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, October 23, 2010

Some Serious Food For Thought For Hospital Managers. Your Safety Performance Needs Improvement!

The following appeared a day or so ago:

HealthGrades study: 'Unacceptably wide gap' between top peforming hospitals, others

October 19, 2010 | Molly Merrill, Associate Editor

GOLDEN, CO – Patients at five-star rated hospitals had a 72 percent lower risk of dying when compared with patients at one-star-rated hospitals, according to a new independent study by healthcare ratings organization HealthGrades.

Experts say this is an enormous gap that has held steady over the past years even as overall mortality rates have improved.

The "Thirteenth Annual HealthGrades Hospital Quality in America" study analyzed objective mortality and complication rates at all of the nation's 5,000 nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services.

The study, the largest of its kind, identified national and state-level trends in hospital care quality and established quality ratings for each hospital, across 26 different procedures and diagnoses. The ratings are now online, allowing individuals to compare their local hospitals.

Looking at overall trends, the HealthGrades study found that hospital mortality rates, on average, have declined by 7.98 percent over the three-year period studied, from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, only two bucked the overall trend with increasing mortality rates – gastrointestinal surgeries and coronary intervention procedures.

As part of the study, HealthGrades rated individual hospitals with a one-star, three-star or five-star rating in each of 26 procedures and diagnoses, from bypass surgery to total knee replacements. A one-star rating means that the hospital performed below average, to a statistically significant degree, when compared with the other 5,000 hospitals. A three-star rating means the hospital's performance was average, and a five-star rating means the hospital outperformed the national average to a statistically significant degree.

Lots more detail here:

http://healthcareitnews.com/news/healthgrades-study-unacceptably-wide-gap-between-top-peforming-hospitals-others

The astonishing fact that emerges from all this is that if all patients were treated in 5 star organisations over 230,000 more would be saved.

There is no reason to believe we do not have similar levels of performance and variability here in Australia.

Put this together with this following and there is a partial and e-Health related explanation:

Joint Commission Touts Research on Reducing Handoff Failures

Cheryl Clark, for HealthLeaders Media , October 22, 2010

A 10-hospital collaborative to reduce handoff failures, the root cause of four in five adverse events, successfully cut by 52% the number of faulty handoffs by identifying reasons why communication fails, says Mark Chassin, president of the Joint Commission.

Chassin says that when these solutions are refined, they may become part of the commission's hospital accreditation process, with a report on their outcomes expected by mid 2011. Also in the works is the development of a way to quantify how reducing handoff failures improves outcomes, he says.

Chassin spoke during a briefing with representatives of several hospitals participating in the commission's Center for Transforming Healthcare. And during that session, many noted that lack of respect between sender and receiver, and varying cultures and focus—for example between the emergency room team and an inpatient team—may explain some reasons why information that must be conveyed is not.

"This is a ubiquitous problem," said Chassin, former Executive vice president for Excellence in Patient Care at Mount Sinai School of Medicine and former Commissioner of the New York State Department of Health.

Lots more details here:

http://www.healthleadersmedia.com/content/QUA-258102/5-Tips-for-Reducing-Handoff-Failures

From here we are told e-Health has a role:

Restructuring is not the answer: healthcare reform

  • OPINION: Jeffrey Braithwaite
  • From: The Australian
  • October 23, 2010 12:00AM

WE often hear about terrible things happening to ordinary people in our hospital system.

And just as regularly we hear tales of doctors and nurses stretched to their limits, and a healthcare system in crisis.

It's a strange kind of cold comfort to know that across the developed world, error rates are about the same: that of all the people who go into hospital about 10 per cent will end up being harmed.

There may be a medication error, patients could acquire an infection, fall in the shower, or suffer from surgical complications.

This sort of thing shouldn't happen, yet with more than 7 million in-patients treated in Australian hospitals last year, it is impossible to imagine a nil error rate.

But as the medical profession's primary motto is "first do no harm", 10 per cent seems unacceptable.

As we undergo national reform of our healthcare system it is useful to reflect on what effects these changes will have on this impenetrable statistic.

My concern with the federal government's health reform is that it is very top-down and it's going to take two or three years before we see a system in place where smaller groups of joined-up hospitals are looking after patients in a more focused way.

What happens in the meantime is a worry for all of us.

The reform agenda assumes people are going to work together effectively. That's a big conjecture and something health systems worldwide are struggling to achieve.

Government is doing what it always does: it looks at how things are financed, how they are structured and where all the boxes go on the organisational chart; it changes the boundaries of the health districts every few years so they are sometimes larger and sometimes smaller.

Do any of these things translate into better outcomes when it comes down to patients getting care from clinicians? Not really.

At the coalface, hospitals are being asked to tell people about errors when they are made and to explain how they happened, how hospitals are sorry for the effects, and how they plan to stop it occurring again.

This is much more important than any restructuring.

E-health initiatives play a huge role in the area of monitoring patients and in improving communication, the root cause of most errors, but we have a long way to go on that front and we've been reading a bit recently in Weekend Health about the challenges the federal government is facing in this area.

We are struggling to find a system that provides physicians timely, accurate information while safeguarding patients' privacy.

More here:

http://www.theaustralian.com.au/news/health-science/restructuring-is-not-the-answer-healthcare-reform/story-e6frg8y6-1225941975622

And at the end we are also told:

“The three-day National Forum on Safety and Quality in Healthcare begins in Canberra on Monday.”

I would suggest there is a pretty large elephant in the room (many too many unnecessary deaths in hospitals) here that we might want to see action on for all our sakes. (We don’t really know bad it is because the statistics are a trifle hard to come by - and politicians don’t want to scare the horses). What betting it is an ineffective talkfest as these meetings seem always to have been over the years. Maybe this time it will be different!

I note in passing the promised web site that might assist is still not operational - see www.myhospitals.gov.au for a blank look!

David.

Friday, October 22, 2010

Weekly Overseas Health IT Links - 21 October, 2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. 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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http://healthit.hhs.gov/blog/onc/index.php/2010/10/07/the-gift-of-innovation-from-within/

The Gift of Innovation from Within

Thursday, October 7th, 2010 | Posted by: Dr. David Blumenthal | Category: ONC

The health information technology (health IT) sector received an important gift on Sept. 29. In fact, we received two important gifts. Both these gifts came from Kaiser Permanente. And both stemmed from Kaiser’s long-time investment and innovation in health IT adoption and use.

At a ceremony at HHS headquarters last week, Kaiser donated its Convergent Medical Terminology (CMT) for open availability to any HIT developer. The technology enables clinicians to use the terms that are familiar to them in diagnosis and treatment. CMT acts like a simultaneous translator in several directions. For clinicians, it translates clinical language they use to communicate with colleagues into the technical terms that electronic health records (EHRs) use to communicate with other records. For patients, it takes those underlying technical terms and makes them understandable to lay persons. And, it can translate clinicians’ terminology directly into lay language as well. It also facilitates the usability of EHRs and the sharing of health information among clinicians and patients.

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http://www.healthleadersmedia.com/print/MAG-257394/Data-in-the-Clouds

Data in the Clouds

Gienna Shaw, for HealthLeaders Media , October 13, 2010

Web-based data sharing is one solution to the interoperability problem—the challenge of communication between healthcare providers, including physician's offices, hospitals, and specialty practices, which often have different computer and software setups and use a variety of external devices to store and share images. Because everything is online, it's easy to share simple health data such as patient test results and medical history, and it allows patients access to their records, as well. Cloud computing requires no special equipment—just a computer and an Internet connection.

But when it comes to medical imaging, the massive image files shared in picture archiving and communications systems can bog down even moderately speedy Internet connections during peak hours—and accessing large files via a dial-up connection is basically a hopeless prospect.

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http://www.fastcompany.com/1693973/health-20-makes-industry-shift-in-five-years

Health 2.0 Causes Industry Shift in Five Years

BY FC Expert Blogger Francine HardawaySat Oct 9, 2010

This blog is written by a member of our expert blogging community and expresses that expert's views alone.

Since December 2006, when Matthew Holt and Indu Subiya almost single-handedly began the Health 2.0 movement with Matthew's blog and their first conference, the entire world of health care has begun to change. And that's not a simple thing to achieve. Health care is steeped in tradition, regulation, disparate moving parts, and territorial entities (witness the issues involved in health insurance reform). But Matthew and Indu did not shift the system the way President Obama and Congress tried to do, through "push marketing." Rather, they decided to harness the grass roots "pull" brought about by patients and the Web to force movement of the inertial forces.

They took what was already happening--patient empowerment through online communities and early health information sites such as Medscape for physicians and WebMD for patients, and accelerated it by evangelizing patient engagement and empowerment, the prototyping of new technologies, and the shift of responsibility from the doctor to the doctor-patient partnership.

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http://www.govinfosecurity.com/articles.php?art_id=2996

FTC: No Major PHR Breaches So Far

Only Incidents Listed Are Lost or Stolen Credentials

Howard Anderson, Managing Editor, HealthcareInfoSecurity.com

October 11, 2010

In the year since the breach notification rule for personal health records took effect, no major breaches affecting 500 or more individuals have been reported, according to the Federal Trade Commission.

A personal health record is an "electronic record of identifiable health information on an individual that can be drawn from multiple sources and that is managed, shared and controlled by or primarily for the individual," according to the FTC.

Last year, the FTC issued a PHR breach notification rule, as called for under the HITECH Act. Under the rule, which took effect Sept. 24, 2009, major breaches must be reported to the FTC within 10 business days. PHR vendors, and certain companies with which they do business, must report any size breach to the individuals affected within 60 days. But they only have to report the smaller incidents to the FTC annually, 60 days after the start of the calendar year.

Incidents Listed

The FTC has posted a list of 13 incidents affecting 15 individuals in 2009. All were reported by Microsoft Corp., which offers the HealtVault PHR platform. Each case involved lost or stolen credentials, and none of the cases involved is known to have resulted in inappropriate use of patient information, says Cora Han, attorney in the division of privacy and identity protection in the FTC's bureau of consumer protection.

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http://articles.orlandosentinel.com/2010-10-11/health/os-medical-student-ipod-touch-20101011_1_ipod-touch-ucf-students-medical-schools

UCF gives med students high-tech devices to stay in touch, iPod style

October 11, 2010|By Sarah Lundy, Orlando Sentinel

Second-year medical student Lynn McGrath knows the iPod touch he carries will help him become a better doctor.

If a patient reports certain symptoms, McGrath, 25, can quickly research it on the high-tech device and learn how to treat it in minutes.

"The first year as medical students, it helps us figure out what's going on, but as you become more familiar, it's more of a confirmation," he said.

Starting this semester, the UCF's College of Medicine, which in its second year, is giving every medical student an iPod touch to help in their training.

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http://www.scmagazineus.com/only-40-percent-of-canada-doctors-connected-with-ehr-report/article/180860/

Only 40 percent of Canada doctors connected with EHR, report

James Hale

October 12 2010

Put the patient first.

That's what two of Canada's leading health organizations are saying is the prescription for fixing the country's poor history of introducing electronic health records (EHR). The Health Council of Canada – a nonprofit watchdog agency – released a report that warns that the lack of an integrated EHR is leading family physicians to order unnecessary medications and diagnostic tests. Three days later, the Canadian Medical Association (CMA) – which represents many of the country's doctors – released a health information investment strategy that calls for major investment in primary care technology.

Both reports are a reaction to the fact that fewer than 40 percent of Canada's primary care doctors have access to EHR, compared to 99 percent of physicians in the Netherlands and 96 percent in the United Kingdom.

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KLAS Grades EMR Packages By Specialty

Ambulatory electronic medical record packages used in the 10 most common specialties were evaluated based on client feedback and 25 performance indicators by the research firm.

By Marianne Kolbasuk McGee, InformationWeek

Oct. 14, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227701294

When it comes to E-medical record packages and doctor practices, one size doesn’t fit all. Whether an EMR system is right for a particular physician depends on a number of factors, including the number of doctors in the group as well as medical specialty. A new report by research firm KLAS gives grades to EMR packages by specialties.

The new report, which is available free to healthcare providers, covers ambulatory EMR packages used predominately in or sold to 10 of the most common medical specialties, ranging from pediatrics, ear, nose and throat, cardiology, OB-GYN, to multi-specialty.

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http://trailblazersblog.dallasnews.com/archives/2010/10/obamas-health-it-czar-young-pe.html

Obama's health IT czar: young people won't tolerate pen-and-paper medicine

10:45 AM Fri, Oct 15, 2010

Robert T. Garrett/Reporter

The Obama administration's point man on health information technology said today that medical caregivers resist the brave new world of computers at their peril.

"The next generation of patients is not going to be happy with physicians and hospitals and nurses that don't use computers," David Blumenthal , the national coordinator for health IT at the U.S. Department of Health and Human Services , said in Austin. He was in town to speak yesterday at the Texas e-Health Symposium. This morning, he toured a University of Texas learning lab that has produced the nation's first graduates from a stimulus-funded training program designed to crank out medical-sector computer geeks.

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http://www.mobilenewscwp.co.uk/2010/10/healthcare-market-turned-on-to-mobile-reckons-rim/

Healthcare market turned on to mobile, reckons RIM

BlackBerry-maker looks to ingratiate itself more deeply in vertical business markets
UK healthcare bodies are waking up to the efficiency and productivity benefits of mobile applications, according to Research In Motion (RIM) UK healthcare director Daniel Morrison-Gardiner.
Morrison-Gardiner said that, in an economic climate of public spending cuts, healthcare bodies are looking at mobile as a means to reduce operational expenditure.

He said mobile health (mHealth) solutions offer NHS and other healthcare functions an opportunity to reduce the administrative burden on professionals such as midwives, health visitors and community nurses, enabling them to spend more time in the field.

Said Morrison-Gardiner: “We want to allow health professionals to spend more time with patients to deliver a better quality of care and to remove the burden of their everyday activities. What is telling is the number of clinical system providers and other companies approaching RIM over the last 18 months to see how they can leverage our platform to deploy mobile versions of existing solutions.”

Morrison-Gardiner said BlackBerry-maker RIM is in discussion with a number of providers to the healthcare market about deploying its mobile systems.

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http://www.fierceemr.com/story/data-exchange-must-become-seamless-and-invisible/2010-10-14

PHR data exchange must become 'seamless and invisible'

October 14, 2010 — 12:24pm ET | By Neil Versel

While vendor after vendor and publicist after publicist keep contacting a certain FierceEMR editor about how their personal health records are going to revolutionize healthcare by empowering consumers, some people still keep their heads out of the clouds and somewhere close to reality. To the exclusive latter group we can add David Ellis, corporate director of planning and future studies at the Detroit Medical Center and publisher of Health Futures Digest, and Stephen J. Cavanagh, associate dean of the Wayne State University College of Nursing in Detroit.

"PHRs require considerable attention from the patient, do not talk to one another and are built on a shaky centralized foundation. To reach their true potential, PHRs must become largely invisible, communicate with each other, and remain a network of information stored in various locations," Ellis and Cavanagh write in the October issue of Hospitals & Health Networks.

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http://www.fierceemr.com/story/next-generation-emrs-may-include-personal-genomics/2010-10-14

Next generation of EMRs may include personal genomics

October 14, 2010 — 2:37pm ET | By Neil Versel

As if putting medication histories and care plans into EMRs weren't causing enough consternation for doctors and nurses nationwide, wait until you hear what's coming down the pike.

"The vision, as we see it, is that the genome is really a component of the patient's electronic medical record," Richard Resnick, acting CEO of personal genomics firm GenomeQuest said Wednesday, MassDevice reports. Extra work, perhaps, but it's for the betterment of patient care, according to Resnick and other speakers at Harvard Medical School's World Health Forum in Boston.

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Small Medical Practices Don't Find EHR Adoption Meaningful

Federal incentive payments aren't enough to overcome problems, like increased costs and disruption to workflow, doctor offices perceive with electronic health records.

By Nicole Lewis, InformationWeek

Oct. 12, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=227701184

Even as the federal government continues to push the adoption of electronic health records (EHRs) by injecting billions of dollars into programs that encourage healthcare delivery organizations to implement the technology, these efforts may not be enough to lure many physicians at small practices to purchase an EHR, Richard Gibson, president of Oregon Health Network in Portland, Ore., told members of Congress

In testimony before the subcommittee on technology and innovation on September 30th, Gibson said that while the majority of 400,000 eligible professionals still need to acquire an EHR, adoption will be toughest in small physician offices that don't have the resources to acquire an EHR or the time and staff to install the technology.

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http://govhealthit.com/newsitem.aspx?nid=74826

Veterans’ CIO pledges no more major IT failures

By Kathryn Foxhall
Friday, October 08, 2010

The Veterans Affairs Department will have no more “hundred million dollar” IT project failures, VA’s chief information officer told senators who oversee the VA.

At a hearing this week, members of the Senate Veterans Affairs Committee made it clear that they want to keep a spotlight on VA’s IT management practices in view of the agency’s mixed record meeting production and efficiency targets. Roger Baker, VA’s chief information officer, who’s been on the job for 16 months, said the agency is not where it should be. He described efforts at VA to instill better project management procedure.

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http://www.ehealtheurope.net/comment_and_analysis/644/expert_view:_martin_ellis

Expert view: Martin Ellis

13 Oct 2010

The chair of the Intellect Clinical Safety Committee discusses recent changes to European regulations that are likely to affect healthcare IT providers. He also outlines the work that Intellect will be doing to develop documentation and guidance for e-health manufacturers.

It is an unfortunate fact of life, but on rare occasions the very health services that you rely on to make you better can end up causing you harm.

For example, errors in medication management, incorrect surgery and hospital acquired infection all contribute to patient mortality and morbidity. Fortunately, patient safety management is now a high priority for trust boards.

Similarly, while information technology is a powerful component of a healthcare provider’s strategy to help reduce clinical risks, it also has the potential to introduce new hazards for patients.

These include, for example, organisation-wide unavailability of electronic drug charts or the failure to correctly display critical clinical information.

This has sparked urgent debate in the international health informatics community about the risks of harm associated with introducing this new technology.

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http://www.healthleadersmedia.com/content/TEC-257573/Predictive-Modeling-May-Reduce-Hospitalizations

Predictive Modeling May Reduce Hospitalizations

HealthLeaders Media Staff , October 12, 2010

The Visiting Nurse Service of New York has adopted advanced information technology designed to improve patient care. The effort appears to be effective in reducing hospitalizations and re-hospitalizations, according to a paper published in the Journal for Healthcare Quality.

The VNSNY Center for Home Care Policy & Research launched the Outcomes Initiative to support research, evaluation, and informatics services. The system identifies patients at risk for hospitalization, identifies patients eligible for and in need of physical therapy, and assesses the performance of clinical staff and programs.

Together, these and other HIT initiatives have been instrumental in helping VNSNY achieve a 12% decrease in the overall patient rehospitalization rate between 2001 and 2009, according to the authors. They also report a reduction in patient episodes ending in hospitalization, from 37% to 27%, during that period.

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http://www.healthdatamanagement.com/issues/18_10/health-care-technology-news-connecting-the-dots-41054-1.html?zkPrintable=true

Connecting the Dots

Health Data Management Magazine, 10/01/2010

When it comes to business intelligence, the University of Pittsburgh Medical Center offers an object lesson in a major industry challenge. The integrated delivery network-which spans 20 hospitals and a health plan-runs some 200 different information systems, of which 100 publish to a data warehouse. Depending on the need, UPMC administrators can turn to several sources for BI metrics, says Lisa Khorey, director of interoperability. These include UPMC's inpatient EHR system, from Cerner; its ambulatory record system, from Epic; and the data warehouse, a store house whose supporting vendors include Cognos and DBMotion. "You ask different questions, you need different views into the data," says Khorey, who oversees the warehouse.

For many provider organizations, creating such a diversely-sourced data warehouse is the first step toward creating the kind of data analytics tool they will need as the industry is reshaped by payer requirements and patient expectations.

"The industry's biggest need is a reporting overlay over multiple vendors in disparate systems to drive actionable results," says Matt Seefeld, CEO of Interpoint Partners, an Atlanta-based BI software and consulting firm. "There is too much data flowing through health care. If you're going from system to system hoping to get the big picture, you will need a BI medium to create a layer to look across the organization."

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http://www.healthdatamanagement.com/issues/18_10/health-care-technology-news-a-little-faith-goes-a-long-way-41056-1.html

A Little Faith Goes a Long Way

By Greg Gillespie

Health Data Management Magazine, 10/01/2010

Spring and summer were filled with restless nights for Jim Sinek. The president and CEO at Faith Regional Health Services was losing a lot of sleep over the huge gamble the 166-bed community hospital was taking: implementing an electronic health record in less than six months, though it had little experience with enterprisewide I.T. implementations. And, unlike many decisions, this decision couldn't be undone or slowed down.

Sinek and his management team already had drunk the Kool-Aid by having Faith Regional's new bed tower designed in a way that made it hostile to paper charts by decentralizing nursing units and limiting printing capabilities. When the lights went on in that tower, the EHR simply had to be in place at the Norfolk, Neb.-based provider, which sits in a largely rural region in the Northeast corner of the state.

But Sinek had faith, pun intended, in both the project leaders and the management structure devised to execute the implementation and the subsequent changes in workflow and care processes.

The community hospital took calculated risks at every step of the project: implementing a complex EHR-Soarian Clinicals, from Siemens Healthcare, Malvern, Pa.-developed for large hospitals; focusing first on computerized physician order entry, politically and technologically the most fearsome of technologies; taking a multi-year implementation timeline and trimming it down to less than six months; and simultaneously doing a staff reorganization that initially spread fear through the nursing staff.

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http://www.healthdatamanagement.com/news/health-care-technology-news-privacy-federal-claims-database-41149-1.html

Privacy Pros to Feds: Not So Fast on Database

HDM Breaking News, October 8, 2010

The federal government's plan to create a national database of health care claims data is raising red flags for privacy advocates. The proposal, they argue, gives lip service to ensuring the privacy and security of the data and needs considerable additional details.

In a notice published Oct. 5, the U.S. Office of Personnel Management briefly outlined the Health Claims Data Warehouse that will contain a range of protected health information culled from claims handled by three federal insurance programs (see story). They are the existing Federal Employee Health Benefit program and two benefit programs created under the health reform law: The National Pre-Existing Condition Insurance Program and the Multi-State Option Plan.

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http://www.healthleadersmedia.com/content/TEC-257634/Costly-eICUs-Get-Results.html

Costly eICUs Get Results

Gienna Shaw, for HealthLeaders Media , October 12, 2010

Virtual ICUs got a bad rap: That's what early adopters of remote intensive care unit monitoring systems said in response to a study published last year in the Journal of the American Medical Association. The authors of the JAMA study said they found "no association between implementation of telemedicine technology and adjusted hospital or ICU mortality, [length of stay], or complications." And, the authors noted, the systems are expensive, easily running to seven figures a year for software, hardware, two-way video and audio equipment, clinical salaries, and licensing fees.

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http://www.ehiprimarycare.com/news/6306/english_nhs_urged_to_adopt_welsh_eps

English NHS urged to adopt Welsh EPS

11 Oct 2010

A pharmacy body is calling for NHS Connecting for Health to adopt the Welsh model for electronic transfer of prescriptions, in place of Release 2 of the Electronic Prescription Service.

Numark, a support organisation representing 2,500 community pharmacies, said the experience of its members has shown that the Welsh 2DRx project was working much more effectively than EPS R2.

Numark’s IT steering committee said it was impressed with the ease with which Wales was coping with 2D electronic prescriptions.

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http://www.govhealthit.com/newsitem.aspx?nid=74844

Dash it all

By John Moore

Monday, October 11, 2010

When the Michigan Health Information Authority (MiHIA) sought a way to boost the visibility of population health quality among its constituents, the group took its cue from the business world: it decided to build a performance measurement dashboard.

A dashboard takes in performance information of various kinds and presents the underlying trends in graphical format. Users can scan charts and diagrams depicting key performance indicators in much the same way a driver views a car’s instrumentation. The technology has typically been the province of corporate executives who need a quick, at-a-glance overview of sales, ongoing projects and other activities.

In MiHIA's case the objective is to get local government leaders, providers and the public to rally around community health improvements. Traditionally, public health officials were the individuals most concerned with community health data. But MiHIA seeks an expanded audience.

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http://www.modernhealthcare.com/blogs/it-everything/20101011/310119999

Predicting your future

Pharmacy benefits manager Express Scripts says it can predict the future.

It may not have a crystal ball tuned in for lottery numbers, but when it comes to drug compliance, the St. Louis-based pharmacy benefits manager says its computers can "accurately predict up to a year in advance which patients are most at risk of falling off their physician-prescribed drug therapy" and then "intervene in customized ways to improve those patients' adherence."

How?

Both Express Scripts in its news release and company spokesman David Whitrap are a bit sketchy on the details.

Whitrap, senior manager of public affairs, said the technology is proprietary, so, "there is a limit to how much we can talk about all of the factors that go into the mix."

In the news release, though, Express Scripts raised the lid on its black box for just a peek. According to the release, the company's computer models, developed over the past year by Express Scripts researchers and predictive modelers, "incorporate past patient behavior and demographics, characteristics of the particular medical condition and prescription drug and a number of other factors that Express Scripts has identified as relevant."

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http://www.kjonline.com/news/health-care-workers-get-computer-skills-training_2010-10-09.html

October 10

Health-care workers get computer skills training

By Leslie Bridgers

Staff writer

FAIRFIELD — Before Jeri Gilbert started an online course in electronic health records last week, she didn’t know what a Web browser was.

Many of the students who signed up for the Kennebec Valley Community College course are a lot like Gilbert — nurses, not computer people.

Their workplaces, however, now need people with expertise in information technology as they move toward computerizing all their health records — a change President Barack Obama charged all hospitals and health care providers to make by 2015.

The purpose of electronic health records is to make patients’ complete medical histories readily available to any health-care provider, in order to avoid repetition of tests and medical errors. Concerns have been raised about ensuring that the records are kept private.

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http://www.jsonline.com/business/104617969.html

Epic Systems rides wave of records upgrades

Verona company profits as hospitals make move to digital

Oct. 9, 2010

Aurora Health Care has spent more than $150 million to move to electronic health records since it began the arduous task 15 years ago.

The foundation for its system, spanning its hospitals throughout eastern Wisconsin, has been software from Cerner Corp. Aurora was one of the company's first large customers.

Yet this year, Aurora decided to replace its system with one designed by Cerner's biggest competitor, Epic Systems Corp. in Verona.

The move will cost Aurora more than $100 million and take at least three years.

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http://www.fiercehealthit.com/story/markle-survey-shows-strong-consumer-physician-support-blue-button-downloads/2010-10-11

Markle survey shows strong consumer, physician support for 'blue button' downloads

October 11, 2010 — 12:13pm ET | By Neil Versel

Remember the idea of adding a "blue button" to EMR screens to make it easy to output personal health data? The Markle Foundation, which has been leading the campaign, has released a study showing that two-thirds of physicians and consumers alike "agreed with the concept of a blue button that you can click to download your own health information," according to a press release.

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http://www.fiercehealthit.com/story/population-health-management-improves-prevention-outcomes/2010-10-11

Population health management improves prevention, outcomes

October 11, 2010 — 1:34pm ET | By Neil Versel

Two new studies suggest that a Kaiser Permanente population health management application can help physicians provide better care for a large, diverse panel of patients with diabetes and heart disease. (We're bracing ourselves for a certain anonymous commenter to rant again about how we must be on the Kaiser payroll or something for highlighting this news.)

The app, called the Panel Support Tool, is a web-based tool for primary-care physicians to manage care for individual patients, small groups or entire panels by comparing the care they deliver to nationally recommended best practices. It is integrated with KP HealthConnect, the organization's name for its Epic Systems EMR.

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http://www.fiercehealthit.com/story/onc-contract-could-lead-another-seminal-iom-report/2010-10-04

ONC contract could lead to another seminal IOM report

October 4, 2010 — 5:52pm ET | By Neil Versel

I've lost count as to the number of contracts the Office of the National Coordinator for Health Information Technology has handed out in its efforts to promote and advance the field of health IT, but a new one deserves more attention than most. That's because the recipient is the Institute of Medicine and the purpose is to help assure that the nation's massive investment in IT will pay off in terms of patient safety.

For all the nasty politicking that's gone on over health IT and other aspects of healthcare policy, the IOM remains perhaps the nation's most unassailable authority on patient safety and healthcare quality--something ONC mostly acknowledged in awarding the one-year, $989,000 contract.

"Since 1999, when the IOM published its ground-breaking study To Err Is Human, the Institute has been a leader in the movement to improve patient safety," national health IT coordinator Dr. David Blumenthal said in an HHS press release. "This study will draw on IOM's depth of knowledge in this area to help all of us ensure that HIT reaches the goals we are seeking for patient safety improvement."

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http://www.zawya.com/Story.cfm/sidZAWYA20101011050112/Jordan%20Health%20Initiative%20launched

Jordan Health Initiative launched

11 October 2010

AMMAN - The government on Sunday announced the launch of the Jordan Health Initiative (JHI), which seeks to improve medical services and healthcare offered to citizens through the integration of technology.

Underlining the importance of the initiative, prepared in collaboration with Cisco, Minister of Health Nayef Fayez said it will be implemented in the country's 32 public hospitals, noting that the national e-health programme launched early 2009 is an integral part of the initiative.

The JHI is a national public-private partnership, which aims to transform the delivery of healthcare in Jordan into a world-class regional best practice focused on providing high quality medical services through the utilisation of state-of-the-art technologies designed to provide citizens with the best affordable service and thereby achieving economic growth, according to the health ministry.

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Enjoy!

David.

Thursday, October 21, 2010

NEHTA Unaccountability Just Rolls On. It Is A Serious Worry I Believe.

The following appeared yesterday.

NEHTA HR bill off limits

  • Karen Dearne
  • From: Australian IT
  • October 20, 2010 3:10PM

OPPOSITION calls for details of the National E-Health Transition Authority's spending have once again been rebuffed by the Health Department.

In replies to outstanding Senate estimates questions from June 3, Health yesterday released year-old figures for NEHTA's expenditure on contractors and consultants.

With Health back before the Community Affairs committee today and e-health matters on the agenda for tonight at an estimates hearing, Health belatedly supplied information from NEHTA's 2008-09 annual report, published last October 29, among a flurry of answers over the past week which saw the portfolio file expand from around 230 pages to 772 by the close of business yesterday.

The department's response simply repeats the 2008-09 financial statements showing NEHTA spent $56.4 million on consultants and contractors that year, up from $13.4m in 2007-08.

More here:

http://www.theaustralian.com.au/australian-it/government/nehta-hr-bill-off-limits/story-fn4htb9o-1225941274683

Yesterday we had the Secretary of the Department of Health saying at Senate Estimates she could not control NEHTA but if she wanted anything she had to, essentially, ask nicely.

Now we have this.

I really wonder if our parliament is actually running the country or not. If it was then the views and concerns of Senators would be treated with a great deal more respect I believe.

With the bizarre Government we have had over the last three years with sudden unconsulted announcements and so one I really wonder just what is going on.

The last government effort was Senator Conroy saying he would legislate adoption of the NBN. One wit quickly asked “Why would that be needed if it was so good?”

See here:

Minister threatens to use law to force people on NBN if states revolt

Georgina Robinson and Ben Grubb

October 21, 2010 - 11:03AM

Communications Minister Stephen Conroy says he will wield federal law as a weapon to force people on to the national broadband network (NBN) if the states and territories don't make connections mandatory.

"We are working our way through the issues with the states and ... we ultimately would consider if we can't reach settlement, mandating it through the federal parliament. But we prefer to be engaged with the states," Senator Conroy said, speaking to this website from Parliament House yesterday.

He added that the federal government hadn't "exhausted those conversations yet". He also said that the matter of a connection being mandated was "not a new issue".

http://www.smh.com.au/technology/technology-news/minister-threatens-to-use-law-to-force-people--on-nbn-if-states-revolt-20101021-16uge.html

Hardly a core Labor value to stuff technology that people may not want or need down their throat! Maybe they will legislate iPads or Pay TV next?

This was then added to today as the Shadow Treasurer (Joe Hockey) witters on about re-regulation of banking system for pure political theatre and populist appeal - talk about giving up on basic Liberal values and throwing integrity out the window.

Heaven spare us from either mob. I wonder who is actually running things. NEHTA perhaps? Or maybe there is some wacky gas affecting all of Canberra - who knows? There is something going on that feels pretty odd to me!

Sorry for some of this being political comment but it all seems really that this odd 'hung' political environment has had all sorts of, usually reasonably sane, people just 'slip their moorings'!

David.

There Are A Few Different Ways To Skin The Discharge Summary Cat!

After having blogged a day or so ago about the slowness of NEHTA in the discharge summary space I came upon this press release today.

Ealing Hospital goes live with SRC electronic Discharge Summary Solution

London, 20 July 2010 – SRC, a UK provider of clinical information and digital document creation solutions, has announced that Ealing Hospital NHS Trust in London now routinely delivers discharge summaries within 24 hours of patients leaving hospital using SRC’s electronic Discharge Summary (eDS) Solution. The solution was rolled out Trust-wide to 15 wards and clinical areas in under two months.

The solution has also enabled Ealing Hospital NHS Trust to improve patient safety and patient experience using the built-in medicine management tools.

Clinicians at the hospital now complete accurate and legible discharge summaries electronically, which are then reviewed and authorised by pharmacists before prescriptions are dispensed. This is a paperless process. Upon patient discharge, the completed summary is automatically sent via a secure electronic link to the patient’s GP practice. Patients leave the hospital with a printed copy that includes information about their medications.

The Multilex Drugs Dictionary from First Databank is built into the solution and has been configured to pre-populate dosages for common medications and to allow only senior clinicians to prescribe certain drugs, such as chemotherapy agents. The solution also prevents the prescribing of medicines prior to the discharge assessment and notes patients’ allergy status.

Ward-based nurses can track the status of prescriptions, allowing them to plan discharges for individual patients. Patients receive written information about what their medications are treating, as well as when and how they should take them.

Clinicians have found the solution very easy to use with the Microsoft Healthcare CUI standard compliant user interface. The solution is integrated and synchronised with the hospital Patient Administration System (PAS), updating patient records using the global standards HL7 messaging. The interface ensures that discharge summaries can be produced quickly with all the correct patient data available through one single application.

During the implementation SRC and clinical software specialists Bluewire Technologies worked closely with the hospital’s senior pharmacists and clinicians to ensure that the solution fitted hospital workflows and to tailor the built-in medicines management features. Ealing’s pharmacy department deals with approximately 300 discharge prescriptions a week.

Chief pharmacist Stuart Richardson said: “Prescriptions are now legible and clear and are being written to a standard format that complies with the contract agreed with our commissioners.”

He added: “Patient safety is a huge component of this and it has been an interesting and enjoyable process developing the medicines management features with SRC and Bluewire Technologies.”

“It’s been great to engage with the designers to tailor the eDS to suit our needs, and those of other hospitals too.”

Kevin Connolly, Director of ICT at Ealing Hospital, added: “This has been a major strategic project and I am very pleased to confirm that our key investment objectives have now been enabled. The pace of implementation has been swift but this has not compromised on attention to detail, nor commitment to delivering a robust end product.”

“At the commencement of the project we had considered the major challenge to be achievement of a binding consensus around the necessary clinical/pharmacy workflows – and then to successfully reflect these decisions in the system configuration and design.”

“The system has now been live for over a month and in that time we have not encountered any significant issues, nor complaints amongst clinical staff about the burdens introduced by a new computer system. This should not be under-estimated. It is indeed the pay-off for the very detailed initial process design work undertaken by our clinical and pharmacy leads, expertly guided by the SRC and Bluewire Technologies implementation lead.”

Chris Hart, CEO at SRC, said: “Our eDS solution, part of the SRC Clinical Information Toolkit, is unique in its ability to reduce production and delivery timescales as well as significantly improving the quality and content of discharge summaries. All key objectives of the Ealing Hospital NHS Trust.”

“We are delighted by the successful and rapid rollout which the joint project team has achieved at the Ealing Hospital NHS Trust.”

Release is found here:

http://www.src.co.uk/pressreleases/SRC_Discharge_Summary_Ealing_Hospital_2007.html

Looking at their site they seem to have a goodly number of satisfied clients. Just so we are all clear there are other ways to get the outcomes we want than those presently being pushed upon us by those of the ‘power tripping’ mentality that live in NEHTA.

A little more discussion, flexibility, research and open mindedness might go a long way indeed in getting us to where we would all like to be!

David.