Report Watch – Week of 16th February, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Published 27 January 2009, doi:10.1136/bmj.b81
Cite this as: BMJ 2009;338:b81

Research

Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings

Richard L Tannen, professor of medicine, Mark G Weiner, associate professor of medicine, Dawei Xie, assistant professor of biostatistics and epidemiology

¹ University of Pennsylvania School of Medicine, 295 John Morgan Building, 36th and Hamilton Walk, Philadelphia, PA 19104, USA

Correspondence to: R L Tannen tannen@mail.med.upenn.edu

Abstract

Objectives To determine whether observational studies that use an electronic medical record database can provide valid results of therapeutic effectiveness and to develop new methods to enhance validity.

Design Data from the UK general practice research database (GPRD) were used to replicate previously performed randomised controlled trials, to the extent that was feasible aside from randomisation.

Studies Six published randomised controlled trials.

Main outcome measure Cardiovascular outcomes analysed by hazard ratios calculated with standard biostatistical methods and a new analytical technique, prior event rate ratio (PERR) adjustment.

Results In nine of 17 outcome comparisons, there were no significant differences between results of randomised controlled trials and database studies analysed using standard biostatistical methods or PERR analysis. In eight comparisons, Cox adjusted hazard ratios in the database differed significantly from the results of the randomised controlled trials, suggesting unmeasured confounding. In seven of these eight, PERR adjusted hazard ratios differed significantly from Cox adjusted hazard ratios, whereas in five they didn’t differ significantly, and in three were more similar to the hazard ratio from the randomised controlled trial, yielding PERR results more similar to the randomised controlled trial than Cox (P<0.05).

Conclusions Although observational studies using databases are subject to unmeasured confounding, our new analytical technique (PERR), applied here to cardiovascular outcomes, worked well to identify and reduce the effects of such confounding. These results suggest that electronic medical record databases can be useful to investigate therapeutic effectiveness.

Access the full report is here if you have access from www.bmj.com.

Second we have:

‘Dear Mr. President’

• Jan 26, 2009

Letters from 21 health information technology leaders to the new president portray a road map for building an electronic health care system that rewards productivity, retains knowledge and supports effectiveness of care.

Reward physicians for using health IT

You enter office during a time of unprecedented growth and opportunity in the field of health care information technology. Health care is an issue that goes beyond party affiliations and affects every citizen, and as you begin your term as president, we urge you to continue building on the momentum this industry has gained in the past decade.

Investing in health IT, such as the adoption and advancement of electronic health records, will help bring about an interoperable health care system, which studies have shown can save upwards of $150 billion to $300 billion annually to numerous stakeholders, including the federal government and, thus, taxpayers.

Furthermore, EHR adoption improves the quality of care that physicians and other caregivers are able to provide. In times of disaster and crisis, properly constructed EHR networks enable health care professionals to access a patient’s medical records at a moment’s notice, whereby they can quickly and effectively administer the proper care.

The benefits of widespread EHR adoption are hard to ignore. Yet many physicians remain reluctant to use these solutions to their fullest potential. A key step in advancing the adoption of EHRs is the creation and support of legislation and regulations that provide monetary incentives to physicians who successfully deploy health IT systems at the point of care. EHR adoption furthers the ability for physicians to perform more accurate and widespread clinical research that can unlock new medicines and treatments that benefit the greater good, from treating common illnesses to curing chronic diseases.

We urge you to continue supporting legislation and regulations that advance health care information technology.

Justin Barnes

Vice President of Marketing and Government Affairs,

Greenway Medical Technologies

Other 20 letters are found here:

http://govhealthit.com/articles/2009/01/26/dear-mr-president.aspx?s=GHIT_100209

This is the equivalent of a small report and is well worth reading. It summarises the wisdom of a generation as to what is vital in getting Health IT adoption and use underway. Mandatory reading in my view!

Third we have:

Access to electronic health records would help cancer patients: report

TORONTO — Many Canadians with cancer have yet to benefit from advances in electronic information technology that could improve how their disease is treated and managed, the Cancer Advocacy Coalition of Canada says in its annual report card.

The Report Card on Cancer in Canada, released Tuesday, suggests there it too little use of electronic health records to link distant communities to regional cancer centres, potentially robbing patients of better health outcomes.

The coalition recommends that patients should be given access to their own electronic health records.

"If patients can access their financial records from anywhere in the world, why not their health records?" says Dr. William Hryniuk, medical oncologist and past-chair of CACC. "If they could, their disease management would greatly improve and many system changes would quickly follow."

Research shows there is little or no use of electronic health records in remote communities that need them the most, says the coalition, noting that cancer patients need continuing access to those records to ensure optimal care, especially if they live a distance from a regional cancer centre.

Yet a CACC survey of oncology clinics located more than two hours from a regional cancer centre found that most aren't using electronic health records to record vital information.

Of 11 clinics surveyed across the country, seven had access to an integrated electronic health record (EHR) system linking them to the other centre; and of these seven, only three allowed clinicians to enter data.

"The net result in these cases is that tertiary centre oncologists who originally devised the treatment plans were not able to follow whether treatment was being given or what complications were encountered," Hryniuk, lead author of the study, said in a release.

"This raises the possibility that patients in these communities may not be getting the full benefits of care in terms of efficacy, safety and efficiencies received by patients in direct proximity to regional cancer centres."

In virtually every case, managing a patient's care requires treatment delivered by a large number of health-care personnel located in different locations, he said.

More here:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jHNo2SNF0Dmf1vtBIkzL6S1mErVg

The report can be found here:

http://www.canceradvocacy.ca/reportcard/2008/reportcard-2008.pdf

The value of Health IT in regional areas is argued persuasively here and it is a useful part of the overall report.

Fourth we have:

A Shared Roadmap and Vision for Health IT

By John Halamka, Mark Leavitt & John Tooker

Today’s economic crisis has highlighted our need for breakthrough improvements in the quality, safety and efficiency of health care. The nation’s business competitiveness is threatened by growing health care costs, while at the same time our citizens risk losing access to care because of unemployment and the decreasing affordability of coverage. Meanwhile, the quality variations and safety shortfalls in our care system have been well documented.

Health IT is not a panacea for all of these challenges, but it is a critical first step toward addressing many of them. Before we can restructure payment systems to reward quality, we need reliable, near real time data on outcomes. Before we can reward teamwork and collaboration that re-integrates care, we need applications that let clinicians communicate patient information instantly and securely. And in order to reverse the growing burden of chronic diseases, we need online connections that engage individuals in their care and motivate them to make healthier lifestyle choices.

Our current, paper-based health information process wastes hundreds of billions of dollars annually. Transforming this into a streamlined twenty-first century electronic system will require many components: a conversion to interoperable electronic health records (EHRs) at healthcare facilities, the adoption of online personal health records (PHRs) for individuals, health information organizations that support and connect these systems to allow information sharing, and finally a national health information network that allows instantaneous secure access – always with appropriate consent from the individual -- wherever and whenever their records are needed.

More here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/a-shared-roadmap-and-vision-for-health-it.html

The full Shared Vision document is found here:

http://ehrdecisions.com/wp-content/files/SharedRoadmapVisionHealthIT200902.pdf

Fifth we have:

Clinicians Override Most Medication Alerts

Laurie Barclay, MD

February 11, 2009 — Because clinicians override most current medication safety alerts generated by electronic prescribing systems, these warnings may be insufficient to protect patient safety, according to the results of a retrospective analysis in the February 9 issue of Archives of Internal Medicine.

"Electronic prescribing clearly will improve medication safety, but its full benefit will not be realized without the development and integration of high-quality decision support systems to help clinicians better manage medication safety alerts," senior author, Saul Weingart, MD, PhD, vice president for patient safety at Dana-Farber and an internist at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, said in a news release. "We need to find a way to help clinicians to separate the proverbial wheat from the chaff. Until then, electronic prescribing systems stand to fall far short of their promise to enhance patient safety and to generate greater efficiencies and cost savings."

The investigators reviewed 233,537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. Multivariate techniques helped to determine factors associated with alert acceptance.

More here:

http://www.medscape.com/viewarticle/588151

The original abstract and links to the full article are found here:

http://archinte.ama-assn.org/cgi/content/abstract/169/3/305?etoc

Clearly this issue needs to be carefully addressed by system designers ASAP.

Sixth we have:

HHS Enhances Privacy Web Site

February 11, 2009

The Department of Health and Human Services' Office for Civil Rights has revamped its health information privacy Web site.

The site has long had a variety of information about the HIPAA privacy rule. Now, it has added content on the Genetic Information Nondiscrimination Act and the privacy provisions in the rules that implemented the Patient Safety and Quality Improvement Act.

More here:

http://www.healthdatamanagement.com/news/privacy27712-1.html

Not quite a report but a useful reference web-site for health information privacy in the US.

The site is here:

http://hhs.gov/ocr/privacy/index.html

Seventh we have:

White Paper Discusses Smart Cards

February 13, 2009

The Smart Card Alliance Healthcare Council has issued a white paper offering guidance to CFOs on the use of the technology.

The white paper, “A Healthcare CFO’s Guide to Smart Card Technology and Applications,” is designed to help financial executives weigh the potential benefits of the technology, according to the council.

More here:

http://www.healthdatamanagement.com/news/smart_cards27720-1.html?ET=healthdatamanagement:e768:100325a:&st=email&channel=consumer_health

To obtain the report, visit smartcardalliance.org.

Last – and not quite a report – but an excellent summary of the facts – we have:

Consensus From Contradiction: A Clear Case for Reform Plus Health IT

by Peter Basch

The verdict on the value of health IT has always been divided and increased attention to the issue has done little to narrow that divide. Indeed, the entrance of a new administration committed to including health IT in its health care agenda has produced a near daily barrage of reports and commentary on the value of health IT -- with their verdicts increasingly disparate.

How should the incoming administration read this "scatter-gram" of recommendations? Should it conclude that health IT is so immature and unreliable that each study has legitimately arrived at a very different conclusion? Should President Obama modify his vision of moving all Americans to electronic health records from a horizon of five years to something considerably longer?

I think not. I believe a careful read of most studies -- including what lies between the lines -- reveals these common threads:

• Health IT is not mature, and does not yet contain all of the features that are necessary for it to serve as the infrastructure of 21st century health care (as defined by the Institute of Medicine); however, it is mature enough in most settings for use today;
• Health IT per se has a neutral effect on health care quality, safety and effectiveness and in some settings will be associated with worse results, in some will show no influence, and in some will show improvements to care;
• Adoption of health IT alone will not and cannot result in health care reform; however, meaningful health care reform is not possible without near universal adoption of advanced health IT;
• Health IT implemented in a dysfunctional and fragmented health care delivery and payment system will always show suboptimal and inconsistent results. This inconsistency always will be present until the variables of health care processes and incentives are controlled; and
• Adoption of health IT without health care delivery and payment reform is not enough and all but guarantees that the time, effort and dollars expended will disappoint the IT purchasers. It will certainly not give patients what they need and deserve -- which is a better, safer, and more value-laden health care system.

More here:

http://www.ihealthbeat.org/Perspectives/2009/Consensus-From-Contradiction-A-Clear-Case-for-Reform-Plus-Health-IT.aspx

Those bullet points above are pretty spot on for both the US and OZ I believe.

Again, all these are well worth a download / browse.

David.

When Do You Think Australian Politicians Will Get It?

Sometimes an article appears that really frustrates and annoys me. This is one!

Europe to double e-health research

19 Feb 2009

Viviane Reding today announced that the European Commission will double funding for e-health research over the next two years.

The European Commissioner for Information Society and Media said that over the next two years the Commission will invest €163m in e-health research. The funding will be channelled through its framework seven funding call.

Speaking by video link to the e- Health 2009 conference in Prague the Commissioner said the current economic crisis facing Europe had not deterred investment in e-health research but “put the long term benefits of e-health into sharp focus”.

More here:

http://ehealtheurope.net/news/4591/europe_to_double_e-health_research

The EU has invested heavily in e-Health research heavily over the last decade and a doubling shows just how it is valued and has apparently contributed to attract the additional funds.

This is quite a lot on money. 1 Euro is $A1.96397 so it is $A320 Million over 2 years. On a proportional basis (based on Nominal GDP) the figure would be $A20M+

I believe Australia would be very lucky to be spending that amount on dedicated e-health research from Government funds.

If so, this is another gap we should address. A doubling of what we are spending would be nice!

David.

International News Extras For the Week (19/02/2009).

Again there has been just a heap of stuff arrive this week.

First we have:

Why Clinical Groupware May Be the Next Big Thing in Health IT

By David C. Kibbe

What would you call health care software that:

• Is Web-based and networkable, therefore highly scalable and inexpensive to purchase and use;
• Provides a 'unified view' of a patient from multiple sources of data and information;
• Is designed to be used interactively - by providers and patients alike - to coordinate care and create continuity;
• Offers evidence-based guidance and coaching, personalized by access to a person's health data as it changes;
• Collects, for analysis and reporting, quality and performance measures as the routine by-product of its normal daily use;
• Aims to provide patients and their providers with a collaborative workflow platform for decision support; and
• Creates a care plan for each individual and then monitors the progress of each patient and provider in meeting the goals of that plan?

I call this Clinical Groupware. The term captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.

Clinical Groupware is a departure from the client-server and physician-centric EHR technology of the past 25 years, a fixed database technology that never really became popular. It is a substantially new and disruptive technology that offers lower price of purchase and use, greater convenience, and is capable of being used by less skilled customers across a broader range of settings than the technology it replaces.



As the name indicates, Clinical Groupware is intended for use by groups of people and not just independent practitioners or individuals. It is not the same thing as an electronic health record, but may share a number of features in common with EHRs, such as e-Prescribing, decision support, and charting of individual visits or encounters, both face-to-face and virtual. Neither is Clinical Groupware bloated with extra features and functions that most providers and patients don't need and, with good reason, don't want to pay for.

Some Clinical Groupware may look and feel like a web-based "EHR lite." But Clinical Groupware aims to create a unified view of the patient, assembling health data and information that may be stored in many different places and in several different organizations - including HealthVault or Google Health -- which most EHRs cannot do.

Clinical Groupware is an evolutionary approach to a shifting health economy in which doing more is not always equated with better care, and the physician or provider role is transforming from autonomous expert to advisor, partner, and guide. It is also an organic response to the reality that most health care data in electronic format is dispersed across numerous organizations and companies - e.g. hospitals, labs, pharmacies, and devices - and provides a means of accommodating patient demands for a more participatory practice of medicine.

A huge amount more here:

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/why-clinical-groupware-may-be-the-next-big-thing-in-health-it.html

This is a fascinating blog post that has triggered a great deal of discussion – well worth a careful browse.

Second we have:

Achieving Meaningful EHR Use: Leveraging Community Structures

by Farzad Mostashari and Micky Tripathi

Widespread use of interoperable electronic health records is necessary for transforming how health care is delivered and will be a key enabler of health care reform.

The Health IT provisions of the American Recovery and Reinvestment Act seek to promote nearly universal EHR adoption over the next 10 years, largely through incentive payments to be paid following meaningful use of EHRs for improvements in health quality, efficiency, prevention and safety.

However, successful implementation of EHRs is challenging, especially among small practices where most primary care is delivered.

These practices generally lack expertise and resources to purchase, install and use information technology to work better and more efficiently. Furthermore, despite the requirements for standards and certification, uncoordinated EHR implementations are unlikely to result in functional interoperability between systems.

More here:

http://www.ihealthbeat.org/Perspectives/2009/Achieving-Meaningful-EHR-Use-Leveraging-Community-Structures.aspx

The article provides two references and some useful links.

[1] Blumenthal D, The Federal Role in Promoting Health Information Technology, The Commonwealth Fund, January 2009

2. Mostashari F, Tripathi M, Kendall M. Lessons Learned From Two Large Community Electronic Health Record (EHR) Extension Projects. Health Affairs 28(2). March 2009 Forthcoming

MORE ON THE WEB

• List of signatories to the statement
• Massachusetts eHealth Collaborative
• New York City Primary Care Information Project

A useful article and a valuable perspective on major Health IT projects. This one will be a real ‘biggie’.

Third we have:

Prescribing errors are the most common medication errors in primary care practices

Most of the medication errors in primary care practices are prescribing errors, and more than half of these errors reach patients, concludes a new study. Electronic tools are necessary to reduce the rate of errors and subsequent harm (adverse drug events or ADEs) to patients, suggest the study authors. Studies of medication errors have typically been conducted in hospitals, rather than in primary care settings. To understand the nature of medication errors in primary care settings, the American Academy of Family Physicians (AAFP) Research Network and the AAFP Robert Graham Policy Center looked at medication error reports from two studies conducted in the network.

The researchers combined reports of medication errors from a 20-week medical error study involving 42 family physicians at 42 practices with those from a 10-week study involving 401 clinicians and staff from 10 diverse family medicine offices. Of a total of 1,265 medical errors reported, 194 reports concerned errors in medication. Seventy percent of the medication error reports involved prescribing errors, 10 percent each involved medication administration or documentation errors, 7 percent involved errors in dispensing drugs, and 3 percent involved medication monitoring errors. In 41 percent of the reports, the errors were prevented and did not reach the patients, while 59 percent reached the patient 35 percent did not require monitoring. Monitoring was required in 8 percent of the reports, intervention in 13 percent, and hospitalization of affected patients in 3 percent). Although 16 percent of the medication errors were ADEs, none of the errors resulted in permanent harm or a patient's death.

Pharmacists were most likely to prevent the errors from reaching the patients (40 percent of intercepted medication errors), while physicians and patients were almost equally likely to intercept the medication error (19 percent and 17 percent of intercepted errors, respectively). The researchers determined that more widespread use of heath care information technology, such as electronic medical records or computer physician order entry systems, could have prevented as many as 57 percent of the medication errors. The study was funded in part by the Agency for Healthcare Research and Quality (HS11584 and HS14552).

More details are in "Medication errors reported by US family physicians and their office staff," by Grace M. Kuo, Pharm.D., M.P.H., Robert L. Phillips, M.D., M.S.P.H., Deborah Graham, M.S.P.H., and John M. Hickner, M.D., M.Sc., in Quality and Safety in Health Care 17, pp. 286-290, 2008.

Site is here:

http://www.ahrq.gov/research/feb09/0209RA5.htm

This is another brick in the wall of the evidence for CPOE being of value in preventing error.

Fourth we have:

At-home monitoring helps seniors living with heart failure

February 9, 2009 (Victoria, BC) – Some heart failure patients who live in the Greater Victoria area are now able to manage their health care in just a few minutes a day, from the comfort of their own homes, with the help of Telehomecare – an in-home monitoring system being launched by the Vancouver Island Health Authority (VIHA).

"Telehomecare enables rapid detection of problems, allows patients to self-manage their care and saves travel time for both patients and caregivers," said Health Services Minister George Abbott. "It is one way we are breaking down barriers to quality health care for British Columbians regardless of where people live."

Every day at a set time, an in-home monitoring device will greet the patient with a pre-recorded message to remind them to take their vital signs: blood pressure, pulse, oxygen saturation level and weight. This information is then automatically transmitted over the phone to a computer in VIHA’s Home and Community Care office where the data is reviewed.

Christine Gotzman, VIHA’s Home and Community Care’s Heart Failure Nurse, recognizes the impact that this new service will have on patients who live with heart failure. "Until now, my only communication with my patients has been in person or over the phone," she says. "This new Telehomecare service gives me the ability to remotely ‘see’ how my patients are doing on a daily basis and deliver care proactively. Once the data is sent to my computer, I can quickly assess their condition and, if necessary, provide a targeted response to their changing health status."

The first phase of the Telehomecare program will measure the progress of approximately 100 patients living with heart failure chosen through VIHA’s Seniors At Risk Integrated Network, currently operating in the Greater Victoria area. The long-term goal is to provide Telehomecare services throughout Vancouver Island.

"This innovative program offers many direct benefits to our patients," said VIHA’s Board Chair Jac Kreut, "including improved access to care, a reduction in emergency room visits, shorter hospital stays and fewer hospital admissions."

The Telehomecare program is being delivered as part of a larger provincial Telehealth strategy that includes VIHA and Interior Health, with a combined budget of $836,000. Interior Health initially launched its Telehomecare program in 2006, and recently expanded its program last fall to include patients in the East Kootenays.

More here:

http://www.infoway-inforoute.ca/lang-en/about-infoway/news/news-releases/392-at-home-monitoring-helps-seniors-living-with-heart-failure

Another interesting study in the area of remote monitoring.

Fifth we have:

Teaching old docs new e-health tricks proves difficult

Younger physicians are more likely to gravitate to automated systems

Lucas Mearian

February 9, 2009 (Computerworld) Before the rollout an all-electronic health records (EHR) system about a year ago, only about half of the doctors and nurses in West Virginia's state hospitals were familiar with medical computer systems. So when technology rolled in, staffers pushed back.

"We actually had some nurses who were completely computer-illiterate. They didn't use a computer at work, and they had no use for it at home," said Jerry Luck, director of facilities systems administration at the West Virginia Department of Health and Human Resources.

West Virginia is not alone. Hospitals across the country are feeling pressure to implement more efficient IT systems in light of President Barack Obama's plan to establish a nationwide EHR system in the next five years. Under the Health Information Technology for Economic and Clinical Health Act (HITECH), physicians would be eligible for between $40,000 and $65,000 if they show they are using IT to improve the quality of care.

EHR systems are expected to streamline health care workflow, improve the quality of care and cut costs, according to experts. But medical facilities could also find themselves at loggerheads with some of their own staffers, which are far more familiar with pen and paper than a keyboard or tablet PC. Adding to the problem: the bulk of HITECH money will be awarded beginning in 2011, according to current legislation pending in the House. That doesn't give hospitals much time to prepare, and organizations that aren't ready won't receive funds.

West Virginia is a rarity: Its state government health care system has an all-electronic record-keeping system spread across seven medical facilities.

Lots more here:

http://www.computerworld.com/action/article.do?command=viewArticleBasic&taxonomyName=knowledge_center&articleId=9127549&taxonomyId=1&intsrc=kc_top

This is a useful summary of the issues encountered in an EHR roll-out and how they were addressed – a good read.

Sixth we have:

Users of prescription drugs being tracked in Arizona

by Ginger Rough - Feb. 9, 2009 12:00 AM

The Arizona Republic

Have you taken the painkillers OxyContin or Vicodin in the past 10 months? How about the sleep aid Ambien or the stimulant Ritalin?

If you have and you obtained the drug legally, your prescription information is likely being stored in a centralized, state-managed database that can be accessed by doctors and pharmacists around Arizona.

The program, which debuted in December and is overseen by the Arizona State Board of Pharmacy, is designed to cut down on the persistent problem of prescription-drug abuse. But it also has raised concerns among privacy-rights groups that fear computer hackers or unscrupulous health workers will access patients' personal information. State health officials who pushed for the program say they know of no breach of any similar database in another state.

The system, they say, allows physicians and pharmacists to more easily identify "doctor shoppers," people who visit various doctors to obtain drugs that are potentially addictive.

Doctors and pharmacists who learn of a patient's overuse through the system can stop providing him or her the drug, alert other doctors and pharmacists treating the patient, counsel the patient or even contact law-enforcement agencies.

"I am so excited that we are finally getting this for our state," said Dr. Stephen Borowsky, an anesthesiologist and pain-management specialist.

"It's absolutely necessary. . . . These medicines have such great potential for addiction."

The first prescription-monitoring database in the country was set up 13 years ago in Nevada. Now, more than 30 states have authorized or created such lists after deciding that the potential benefits outweigh privacy concerns.

More here:

http://www.azcentral.com/news/articles/2009/02/09/20090209pharmacydrugs0209.html

Clearly this is a useful initiative. The description of how the system works makes interesting reading and deserves consideration as one model of controlling prescription drug abuse.

Seventh we have:

New Devices Track Patients Who Wander

By PHILIP SHISHKIN

When an autistic child or an adult with dementia wanders off and gets lost, finding them quickly sometimes can make a difference between life and death.

As the market for search-and-rescue technology expands, LoJack Corp., the maker of wireless devices that allow cops to find stolen cars, is announcing Tuesday the launch of a radio-based product designed to locate people.

Several companies already offer devices that use wristband radio transmitters to help police locate people quickly. But advocates for the elderly and disabled say there's a large and unmet need for more such services.

An estimated 18,000 people are already using wristband radio-tracking devices made either by Care Trak International, a LoJack competitor, or by Locator Systems, a Canadian company acquired by LoJack last year. Some of them are distributed by police departments. On average, they cost about $25 to $30 a month to use, though in cases of need, they may be provided free.

There are an estimated 5.2 million Americans with Alzheimer's, and more than half of those affected sometimes go on random and dangerous walks, according to the National Alzheimer's Association. Wandering is considered among the most life-threatening behaviors associated with the illness.

More here:

http://online.wsj.com/article/SB123423274308166263.html

This seems like a useful innovation that has now been brought to market.

Eighth we have:

http://www.e-health-insider.com/news/4564/cerner_gets_green_light_in_london

Cerner gets green light in London

11 Feb 2009

NHS London and the NHS London Programme for IT have given the green light to further Cerner deployments in the capital.

The decision comes despite a the fact a programme of work to fix 22 known problems is running late and has yet to be completed. Royal Free reports that although good progress has been made it will not be possible to judge until March whether the fixes require work.

All further implementations of Cerner were shelved in October and an emergency ‘recovery plan’ instituted by LPfIT, BT and Cerner after serious problems with the Cerner Millennium software came to light at Barts and the London and Royal Free.

In January board papers, Andrew Way, chief executive of Royal Free Hampstead NHS Trust, reported good progress had been made, though the 90 day rescue project had been extended by agreement. The trust’s project board will monitor progress and “test the views of clinical and administrative staff in early March to assess the degree of improvement”.

EHI understands that a decision to restart Cerner implementations in London was taken at the beginning of February.

In December, NHS chief executive David Nicholson told the Commons health Select Committee that no more Cerner implementations would occur until known problems were resolved: “We’ve got some serious issues around the Cerner system, particularly in London at the Royal Free, and what we’ve said to Cerner and BT is that they’ve got to solve that problem at the Royal Free before we think about rolling it out across the rest of the NHS.”

At least one London trust reports having been told in the last few days that it should now “re-engage with Cerner”.

More here:

Cerner must be breathing more easily now the roll-out is progressing. One fears it still may be a bit of a poison chalice.

Ninth we have:

SafeMed changes name to Anvita Health, debuts Google application for mobile viewing

February 06, 2009 | Eric Wicklund, Managing Editor

SAN DIEGO – SafeMed is venturing into new territory, with a new name and some new products designed to push the company's healthcare footprint into new areas.

The San Diego-based healthcare analytics company - it provided the analytics engine for Google Health - announced this week that it will now be known as Anvita Health. In addition, the company launched a new mobile viewer for Google Health that allows users to gain access to their personal health records at any time and from any place.

"We see Google Health as a vital tool in allowing consumers to take a more active role in their own healthcare and the care of their families," said Ahmed Ghouri, Anvita Health's co-founder and chief medical officer, in a press release. "The Anvita Mobile Viewer builds a bridge between the home and the doctor's office and allows Google Health users to realize the full worth of their PHR data by taking it to where critical medical decisions are made."

Full article here:

http://www.healthcareitnews.com/news/safemed-changes-name-anvita-health-debuts-google-application-mobile-viewing

This is an interesting evolutionary direction for access to one’s PHR.

Tenth we have:

How Electronic Medical Records Can Be Used To Test Drug Efficacy

ScienceDaily (Feb. 9, 2009) — For years controversy has surrounded whether electronic medical records (EMR) would lead to increased patient safety, cut medical errors, and reduce healthcare costs. Now, researchers at the University of Pennsylvania School of Medicine have discovered a way to get another bonus from the implementation of electronic medical records: testing the efficacy of treatments for disease.

In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study recentlly appeared online in the British Medical Journal.

“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen says. “That’s the real message of our paper — this can work.”

More here:

http://www.sciencedaily.com/releases/2009/02/090206135313.htm

This is really interesting and important stuff – and adds another arm to the value proposition for EHRs. (See abstract in the report post for the week).

Eleventh we have:

New QRISK2 for heart disease launched

09 Feb 2009

A new version of the QRISK software which identifies patients most at risk of developing cardiovascular disease (CVD) has been released for clinical use.

QRISK2 uses a new CVD equation to estimate an individual’s risk of developing heart disease over the next ten years, drawing on analysis of primary care data from practices using the EMIS GP computer system.

Its creators argue that it provides an accurate and fairer assessment of CVD risk than the widely-used Framingham risk equation, taking into account the higher risk of developing CVD to patients from deprived areas and from certain ethnic groups. It also considers other risk factors including whether the patient already suffers from a pre-existing condition such as diabetes.

Last year the National Institute for Health and Clinical Excellence (NICE) made a draft recommendation that the QRISK formula should replace the Framingham risk score currently used but later reversed its decision.

More here:

http://www.ehiprimarycare.com/news/4553/new_qrisk2_for_heart_disease_launched

This is very important work as it will assist in identifying – before the event – those who need preventive cardiovascular treatment and hopefully avoid both suffering and cost!

Twelfth for the week we have:

Patient privacy is not a 'black vs. white' issue

Posted: February 12, 2009 - 5:59 am EDT

In response to Jean DerGurahian's “HIPAA privacy rule not enough to protect info: IOM":

The current debate over the security and privacy of health records has generated many hardened “black vs. white” positions. As I read them, most of these positions are based on the fear of the writer that something important to them will be impeded by whatever rules they imagine coming out of the debate. There is a simple solution to the problem, one which can address every need, if we accept a few principles.

• We must agree that the patient must be able to control the use of their personally identifiable health information, or PHI. The HIPAA regulations got this right! This first principle has a social benefit policy corollary: Information derived from my record, but which cannot be used to identify me, is not under my control. Rather it is under the control of any provider I have granted access, and they can authorize its use for research and public health purposes under appropriate safeguards.
• We need to acknowledge that no medical provider can properly care for a patient unless they have access to the full health records of the patient.
• We need to recognize that a person who seeks care from a provider must allow that provider to access their complete health record.
• We need to acknowledge that designated emergency providers, when presented with a patient that they can identify, must have access to that patient's records. This situation is equivalent to a self-referral since we presume that a patient unable to give consent for treatment gives it implicitly unless they have explicitly denied permission.
• When a patient allows a provider currently caring for them to consult with, or to refer them to, another provider, they also grant that provider access to their records, and grant the referring provider the right to pass on the access rights they hold. This the central principle that makes the solution work.
• Finally, we must provide, on behalf of the patient, assurance that no other person, provider or not, can see their PHI.

More here:

http://www.modernhealthcare.com/article/20090212/REG/302129988/1031/FREE

This article strikes me as a nice succinct statement of principles.

Second last for the week we have:

Reporter's Notebook: TEPR a show to be remembered

By Joseph Conn / HITS staff writer

Posted: February 11, 2009 - 5:59 am EDT

If, as C. Peter Waegemann has said, last week's Towards an Electronic Patient Record conference and exhibition was to be the last TEPR, it’s an appropriate time to salute Waegemann and the folks at his Medical Records Institute, who have produced the show for a quarter of a century.

Trade shows are what you make of them. The time and effort you spend plotting and sailing your course through the schedule of keynote speeches, presentations and vendor exhibition hall visits and the attitude you bring to those encounters has a direct bearing on the benefit you derive from the experience.

The show Feb. 1-5 in Palm Springs, Calif., this year was something on the order of my eighth TEPR, and I’ve enjoyed every one of them.

What I’d always found about TEPR, in comparison to its major competitor, the Healthcare Information and Management Systems Society show, was that TEPR was on a more human scale, more approachable. If TEPR was vaudeville, HIMSS was the Greatest Show on Earth.

During a TEPR session, you could always get a question asked and answered as it came up, and afterward, grab a word or two with a speaker or panelist and swap business cards without waiting in line behind two dozen other people.

I remember one of the great thrills of the TEPR shows of yesteryear was the notorious TEPR Challenge.

Electronic health-record system vendors, often fretful and sweating, would demonstrate their software on stage during documentations of a mock patient encounter. The vendors had 10 minutes to complete the patient record. Live shots of their systems were projected onto huge screens for viewing by an audience of many hundreds of potential customers and competitors.

More here:

http://www.modernhealthcare.com/article/20090211/REG/302119960/1029/FREE

This is a sad announcement with TEPR shutting up shop after so many years. The discussion of ‘foilware’ that was so prevalent in this space a few years I found especially amusing. Live demonstrations are certainly a valuable way to sort the wheat from the chaff.

Last for this week we have:

Infoway launches new certification service for health information technology vendors

Certification of consumer health platforms now available

February 12, 2009 (Toronto, ON) - Health information technology vendors entering the Canadian consumer health solution market can now apply for pre-implementation certification for their consumer health platforms from Canada Health Infoway (Infoway).

The e-Health Certification Services, launched today, will be broadened in the coming months to include consumer health applications.

“Infoway’s new certification service will help health information technology vendors develop solutions that leverage the considerable progress Canada is making in setting standards and deploying interoperable electronic health records throughout the health care system,” said Richard Alvarez, President and CEO, Canada Health Infoway. “Interest in consumer health solutions is growing, and ensuring these solutions are interoperable with the technologies clinicians are using to store Canadians’ health data is central to maximizing their potential.”

Certification will ensure consumer health solutions comply with Infoway’s privacy, security, interoperability and management standards and complement and leverage Canada’s investments in electronic health records. It will also provide vendors with an opportunity to demonstrate compliance with pan-Canadian standards.

Organizations investing in certified solutions can expect a higher degree of confidence that the products they purchase are reliable, interoperable, private and secure.

Vendors whose solutions achieve certification will be authorized to apply the “Infoway Certified” certification mark to their product and related marketing materials.

More here:

Again OZ is behind the US and Canada. I hope NEHTA’s plans in this area see the light of day soon so the painful process of catching up can begin.

There is an amazing amount happening (lots of stuff left out). Enjoy!

David.

E-Health to Assist Ill and Disabled Young Australians Communicate and Interact.

The following was released today – and I felt it was worth a post. Sounds like a great idea to me!

New Livewire Online Community Connects Young Australians Living With A Serious Illness, Chronic Health Condition Or Disability

The Hon. Senator Conroy, Minister for Broadband, Communications and the Digital Economy, today launched Livewire, a new online community which is the first of its kind in Australia, to help improve the emotional and social wellbeing of children and young people aged over 10 and under 21, living with a serious illness, chronic health condition or disability.

A wholly owned subsidiary of the Starlight Children’s Foundation, and co-funded by the Australian Government’s Clever Networks program, Livewire is designed to provide a free, safe and supportive online community for children and young people to hang out, connect, share experiences, creatively express themselves and know that they are not alone in their situation.

An estimated 450,000¹ young Australians aged between 10 and 21 are currently living with a serious illness, chronic health condition or disability. These conditions can profoundly impact their everyday lives, leading to frequent absences from school, sport and other social activities. The internet provides an innovative way to reach and connect these young people through a supportive online community.

“Connecting and supporting young people with a serious illness, chronic health condition or disability through a safe online community has been a vision of the Starlight team for many years,” said Jill Weekes, CEO of the Starlight Children’s Foundation. “Livewire helps to distract that young person from their pain, helps them better understand their illness and connects young people facing similar challenges so that no one feels alone.”

Unlike other social networks, Livewire is a secure, moderated community tailored to the needs of its private members.

“By combining the latest in online and mobile technologies with a safe and secure approach, we are developing a great online community for young people who are also dealing with a disability, chronic condition or serious illness,” said Omar Khalifa, Managing Director of Livewire. “With video, music and games, Livewire is a fun place to check out. However, it’s the young people who create blogs, chat and interact that will shape Livewire, keep it relevant and a make it a really great place to hang out.”

The Hon. Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy, said “The Livewire online community is a great example of broadband and digital technology assisting the support and well-being of people whose lives have been disrupted by chronic illness or disability. Livewire helps young people to stay in touch with those they love and to connect to gain support from others who may be sharing a similar situation.”

Livewire aims to have a significant impact on the social and emotional wellbeing of its members, to help relieve stress and anxiety, alleviate boredom and to help empower them to develop new life skills and make new friends.

Prominent child and adolescent psychologist, Dr Michael Carr-Gregg commented, “Too often, it goes unrecognised that young people with chronic illness or disability can be affected by anxiety disorders, mood disorders, self harm and even suicidal tendencies, and that these go hand in hand with their situation.

“Livewire is wonderful because you have 24 hour a day, immediate connection with a community of people feeling exactly the same way. This can instantly reduce their sense of isolation and put them in touch with someone who understands,” he concluded.

Livewire complies with strict safety measures to ensure the safety and security of its members. Each member’s parent or guardian is contacted personally to verify their identity before joining the community. What’s more, chat hosts trained by the Australian Federal Police are present seven days a week to moderate discussions.

The program is made possible by an investment of $7.2 million from the Australian Government’s Clever Networks program, and support from its launch partners. This funding has enabled Livewire to develop a long lasting, sustainable program that will support, inspire and encourage its members.

Livewire aims to connect 20,000 young people, siblings and parents by the end of 2009, and will work with and through other Not For Profit organisations, such as The Spastic Centre and Diabetes Australia to provide access to Livewire to its eligible members.

The next phase of Livewire will be the launch of Livewire Mobile which will enable young Australians to access the site and its community via their mobile phone. Livewire on Wheels, a bedside access program, has already rolled out at Canberra Hospital and The Sydney Children’s Hospital at Randwick. Throughout 2009, the program will aim to target an additional seven hospitals right throughout Australia, including The Children’s Hospital at Westmead, John Hunter Hospital in Newcastle, Princess Margaret Hospital for Children in Perth, Mater Hospital in Brisbane, Royal Brisbane and Women’s Hospital, and Royal Children’s Hospital in Melbourne.

This will be followed by the creation of dedicated Livewire sites for both parents and siblings of young people with a serious illness, chronic health condition or disability, enabling them to share experiences with others who understand what they are going through, and a research program which examines the therapeutic benefits of Livewire services and the impacts of Internet use on members’ social and emotional well-being.

Any young Australian aged over 10 and under 21, who is currently living with a serious illness, chronic health condition or disability who wishes to join Livewire or find out more information should visit http://www.livewire.org.au or contact member.services@livewire.org.au.

----- End Release.

Great idea – I hope it really helps!

David.

Does the National Health And Hospital Reform Commission (NHHRC) Know What it is Talking About in e-Health?

I have been reflecting for the last couple of days on the NHHRC comments in the e-Health area.

To me what seems to be the core of what they have said we have:

“Finally, in our Interim Report we argue that creating a robust and integrated primary health care service will require the implementation of a person-controlled electronic personal health record. Across Australia’s range of community- and hospital-based health care settings the sharing of information is limited, fragmented or non-existent. This results in high dissatisfaction from patients, exasperation from clinicians, adverse events and sub-optimal care.

An electronic health record that can be accessed – with the person’s agreement – by all health professionals and across all settings is arguably the single most important enabler of truly person centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia. We will explore the prerequisites and incentives to allow us to reach this goal in our final report.”

(See Page 8)

As previously noted the full report and broken down sections of the report are available from the NHHRC website.

Close reading of this suggests there is some confusion between two possible ways forward and that the thinking on the various options is, right now, quite muddied.

By “person-controlled electronic personal health record” I assume they are taking about an electronic health record for an individual that that individual has control and ownership of and which the individual decides who – and who not – is permitted access to the record. This seems to me to be describing a form of record as already offered (for free) by Microsoft Vault, Google Health and a host of smaller providers. This seems to be talking about a classic Personal Health Record (PHR).

While such records have now been available for a good few months there does not seem to be any information presently available on their use in Australia

It needs to be noted that the benefits profile and utility of PHRs is still to be clarified – although it makes intuitive sense there are situations where value will be easily demonstrable. What is seriously up for discussion at this time is just how the patient held and controlled record should interact with the clinician held ‘professional’ record.

However they then go on – in the same paragraph - to talk about the sharing of professional information between health care providers in hospitals and practices – somehow envisaging the person is also going to control this information as well. This is all very vague and muddy to me. This really conforms to no model I am aware of – except possibly in some UK practice management systems which can share information between the various clinicians associated with the practice while at the same time providing the patient with a view of the information held in the record on them as an individual. The record is controlled by the clinician but the patient has secure access to the same information.

In the next paragraph we have a description of what I would describe as a traditional Electronic Health Record (EHR) which is used by the clinician to manage and provide clinical care. It is this sort of record which has been evaluated so far in terms of making a positive difference to the quality and safety of patient care.

When the NHHRC says “We will explore the prerequisites and incentives to allow us to reach this goal in our final report.” I think there are a few things that it needs to do first – and given it has only five months until the final report it had better get going.

First it needs to assemble the evidence on what works and what does not work in the e-Health domain and how vital such technology is to health reform in general – taking into account overseas and local experience to date.

A useful source it might start from is found in my submission which can be found here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/113-moreassoc

Second it might like to consider the work done in the US on defining terms. If they see some value it might help discussions if they use language more precisely.

http://www.healthnewsdirect.com/?p=329

To the expert eye their words lack clarity and understanding at present.

Third it might then be an idea to define the strategic objectives and priorities the NHHRC has in the health record domain so that appropriate technical, security, privacy and so on architectures can be evolved and reviewed. Ultimately this work will inform what is delivered and what it will cost, as Government will certainly be keen to know!

I am sure NEHTA is keen to know if what the NHHRC is talking about is their IEHR of something different. If it is, it would be good if the NHHRC said so and defined how it envisaged it would work practically – given the dearth of detail so far from NEHTA.

This should then result in some sort of coherent set of suggestions as to what to do in this area.

To do this work the Commission will need some serious help, lots of it and soon!

Alternatively the Commission could review the Deloittes National e-Health Strategy developed a few months ago, conclude it is a useful way forward and endorse it (as Australian Health Ministers already have) as a way forward with any modifications it feels are vital after discussion with the authors and Booz who developed the NHHRC discussion paper on the issue.

The second approach is vastly to be preferred in my view, as it is not at all clear that if the Commission has not developed some clear, well articulated ideas by now, that it will in the next five months. Clarity and coherence of thought will be vital if any of these reforms are to succeed and e-Health will be a key enabler of that success.

David.

Personal Medical Devices are Linked to Personal Health Records

The following release appeared a few days ago.

IBM Teams With Google and Continua Health Alliance to Move Data From Remote Personal Medical Devices Into Google Health and Other PHRs

Efforts Expand the Content and Value of Personal Health Records

February 05, 2009: 12:01 AM ET

IBM (NYSE: IBM), in collaboration with Google and the Continua Health Alliance, today announced new software that will enable personal medical devices used for patient monitoring, screening and routine evaluation to automatically stream data results into a patient's Google Health Account or other personal health record (PHR). This breakthrough extends the value of PHRs to consumers and also helps to ensure that such records are current and accurate at all times. Once stored in a PHR, the data can also be shared with physicians and other members of the extended care network at a user's discretion.

Using IBM software to connect personal medical devices to Google Health and other health-record systems will allow patients to exchange vital health information with their doctors and other health services professionals more easily, and in real-time. As a result, health professionals can provide more timely feedback to patients on their conditions, suggest treatments, and help improve overall quality of life. In a world where chronic diseases like diabetes afflict more than 600 million(1), where more than one billion are overweight(2), and where the number of people older than 60 years will reach 1.2 billion by 2025(3), the IBM software solution can also help advance personalized healthcare.

For example, a busy mom can receive daily electronic updates on the health status of an aging parent who lives alone, is suffering from high blood pressure, and is on multiple medications. A traveling businessperson, who is diabetic and training for a marathon, can have a real-time discussion about her blood sugar levels and heart rate with her coach hundreds of miles away.

Google Health allows users to store, manage, and share their medical records and personal health information securely online. Google Health was officially launched last May, and is free to users and available online at www.google.com/health.

"Our partnership with IBM will help both providers and users gain access to their device data in a highly simplified and automated fashion," said Sameer Samat, Director for Google Health. "IBM has taken an important step in providing software that enables device manufacturers and hospitals to easily upload recorded data into a PHR platform, such as Google Health."

IBM integrated the capabilities of Information Management, Business Intelligence and the WebSphere Premises Server sensor event platform with Google Health. The new IBM solution will be able to:

· Support a wide variety of use cases, including chronic disease management, health and wellness, and elderly care, both in the United States as well as in countries and health-services enterprises around the world.

· Leverage the power of Services-Oriented Architectures, so that the partners can quickly build increasing volumes of flexible solutions for healthcare consumers and services providers based on modular components.

· Support the rapid growth of open standards through the power of the Continua Alliance, which is dedicated to enabling interoperable healthcare products and solutions.

· Support the development of solutions using the Google Health open platform.

"By harnessing the rapidly growing use of remote patient monitoring across every part of the healthcare services industry, our new IBM solution greatly increases the real-time value of PHRs for consumers everywhere," said Dan Pelino, General Manager, IBM Healthcare & Life Sciences Industry. "Open standards-based systems and technologies -- freely available to anyone interested in using them -- are key to fueling the development of systems that can share and exchange vital healthcare information on a timely basis, whenever and wherever it's needed."

IBM developed the software based on guidelines from Continua Health Alliance, a globally recognized organization dedicated to enabling interoperable personal healthcare products and solutions. It is also based in part on key open-source software available now from Eclipse and Open Health Tools, which are open-source communities dedicated to supporting advancements in healthcare.

"With close to a quarter of the world's population overweight, more than 600 million people with some form of chronic disease, and millions more reaching retirement age, the time for greater personal health management is now," said Dave Whitlinger, Continua Health Alliance President. "Continua member companies like IBM and Google are working on real solutions that will empower consumers and healthcare professionals to access and share information quickly and easily through connected products and solutions. Together, we can create a new marketplace, improve health and quality of life, and advance personal telehealth worldwide."

The technology behind this open, interoperable advance in PHR function was demonstrated successfully in October at the Partners Connected Health Symposium in Boston, MA, by IBM and Google, with the support of Continua Health Alliance.

(1) World Health Organization. (2005) Ten Facts About Chronic Disease

(2) World Health Organization. (2003). Obesity and Overweight: Dr. P. Puska, Dr. C. Nishida, Mr. D. Porter

(3) World Health Organization. (2006, February 13). The world is fast ageing - have we noticed?

About IBM:

For more information about IBM, please visit www.ibm.com.

The release is found here:

http://money.cnn.com/news/newsfeeds/articles/marketwire/0471635.htm

This is an important release in my view as it shows the work being done to have information flow on patient information flow directly into their PHRs so the information can then be assessed and acted upon. With the evidence strengthening as to the value and effectiveness of remote monitoring the implications for disease management programs seems to be enormous.

I predict a day a few years down the track when virtually all patients with chronic cardiovascular and respiratory disease, as well as diabetes, will be using devices of this type to assess and monitor their progress.

David.