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, December 07, 2013

Weekly Overseas Health IT Links - 7th December, 2013.

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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EHRs a top priority in 2014 OIG strategic plan

November 22, 2013 | By Marla Durben Hirsch
The security and integrity of electronic health records will be one of the U.S. Department of Health & Human Services Office of Inspector General's highest priorities in 2014 and beyond, according to the OIG's latest strategic plan.
The plan, released Nov. 21, identifies EHRs as one of the OIG's "key focus areas" until at least 2018. Its focus on EHRs is part of a larger priority of addressing long term operational and program vulnerabilities in health IT that also includes the securing the accuracy and completeness of Medicaid data and the privacy and security of personally identifiable information.
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Project to unify LOINC, Radlex

Posted on Nov 27, 2013
By Bernie Monegain, Editor
RSNA and the Regenstrief Institute have begun work to harmonize and unify terms for radiology procedures. The intent is to improve the quality, consistency and interoperability of radiology test results in electronic medical record systems and health information exchange.
The work is funded by a contract from the National Institute of Biomedical Imaging and Bioengineering.
RSNA, which owns and maintains the RadLex medical terminology for radiology, and the Regenstrief, which owns and maintains the Logical Observation Identifiers Names and Codes, or LOINC, terminology standard for medical tests and measurements, share the contract and will collaborate on the endeavor to produce a single unified source of names and codes for radiology procedures.
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Patient safety reporting overhaul

27 November 2013   Lis Evenstad
The NHS is developing the National Reporting and Learning System to become an integrated reporting route for patient safety incidents.
The system was previously run by the National Patient Safety Agency and is used to report and analyse patient safety incidents such as falls or surgical errors.
However, it has taken a back seat since the closure of the agency in June 2012, when responsibility was transferred to NHS England.
There are two national reporting systems for patient safety in the NHS; the NRLS and one run by the Medicines and Healthcare Products Regulatory Agency. This causes inconsistency as some incidents will be reported to both systems, while others will only be reported to one of them.
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Pew: Online resources a 'significant supplement' for chronic condition patients

November 27, 2013 | By Ashley Gold
A new survey from the Pew Research Center and the California HealthCare Foundation finds that while people with chronic conditions are now more likely than ever before to seek health information online, seeking information from a physician remains the most preferred mode for such patients.
Surveying 3,104 adults living in the U.S., Pew researchers found that Internet users are more likely than other online adults to:
  • Obtain information about medical problems, treatments and drugs online
  • Consult online reviews about drugs
  • Read or watch things online about someone else's health experience
"Our research makes it clear that when the chips are down, people are most likely to get advice from a clinician, but online resources are a significant supplement," Susannah Fox, lead author of the study and an associate director at the Pew Research Center, said in an announcement. "Just as significantly, once people begin learning from others online about how to cope with their illnesses, they join the conversation and also share what they know."
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4 super-sized healthcare trends

November 27, 2013 | By Ilene MacDonald
Healthcare leaders must adapt to regulatory, technology, medical and market changes that are forcing the re-invention of healthcare. A report from Mannett Health Solutions identifies 10 "megatrends" and the smaller movementsand sub-trends supporting these super-sized developments.
Here are four of interest:
Patients take control of their care: Consumers are becoming more informed about healthy living and how to manage their own health. In addition, healthcare exchanges now offer Americans more insurance options and many patients will choose high-deductible and cost-sharing plans, the report notes.They will demand more information on upfront costs, as well as information on chronic diseases and treatment options. Expect explosions in the growth in self-monitoring technologies.
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AHRQ Releases Report on Technology and Ambulatory Quality

Written by Ellie Rizzo | November 26, 2013
The Agency for Healthcare Research and Quality has released "Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program," which has found correctly implemented technology systems have the potential to support quality in ambulatory care.
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Report: Bulk of iEHR funds spent on support services

Beth Walsh
Nov 25, 2013
More than $300 million in funding for an integrated EHR system at the departments of Defense and Veterans Affairs was spent on support service contracts in 2012, according to a report from the Interagency Program Office (IPO).
IPO is charged with modernizing the military health system's EHR software.
In 2009, DOD and VA first launched an effort to create a joint integrated EHR designed to allow every service member to maintain a single EHR throughout his or her career and lifetime. In February, however, DOD and VA officials announced plans to halt the iEHR project and focus on making their current EHR systems more interoperable instead.
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EHI Round Table: How to implement an effective EPR

Sponsored by Aura Healthcare as part of The Big EPR Debate

Introduction

In October 2013, EHI convened the second roundtable in The Big EPR Debate that it launched to debate the future of electronic patient record systems in response to health secretary Jeremy Hunt’s call for the NHS to become ‘paperless’ by 2018.
The event in Leeds, sponsored by Aura Healthcare, moved on from earlier discussions about the building blocks of an EPR, and instead gave participants time to explore the best way to implement an effective EPR.
At its simplest, this boils down to a seemingly simple division: work incrementally using ‘best of breed’ systems or go for one system, or at least a set of core systems, from a ‘single supplier’? But as the debate showed, there is more to it than that.
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More seniors expect digital health options

By Anthony Brino, Associate Editor
More and more seniors are interested in using digital health tools in their home, a finding that both health organizations and policymakers might consider as they look for improvements and savings in Medicare, according to a new study.
In a survey of Americans 65 years and older by the consulting and IT company Accenture, more than half said they think it’s important to have the option of emailing their doctors and providers, and almost 70 percent think it’s important to be able to book appointments and request prescription drug refills online.
Yet among the seniors surveyed, access to those kinds of digital choices are still limited among hospitals and physician practices.
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5 ways to avoid HealthCare.gov mishap

Posted on Nov 26, 2013
By Diana Manos, Senior Editor
To say an IT project like HealthCare.gov was a large-scale, complex behemoth undertaking is an understatement, to say the least. All the myriad elements of the project must be successfully interconnected for it to function properly, which clearly did not occur. 
Neglect any one of these elements and it can lead to "outright failure," says Richard Spires a consultant who formerly served as the Department of Homeland Security's chief information officer.
At a Nov. 13 House oversight hearing, Spires offered tips to be gleaned from HealthCare.Gov's difficult launch. Spires, who left DHS in May 2013, said he based this advice solely on information about the project he learned from listening to Congressional hearings and from news stories, rather than internal knowledge.
Here are Spires' five tips for launching a winning IT project.
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Incomplete data hits Hants record use

22 November 2013   Rebecca Todd
Leading users of the Hampshire Health Record have expressed frustration with the growing problem of incomplete data on thousands of patients, caused by GPs switching to TPP’s SystmOne.
Data is incomplete because SystmOne does not currently provide daily extracts to the record, but TPP says it is working on a solution.
Established in 2005, the HHR is one of the best-known shared record projects in the country. It receives data feeds from GP practices, acute and community trusts, using the Graphnet CareCentric portal.
Now run by NHS South Commissioning Support Unit, it covers 1.9m patients and is available to view by anyone involved in a patient’s care.
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ONC's Joy Pritts on breach prevention: Encryption is key

November 26, 2013 | By Ashley Gold
Encryption is the single most essential technology to use for breach prevention, according to Joy Pritts, chief privacy officer at the Office of the National Coordinator for Health IT.
Pritts, in a recent interview with Healthcare Info Security, said that encryption is "much more advanced" than it was five years ago, and necessary as patient privacy issues continue to persist.
"We still see the largest impact of breaches has been from lost and stolen technology," Pritts said. "[T]here really is not a good reason at this point, if you're purchasing new technology, not to make sure that you can encrypt it."
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How IT changes the medical thought process

November 26, 2013 | By Gienna Shaw
Healthcare is a fun and rewarding field, says Steven Steinhubl, M.D., director of the Digital Medicine program at the Scripps Translational Science Institute (STSI). But with pressure to see more and more patients in a fee-for service world and an abundance of new technologies that can improve care but also disrupt workflow, doctors don't always feel that way.
"It's understandable but I find it very depressing," he told FierceHealthIT in an exclusive interview at the STSI offices in La Jolla, Calif.
"It's just one symptom of a broken healthcare system. We definitely have the tools to fix it but we have to figure out exactly how. And the healthcare system is so recalcitrant to change that we have to supply the evidence that will help move that."
To that end, STSI's research projects examine the clinical and financial benefits of mHealth.
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Senate Bill Would Expand Access to Medicare Data

NOV 25, 2013 3:46pm ET
New legislation introduced in the U.S. Senate would expand availability of Medicare data to industry stakeholders and make access and utilizing the data more user-friendly.
Sens. Tammy Baldwin (D-WI) and John Thune (R-SD) sponsor S. 1758, “The Quality Data, Quality Healthcare Act,” referred to the Finance Committee and soon available at congress.gov.
“Congress and the Administration have taken initial steps to make Medicare data more widely available,” according to a fact sheet from the senators. “One of the more promising efforts is the Quality Entity (QE) program, which permits organizations to access and analyze Medicare data for select purposes. The QE program has the potential to empower our nation’s health care decision makers to make better choices. However, current law is far too restrictive on which organizations can participate in the QE program, what QEs can do with the Medicare data once they have received it, and the degree to which QEs can support their own data maintenance infrastructures.”
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Displaying Lab Prices on EHR Systems Cuts Costs

John Commins, for HealthLeaders Media , November 26, 2013

Evidence is mounting that when physicians know the laboratory costs of tests prior to ordering them, they show a decrease in ordering rates, and not only for high-cost tests.

A new study adds to a growing body of evidence suggesting the potential for significant healthcare cost reductions when physicians know the up-front cost of ordering routine lab tests.
The latest study involved 215 primary care physicians at Atrius Health, an alliance of six non-profit medical groups, and a home health and hospice agency in Massachusetts that uses an integrated electronic health record system. Physicians in an intervention group received real-time information on laboratory costs for 27 tests when they placed their electronic orders, while physicians in a control group did not.
Changes in the monthly laboratory ordering rate between the intervention and control groups were compared for 12 months before and six months after the intervention started. Six months after the intervention, all physicians taking part in the study were asked to assess their attitudes regarding costs and cost displays.
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Google Glass Passes IRB Muster, Assists in Cardiothoracic Surgeries

Scott Mace, for HealthLeaders Media , November 26, 2013

Surgeons are justifiably excited by the possibilities of using Google Glass in the operating room. Despite Wi-Fi hurdles, privacy concerns, and speech recognition issues, this device will inevitably become another indispensable tool in healthcare.

Forget the new iPhone. The gift every healthcare technologist wants under his or her tree next month is Google Glass.
Suddenly, talk of Glass in healthcare is snowballing. It's the newest bright shiny object in tech, and we're hearing it could be a panacea for all that ails healthcare—unusable software, patients irritated by doctors glancing at their screens or iPhones, even infections spread by lack of handwashing and further spread by the vector of the keyboard.
Whoa. Not so fast.
Google Glass is undoubtedly a cool step forward in healthcare technology. For one thing, it's the latest marketing tool for the very modern hospital. Second, it's from Google – a company that has already changed the practice of medicine forever. Show me a physician who hasn't Googled something as part of their day's work, and I'll show you an out-of-touch physician.
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Docs tap EMR data for disease research

Posted on Nov 25, 2013
By Erin McCann, Associate Editor
In the realm of modern healthcare, data is king. And, in many cases, the electronic medical record has proven itself a valuable source to extract that data. Most recently, researchers are using the EMR in conjunction with genetic data to discover new disease associations, which may have huge implications for future medical treatments. 
The first large-scale phenome-wide association, or PheWAS, study conducted by researchers at Vanderbilt University Medical Center and co-authors from the Electronic Medical Records and Genomics Network, was released today in Nature Biotechnology.
Traditionally, genetic studies begin with one disease and examine one or many genotypes. PheWAS, officials say, does the inverse by instead examining several diseases for a particular genetic variant or genotype.
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Telemedicine consults may reduce errors at rural ERs

NEW YORK Mon Nov 25, 2013 12:32am EST
 (Reuters Health) - Emergency rooms in rural areas don't see many very sick or badly injured children each year. When they do, bringing in a pediatric critical care specialist by videoconference to help with treatment could prevent errors, a new study suggests.
Researchers found rural ER doctors made errors in administering medication - such as giving the wrong dose or the wrong drug altogether - just 3 percent of the time when they used so-called telemedicine to connect with a specialist.
That compared to an 11 percent error rate when local doctors talked with a specialist by phone and a 13 percent error rate when they didn't consult with a specialist at all.
"We know that we make a difference by being able to see the patient," Dr. James Marcin said. The study's senior author, he is on the telemedicine team at the University of California Davis Children's Hospital in Sacramento.
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Patient-Reported Functional Status Data May Soon Be Included in EHRs

by Ken Terry, iHealthBeat Contributing Reporter Monday, November 25, 2013
In our tech-obsessed era, remote patient monitoring is often viewed as the most promising method of obtaining in between physician visits data on patients who have chronic diseases or who have been recently discharged from the hospital. Yet lower-tech approaches to getting feedback from patients on their functional status are likely to have more impact on health care providers and patients, at least in the short term, than home and mobile monitoring will.
Functional status can be evaluated through clinical observations, patients' verbal reports to caregivers and/or functional status surveys completed by patients. It has been described as essential to outcomes measurement, transitions of care and care management, especially of geriatric patients. Yet until recently, functional status information has not been well documented in electronic health records or in paper records. With a push from the Office of the National Coordinator for Health IT, however, that may change dramatically in the next few years.
Kevin Larsen, medical director of meaningful use for ONC, said that incorporating patient-reported data, including functional status information, in certified EHRs "has been a high priority for us from the beginning, and it continues to be a high priority for us now."
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Analysis of huge data sets will reshape health care

Kelly Kennedy, USA TODAY 5:32 p.m. EST November 24, 2013

The analysis of huge data sets can help researchers and physicians develop more effective medical treatments.

Story Highlights

  • Analysis will guide physicians on which drugs are most effective
  • The Affordable Care Act provisions for electronic records have created more data to analyze
  • Genome research coupled with data analysis the next frontier
WASHINGTON — Insurers will soon reassess how they predict costs; patients will let doctors know what medications won't work with their particular genomes; and researchers will look at hospital records in real time to determine the cheapest, most effective ways to treat patients — all because of developments in what is known as big data.
Driven by industry trends and the Affordable Care Act, the analysis of large sets of data, such as medication usage or hospital readmissions, has enabled health care providers and policymakers to make smarter decisions and predict future trends. Electronic medical records and decisions by governments and companies to share data have made for smarter decision-making that can save money and provide better care, experts say.
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Enjoy!
David.

Friday, December 06, 2013

This Is A Technology Trend That Could Really Make A Big Difference. Do Keep A Close Eye On It.

This appeared a little while ago.

3D printing is new face of medicine

By Sally Davies
Inside the pistachio-coloured walls of a London hospital, 16 fake eyeballs sit gleaming on a shelf next to a collection of noses. A man holds up a slice of green silicone in the shape of an ear.
“It’s a very early sample,” says Tom Fripp, managing director of Sheffield-based design consultancy Fripp Design and Research. The company is the first to directly print an object in medical grade silicone, a substance whose pliable texture is well-suited to soft tissue prosthetics.
In the next room London dentist and implant manufacturer Andrew Dawood shows a 3D printed copy of the vascular system of conjoined twins. They were separated in 2011 after doctors used Mr Dawood’s model to practice the surgery beforehand, improving the odds of success and reducing the risky time the patients spent under the knife.
The hospital where the medical products were on display was an ersatz affair at a November trade show. But their makers were serious about the importance of 3D printing – a group of novel production methods, also known as “additive manufacturing”, which build up objects layer by layer, instead of more traditional approaches such as carving them out from chunks of material.
“Whenever you have relatively small volumes of high value parts, that’s when it begins to make sense to use additive manufacturing,” says industry analyst Terry Wohlers, commenting on the medical sector.
The technology lends itself to customisation, and its evangelists claim it will lead to printing drugs and even organs. But British medical businesses, from dentistry to orthopaedics, are already using 3D printing to design highly personalised products.
Improvements in digital imaging have prompted the latest wave of 3D medical manufacturing innovation, says Thierry Rayna, a technology and economics expert at ESG Management School in Paris.
Mr Fripp’s consultancy is conducting early patient trials for nose prosthetics designed from patient scans. They are made from a hybrid process, different to that of the ear, in which silicone is forced into a 3D printed starch scaffold under pressure.
This cuts down production time from six weeks for a handmade version to 48 hours for a printed one. At £1,500, the first item costs as much as a standard prosthesis but falls to about a tenth of the cost for reprints from the digital file – a handy saving if the nose is damaged or if the patient’s skin-tone changes with a summer tan.
Lots more here:
This really is exciting stuff even now - but as we start to see actual real live organs being printed - which is already happening in the lab - it will be hard to imagine what next.
A must read to get a feel for the possibilities.
David.

Thursday, December 05, 2013

Australian Telehealth Gets A Couple Of Discussions and Reviews. Well Worth A Browse.

This appeared a just few days ago.

How new technology is changing access to health care in Australia

  • November 24, 2013 12:00AM
FROM a smartphone app that scans your vital signs to doctors treating their far distant patients through "face time" on their tablets or computers, technology is changing the way thousands of Australians access health care.
General Practitioner Ashley Collins is stationed more than 1000 kilometres from his patient but he can get a blood pressure reading without laying a hand on the company director.
Using a video link and a portable machine owned by the patient he can measure blood glucose, pulse rate, body temperature, cholesterol and even get an ECG measurement.
When he's completed his diagnosis he faxes a script to the chemist nearest his patient.
Dr Collins, from Temorah in central western NSW, uses a specialised computer to deliver this care but from next year he says patients will be able to do this from their mobile phone.
Already there are new devices including ultrasounds, ECG monitors, mirocroscopes and dermatascopes that can view skin cancers and blood pressure monitors that can be plugged into a smartphone.
A picture of an inner ear or throat taken on a smart phone can help a doctor diagnose and infection.
One app even allows you to scan your vital signs just by placing the phone on your forehead to measure heart rate, and body temperature.
Telemedicine Australia GP Dr Collins is part of a network of 15 general practitioners and 270 specialists providing telemedicine to thousands of patients around Australia.
There is no Medicare rebate for the GP service he provides at a cost of $50 a session, a problem he thinks Medicare and health funds should remedy.
Lots more here:
Second I noticed this a few days ago.

Telehealth: The healthcare and aged care revolution that can pay for the whole NBN

Nick Ross ABC Technology and Games Updated 20 Sep 2013 (First posted 19 Sep 2013)
Australia will spend over $10 trillion on healthcare over the next thirty years - much of it on aged care. If the new NBN-related health applications make a tiny dent in that figure, they would pay for the whole NBN. And revolutionise healthcare for all.
In the toxic fact-free zone that represents the bulk of National Broadband Network discussion, most people would be shocked to know that the NBN is likely worth building for the healthcare benefits alone - especially for the old and infirm. And the NBN doesn't just offer a healthcare revolution, it's likely to save tax payers billions of dollars every year. Most important of all, however, is the notion that these new-generation 'Telehealthcare' applications are only viable using the current Fibre to the Home broadband policy and not the Coalition's alternative. Could it be that convalescing old ladies, who have never used a computer in their lives, are the pin-up girls for fibre-based broadband?
Meaningless phrases and numbers
Many people are sick of hearing nebulous terms like 'superfast broadband' and jargon like 'jigabits per second' and 'download speeds.'
Telehealthcare ignores all of that and treats the NBN like the infrastructure that it is - a network which provides a medical-grade, reliable connection to each home and a complete standardisation of equipment - i.e. 'one box and one interface for everyone' - instead of the hotchpotch, 'every-situation-is-different' situation that we have today.
Why is this important?
Australia's ballooning health spend
According to the Australian Institute of Health and Welfare, the country spent over $121bn on healthcare between 2009-10. The following year it surpassed $130bn and it's been rising at six per cent each year - twice the growth rate of GDP.
Healthcare expenditure currently makes up 10 per cent of GDP but analysts Mark Dougan from Frost and Sullivan says that, "At the current rate, in perhaps about ten years or so, it will hit 15 per cent of GDP - mostly from public sources." He points out that this growth rate is "unsustainable."
At the time we released the 2007 South Australian Health Care Plan, if SA Health had continued spending at the same rate, then by 2032 the entire State budget will be consumed by Health alone. Our efforts to reduce growth in demand has now pushed this back to 2038. Slowing the growth in demand, however, must be accompanied by providing more efficient services in order to deliver a balanced budget...
Peter Croft from Allocate (healthcare) Software adds, "Most State governments have identified a point in the future where the growth in funding for health is going to consume the entire state budget."
The problem is that improvements have to come from efficiency gains and not spending cuts. As Stephen Duckett and Cassie McGannon said recently in The Conversation:
Reducing health spending growth will not be easy. As Grattan's Game-changers report last year showed, Australia already has one of the OECD's most efficient health systems, in terms of life expectancy achieved for dollars spent. Sweeping cuts to health funding, or shifting costs to consumers, could have serious consequences. Blunt cost-cutting risks reducing health and well-being, and could ultimately lead to higher government costs due to illness, increased health-care needs and lower workforce participation.
What do we spend the money on?
The Australian Institute of Health and Welfare published the following:
On an average day in Australia...
  • 342,000 people visit a GP
  • 6,800 people are transported by ambulance; a further 900 are treated but not transported
  • 71,000 km are flown by the Royal Flying Doctor Service and 107 evacuations performed
  • 23,000 people are admitted to hospital (including 5,000 for an elective surgery)
  • 17,000 people visit an emergency department at larger public hospitals
So how much does do these things cost?
Pages and pages more here:
Both these article describe some good things that are happening now which seems rather better than we are presently getting now from the PCEHR for a great deal less money!
The second article contains many examples and a discussion of where the NBN fits in the telehealth story in considerable detail.
Definitely one for the files.
David.

Seems E-Health Got A Run In Question Time Today. A Liberal Dorothy Dixer No Less.

This just popped up on my feed.
Zero! says Health Minister Peter Dutton. Because the previous Government forgot to organise it!
How many constituents in Deakin would be able to turn up at emergency and have their e-records available? was the question.
Question to Peter Dutton on how the whole e-health thing is working out.
Now I wouldn’t like to be reading tea-leaves but it is hard not to wonder what the PCEHR Review has been telling him. The question was from a Liberal Member and was clearly to give Mr Dutton an opportunity to comment on the PCEHR.
Make of that what you will.
David.