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, March 12, 2011

Weekly Overseas Health IT Links - 12 March, 2011.

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.

-----

http://healthcareitnews.com/news/ipad-2-looks-even-better-docs

iPad 2 looks even better for docs

March 03, 2011 | Molly Merrill, Associate Editor

SAN FRANCISCO – Apple introduced the iPad 2 on Tuesday with a special event that included a video highlighting the technology's use in different fields, with an appearance by John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center.

"Sometimes doctors are overwhelmed with data," said Halamka on the video shown at Apple's launch event. "What we have tried to do on the iPad is give doctors at the point of care the tools they need at the exact moment the doctor can make a difference.

"We are finding with the iPad, is that doctors are spending more time with patients, in fact doctors are engaging patients by showing them images, showing them data on the screen," he added. "So it is empowering doctors to be more productive. But it has also brought doctors and patients together.

"So I think what is so exciting about the iPad is that it will change the way doctors practice medicine," Halamka concluded.

-----

http://www.nytimes.com/2011/02/27/business/27unboxed.html?_r=1

Carrots, Sticks and Digital Health Records

By STEVE LOHR

THE United States is embarking this year on a grand experiment in the government-driven adoption of technology — ambitious, costly and potentially far-reaching in impact. The goal is to improve health care and to reduce its long-term expense by moving the doctors and hospitals from ink and paper into the computer age — through a shift to digital patient records.

Step back from the details and what emerges is a huge challenge in innovation design. What role should government have? What is the right mix of top-down and bottom-up efforts? Driving change through the system will involve shifts in technology, economic incentives and the culture of health care.

“This is a big social project, not just a technical endeavor,” says Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology.

-----

http://www.deloitte.com/us/privacyandsecurityinhealthcare

Privacy and Security in Health Care: A Fresh Look

New Issue Brief updates industry challenges and preparedness measures

Privacy and security is a significant challenge for every health care organization and a concern for every U.S. citizen. The move toward an entirely automated health care system featuring electronic and personal health records, clinical data warehousing, and increased transparency means more data is at risk and suggests an urgent review of industry privacy and security safeguards.

The potential liability for data breaches is significant and increasing. Stakeholders must act now to prevent compromising sensitive patient data, preserve brand value, and avoid substantial financial penalties for violations.

-----

http://www.ehi.co.uk/news/EHI/6694/slow_progress_halts_eps_r2_applications

Slow progress halts EPS R2 applications

4 March 2011 Fiona Barr

The Department of Health has stopped any more primary care trusts from applying to take part in Release 2 of the Electronic Prescription Service, blaming slow progress from system suppliers.

The roll-out of EPS R2 began in Leeds almost 20 months ago with one GP practice and one community pharmacy. But since then, only seven further GP practices and 30 pharmacy sites have begun using the system.

EPS R2 was originally due for roll-out in 2007. This week, Tim Donohoe, director of programmes and operations at NHS Connecting for Health, and Susan Grieve, DH principal pharmacist, wrote to PCTs to tell them the scheme will be closed to new PCTs with immediate effect.

Donohoe and Grieve said “system availability” was limiting the roll-out so the DH has decided to stop further PCTs from applying at the moment.

-----

http://www.modernhealthcare.com/article/20110304/NEWS/303049952/

Proposed Stage 2 meaningful-use criteria unreasonable: CCHIT survey

By Joseph Conn

Posted: March 4, 2011 - 11:15 am ET

All nine of the proposed Stage 2 meaningful-use measures that were enhancements of the Stage 1 criteria for successful electronic health-record use are considered too aggressive by at least one-third of all participants in a survey conducted by the Certification Commission for Health Information Technology, a federally authorized health IT testing and certification body.

To be paid under the health IT incentive program of the American Recovery and Reinvestment Act, providers must demonstrate that they are meaningful users of an electronic health-record system measured against government-developed criteria. A work group of the federally chartered Health IT Policy Committee released for public comment its initial recommendations for Stage 2 meaningful-use criteria, scheduled to take effect in 2013, and preliminary directions toward Stage 3 criteria, set to take effect in 2015.

-----

http://www.healthdatamanagement.com/news/McKesson-to-Buy-British-HIT-Firm-42099-1.html

McKesson to Buy British HIT Firm

HDM Breaking News, March 3, 2011

McKesson Corp. will acquire British hospital software vendor System C Healthcare for about $141.5 million in U.S. dollars.

System C serves about 40 hospitals in the National Health Service. Its Medway product line includes a core hospital and ambulatory clinical information system and multiple modules supporting emergency care, maternity, diabetic care, ambulance care, infection control, and data analytics, among other functions. The company also sells software to social services agencies.

-----

http://www.fiercehealthit.com/story/health-data-exchange-cloud-computing-among-key-himss-trends-noticed-observe/2011-02-28

Health data exchange, cloud computing among key HIMSS trends noticed by observers

February 28, 2011 — 1:18pm ET | By Ken Terry

HIMSS11 in Orlando, Fla., was notable as much for its timing as for its 31,000-plus participants--a new record--and the positive energy they radiated. The show occurred just as registration for the government "meaningful use" incentives was getting off the ground, and it arrived in the midst of a veritable explosion of health IT vendors drawn by the prospect of $27 billion in federal funds. That said, here are a few of the viewpoints that the HIMSS convention stimulated among industry observers.

-----

http://www.fiercehealthit.com/story/insurance-companies-leap-hie-field-will-change-health-it/2011-03-02

Insurance companies' leap into HIE field will change health IT

March 2, 2011 — 1:02pm ET | By Ken Terry

Health plans are preparing for a change in their business models by investing in health IT firms that will get them more involved in the clinical workflow of providers, according to participants at the recent HIMSS11 conference in Orlando, Fla. This accounts for the recent purchases of leading health information exchange vendors Medicity and Axolotl by Aetna and Ingenix--the latter a subsidiary of UnitedHealth Group--respectively. It also explains why several health plans have sponsored the activities of Prematics, an e-prescribing vendor that recently was acquired by Navinet, which provides online connectivity between providers and health plans.

David Classen, MD, senior partner at consulting firm CSC, says that health plans are "looking at their future business model under healthcare reform." They view health information exchange (HIE) as an implementation tool for the value-based reimbursement methods that are coming, he says. Accountable care organizations (ACOs) also will be a big issue, and Classen expects hospitals to partner with health plans to create ACOs. Health plans have core competencies that most providers lack but will need for ACOs, such as the ability to analyze data and manage care, he notes.

-----

http://www.fierceemr.com/story/dod-va-closing-ground-joint-ehrs/2011-03-03

DoD, VA closing ground on joint EHRs

March 3, 2011 — 2:52pm ET | By Janice Simmons - Contributing Editor

The Departments of Defense (DoD) and Veterans Affairs (VA) appear to be moving closer to agreeing on a common electronic health record (EHR) system--and could, perhaps, make an announcement by the end of March.

Both agencies have been under fire recently to reduce duplicative efforts in modernizing their EHR systems. This week, the Government Accountability Office (GAO) said in a new report--"Opportunities to Reduce Potential Duplication in Government Programs"--that both departments could "save system development and operation costs while supporting higher quality healthcare for service members and veterans" if duplication in the EHR area was eliminated.

-----

http://www.fierceemr.com/story/indianas-hie-now-reaches-1500-physicians/2011-03-03

Indiana's HIE now reaches 1,500 physicians

March 3, 2011 — 3:03pm ET | By Janice Simmons - Contributing Editor

The Indiana Health Information Exchange (IHIE) passed another milestone this week with its Quality Health First Program now enrolling more than 1,500 physicians in over 50 communities throughout Indiana. The HIE--developed to improve screenings rates and to support the management of medical conditions such as diabetes, heart disease, asthma, and breast cancer--now reaches nearly 1 million patients.

Patients needing these and other interventions are flagged in the reports to their primary-care physicians, which helps them make better healthcare decisions possible before, during and after patient visits. Participation in the HIE--a non-profit corporation formed in 2004 by the Regenstrief Institute--is open to all primary-care practices in Indiana, regardless of their size or number of physicians, and is not restrictive to practices not using EHRs.

-----

http://www.fierceemr.com/story/what-should-meaningful-use-stages-2-and-3-include/2011-03-03

What should Meaningful Use Stages 2 and 3 include?

March 3, 2011 — 3:15pm ET | By Janice Simmons - Contributing Editor

During two days in late April 2009, the National Committee on Vital and Health Statistics convened a meeting in Washington, D.C., to better define what "meaningful use" was--and who could be a "meaningful user." More than three dozen experts--representing physicians, hospitals, vendors, consumers, academia, and public health interests, to name a few--presented their comments and visions before the panel.

Flash forward two years now. The panel is now a memory. We're now familiar with the Stage 1 requirements of the Meaningful Use incentive program. But the funny thing is, the interest is still very much there about getting the MU concept and the use of electronic medical records (EMRs) right.

-----

http://www.ihealthbeat.org/perspectives/2011/not-so-fast-why-it-pays-to-wait-until-fy-2012-on-meaningful-use.aspx

Thursday, March 03, 2011

Not So Fast -- Why It Pays To Wait Until FY 2012 on Meaningful Use

The registration process and reporting period for the meaningful use incentive program officially commenced on Jan. 3. More than 21,000 health care providers have registered to date and many more are ramping up efforts to meet meaningful use criteria and collect federal incentives in fiscal year 2011. However, rushing out the gates in FY 2011 is extremely risky and not advisable. In fact, the Advisory Board Company strongly recommends waiting until FY 2012 to first demonstrate meaningful use.

-----

http://www.modernhealthcare.com/article/20110302/NEWS/303029950/

AMA to ONC: EHR program doesn't work for docs

By Rich Daly

Posted: March 2, 2011 - 11:00 am ET

Many physicians—specialists in particular—will not participate in the federal electronic health-record adoption incentive program because it requires them to include patient data that they do not otherwise collect, according to a Feb. 25 letter from 39 medical organizations (PDF) letter to the Office of the National Coordinator for Health Information Technology.

"From both a clinical and legal standpoint, physicians will be reluctant to take part in the Medicare or Medicaid EHR incentive program if they are being required to record data in their EHRs that they typically do not collect or that is not relevant to their scope of practice or the services that they provide to their patients," wrote the physician advocate groups, among them the American Medical Association.

-----

http://www.modernhealthcare.com/article/20110302/NEWS/303029952/

GAO: Military, HHS could save millions on IT

By Joseph Conn

Posted: March 2, 2011 - 11:00 am ET

A government watchdog agency says the federal government could save as much as $460 million a year if the Military Health System would eliminate some top brass and consolidate its upper management operations.

The Defense Department and the Veterans Affairs Department probably also would save a good deal of money if they jointly modernized their disparate health IT systems, according to the Government Accountability Office.

The GAO cost-cutters called out HHS as well, saying the department would likely reduce its own health IT costs as well as those of state and local governments if it developed an overall strategy to better integrate a nationwide, electronic public health information system.

-----

http://www.healthdatamanagement.com/news/privacy-ehr-meaningful-use-stage-2-onc-comments-42089-1.html

Patient Privacy Rights Comments on Stage 2

HDM Breaking News, March 1, 2011

Patient privacy safeguards are woefully missing from initial draft criteria for Stages 2 and 3 of meaningful use, according to Deborah Peel, M.D., founder of the Patient Privacy Rights organization.

"Like the criteria for Stage 1, the criteria for Meaningful Use Stage 2 and 3 are missing the key elements Americans expect from electronic systems: the ability to control who can see and use personal health information and the ability to segment information so they can selectively share information," Peel said in a comment letter to the Office of the National Coordinator. "Segmentation is essential to protect sensitive information, but also is absolutely critical for patient safety, so that erroneous health information can be kept from disclosure."

-----

http://ehr.healthcareitnews.com/blog/privacy-advocates-slam-mu-stage-2-proposal

Privacy advocates slam MU stage 2 proposal

By Jeff Rowe, Editor

We recently noted the “applause” some consumer groups are giving HIT policymakers for the proposed criteria for Stages 2 and 3 of Meaningful Use, but another prominent group has a markedly different view.

According to the Patient Privacy Rights organization(PPR), privacy safeguards are “woefully missing” from the draft regulations.

In their comment letter, PPR claims “the criteria for Meaningful Use Stage 2 and 3 are missing the key elements Americans expect from electronic systems: the ability to control who can see and use personal health information and the ability to segment information so they can selectively share information.”

-----

http://www.nytimes.com/2011/03/01/technology/01iht-srhealth01.html

February 28, 2011

Do-It-Yourself Health Care With Smartphones

By SONIA KOLESNIKOV-JESSOP

SINGAPORE — For more and more people, computers and software are becoming a critical part of their health care.

Thanks to an array of small devices and applications for smartphones that gather vital health information and store it electronically, consumers can take a more active role in managing their own care, often treating chronic illnesses — and preventing acute ones — without the direct aid of a physician.

“Both health care providers and consumers are embracing smartphones as a means to improving health care,” said Ralf-Gordon Jahns, head of research at research2guidance, which follows the mobile industry.

He added that the firm’s findings “indicate that the long-expected mobile revolution in health care is set to happen.”

-----

http://healthcareitnews.com/news/black-book-poll-names-top-4-internal-medicine-emr-vendors

Black Book poll names top 4 internal medicine EMR vendors

February 28, 2011 | Molly Merrill, Associate Editor

NEW YORK – A poll conducted by Black Book Rankings, a division of the market research firm Brown-Wilson Group, ranked four electronic medical record vendors as the top internal medicine EMRs based on physician satisfaction.

"CureMD, eClinicalWorks, Greenway Medical Solutions, Henry Schein MicroMD, and NextGen GBS consistently ranked among the top 10 highest ranked EMR firms including single and multi-physician Internal Medicine environments," said Doug Brown, managing partner of Black Book Rankings.

-----

http://govhealthit.com/newsitem.aspx?nid=76404

Best practices for physician directories will promote info exchange

By Mary Mosquera

Tuesday, March 01, 2011

An advisory panel has completed its recommendations for best practices and minimal requirements for individual level provider directories, or “white pages” listing physicians. The directories will, it believes, help to promote health information exchange by assuring that a message connects to the right physician at the correct address.

The information exchange work group plans to offer its proposals for endorsement by the Health IT Policy Committee on March 2. The committee will then relay them to the Office of the National Coordinator for Health IT.

States are already beginning to create their own provider directories so it’s important to come up with recommendations for best practices, such as data accuracy, and for those local policy levers that will drive participation in the directories, said Dr. Walter Suarez, co-chair of the provider directory task force on the work group. He is also director of health IT strategy and policy at Kaiser Permanente.

-----

World Economic Forum Drives Health Data Initiative

The Global Health Data Charter calls for the use of technology to overcome worldwide gaps in health information collection, availability, privacy, and analysis.

By Nicole Lewis, InformationWeek

Feb. 28, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229219488

The World Economic Forum has launched the Global Health Data Charter, an initiative to advance global health through the management and collection of data. The charter aims to enable individuals and patients, health professionals, and policymakers to make more informed decisions through secure access to comprehensive health data.

Officials at the World Economic Forum in Geneva said at the charter's unveiling last week that accurate health data is not available across health systems operating in developed and developing countries, and that gaps in data can be overcome through the use of technology, which will be a main driver in the collection, analysis, and application of health information.

-----

http://www.modernhealthcare.com/article/20110301/NEWS/303019988/

Doc looks to apply AI to healthcare

By Joseph Conn

Posted: March 1, 2011 - 11:45 am ET

A Philadelphia-based developer of clinical decision-support technology plans to add new meaning to the concept of defensive medicine.

Clinical Performance Solutions is a new company formed as a partnership between Amity Health of Philadelphia and SoarTech of Ann Arbor, Mich. Amity was founded by Dr. Steven Merahn to "identify intelligence and best practices from outside of healthcare that can contribute to and enhance new approaches to healthcare systems and operations," according to an Amity news release.

SoarTech is a military information technology contractor working in the field of artificial intelligence that develops systems that "enhance human performance by modeling human reasoning in complex situations such as tactical air support, special forces operations, global intelligence analysis and command and control scenarios," according to the release.

-----

http://www.healthleadersmedia.com/print/TEC-263182/HIMSS-2011-4-Long-Days-5-Short-Stories

HIMSS 2011: 4 Long Days; 5 Short Stories

Gienna Shaw, for HealthLeaders Media , March 1, 2011

Last week my pedometer called to alert me to suspicious activity on my count—I'd logged so many steps over the course of four days at the CHIME and HIMSS conferences in Orlando that the device assumed someone else was using it. If you don't get the joke, you've never been to HIMSS. The number two topic of conversation there (second only to healthcare technology) is whether or not you wore the right shoes. As a friend said, at HIMSS there's no such thing as the "right shoe."

By the way, although the steps on my pedometer were all me, I assure you I had nothing to do with the emails that someone in Turkey sent to everyone in my address book after I used the hotel's free wireless Internet access.

Here are a few other notes and observations from the show (mostly of a more serious nature than shoes and Turkish malware).

-----

http://www.healthdatamanagement.com/news/ehr-market-report-kalorama-42085-1.html

Report: EHR Growth is Spiking

HDM Breaking News, March 1, 2011

A new report from Kalorama Information, a New York-based research firm, estimates the U.S. electronic health records market at nearly $15.8 billion and predicts it will rise to $31.9 billion in 2015.

The revenue figures cover software systems, consulting, installation fees and training, but not hardware. Kalorama estimates the EHR market grew 10.5 percent in 2009 and 13.6 percent in 2010, down from its previous estimates of 15 percent for both years. The firm attributes the lower growth to initial confusion over meaningful use requirements, and some market uncertainty around certification of EHR products.

-----

http://www.ihealthbeat.org/features/2011/questions-linger-on-social-media-regulations-for-pharma.aspx

Tuesday, March 01, 2011

Questions Linger on Social Media Regulations for Pharma

Consumers increasingly are tapping the Internet and social media sites for health-related information. A recent survey conducted by the Pew Internet Project and the California HealthCare Foundation, which publishes iHealthBeat, found that 80% of Internet users look up medical-related information online. According to the survey, online searches for specific diseases or medical problems are among the most popular health-related inquiries.

While online, consumers are likely to view promotions for health care products, but there currently are no federally imposed rules of the road governing pharmaceutical marketing activities.

-----

http://www.healthleadersmedia.com/print/LED-263095/Patient-CheckIn-Technologies-Cut-Cost-Wait-Times

Patient Check-In Technologies Cut Cost, Wait Times

Anna Webster, for HealthLeaders Media , February 28, 2011

Kiosks and automated check-in processes are making their way from the airport lobby to the doctor's office.

Eighty-nine percent of physicians polled in the 2011 HealthLeaders Industry Survey say they have or will have electronic health records in place within two years, what many consider the first step in streamlining the check-in process.

Physician practices are adopting touchscreen tablets, kiosks, or patient portals that automate the check-in process, resulting in shorter wait times, reduced errors, and lower labor costs.

-----

http://www.fiercehealthit.com/story/himss-analytics-survey-shows-uptick-hospital-readiness-meaningful-use/2011-02-24

HIMSS Analytics survey shows uptick in hospital readiness for meaningful use

February 24, 2011 — 1:49pm ET | By Ken Terry

More and more hospitals are developing the capability to show meaningful use of electronic health records. HIMSS Analytics defines 44 percent of respondents to its continuing survey as "likely" or "most likely" to meet Stage 1 Meaningful Use criteria. Of the 999 hospitals that have responded to the survey since May 2010, 25 percent already can meet 10 of the 14 core measures and at least five of the menu items required for meaningful use.

-----

http://www.fiercehealthit.com/story/it-companies-have-vested-interest-success-healthcare-reform/2011-02-24

IT companies have vested interest in success of healthcare reform

February 24, 2011 — 5:47pm ET | By Ken Terry

Health IT has been one of the few areas of bipartisan agreement in recent years, observed Health and Human Services Secretary Kathleen Sebelius in her keynote address Wednesday at the HIMSS conference in Orlando. She's right about the history. For example, former President George W. Bush launched the federal government's campaign to increase EHR adoption in 2004, and both former HHS chief Mike Leavitt and ex-Senator Majority Leader Bill Frist have been strong supporters of the technology.

But the hyper-partisan warfare over the budget deficit has produced some dissonant notes in that picture of harmony. For example, the recently introduced bill to take back some of the money allocated for meaningful use incentives is not likely to pass, but it shows that some Republicans don't give a hoot about health IT. The GOP catcalling over President Obama's proposed "investments" in the economy also calls into question the future of federal efforts to promote information technology.

-----

http://www.healthdatamanagement.com/news/HIMSS11_HIE_consumer_awareness-42015-1.html

Consumers ‘Don’t Have a Clue’ About HIEs

HDM Breaking News, February 23, 2011

By many measures, the Keystone HIE has made steady progress toward the goal of widespread community health data exchange. Formed in 2005, the HIE, which serves 14 hospitals in Pennsylvania, has a database of 2.9 million records with seven hospitals and five emergency departments publishing to it. A number of labs and clinics are also members.

About 450,000 patients have given consent to have their information available via the exchange, but more are needed, said James Younkin, director of the HIE, during a HIMSS11 presentation. Younkin, who also serves as I.T. director for Geisinger Health System, a Danville-based provider organization participating in the exchange, noted that only a small minority actually decline to participate in the effort. “Our decline rate is about 5 percent,” he said. “Our ‘not asked’ rate is much higher.”

-----

Microsoft, Dell To Deliver SaaS Analytics For Community Hospitals

Duo teams on analytics, informatics, business intelligence and performance improvement technology.

By Robert N. Mitchell, InformationWeek

Feb. 23, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229219183

Dell and Microsoft announced that they will deliver analytics, informatics, business intelligence and performance improvement technology for community hospitals.

Delivered by Dell as a hosted online service, the technology combines Microsoft Amalga, a health intelligence platform, with Dell's cloud computing infrastructure and informatics, analytics and consulting services, the companies said at the Healthcare Information and Management Systems Society (HIMSS) conference on Tuesday.

-----

http://www.montereyherald.com/health/ci_17469948?nclick_check=1

Bar code system helps Salinas Valley Memorial prevent drug errors

By CATHERINE MEYERS

Herald Staff Writer

Posted: 02/24/2011 01:33:40 AM PST

Updated: 02/24/2011 08:19:37 AM PST

Hundreds of thousands of hospital patients in the U.S. experience adverse reactions to preventable medication errors every year, but at the Salinas Valley Memorial Healthcare System, a new high-tech pharmacy aims to significantly reduce errors.

The pharmacy, which opened in October, uses bar codes to track drugs at every step of the medication process. The system issues an alert if a medicine, dosage, or time of day does not match the prescription in a patient's medical record.

-----

http://govhealthit.com/newsitem.aspx?nid=76390

EHRs, health IT will play expanding role in national vaccine plan

By Kathryn Foxhall

Thursday, February 24, 2011

Electronic health records and other health information technology will play a growing and significant role in vaccine safety surveillance and reporting to registries as part of the recently released National Vaccine Plan, according to senior Health and Human Services Department officials.

One of the top priorities of the vaccine plan is to expand and improve the use of health IT and electronic health records that can exchange health information. The plan lays out strategies and goals over the next 10 years to develop vaccines, increase their safety and assure access to a stable supply.

-----

http://healthcareitnews.com/news/ge-healthcare-moves-centricity-ipad

GE Healthcare moves Centricity to iPad

February 25, 2011 | Mike Miliard, Managing Editor

ORLANDO – GE Healthcare showcased the extension of its healthcare IT portfolio to mobile devices and tablet computing at HIMSS11 earlier this week. Its portfolio of EMRs for physician practices, including Centricity Advance and Centricity Practice Solution, is now available for use on the iPad and iPhone.

Officials say GE Healthcare is focused on shifting the architecture of its proven software solutions to web technologies, which lighten the application footprint and bring clinicians the benefits of anytime, anywhere access to critical patient data.

-----

http://healthsystemcio.com/2011/02/23/klas-docs-look-to-established-vendors-in-tumultuous-emr-market/

KLAS: Docs Look to Established Vendors in Tumultuous EMR Market

Posted by Anthony Guerra on February 23rd, 2011

Many Docs Switching Out EMRs

AllScripts is the most considered ambulatory EMR in a market rife with turnover, according to a new KLAS report, Ambulatory EMR: Win Rates, Replacements, and Provider Loyalty.

That turnover is represented by the fact that 35 percent of all providers interviewed for the report are replacing their existing EMRs. This includes nearly a third of the smallest practices, as well as 43 percent of groups with 100-plus physicians, according to KLAS.

-----

http://www.healthdatamanagement.com/news/ahima-meaningful-use-criteria-comment-42028-1.html

AHIMA Comments on Stage 2

HDM Breaking News, February 25, 2011

Providers choosing not to adhere to clinical decision support information during treatment should document the reason why under Stage 2 meaningful use criteria, according to comments from the American Health Information Management Association on initial draft criteria. "When the treatment of care deviates from the direction guided by the CDS, this should be captured and included in the reporting for meaningful use," the association recommends.

AHIMA also urges policymakers to consider the current regulatory environment, which includes ICD-10 compliance and health reform initiatives among others, as 2013 draws near. "There are a number of other regulatory initiatives developing with a compliance timeframe of 2013 and we suggest aligning these programs to allow for a coordinated approach to implementation and production."

-----

http://www.cmio.net/index.php?option=com_articles&view=article&id=26548&division=cmio

Consumer groups laud measures in Stage 2

Written by Editorial Staff

February 28, 2011

“Robust advancement of meaningful use criteria is essential both to ensure a return on investment for taxpayers who are funding the incentives and to lay a firm foundation for meeting the broad goals of healthcare reform,” wrote 25 consumer groups in a collective comment filed last week that that commend many components of the proposed meaningful use Stage 2 criteria included in the Health IT (HIT) Policy Committee’s Request for Comments.

In a letter sent to the Office of the National Coordinator (ONC) for Health IT, the groups laud the proposed Stage 2 meaningful use criteria for the steps they take toward a “seamless integration of health information, coordination of care…and the ability to monitor improvements in outcomes and functional status.”

-----

Enjoy!

David.

Friday, March 11, 2011

A Different View On HL7 Version 3.0. There Are Quite A Few Who Agree With These Views.

The implementation success has been somewhat patchy, with at least some proponents scaling back their enthusiasm for full adoption of the V3 Standard as some see it is lacking the necessary robustness and internal consistency for ongoing use.

The following blog from Professor Barry Smith had the effect of reminding me there are a variety of views on the topic - some of which may not be all that heartily embraced by HL7 and NEHTA. If the dissenters are right the implications are pretty serious.

The views expressed here are quite provocative but I believe need to be aired.

Monday, February 28, 2011

Cries for Help

One of the disturbing aspects of the HL7 phenomenon is the degree to which so many of those who have strong critical views are reluctant to express these criticisms in public. Here a sample criticism of the HL7 RIM, by a leading healthcare IT specialist in Asia who has given me permission to quote from his email communications, as follows:

It is abundantly clear that V3 is an unnecessarily complex, incoherent and confusing messaging standard while V2 is simple, workable, elegant and deployed at more than 95% of healthcare institutions wherever HL7 is used.

Why not scrap V3 and simply work on improving the V2.x standard (say V2.7)?

.....

I am concerned about the growth and proliferation of a meaningless standard because it is fraught with danger and is leading to:

(a) Increase in the cost of Hospital IT implementation

(b) Making coding complex which could lead to errors and thereby lower care of (and even endanger) patients

(c) Increasing the cost of software

(d) Increasing the cost of training and implementation

(e) Forcing the use of two standards in parallel when one could have sufficed

(f) Diverts funds from useful IT apps to feed V3

The only people/groups that could possibly gain from this are:

(a) HL7 org and their collective egos

(b) Trainers who will make money from teaching this "complex" 'new' standard

(c) IT companies that make money from pushing newer versions and widgets to "upgrade" to V3

.....

Here is another example of a desperate push through a back door: Pushing and converting a perfectly good CCR to a CCD by unnecessarily insisting on a RIM based approach (where none was required) shows desperation to push the RIM, come what may.

It is my personal opinion that there should be no shame in accepting that a certain approach has failed. We are doctors and scientists and accept, humbly, that we do not always succeed. The real shame and loss would come from stubbornly trying to flog a dead horse putting time, money and people at stake, just so as not to declare failure. I say, be brave enough to move on and use the excellent collection of thinkers at HL7 to develop a fresh, focused and simple solution. To try and capture the complete medical domain (present and future) into one core model is not only foolish but also unachievable. We as doctors know that and therefore only focus on our core specialty.

The full blog and many others are found here:

http://hl7-watch.blogspot.com/2011/02/cries-for-help.html

It is definitely worth reading this blog where some Australian contributors express their concerns.

http://hl7-watch.blogspot.com/2010/11/are-iso-21090-data-types-too-complex.html

While I am not sufficiently across the details of some of this to be able to form a trustworthy opinion a number of very smart people I have chatted with have expressed similar concerns.

I highlight the material for people to review and consider on that basis. Form your own conclusions, from a position of being aware that there are a range of views out there about the whole HL7 V3 project and just where it is leading!

David.

Thursday, March 10, 2011

I Am Wondering Just What is Driving The Comment Stream on the PCEHR Blogs? Are They Just Hoping Against Hope It Will Work?

It seems that in the last 48 hours there have been a number of comments on my remarks on the PCEHR program that I find rather surprising.

It seems, just on a quick browse, that there are many correspondents who are expressing the view that the PCEHR program is much better than doing nothing. I would like to suggest there are much better ways the invest the funds - as highlighted in the blog here:

http://aushealthit.blogspot.com/2011/03/current-literature-shows-that-health-it.html

A little history is in order. The idea for a PCEHR sprang from a report to the National Health and Hospital Commission (NHHRC) that came out late in 2009.

As far as I can tell the PCEHR popped up earlier in 2009.

NHHRC Backs Person-controlled Electronic Health Records

Media Release - 30 April 2009

The National Health and Hospitals Reform Commission (NHHRC) today released a supplementary paper to its Interim Report, which outlines the Commission’s support for person-controlled electronic health records for every Australian.

NHHRC Chair, Dr Christine Bennett, said today that the supplementary paper spells out the Commission’s position that an electronic health record is arguably the single most important enabler of truly person-centred care.

“The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” Dr Bennett said.

“A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.”

According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record.

The Commission has made seven recommendations to make person-controlled electronic health records a reality. These include:

    • By 2012, every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person;
    • The Commonwealth Government must legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers;
    • The Commonwealth Government must introduce unique personal identifiers for health care by 1 July 2010;
    • The Commonwealth Government must develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach; and
    • The Commonwealth Government must mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record.

The NHHRC supplementary paper, Person-controlled Electronic Health Records, is available on the NHHRC website at www.nhhrc.org.au under Interim Report of the NHHRC. Feedback can be sent to talkhealth@nhhrc.org.au but must be received by Friday 8 May.

The release is here:

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/mediaRelease300409

The supplementary paper is found here:

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/BA7D3EF4EC7A1F2BCA25755B001817EC/$File/Person-controlled%20Electronic%20Health%20Records.pdf

As far as I can tell nothing in the paper demonstrates any proven value in the concept of a PCEHR and the reference provided earlier in the blog today confirms that view.

You can read my detailed negative submission on the whole idea dated May, 2009

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/309-interim

As I pointed out then, and re-iterate now, this is an concept which is just not supported by any evidence at present that I am aware of.

Please send the refereed papers along that now confirm the PCEHR concept is a proven one.

Just doing something because it seems like a good idea - and to also plan to spend half a billion dollars in the process - is just not good enough and is appalling process and project management.

This project seems a bit like the NBN that was apparently just made up on the back of an envelope initially and has now grown a life of its own - on very flimsy evidence indeed. I believe there are much better ways to improve Australian E-Health than this nonsense idea.

If any correspondents have evidence that confirms the value of the specific PCEHR proposal - other than to the service providers who hope to deliver it - I look forward to the link!

David.

Lots Of People Seem to be Reading The Blog! I Hope It Will Make A Difference In the End!

Here are the stats from yesterday. Just crept over 400,000 page views!

Australian Health Information Technology
Site Summary

VISITS

Total - 234,956

Average Per Day - 350

Average Visit Length - 3:51

Last Hour - 22

Today - 486

This Week - 2,452

PAGE VIEWS

Total - 400,000

Average Per Day - 676

Average Per Visit - 1.9

Last Hour - 40

Today - 1,006

This Week - 4,730

This certainly makes the effort worthwhile!

Thanks to everyone who reads and especially to the fantastic commenters!

David.

The Current Literature Shows That Health IT Actually Works in Traditional Types of Use! PHRs are Still an Evidence Free Zone!

The following release has just appeared.

News Release

FOR IMMEDIATE RELEASE

Tuesday, March 8, 2011

Contact: ONC Press Office

(202) 690-7385

Review of recent studies shows predominantly positive results for health information technology

A study completed by the Office of the National Coordinator for Health Information Technology (ONC) and published in the journal Health Affairs finds growing evidence of the benefits of health information technology (HIT). Using methods that were employed by two previous independent reviews, the new study finds that 92 percent of articles on HIT reached conclusions that showed overall positive effects of HIT on key aspects of care including quality and efficiency of health care.

In addition, the study finds increasing evidence of benefits for all health care providers, not just the larger health IT “leader” organizations (i.e., early adopters of HIT) that have provided much of the data regarding experience with HIT in the past. The previous reviews identified a gap between “leaders” and non-leaders in demonstrating benefits from HIT.

“This article brings us much more up-to-date, both in our confidence regarding the overwhelming evidence of the benefits of adoption and use of HIT, and also in our understanding of problem areas that still need to be addressed, “ said David Blumenthal, M.D., the national coordinator for HIT and one of the authors of the review. “This review is important because it helps us correct for the lag in evidence that occurs naturally in the dynamic HIT field, where changes in technology and accelerating adoption cause the old literature to become quickly outdated.”

The review included articles published from July 2007 up to February 2010, following up on earlier reviews of articles from 1995 to 2004 and from 2004 to 2007. This latest review initially surveyed more than 4,000 peer-reviewed articles, of which 154 were found qualified for the parameters of the study, a number similar to the previous efforts.

The current review found positive results in 96 of the articles (62 percent), and mixed but predominantly positive results in 46 other articles (30 percent). Ten articles were found to have negative or mixed-negative results. In addition to quality and efficiency of care, the authors categorized additional outcomes including access to care, preventive care, care process, patient safety, and provider or patient satisfaction.

The review also reflected a new balance of evidence between HIT “leader” organizations and other entities, especially smaller medical practices. In previous years, much evidence has come from the “leaders.” The current review shows increased evidence of benefits for others as well.

“These new findings are very significant in helping to confirm that our Nation has made the right choice in moving aggressively toward adoption of health information technology,” said Donald Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, as much as $27 billion Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

Positive results highlighted in the article include:

  • One study found that at three New York City dialysis centers, patient mortality decreased by as much as 48 percent while nurse staffing decreased by 25 percent in the three years following implementation of EHRs.
  • In an inpatient study, a clinical decision support tool designed to decrease unnecessary red blood cell transfusions reduced both transfusions and costs, with no increase in patient length-of-stay or mortality.
  • Another study addressing HIT in 41 Texas hospitals found that hospitals with more advanced HIT had fewer complications, lower mortality and lower costs than hospitals with less advanced HIT.

Negative findings in the study were most often associated with provider or staff satisfaction related to difficulties in the process of transitioning from paper-based to electronic-based records and care. According to the article, these findings “highlight the need for studies that document the challenging aspects of implementing HIT more specifically and how these challenges might be addressed,” such as through strong leadership or staff participation when adopting and implementing HIT.

The full release is here:

http://www.hhs.gov/news/press/2011pres/03/20110308a.html

What the review does not show is that what I would term ‘fringe uses’ of health IT such as PCEHR’s make any difference.

This review is all about the use of Electronic Health Records in the hands of healthcare providers and in this role it is clear Health IT actually works and makes a difference.

What is simply unknown is the impact and value of initiatives like the PCEHR. Until there are reasonable studies to show it actually works and makes a real positive difference our investment on e-Health should be directed at improved provider systems. We have a Government that claims to act in an evidence based way, but for purely political reasons all that goes out the door and the nonsense of the PCEHR gets funded.

The litany of silliness from this Government just seems to roll on. No wonder consumer confidence and retail sales are plunging. People are saving against the inevitable worse times ahead unless sanity will somehow prevail again. I sure hope so.

Go here to read how our markets and economy are so NOT prospering under this Government (despite a mining boom) and do note that the jobs report today actually showed that in February the total hours worked in Australia actually fell (on a trend basis) - so much for a boom.

http://www.theaustralian.com.au/business/six-good-reasons-to-avoid-local-stocks/story-e6frg8zx-1226018685710

The public just does not know what crazy policy to expect next and in our small e-Health part of the world we are also victims of the silliness!

I increasingly believe that populist health policy and quality e-Health initiatives (which needs sustained leadership, governance and investment) just don’t mix.

To re-assure us all maybe NEHTA or DoHA would like to release their literature review of peer-reviewed literature that shows that the PCEHR is a great idea. I bet it does not exist! It should if this is PCEHR proposal is anything other than populist evidence free nonsense.

My view is confirmed here by CSC who are actually working with the Federal Government in e-Health.

http://www.csc.com/health_services/insights/61137-personal_health_records_a_true_personal_health_record_not_really_not_yet

Personal Health Records: A True "Personal Health Record"? Not Really ... Not Yet.

Author:

Jason Fortin and Erica Drazen

Summary:

A true personal health record (PHR) needs to be comprehensive, interactive, patient-controlled and secure. Despite renewed interest in the potential benefits, the reality is that the PHR market remains fairly fragmented today and outside of a few well-publicized initiatives, current adoption is limited to niche uses of silos of information. Without major changes in behavior and dramatic increases in adoption of clinical systems, a true PHR – and the benefits associated with it – will not be possible.

Download "Personal Health Records: A True 'Personal Health Record'? Not Really ... Not Yet." (PDF 405KB)

I wonder do the US and Australian parts of CSC chat often? Note the point about the need for full clinical systems first!

Pretty sad.

David.

Afternote: The points made about the need to use current studies to asses Health IT value are very important and should not be ignored. Articles from before 2000 seldom have much useful to say!

D.

Wednesday, March 09, 2011

The Current Operational Plans For The PCEHR Fail The Sanity Test Badly and Shows That NEHTA and DoHA Reside in Some Alternate Universe!

(Note - click on images to enlarge)

As part of a Vendor Briefing NEHTA have provided some slides related to how they see the PCEHR working.

You can access the various files from this link:

http://aushealthit.blogspot.com/2011/03/it-has-taken-me-day-or-so-to-spot-these.html

In the view of the Operating Model we see in the top image the plan appears to be that an individual will access a Personally Controlled EHR (PCEHR) having registered and asked to do so.

This service will be via a portal. The security and authentication for individuals is not yet clear to me.

Interestingly the individual or their representatives will be in control of who can access their PCEHR and decides who else might.

In the bottom half of the we have the provider with their electronic record. For some reason the picture seems to be suggesting that the clinician will register for access to each individual PCEHR and then only be able to see what the patient deems to be appropriate. It is not clear why the clinician would bother to either access or update the individual’s PCEHR.

On the second slide we have a patient having a consultation with a clinician, reviewing the content of the summary record and authorising that to be uploaded to the PCEHR - presumably after the clinician has registered for access.

Unless there is a substantial fee attached to doing all this - the chance of this happening in our fee for items of service environment are two. Buckley’s and None with None being the most likely.

I really have not - especially with the experience of HealthELink behind us - seen thing near such a stupid plan.

Back to the drawing board guys - this dog simply will not hunt!

David.

We Press Stupidly On As the UK Realises Shared EHRs Are Very, Very Hard to Get Right!

(Note - click on images to enlarge)

From the UK comes a really timely warning about the critical need to really move slowly and simply on Shared EHRs and our proposed PCEHR.

Scope of SCR reduced further

1 March 2011 Fiona Barr

Plans to allow hospitals and patients to add to the Summary Care Record have been put on hold as the Department of Health seeks to rein in both the content of the record and who can view it.

A revised scope document for the SCR, published by NHS Connecting for Health, makes it clear that, for the moment at least, information will be limited to details uploaded from GP records.

It says the scope of the SCR needs to be clearly defined “to avoid scope creep, which has the potential to lead to unexpected consequences, clinical safety issues or additional costs.”

The document confirms the conclusion of the DH's review of the content of the record that was published last October and which said initial content should be limited to details of a patient’s medications, allergies and adverse reactions.

The scope document says GPs can add additional information with the patient’s explicit consent, but qualifies this by saying it should only be information that will improve the quality of care provided by clinicians working out-of-hours or in an emergency care situation.

The DH has made it clear that it plans to limit access to urgent and emergency care settings and suspended a planned pilot of access in a community pharmacy, as EHI Primary Care revealed last month.

Two years ago, the DH was drawing up plans for ‘Release 2’ of the SCR. This would have involved staff in A&E departments and other NHS organisations entering data including discharge summarues, outpatient clinic letters and Common Assessment Framework documents.

The plan also included proposals to allow patients to enter their own data via the HealthSpace portal.

Last summer two hospitals, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Pennine Acute Hospitals NHS Trust, were planning to upload non-GP summary data.

However, both have now abandoned those plans. In November, the Information Commissioner’s Office was told that additional feeds from secondary care were on hold.

More here:

http://www.ehi.co.uk/news/primary-care/6681/scope_of_scr_reduced_further

I have had a look at the scope document and the planned scope of the shared record is now:

----- Begin Extract

2 Scope of the SCR

2.1 Content of the SCR

The SCR is designed to provide a summary of clinical information which would be deemed useful in the event of urgent or emergency care for a patient, particularly when other sources of information may not be readily available. The over arching aim is that the SCR will contain only significant aspects of a person’s care, those deemed to deliver benefit to a patient when receiving urgent and emergency care.

When a patient’s SCR is first created it will contain details of:

• Medications;

• Adverse reactions; and,

• Allergies.

This will be copied to the Summary Care Record from the patient’s GP record, under “informed implied consent”.

Following this a patient and their doctor may wish to add additional information to the patient’s Summary Care Record. This must only be added with the explicit consent of the patient.

Any additional information will be selected to allow a greater quality of care to be delivered to the patient by other clinicians who may access the patient’s SCR whilst providing treatment in an urgent or emergency setting. A specific example of this additional information is the inclusion of End of Life Care Plans for patients undergoing palliative care.

An update will be sent to the SCR as information in a patient’s General Practice record is changed, for example, as new medications are prescribed. Each update sent to the SCR is time and date stamped and replaces the information already held. The latest version of the patient’s SCR is the only one available for staff giving care to the patient.

---- End Extract

So here after over a decade’s research trial and work we find what the UK has worked out is practicable and useful - and it is just nothing like the over-engineered and doomed to fail in my view PCEHR.

We have to walk before we can fly and showing a level of competence by getting the very basics in place would be a really good place to start!

The following diagram shows just what is intended by NEHTA - and the scale and complexity just boggles the mind from an organisation that has never actually delivered an operational system to anyone anywhere.

Of course we have seen all this before. Compare this with NSW HealthELink in 2006. Same excessive complexity and over done approach!

Needless to say HealthELink is now a small historical note in the History of E-Health in NSW.

Remarkably many of the flaws in HealthELink (workflow issues, lack of incentives and usefulness) are just the same in the PCEHR.

This is just utter madness! We really do need to take things one step at a time and not let over ambitious engineers ruin any hope for success.

David.