT in the NHS is finally being resolved; and that trusts are starting to take important decisions about their future IT systems.
However, suppliers and trusts will not have a monopoly on shaping the new market; increasingly, ‘frustrated clinicians’ are getting involved in hack days and open source initiatives.
Meanwhile, the new NHS commissioning structures and government pledges to open up services to patients will have a big impact in 2013; particularly in GP IT – where decisions are being made perilously late.
All this means that EHI’s list of expert contributors are agreed that whatever happens over the next twelve months, 2013 is unlikely to be dull.
Note: The patient contribution is really interesting and useful.
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2012 changes to be felt in 2013

31 December 2012  
The transition from the era of the National Programme for IT in the NHS to the era of more IT choice for trusts in a more competitive market is finally underway.
That, at least, is the view of the trust IT directors and other experts that eHealth Insider asked to reflect on 2012 and the year ahead.
Although the coalition government made big announcements about abolishing NPfIT in both 2011 and 2010, it was not until late this year that one of its big, unfinished pieces of business was completed.
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Computer-based testing method predicts side effects for hundreds of drugs

January 3, 2013 | By Ashley Gold
A new study published recently in the American Chemical Society's Journal of Chemical and Information Modeling outlines a method that gives doctors the ability to predict negative or dangerous side effects patients may experience when taking prescription drugs.
The study's authors explain how drug side effects--the fourth-leading cause of death in the U.S. according to an ACS announcement--are not tested accurately. A more cost-effective and viable way to test for side effects would be a computer-based approach, according to the researchers.
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HIE in 2013: Climbing past the low-hanging fruit

By Anthony Brino, Associate Editor
Unlike western and central Pennsylvania, providers in greater Philadelphia are not linked by a health information exchange, perhaps because until recently there wasn’t a huge need for one among uber-competitive, highly-rated providers like the University of Pennsylvania Health System and Hahnemann University Hospital.
Now though, providers in and around Philadelphia are in the late stages of planning for HealthShare of Southeastern PA, developing governance and funding models and hoping to have a rough framework by February, said Michael Restuccia, University of Pennsylvania Health System CIO.
“Then we can push it forward from a use case perspective,” Restuccia said. About 20 hospitals are set to participate by 2014, with two use cases initially: medication history lists and discharge summary.
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How Does the Rise of Computers in Exam Rooms Impact Patient Care?

Written by Kenneth Bertka, MD, Vice President of Physician Clinical Integration, Mercy | December 31, 2012
Social Sharing
The introduction of electronic health records is transforming the healthcare industry and patient care. With the advent of EHRs, a physician has a patient's medical history along with access to evidence-based guidelines at his or her fingertips. However, getting this information at a physician's fingertips involves a fundamental change to the traditional patient exam room interaction. Now, physicians or other clinicians must search for and enter information into computers or other devices while treating a patient. This computer-physician-patient interface is taking place every day in exam rooms, and its impact on patient care and patient satisfaction isn't yet fully understood.
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Thursday, January 03, 2013

11 Experts on Health IT Progress, Frustrations and Hopes for 2013

by Kate Ackerman, iHealthBeat Managing Editor
2012 was a year of much progress for health care IT. An annual survey from CDC's National Center for Health Statistics found that nearly 40% of office-based physicians are using a basic electronic health record system, nearly twice as high as the percentage in 2009, when the meaningful use incentive program was established. Further, an analysis from the Office of the National Coordinator for Health IT noted that more office-based doctors are using EHR systems with the higher-level functionality necessary to meet the meaningful use program's requirements.
As of the end of November 2012, $9.2 billion had been distributed to 177,100 eligible health care providers and hospitals through the meaningful use incentive program.
In August 2012, HHS announced the release of the final rules on Stage 2 of the meaningful use program, and in November 2012, the Health IT Policy Committee announced that it is seeking public comment on proposed recommendations for Stage 3 of the meaningful use program.
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5 reasons EHR functionality hasn't changed since 1982

By Timathie Leslie and Megan Doscher and Brynnan Toner, Booz Allen Hamilton
Electronic health records (EHRs) have traveled on quite a journey since their inception in the 1960s. Powered by the advancement of modern technology, they no longer exist simply on stand-alone terminals – EHRs are now mobile, enabled by mobile broadband, smart phones, and tablets. In recent years, EHR adoption has increased quickly, spurred in part by the federal Meaningful Use Incentive program, bringing promise of vast improvements in healthcare quality, patient safety, workplace efficiencies, and patient empowerment.
Despite this progress, basic EHR functionality remains largely unchanged since 1982, slowing the evolution and integration of new technologies and capabilities, which remain paramount to transforming the healthcare system.
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Docs lack access to psychiatric records

By Bernie Monegain, Editor
Created 01/02/2013
Medical centers that elect to keep psychiatric files private and separate from the rest of a person's medical record may be doing their patients a disservice, a Johns Hopkins study concludes.
In a survey of psychiatry departments at 18 of the top American hospitals as ranked by U.S. News & World Report's Best Hospitals in 2007, a Johns Hopkins team learned that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical record (EMR) systems and that fewer than 25 percent gave non-psychiatrists full access to those records.
Researchers say, psychiatric patients were 40 percent less likely to be readmitted to the hospital within the first month after discharge in institutions that provided full access to those medical records.
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Looking to EHRs to automate quality reporting

January 2, 2013 | By Julie Bird
The Centers for Medicare and Medicaid Services (CMS) wants to help hospitals use electronic health records to automatically report patient data required to meet clinical quality standards.
In a request for information published Dec. 28 in the Federal Record, CMS says it wants to make quality reporting more efficient and less burdensome for hospitals. The idea: Use certified EHR technology to electronically report certain patient-level data to the Hospital Inpatient Quality Reporting (IQR) program.
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4 more predictions for 2013

By Benjamin Harris, New Media Producer, Healthcare IT News
Created 12/28/2012
It's that time again. There's snow on the ground (in some places, at least), fir trees have been sawn down and adorned with bright flashing lights and people are beginning to make their predictions for the year ahead. The healthcare IT industry being just like any other in that respect, practitioners, providers and pundits alike are sounding off on what 2012 was all about, and what the next rapidly approaching year has in store. In addition to providing a reading list of some of the best (and most out of the box) year in review and predictions lists, we've compiled a list of our own here.
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11 healthcare data trends in 2012

By Michelle McNickle, New Media Producer
Created 01/06/2012
Mobile devices, data breaches and patient privacy rights were some of the most talked-about topics in health IT in 2011, and according to expert opinions complied by ID Experts, 2012 won’t be any different. 
In fact, experts continue to predict an upswing in mobile and social media usage, response plans, and even reputation fallout. Eleven industry experts outlined healthcare data trends to look for in 2012.
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December 26, 2012

Cloud Computing: Changing HIT and HIE Deployment Strategies

Many professionals dealing with personal health information see something akin to a flashing “danger” sign when someone mentions “the cloud.” Similar to its natural namesake, “the cloud” seems fuzzy and elusive and thus raises concerns about security. But “the cloud,” or “cloud computing,” as it’s formally referred to, offers many benefits that some healthcare organizations are already using to deploy health information technology across their enterprises. 
Cloud computing also enables revolutionary research accelerating the drug discovery process and lowering drug costs. Healthcare professionals need to worry less about the infrastructure of cloud computing, and focus more on understanding it as a new method for deploying technology, helping organizations to meet new requirements for data exchange and more coordinated, team-based care.
Note: Really Useful Review Of the Topic
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Patient privacy group asks HHS for HIPAA cloud guidance

By Anthony Brino, Associate Editor
In April, the Department of Health and Human Services reached a $100,000 HIPAA settlement with Phoenix Cardiac Surgery, after the small physician practice had managed clinical and surgical appointments, between 2007 and 2009, using an Internet-based calendar that also happened to be publicly-available.
The Internet being the most ubiquitous form of cloud computing, an Austin, Texas-based advocacy group called Patient Privacy Rights is pointing to the Phoenix Cardiac Surgery HIPAA violation as an example of why HHS should regulate, or at least guide, cloud use in healthcare.
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Pregnant? There's an app for that

Published: Dec. 30, 2012 at 1:36 PM
ROCHESTER, Minn., Dec. 30 (UPI) -- ROCHESTER, Minn., Dec. 30 (UPI) -- Doctors at the Mayo Clinic in Rochester, Minn., say their app for pregnancy maps out what couples can expect during pregnancy, birth and baby's first months.
Dr. Roger Harms, a Mayo Clinic specialist in obstetrics and gynecology, and senior medical director for operations in Mayo Clinic's Global Business Solutions division, said Mayo Clinic on Pregnancy is available for desktop/laptop and tablet users on the Windows 8 platform.
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Top 5 healthcare IT trends to look out for in 2013

Summary: As we look forward to 2013, these are just some of the trends and situations we expect to be dealing with.
By Denise Amrich for ZDNet Health | December 27, 2012 -- 16:51 GMT (03:51 AEST)
Healthcare IT, like all of IT, has changed tremendously over the past year. The Affordable Healthcare Act is now the law of the land (and will probably stay that way), which means digital record-keeping will continue to grow in importance. 2013 also marks the beginning of payment bundling, which will mean that more (and more reliable) data interchange will become increasingly necessary.
Our own ZDNet columnist, David Gewirtz, is also IT advisor to the Florida Public Health Association. I asked David to look forward into the new year and identify five major trends that will truly have an impact on the healthcare providers he advises.
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EHRs May Turn Small Errors Into Big Ones

By Stephanie Baum, MedCity News
Published: December 16, 2012
As electronic health record systems become more interconnected, errors may propagate much farther than under old paper-based systems, a recent study suggested.
According to a review by the Pennsylvania Patient Safety Authority, mistakes and near misses involving electronic health records were analogous to those made with paper-based records with one caveat: those made with EHRs tend to be amplified and can affect a larger group of people.
The Authority's study looked at 3,099 reports from Pennsylvania hospitals detailing 3,946 problems. More than 2,700 incidents involved near misses and 15 involved temporary harm to patients.
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Monday, December 17, 2012

Health IT Security Resolutions for 2013

The New Year inspires many people to face their shortcomings and commit to those self-improvement to-do lists known as resolutions.
For IT security personnel, however, the task of seeking out flaws and addressing them is a continuous process, as opposed to an annual event. That said, health care managers and consultants point to several data protection priorities and initiatives in the offing for 2013. Those include data, device and email encryption, improved mobile security programs and a strengthening of traditional security measures such as spam filters.
Based on interviews with health care IT managers and industry consultants, here's the rundown on the top health IT security resolutions for 2013.
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Web-based solution allows UK docs comprehensive access to patient data

By Jamie Thompson, Web Producer
Created 12/10/2012
CareInform is a new Web-based solution that allows access to a patient’s current and past healthcare records sourced across multiple clinical IT systems.
As pressure to improve NHS patient services continues, CareInform is meant to help local health organizations achieve the Department of Health’s Quality, Innovation, Productivity and Prevention targets. The solution will also adhere to a new NHS mandate that states “that all patients should have an integrated electronic record of their care that can follow them to any part of the NHS or social care system, by 2015.”
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'Not One Successful EHR System In Whole World'

Longtime advocate of computerizing healthcare C. Peter Waegemann calls current health IT policy 'misguided.'
While federal health IT officials were touting the perceived successes of their efforts to increase physician usage of electronic health records (EHRs), one longtime advocate of EHRs was criticizing the whole direction of health IT policy.
"In my opinion, there is not one successful EHR system in the whole world," said C. Peter Waegemann, who founded and ran the Boston-based Medical Records Institute from 1984 to 2009. "User friendliness, usability, and interoperability are not there," he added in an interview with InformationWeek Healthcare. AdTech Ad
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12 Expert Health IT Predictions For 2013

Better care coordination technology, the explosion of mobile health and the downfall of independent physician practices are just a few of the health IT predictions experts are making for 2013.
What do healthcare IT experts believe is bound to happen in the year to come?
InformationWeek Healthcare recently offered its own take on the subject. Now we've reached out to CIOs, health IT professionals, analysts, bloggers and other HIT heavyweights in a series of email interviews to get their health information technology predictions for 2013. Here's what they predicted. AdTech Ad
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The Challenge in Stage 2: Involve the Patient

DEC 1, 2012
It seems that every deadline and compliance date for health I.T. leaders is just around the corner. And unfortunately, they are, including the start of the Stage 2 EHR meaningful use program. The beginning of the 2014 federal fiscal year (in October 2013) is when hospitals need to have their ducks in a row to apply for Stage 2 payments. The application period for physicians and other eligible professionals opens January 2014 (for more on attestation and reporting periods, see sidebar, page 32).
Mind you, those are the earliest dates when hospitals and EPs can apply. But many feel an urgent need to get meaningful use Stage 2 done so they can tackle the other pressing items on their plate, such as ICD-10 compliance work, as well as multiple components of the health reform law such as new care and reimbursement processes. As Bill Spooner, senior vice president and chief information officer at eight-hospital Sharp HealthCare in San Diego explains it, ICD-10 is in October 2014, state insurance exchanges are in January 2014, Stage 2 is in fiscal 2014, "and we also have to take care of our patients."
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Enjoy
David.

Thursday, January 17, 2013

Some Thoughtful Points On Why It Is Patient Health Information Privacy Matters.

The appeared over the break.

Q&A: Privacy maven Deborah Peel, MD

By Anthony Brino, Associate Editor, Healthcare Payer News and Government Health IT
Created 01/03/2013
Deborah Peel, MD, was trained as a Freudian psychoanalyst and worked as a psychiatrist in Austin, Texas, for nearly three decades before becoming a privacy activist, founding the group Patient Privacy Rights in 2006 after being appalled by HIPAA’s evolution into what she sees as a weak baseline for privacy and security.
Equally skeptical of both private industry and the government, Peel’s views and policy proposals diverge sharply from myriad health IT leaders in a lot of ways. But she shares many of their goals, and the optimism that technology and patient engagement can improve American healthcare systems.
Recently, Patient Privacy Rights urged the Department of Health and Human Services to regulate cloud computing as hosted data services grow and data breaches continue to plague health organizations. In a wide-ranging iinterview, Peel talked about her background as a mental health provider, how healthcare organizations can build patient trust, her ideal model for information sharing consent and more.
Q: How did your view of privacy and patient rights develop?
A: It really grew out of my long-term practice as a boarded psychiatrist and a Freudian psychoanalyst. Literally the first week I hung out my shingle in the late ‘70s, people came in and they said “If we pay you cash, will you keep our records private?” This is a problem that predates electronic health records. Health information doesn’t stay in the doctor’s office. What happened then was information on paper would get sent to pay claims, and it was very detailed and the claims information would many times be shared with employers. That can happen because under ERISA (the Employee Retirement and Income Security Act), if you’re in an ERISA employer-based health plan, they frankly have the right to see your information. Many companies say they don’t do that but it’s a widespread practice. I learned from my patients that if you use any third parties then the privacy of your sensitive information is at risk.
I really learned that there were significant numbers of people who will not get treatment unless they know it’s private.This is long-standing problem that predated electronic health records, but if you think about the scale of things, it’s very different.
Q: Did you know of mental health patients whose employers learned of their conditions and discriminated against them?
A: Absolutely, not only discriminating against them. Another very common complaint would be, “I applied for life insurance or long-term disability insurance, and I’ve been denied.” They would look into it and it would be because of psychiatric records. I wrote many a letter that said, “This person has never been suicidal. This person has not been on medication. They’ve been in therapy; they’ve managed their problems very well.”
It’s my opinion that insurers have long discriminated against anyone with mental health diagnosis, and I don’t believe it’s actually accurate actuarially. I don’t actuarially believe that there’s a basis for discriminating against anyone who has any mental illness or addiction diagnosis. If you think about it, the ones that do well are actually the ones that come in for treatment. These are people that are going to do well and get better, not create major burdens for the insurance industry.
I do have a pretty negative view of the insurance industry and the managed care industry. Insurers, when we had an indemnity model, all they got to pay claims was the diagnosis, the date of treatment, the place of treatment, the type of treatment and the cost — five elements. Their corporate mandate is to return money to shareholders. So they began to think of ways to ratchet down what they were paying out. Insurers began to demand copies of records as a condition for paying claims, and then they would use whatever they found to collect more information about individuals, and also to find ways to deny and limit payments and claims. Insurers began to require that you sign every year a blanket advance consent that in order to pay a claim that your doctor would send records of the treatment to them. They now pore over people’s records to look for ways to take back payments that have already been made, to claim that something was not revealed earlier that would’ve caused you to be denied.
Much more of the interview found here:
I think this is a very useful summary of a considered view of what harms can come from breeches (or breaches - grin) and what might be done about it.
Well worth a read.
David.

Wednesday, January 16, 2013

One Of Our Occasional International Blog Commenters Gets Good Coverage In A Key US Forum.

This appeared over our break.

Scot Silverstein's Good Health IT and Bad Health IT

Scott Mace, for HealthLeaders Media , January 8, 2013

Inevitably, when the subject turns to the pitfalls of bad health IT, you will find Scot Silverstein, MD, ready to comment. He has been writing about health IT difficulties since 1998.
Silverstein is an adjunct professor at Drexel University who I recently interviewed for an upcoming HealthLeaders magazine story on physician resistance to health IT.
A recent Silverstein blog post caught my eye for the following statement: "It is impossible for people, especially medical professionals, to be 'ready' for a system that 'is not ready for them.'"
I wanted to learn about the good doctor's thinking and so I gave him a call. We spoke for two hours and it felt like scratching the surface of issues that healthcare will be facing for a good while to come.
If health IT has a canary in the coal mine, it is Silverstein. His Drexel website and contributions to the Health Care Renewal blog are the places to go to examine the voluminous literature about health IT's many shortcomings, errors, and challenges.
Silverstein completed a postdoctoral fellowship in medical informatics at Yale School of Medicine 20 years ago, but his experience with IT goes back to the 1970s, when building a computer involved using a soldering iron. His technology interests are diverse; he is also a ham radio enthusiast licensed at the highest level ("extra" class) by the FCC. In the 1990s, after years of practicing medicine and the post-doc, he joined Yale's faculty and began building electronic health record systems, including for King Faisal Specialist Hospital in Saudi Arabia, "even though my name's Silverstein," he notes.
After helping implement clinical IT at Yale New Haven Hospital, Silverstein took a CMIO-type role at Christiana Care Health System in Wilmington, Del., at a time when the term "CMIO" hadn't yet been coined.
At Christiana Care, Silverstein architected clinical information systems for critical care areas such as invasive cardiology from the ground up, from data modeling all the way up to supervising the programming team. He also was the clinical leader of commercial health IT acquisition and implementation for other medical specialties.
During the dot-com boom, he worked for an IT vendor, and then got recruited by Big Pharma, to run Merck Research Labs' internal science research library and IT group supporting drug discovery.
Today, at Drexel, Silverstein teaches and also consults with both plaintiff and defendant attorneys on health IT-related issues. "I cannot work in the health IT industry anymore," he says. "If I could even get a job, I'd likely be fired in five minutes from pointing out the problems." In short, those problems are manifestations of what he calls "bad health IT," as opposed to "good health IT."
Unfortunately, critics such as Silverstein are branded as anti-technology Luddites, or worse. "That framing of the issue is misleading," Silverstein says. "It is propaganda generated by the industry. Here's the proper framing of the issue. In fact, physicians are largely pragmatists. They will adopt technology when it's clear to them that it's both safe and effective and might actually make their patient care better. They'll adopt that readily, so much so that often times, one has to be careful of it being over-adopted, say cardiac stents, for example."
More here:
We all need to be utterly clear here. Scot is no madman or Luddite and he is making some points similar - in some ways - to those I am making.
Both he and I agree that ‘Big Health IT’ (Govt. or Private) are not delivering what clinicians want and need. The NEHRS / PCEHR is a banner example of this fact.
We also agree clinicians are not getting anywhere near enough input and influence into what is being designed and inflicted on us in the name of efficiency and not patient care and outcomes.
I suggest you keep a close eye on his blog and his occasional comments here!
David.

An Upcoming Workshop On Benefits Management In Health IT - Late February 2013.

Workshop Objective.
To understand how to manage the benefits of health IT and the fact that this depends on understanding the dynamics of learning to improve health systems.
Details.
There are places available for the 2 day and 5 day workshop in Sydney.
The title is: Dynamic Modelling: What, Why and How? Examples from New Technology Adoption, Infectious Disease and Health Care.
Two world expert practitioners and trainers Nate Osgood, ex MIT, and Andrei Borshchev, from St Petersburg, will be visiting from 18th to 26th  Feb. They specialise in combining different dynamic modelling methods including Discrete event, System Dynamics and Agent Based Simulation in Health and other Industries. There is a 2 day overview or a 5 day practical training option, and a likely choice modelling workshop the following week (Mon 25th and Tues 26th). The current details (including a downloadable flyer and online registration link) are on a temporary wiki page at
Please email geoff.mcdonnell@unsw.edu.au  for further details
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Seems to me that this may be very interesting for many in both the private and public sector - especially those involved in policy formulation and leadership.
I do hope you and your colleagues can attend this exciting event.
David.

Tuesday, January 15, 2013

The Countdown Has Now Really Started For The NEHRS / PCEHR To Prove Itself Adoptable and Useable.

2013 is going to be the year that makes or breaks the NEHRS. A couple of key facts point me to this view.
First we need to have a Federal Election before the end of the year and I suspect the outcome of that election will result in a binary outcome for the NEHRS. If Labor is re-elected the project will go on - at a level yet to be determined - and we will probably reach the stage where it becomes some sort of fixture. On the other had if the Coalition wins I suspect there will be a fairly quick review followed by a determination that enough money has been burnt on the current approach and a revised plan is needed. It may or may or not be funded in the remaining life of that Government.
Second with the commencement of the new upgraded e-PIP requirements in early February and early May we will be able to assess late in 2013 just what impact that upgraded incentive program has had on adoption and use of the NEHRS.
Third it is clear that neither the AMA or the RACGP are entirely comfortable with the various requirements and deadlines that are being imposed. This is the latest I have seen from the AMA.

Renewed calls for e-PIP extension

11th Jan 2013
MANY GPs could lose their eligibility for the e-health Practice Incentive Program (e-PIP) unless the 1 February deadline for software compliance is extended, says the AMA.
Prior to Christmas, AMA president Dr Steve Hambleton was calling for an eleventh-hour delay in the cut-off for payments if doctors do not achieve software compliance – required under new legislation to remain eligible – by the deadline.
Under the new arrangements practices can apply online through the Department of Human Services National Authentication Service for certification that their software is compliant.
However, Dr Hambleton argued during the holiday period many doctors in non-compliant practices were away and would not have been able to do any work to complete this process.
In an AMA poll taken in December asking GPs if they will be ready to have the first of the four e-PIP requirements in place by 1 February, 67% of 139 respondents said they would not be ready with just 33% saying they would make the deadline.
Dr Hambleton told MO he predicted it would be some months until most GPs would be fully compliant and renewed his call for the government to extend the deadline until at least 80% to 90% of practices are ready.
More here
I also note a distinct lack of confidence in being ready has not changed - Results  of GP Poll 13/01/2013 :

Will your general practice have the first four ePIP requirements in place by 1 February 2013?

Choices
Yes 32% (48 votes)
No 68% (102 votes)
Total votes: 150
To not have the clinical actors all lined up, trained and confident bodes pretty badly for what we are going to be seeing in the next 12 months. The bottom line is that this change and adoption task has simply not been managed properly or adequately resourced in my view.
In summary the next 12 months look to me to be make or break for all sorts of reasons, including that covered in Monday’s blog.
Time will tell and I don’t think many of us will die wondering.
David.