Weekly Overseas Health IT Links - 31 July, 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.

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Mayo Clinic Builds Next-Gen Health Information Exchange

Open-source natural language processing software will provide additional context so that clinicians and researchers can better use patient data from a variety of sources.

By Ken Terry, InformationWeek

July 20, 2011

URL: http://www.informationweek.com/news/healthcare/interoperability/231002212

Using a Beacon grant provided by the Office of the National Coordinator of Health IT, the Mayo Clinic is building what may be the next generation of health information exchanges (HIE) with a group of healthcare providers in southeast Minnesota. In this real-world demonstration, Mayo will apply the computer tools it is developing through a federal SHARP grant to create new methods of mining electronic health record (EHR) data.

"We're building a patient data repository for southeast Minnesota that will execute on a lot of the promise and principles we're articulating in our SHARP grant," said Christopher Chute, MD, a Mayo Clinic epidemiologist and the principal investigator on Mayo's SHARP grant.

Mayo is using the government's CONNECT software to establish the HIE. The world-famous group practice also is working with the pioneering Indiana Health Information Exchange to build a data repository like the one in Indianapolis. "We'll use that to do population health management, aggregate outcomes analysis, and comparative effectiveness research pooled across healthcare encounters by different providers with the same patients," said Chute.

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When Health IT Meets Bugs Bunny

HHS seeks vendor to produce cartoons to educate the public about the benefits of EHRs and other types of IT in healthcare.

By Neil Versel, InformationWeek

July 21, 2011

URL: http://www.informationweek.com/news/healthcare/patient/231002359

The U.S. Department of Health and Human Services is looking to educate the public about health IT issues as simply as possible. That simple avenue might just be a cartoon.

HHS, via the Office of the National Coordinator for Health Information Technology (ONC), is looking for a contractor to produce one or two video animations no longer than 10 minutes in length to help educate the public about the value of health IT and how technologies such as electronic health records will change how the public interacts with healthcare organizations. At least one video must be in "plain language," as defined by federal contracting standards.

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http://www.technologyreview.com/biomedicine/38021/?nlid=nldly&nld=2011-07-13

Tuesday, July 12, 2011

Helping Patients Test Treatments for Chronic Illness

Customizable tools will let patients, and their doctors, track various health metrics.

By Emily Singer

A new set of tools could help patients with chronic illnesses track their condition and monitor how they respond to different treatments.

The tools are designed to let physicians run experiments tailored to an individual patient's needs, a faster and more quantitative way than infrequent office visits to determine a treatment's benefits or side effects.

"The idea is to try to make interactions between patients and doctors more continuous, and to provide patients with more information so they can participate more actively in their care," says Peter Margolis, a physician at Cincinnati Children's Hospital. The project is part of the Collaborative Chronic Care Network (C3N), whose goal is to collect real-time data and use it to change how chronic illnesses are managed.

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http://www.iwatchnews.org/node/5146/

Doctors skittish about health technology despite promise of big federal bucks

Cleveland area physicians worried about big hassles, big risks and a big commitment of time they don't have

By Susan Jaffe

6:00 am, July 7, 2011

CLEVELAND — In Dr. Sandra Berglund’s well-stocked waiting room, there’s a box of children’s toys and picture books and, on either side of a magazine rack, framed photographs of sacred places: the stadiums of the Cleveland Browns and Cleveland Indians. And in clear view behind the receptionist’s desk is something the Obama Administration will actually pay her to clear out: folders of paper medical records stuffed into shelves from the floor almost to the ceiling.

The administration is offering what sounds like a pretty good deal. If Berglund, a family medicine doctor in her own practice, transfers the information in those folders to an electronic health record system run on a computer, she could earn a $44,000 bonus over the next five years tacked on to the payments she gets for treating patients in Medicare. Or, if she cares for a certain number of low-income Medicaid patients, she could earn as much as an extra $63,750 over six years.

The doctors still have to buy the system — which can cost roughly $20,000 per physician initially — but the bonus payments are designed to get them interested. The payments are part of a $27 billion incentive program included in the 2009 economic stimulus law. The program also offers health care providers free technical support from new regional extension centers, a certification process to highlight suitable electronic systems, workforce training and a national health information exchange network, among other benefits.

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http://www.healthdatamanagement.com/news/aafp-physician-patient-survey-portal-42828-1.html

AAFP Portal Eases Patient Satisfaction Reporting

Joseph Goedert

HDM Breaking News, July 21, 2011

The American Academy of Family Physicians has launched an online patient survey portal that its members can buy for $150 a year to gather, organize and report satisfaction information from patients.

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http://your-story.org/emr-adoption-to-drive-e-health-market-growth-in-us-254934/

EMR Adoption to Drive e-Health Market Growth in US

July 22, 2011

According to our latest research, “US e-health Market Analysis”, the US represent world’s largest and one of the fastest growing e-Health markets. Past few years have been phenomenal for the industry and it remained almost immune to the economic slowdown. A number of segments, EMR in particular has witnessed excellent market expansion during the last 4-5 years and helped overall industry to post double digit CAGR growth. The research further revealed that e-Health market will follow the same growth trajectory by 2015 and will emerge as one of the most lucrative sector in the US for investment and business execution.

The study identified that EMR is currently the most dominant market segment. The segment growth has largely been benefitted by Government policies and regulations which encouraged public healthcare professionals and private practitioners to adopt and use electronic medical records product and services. It is anticipated that government incentives along with various private sector initiatives as discussed and analyzed in the report will drive the market growth to achieve new heights.

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When Social Features Meet Personal Health Records

Employer consortium Dossia takes cues from social networking and games as it vies to boost usage of its personal health record site.

By Marianne Kolbasuk McGee, InformationWeek

July 20, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231002035

Employer consortium Dossia is adding new functionality to its personal e-health record system to improve engagement with users and help them better manage and improve their health.

The new Dossia Health Manager is an "intelligent" health management system that further extends Dossia's original e-personal health record capabilities beyond being a platform for individuals to store and track their health information to one that enables users' health data to become "actionable," said Dossia CEO Mike Critelli, in an interview with InformationWeek Healthcare.

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http://www.modernhealthcare.com/article/20110721/NEWS/307219975/

Express Scripts will buy rival Medco for $29.1 billion

By Jaimy Lee

Posted: July 21, 2011 - 7:45 am ET

Express Scripts said it will acquire Medco Health Solutions, a rival pharmacy benefits management company, for $29.1 billion in cash and stock.

St. Louis-based Express Scripts will form the Express Scripts Holding Co.; Express Scripts shareholders will own 59% of the new company while Medco shareholders will own about 41%, according to a news release. Medco, which is based in Franklin Lakes, N.J., has 20,000 employees and reported $66 billion in revenue in 2010.

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http://www.fierceemr.com/story/ehrs-too-cumbersome-eye-docs/2011-07-21

EHRs too cumbersome for eye docs

July 21, 2011 — 8:07am ET | By Janice Simmons

An information technology committee organized by the American Academy of Ophthalmology this week released a list of special requirements to help electronic health record (EHR) systems be used more "intuitively and efficiently" by ophthalmology practices.

In a report now available online in the journal Ophthalmology and forthcoming in the Aug. 1 issue, AAO committee members note that many EHRs currently used by ophthalmologists are "large, comprehensive systems that originally were designed for other medical specialties or large enterprises," such as hospitals or health plans. As such, the systems pay little attention to the needs of ophthalmologists.

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http://www.fierceemr.com/story/your-emr-privacy-policy-first-and-foremost-should-be-practical/2011-07-20

Your EMR privacy policy, first and foremost, should be practical

July 20, 2011 — 5:19pm ET | By Janice Simmons

It's not hard to find recent examples of privacy and security at odds with electronic medical records (EMRs). Just this week, for instance, a federal grand jury indicted a former employee of University of Maryland Medical Center with stealing patient identities. Wake Forest Baptist Health in North Carolina, meanwhile, notified 357 people (including employees and patients) that a former employee was hoarding their medical records at home.

Headlines such as these can be scary. What may be even more frightening, however, is that many providers or healthcare organizations unwittingly are violating the trust of their patients every day--without consciously trying.

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FCC Criticized For Not Spending On Telemedicine

American Telemedicine Association urges action on measures to achieve the National Broadband Plan's goals.

By Nicole Lewis, InformationWeek

July 19, 2011

URL: http://www.informationweek.com/news/healthcare/policy/231002124

The American Telemedicine Association (ATA) has fired off a letter to the Federal Communications Commission (FCC) urging that more money be spent on expanding telecommunications services, which will boost telemedicine projects at rural healthcare facilities.

The letter, which was sent last week to FCC chairman Julius Genachowski, noted that 16 months had passed since the FCC adopted the National Broadband Plan, which included an entire chapter on the positive effects that broadband expansion can have on healthcare delivery. The letter also stated that eight months ago the U.S. Government Accountability Office (GAO) issued a report sharply criticizing the Commission's management of the Rural Health Care Program.

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http://www.ehi.co.uk/insight/analysis/763/e-prescribing:-safer-than-paper

E-prescribing: safer than paper?

Alex Jennings, deputy chief pharmacist at University Hospital, Aintree, reflects on the pros and cons of an e-prescribing roll out; and outlines some of the questions other trusts should be asking.

18 July 2011

We have just completed the roll-out of an electronic prescribing and medicines administration system (EPMA) at an 800 bed teaching hospital in the North West, going from zero to full inpatient coverage in 18 months.

We certainly don’t consider ourselves “know it alls’ in this field, but we are hoping that we can raise awareness of some of the issues that we have come across.

We hope that after reading this article, you will have a greater understanding of some of the limitations and potential misconceptions/risks of EPMA - to balance against the more bullish articles that have recently been published.

We also hope that you will be armed with the type of questions that need to be asked of electronic prescribing suppliers, so that informed decisions can be made.

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http://govhealthit.com/news/why-shuttered-rhio-caresparks-chairman-not-giving

Why shuttered RHIO CareSpark's chairman is not giving up

July 19, 2011 | Patty Enrado, Contributing Editor

In June 2011, CareSpark's board of directors voted unanimously to terminate the nonprofit regional health information organization (RHIO), which serves 17 counties in eastern Tennessee and southwestern Virginia.

"It was very devastating," said Jerry Miller, MD, founder of Holston Medical Group and board chairman of CareSpark, of the decision, which was announced last week. The RHIO was burdened with legacy debt and ultimately, he said, "We did not have a sustainable plan."

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http://articles.boston.com/2011-07-19/business/29791294_1_social-security-numbers-hospital-computer-medical-record-numbers

Beth Israel data breach may affect over 2,000

Virus sent records to unknown location

July 19, 2011|By Hiawatha Bray, Globe Staff

Beth Israel Deaconess Medical Center is notifying more than 2,000 patients that some of their personal information may have been stolen from a hospital computer.

The hospital said yesterday that an unnamed computer service vendor had failed to restore proper security settings on a computer after performing maintenance on it. The machine was later found to be infected with a virus, which transmitted data files to an unknown location.

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http://govhealthit.com/news/fda-lays-out-regulation-certain-mobile-medical-apps

FDA lays out regulation of certain mobile medical apps

July 19, 2011 | Mary Mosquera

The Food and Drug Administration has proposed regulation of some medical applications that run on smartphones and other mobile computing devices that could affect the operations of other medical devices already under its governance.

The agency’s draft guidance released July 19 outlines its “current thinking” and focuses on a small subset of mobile medical apps because they can influence the performance or functionality, and potentially the safety, of currently regulated medical devices.

The mobile medical apps that FDA has in mind are those used as accessory to a medical device already regulated by the agency, such as one that enables a provider to make a diagnosis by viewing a medical image from a picture archiving and communication system (PACS) on a smartphone or other mobile device.

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http://www.ihealthbeat.org/perspectives/2011/include-mental-health-addiction-providers-in-meaningful-use-incentives.aspx

Wednesday, July 20, 2011

Include Mental Health, Addiction Providers in Meaningful Use Incentives

by Chuck Ingoglia

When Congress passed legislation in 2009 creating new Medicare and Medicaid incentive payments to encourage health care providers to use electronic health records, much of the health care community applauded. The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act, was long overdue recognition of the importance of health IT in improving care for patients, while also reducing health care spending.

But amid much fanfare for the HITECH Act, a notable group of providers was left with little to cheer about. The nation's mental health and addiction treatment providers were excluded from the incentive payments. So while some providers continue to be offered financial incentives to use health IT to increase health care quality, reduce medical errors and better coordinate care, providers at psychiatric hospitals, mental health and addiction treatment facilities, and community mental health centers are being told to fend for themselves.

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http://www.cmio.net/index.php?option=com_articles&view=article&id=28706

Report: Healthy growth for hospital info systems; U.S. leads way

Written by Editorial Staff

July 18, 2011

The worldwide hospital information system (HIS) market reached a value of $7.4 billion in 2010, and is expected to achieve a value of $14.7 billion by 2017, according to companiesandmarkets.com.

The London-based market researcher predicted worldwide growth of 10 percent annually. “Advancements in technology, combined with increased investment in public and private healthcare sectors, are driving the hospital information systems market,” the company stated.

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New MGMA Chief Brings Patient Safety, EHR Expertise

Medical Group Management Association recruits Wisconsin Medical Society's CEO and the founder of two data-exchange bodies as new leader.

By Neil Versel, InformationWeek

July 18, 2011

URL: http://www.informationweek.com/news/healthcare/leadership/231001993

The Medical Group Management Association has selected a new chief with as strong a background in health IT as practically any other leader of a healthcare organization not specifically dedicated to IT promotion.

MGMA, an Englewood, Colo.-based organization comprised of group physician practice administrators and leaders, has named Dr. Susan L. Turney to succeed Dr. William F. Jessee as president and CEO. Jessee, himself a vocal advocate for IT adoption in healthcare, will retire after 12 years in charge. MGMA says its 22,500 members lead 13,600 healthcare organizations that provide more than 40% of the healthcare services delivered in the United States.

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http://www.govhealthit.com/news/va-launches-contest-expand-blue-button

VA launches contest to expand Blue Button

July 15, 2011 | Mary Mosquera

The Veterans Affairs Department will launch a developers’ competition to expand the deployment and use of its Blue Button functionality that enables patients to download their health information to all veterans who receive care from providers outside of the VA.

Blue Button is a simple, convenient and secure method over the Internet for a patient to retrieve his or her information in plain text ASCII format.

The competition starts July 18, and VA will announce the winner Oct. 18, VA said. The first prize is $50,000.

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http://www.healthleadersmedia.com/print/TEC-268721/5-Steps-to-Successful-CPOE

5 Steps to Successful CPOE

Gienna Shaw, for HealthLeaders Media , July 19, 2011

In the 1990s, big bang rollouts of electronic health systems were all the rage. But have you ever heard the phrase "only fools rush in?" Many organizations learned that while that approach got complete systems up and running, it didn't guarantee that clinicians would like them.

So the industry tried a more drawn-out approach, forming vast committees to get buy-in from every last stakeholder. In the end, though, that didn't guarantee adoption, either. In fact, it created new problems, such as alert fatigue.

Today, organizations are finding a balanced approach to launching systems such as computerized physician order entry that lets them get buy-in and get to go-live faster and more efficiently. I spoke to leaders at several organizations in various stages of implementing CPOE for an article in this month's issue of HealthLeaders magazine.

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http://www.ehi.co.uk/news/EHI/7033/no-national-it-system-for-appraisal

No national IT system for appraisal

19 July 2011 Fiona Barr

The Department of Health had said there will be no national IT system for revalidation when it begins next year. Instead, employers and doctors will be able to choose IT systems locally.

The Department of Health’s Revalidation Support Team has published an evaluation of its Pathfinder Pilots for revalidation, which looked at the experiences of more than 3,000 doctors in the ten pilot areas.

The evaluation found that 96% of organisations expected revalidation to lead to improved quality of care.

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http://www.modernhealthcare.com/article/20110719/BLOGS02/307199999

By Joseph Conn

Only connect—meshing home devices and electronic health records

I won't go into all 11 of the recommendations in a report this week from the National Research Council on improving the connections between electronic health-records systems and home health-care monitoring devices, and the usability of those devices by nonclinicians.

You can read them all in a free copy here.

But two key recommendations in the 203-page report, “Health Care Comes Home: The Human Factors,” were directed at the Office of the National Coordinator for Health Information Technology, and I'll deal with those two in this post.

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http://www.healthdatamanagement.com/blogs/health_care_technology_news_HIE-42805-1.html

HIE Challenge: ‘Breadth of subjects’

Gary Baldwin

Health Data Management Blogs, July 15, 2011

As I mentioned in my initial report covering the MetroChicago HIE, some three-fourths of Chicago-area hospitals have signed on with one of the nation’s most ambitious data exchange projects. To learn more about what has propelled the HIE, I caught up recently with Terri Jacobsen, the project’s director. She’s part of the Metropolitan Chicago Healthcare Council, a long-standing Chicago-based membership organization that is spearheading the data exchange. Some 69 area hospitals have joined, signing letters of intent to participate as dues-paying members. Unlike some data exchanges, which had to build from scratch not-for-profit organizations and boards to operate, the council has enjoyed relationships with Chicago-area providers for years. “Our pre-existing relationships have helped facilitate the effort so far,” Jacobsen says. (click here for a video interview MCHC conducted with Terri).

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http://www.healthdatamanagement.com/news/webmd-stock-online-consumer-content-42813-1.html

WebMD Downgrades Expectations, Investors Bail

Joseph Goedert

HDM Breaking News, July 18, 2011

The stock price of online health information content vendor WebMD Health Corp. fell 30 percent on July 18 after the company downgraded its financial performance for the rest of 2011.

The stock fell in the morning after the announcement and did not recover much after the company issued a follow-up statement from Chairman Martin Wygod saying he has the "utmost confidence in WebMD's growth prospects and the future value of the company." However, speculators came in during early after-hours trading and boosted the stock by 13 percent.

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http://www.healthdatamanagement.com/news/google-health-microsoft-healthvault-phr-42812-1.html

Microsoft HealthVault Ready to Accept Google Health Accounts, Apps

Joseph Goedert

HDM Breaking News, July 18, 2011

Microsoft Corp. has launched a Web page where consumers using personal health records from Google Health can have their personal health information transferred to a Microsoft HealthVault account.

Google Inc. also will support the migration to HealthVault of applications that third-party developers have created for Google Health. Additional information is available here.

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http://news.cnet.com/8301-10805_3-20080403-75/microsoft-offers-transfer-tool-to-google-health-users/

July 18, 2011 10:49 AM PDT

Microsoft offers transfer tool to Google Health users

by Jay Greene

For the seeming handful of people who signed up to use the soon-to-be-shuttered Google Health online medical records service, Microsoft has an answer: join its service.

Microsoft released a tool today that lets Google Health customers transfer their personal health information to a Microsoft HealthVault account. To protect patient privacy, the tool uses the Direct Project messaging protocols established by the Office of the National Coordinator for Health IT that authenticate and encrypt the data, sending it only to known, trusted recipients.

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http://esciencenews.com/articles/2011/07/19/e.health.records.should.play.bigger.role.patient.safety.initiatives.researchers.advocate

E-health records should play bigger role in patient safety initiatives, researchers advocate

Published: Tuesday, July 19, 2011 - 12:37 in Health & Medicine

Patient safety researchers are calling for the expanded use of electronic health records (EHRs) to address the disquieting number of medical errors in the healthcare system that can lead to readmissions and even death. Their commentary is in the July 6 issue of JAMA, The Journal of the American Medical Association . "Leading healthcare organizations are using electronic health records to address patient safety issues," said Dean Sittig, Ph.D., co-author and professor at The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics. "But, the use of EHRs to address patient safety issues hasn't hit the mainstream yet and we think everyone should be doing this."

One way to fast-track the use of EHRs to address patient safety issues would be to incorporate the annual patient safety goals of The Joint Commission, a healthcare accreditation organization, into the criteria for the certification of EHRs, said co-author Ryan Radecki, M.D., who is scheduled to join the UTHealth faculty Aug. 1.

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http://www.gazette.com/articles/health-121643-records-accessing.html

Peeking at medical records an issue for health centers

BARBARA COTTER

2011-07-15 22:23:26

A Colorado Springs city health employee recently accused of inappropriately accessing about 2,500 Memorial Health System patient records claimed that “it’s pretty damn common” for medical professionals to peek at files for unwarranted reasons.

“Common” might be overstating things, but statistics suggest it happens more often than patients might realize.

Since 2008, Memorial Health System has had 22 employees who either resigned or were fired in connection with patient privacy issues, including a woman who lost her job earlier this year for breaching 135 patient records to create a database of her friends’ birthdays. Penrose-St. Francis Health Services declined to provide information on breaches at its facilities or discuss the issue.

Nationwide, the U.S Department of Health and Human Services’ Office for Civil Rights has recorded 292 incidents of electronic medical record breaches involving 500 or more patients since 2009. That excludes the hundreds, if not thousands, of incidents that don’t meet the 500-patient threshold for public reporting.

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http://www.fiercehealthit.com/story/scanning-expensive-nightmare-many-hospitals/2011-07-12

Hospitals spend up to $100M to scan paper

July 12, 2011 — 3:14pm ET | By Ken Terry

Nearly one-fourth of the 200 facilities surveyed said they are spending $100 million or more to scan paper documents. What's more, 36 percent of those hospitals plan to hold onto their paper records after they're digitized, according to document management and storage firm Iron Mountain.

The government's criteria for Meaningful Use of electronic health records (EHRs) does not mention document management. During the transition to EHRs, however, providers need some way to access electronically the paper charts of patients who have been discharged, at least for some years back. Moreover, hospitals continue to generate new paper documents and receive them from other sources. All of this requires high-speed scanners and staff time to operate them and ensure that the documents are correctly filed.

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http://www.fiercehealthit.com/story/imaging-diagnosis-may-represent-best-use-scenario-ibms-watson/2011-07-18

Imaging diagnosis may represent best-use scenario for IBM's Watson

July 18, 2011 — 11:30am ET | By Dan Bowman

Radiology may very well prove to be a sweet spot for IBM's supercomputer Watson.

At heart, Watson is an electronic health record reader. Once that technology is correctly combined with picture archiving and communication system (PACS) technology, diagnosis times for patients could be shortened tremendously, according to Dr. Eliot Siegel, a radiology professor at the University of Maryland's School of Medicine. "There's great potential for Watson to...[also] offer treatment summaries, synthesize charts and perform safety checks," Siegel says, according to a report by Diagnostic Imaging.

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http://www.ihealthbeat.org/features/2011/stimulus-money-still-flowing-to-health-it-projects.aspx

Monday, July 18, 2011

Stimulus Money Still Flowing to Health IT Projects

by Helen Pfister, Susan Ingargiola and Rachel Sam, Manatt Health Solutions

The federal government continues to implement various provisions of the American Recovery and Reinvestment Act, which included the Health Information Technology for Economic and Clinical Health Act. This update summarizes key developments during the second quarter of 2011.

ONC Leadership Changes, Committees March Onward

Farzad Mostashari replaced David Blumenthal as national coordinator for health IT. Mostashari, formerly deputy national coordinator at the Office of the National Coordinator for Health IT, took over the top job in April.

At its June meeting, the Health IT Policy Committee approved the Meaningful Use work group's revised Stage 2 objectives and criteria and the recommendation to delay the transition from Stage 1 to Stage 2 by one year for providers who qualify for meaningful use incentives in 2011. The committee passed on its recommendations to ONC.

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http://www.fiercehealthcare.com/story/security-patient-records-breached-across-country/2011-07-18

Security of patient records breached across the country

July 18, 2011 — 11:38am ET | By Karen M. Cheung

Security breaches of patient records have been popping up in the news recently, with some breaches affecting hundreds.

A federal grand jury on Thursday indicted a former employee of University of Maryland Medical Center, with three others accused, of stealing patient identities to open credit accounts, according to a WBAL TV report.

The Medical Center said, "Protecting our patients' personal information is a top priority. We have policies and procedures in place to ensure that patient information remains strictly confidential. This breach was a result of a crime, and not a lapse of hospital procedures."

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Enjoy!

David.

EHR Usability Is A Really Significant and Important Issue. Interesting Stuff Here!

The following appeared in the New York Times a little while ago.

July 16, 2011

Seeing Promise and Peril in Digital Records

By STEVE LOHR

TECHNICAL standards may seem arcane, but they are often powerful tools of economic development and social welfare. They can be essential building blocks for innovation and new industries. The basic software standards for the Web are striking proof.

Safety is also a potent argument for standards. History abounds with telling examples, like the Baltimore fire of 1904. That inferno blazed for 30 hours, destroying more than 1,500 buildings across 70 city blocks. Fire engines from other cities came to help, but could not. Their hose couplings — each a different size — did not fit the Baltimore fire hydrants. Until then, cities saw little reason to adopt a standard size coupling, and local equipment manufacturers did not want competition. So competing interests undermined the usefulness of, and investment in, the technology of the day.

Today, the matter of standards for electronic health records is raising similar concerns, prompting heated debate in recent meetings of representatives from medicine, industry, academia and government. The stakes, they say, could scarcely be higher. They agree that, when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs. But computer forms, they add, can also be difficult to use, cluttered and distracting, causing more harm than good in health care.

“This is an issue that potentially affects the health and safety of every American,” says Ben Shneiderman, a computer scientist at the University of Maryland.

The controversy points to the delicate balancing of interests involved when creating technical standards that inherently limit some design choices yet try to keep the door open to innovation. It also raises the question of the appropriate role for government in devising such technology requirements.

At issue is the Obama administration’s plan to develop standards to measure how effective and easy digital patient records are to use — applying a research discipline known as human-computer interaction or human factors. (The International Organization for Standardization, which is based in Geneva, defines the usability of a product by three attributes: “effectiveness, efficiency and satisfaction.”)

The need to improve the usability of computerized records is clearly evident — and has been for some time. A 2009 study by the National Research Council, an arm of the National Academy of Sciences, found that electronic health record systems were often poorly designed, and so could “increase the chance of error, add to rather than reduce work flow, and compound the frustrations doing the required tasks.”

At a government-sponsored gathering last month, Dr. David Brick, a pediatric cardiologist in New York, demonstrated how it took eight mouse clicks on a digital record to find the patient information presented comfortably on the single sheet of a paper chart. Hearing such complaints, countless times, from doctors and nurses is what prompted the administration to put usability on its policy agenda.

.....

What is also beyond doubt is that the promise of digital records will be unfulfilled if doctors refuse to adopt them, because they regard the technology as cumbersome, time-consuming and possibly dangerous.

“Usability is going to be the single greatest impediment to physician acceptance,” says Dr. Edward H. Shortliffe, a professor at the University of Texas Health Science Center in Houston and the president of the American Medical Informatics Association.

Lots More here:

http://www.nytimes.com/2011/07/17/technology/assessing-the-effect-of-standards-in-digital-health-records-on-innovation.html?_r=2

This article raises a really important issue. How do you make software work well, be suitable to the needs and at the same time be safe and not get in the way of clinicians trying to get the job done,

My view is that there is a difficult line to draw. We need practitioner systems that work well, are easy to use and foster safe practice but at the same time over regulation might ensure the incentive to create such systems is blunted.

Well worth a read. I would love views from software developers etc.

David.

Twitter Moves Into The E-Health Domain. What A Fascinating Outcome!

The following appeared week or two.

http://healthcareitnews.com/news/scientists-track-health-issues-twitter

Scientists track health trends on Twitter

July 08, 2011 | Molly Merrill, Associate Editor

BALTIMORE – Twitter can be used to track important health trends, according to computer scientists at Johns Hopkins University.

Mark Dredze and Michael J. Paul fed two billion public tweets posted between May 2009 and October 2010 into computers, then used software to filter out the 1.5 million messages that referred to health matters. Dredze, a researcher at the university’s Human Language Technology Center of Excellence and an assistant research professor of computer science, and Paul, a doctoral student, said identities of the tweeters were not collected.

“Our goal was to find out whether Twitter posts could be a useful source of public health information," said Dredze. “We determined that indeed, they could. In some cases, we probably learned some things that even the tweeters’ doctors were not aware of, like which over-the-counter medicines the posters were using to treat their symptoms at home.”

By sorting these health-related tweets into electronic “piles,” Dredze and Paul uncovered patterns about allergies, flu cases, insomnia, cancer, obesity, depression, pain and other ailments. “There have been some narrow studies using Twitter posts, for example, to track the flu,” said Dredze. “But to our knowledge, no one has ever used tweets to look at as many health issues as we did.”

In addition to finding a range of health ailments in Twitter posts, the researchers were able to record many of the medications that ill tweeters consumed, thanks to posts such as: “Had to pop a Benadryl … allergies are the worst.”

Other tweets pointed to misuse of medicine. “We found that some people tweeted that they were taking antibiotics for the flu,” said Paul. “But antibiotics don’t work on the flu, which is a virus, and this practice could contribute to the growing antibiotic resistance problems. So these tweets showed us that some serious medical misperceptions exist out there.”

To find the health-related posts among the billions of messages in their original pool, the Johns Hopkins researchers applied a filtering and categorization system they devised. With this tool, computers can be taught to disregard phrases that do not really relate to one’s health, even though they contain a word commonly used in a health context.

Once the unrelated tweets were removed, the remaining results provided some surprising findings. “When we started, I didn’t even know if people talked about allergies on Twitter,” said Paul. “But we found out that they do. And there was one thing I didn’t expect: The system found two different types of allergies – the type that causes sniffling and sneezing and the kind that causes skin rashes and hives.”

In about 200,000 of the health-related tweets, the researchers were able to draw on user-provided public information to identify the geographic state from which the message was sent. That allowed them to track some trends by time and place, such as when the allergy and flu seasons peaked in various parts of the country. “We were able to see from the tweets that the allergy season started earlier in the warmer states and later in the Midwest and the Northeast,” said Dredze.

More here:

http://healthcareitnews.com/news/scientists-track-health-issues-twitter

First it was Google tracking epidemics based on what was searched for and now we have Twitter offering at least some useful information in the quest to understand patterns of symptom and disease spread.

Talk about an ‘unintended outcome’!

David.

Do You Agree With the Perspective Provided Here On Patient Information Access?

The following appeared a few days ago and I thought it was worth putting up for discussion.

Healthcare Needs Help On Transparency

The industry will need to get over its skittishness about sharing electronic health records with patients. Because patients will demand full access to their digital records, plain and simple.

By Chris Murphy, InformationWeek

July 14, 2011

Dr. Neil Calman wrapped up Tuesday's InformationWeek Healthcare IT Leadership Forum in New York City with a few predictions, including one portending radical change in people’s access to their health records.

He started with the big picture. "If there's one thing that's going to revolutionize healthcare--whether it's IT, ACOs, any aspect of health reform--what you're going to see is patients taking back healthcare from their providers," said Dr. Calman, a physician who is CEO and cofounder of the Institute for Family Health, which runs 17 health centers in the Bronx, Manhattan, and the mid-Hudson Valley in New York State.

Then Dr. Calman got more specific, including one prediction destined to raise some blood pressure:

"You're going to see patients want complete and unfettered access to their medical records. Forget all this about where we're going to keep the data to ourselves for seven days before it's released to patients, or we're going to create models of abstracted data to give to people. They will have total and complete, instant access to their medical information, whenever, in multiple formats, however they want it."

Each of those modifiers -- complete, unfettered, instant -- would rip away a security blanket that healthcare providers and health IT leaders cling to when they start talking about giving patients access to their medical records.

Instant: Some providers give patients access to lab results, but they wait several days so that doctors have time to talk with their patients about the results.

Complete: Should patients be allowed to read their doctors’ notes? To access every lab result? To see images they aren't qualified to assess?

Unfettered: This will mean letting patients have their full health records -- and not just through a hospital's sanitized portal, but as a raw download they can take with them, Dr. Calman predicted. And they'll have to offer a means for the patient to make comments, or corrections in places where they think the information is wrong, he said. Dr. Calman's fellow panelist, Karen Marhefka, associate CIO for UMass Memorial Healthcare, said giving patients the ability to comment on records was a concern when UMass Memorial assessed vendors for its planned patient portal. Its lawyers advised against allowing other sources into the providers' clinical data, even if comments could be identified as coming from the patient.

Dr. Calman predicted that every major electronic health record system or portal will soon allow patient input, and that it shouldn't be controversial. "Every single thing we do in medicine depends on what the patient told us," he said. "… The subjective part of every progress note is us writing down what the patient told us. We don't have any way of independently verifying it. But all of a sudden, when the patient can write it themselves, it becomes something the lawyers are all freaked out about. Anyway, these are the transformations that are going to take place. They just change the way we think about everything in healthcare."

More here:

URL: http://www.informationweek.com/news/global-cio/interviews/231001847

My feeling is that this position is at rather the ‘bleeding edge’ but that there will emerge over the next few years a reasonable number of consumers who would agree with this view. Whether there are enough people who, if such a service were available, would actually use it we will have to just wait and see. The adoption of PHRs makes one wonder but on the other hand the importance for many people to keep track of their clinical story and their preparedness of some to do the work argues against that.

My view is that we should see if offering a service attracts a reasonable amount of use in a confined geography (say one capital city or those insured by one provider) and if there is substantial interest and use then go from there.

There does often seem to be a tendency to want access to material on the part of the public, but once granted a good deal of the interest wanes. Testing is the only way to know.

David.

A Clearly Written And Useful Review of Medical Record Privacy. It Is Not Utterly Straightforward!

This useful article appeared a little while ago.

An unhealthy obsession

Beth Wilson

July 18, 2011

Opinion

Britain's media scandal is a timely reminder that medical records are sacrosanct.

WHY is health privacy so important to people? Britons are reportedly shocked by the invasion of former prime minister Gordon Brown's privacy when his son's health information was allegedly ''blagged'' and published. The Sun has denied accessing the family's medical records without consent and says the story came from a member of the public whose own son has cystic fibrosis and who merely wanted to raise awareness. The Cystic Fibrosis Trust, correctly in my opinion, questioned the decision to publish the information regardless of motivation, saying: ''The release of any medical information to the media or anyone else is a decision for patients or, in the case of children, their parents to make.''

In Victoria we have two separate laws governing information privacy, the Information Privacy Act and the Health Records Act. These laws work concurrently. The Information Privacy Act is administered by the Privacy Commissioner and protects information in the public sector and the Health Records Act is administered by the Health Services Commissioner and protects health information.

When the legislation was passed, the Parliament of the day took the view that our health information is different from other information because it can be extremely sensitive, intimate and prone to misuse for discriminatory purposes. People should be able to reveal intimate details to their health service providers and other organisations trusting their confidentiality will be respected.

Health records are owned by the doctor who created them or to the organisation they work for depending on the contractual agreement, but people do have a legal right to get copies of or inspect records which contain their health information. Organisations that collect our health information must ensure the information is secure, up to date and accurate and is not disclosed without the consent of the person it is about.

It is also important that health information is disposed of securely. In one disturbing case, my office had reports of medical records containing people's names and revealing HIV and hepatitis C status found blowing in the wind in a supermarket car park. A doctor who had taken the files home nipped into the supermarket on the way home. His children thought the records would make good paper planes, and so they did. The hospital is now much more careful about protecting the security of the sensitive information of which it is the custodian.

Many people also don't realise that the media are exempt from privacy laws in connection with their news activities. Privacy is not absolute and there is a balancing act between making sure the right information gets to the right people at the right time, hence the importance of press freedom. The public has a right to be told what is going on in government and society and accountability is, in some cases, more important than individual rights to privacy.

While the media are exempt from privacy laws, they have a corresponding ethical obligation to treat people's health information sensitively. The media are not exempt from receiving information unlawfully. Privacy is a legal concept whereas confidentiality is an ethical obligation which involves making moral judgments. This has been the case at least since the 5th century BC, when Hippocrates included in his Oath: ''All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.''

More here:

http://www.smh.com.au/opinion/contributors/an-unhealthy-obsession-20110717-1hk0t.html

Beth Wilson is the Health Services Commissioner for Victoria.

Ms Wilson rightly notes that there is no real protection for health information if it is disclosed maliciously or for profit as we lack legal protections against public disclosure by media. This really is not a satisfactory situation with respect to private health information - and the only legitimate disclosure I see is that based on direct consent from an individual (e.g. a politician admitting and disclosing treatment for depression etc.).

While Ms Wilson did not mention it, I believe politicians are also exempt from the Privacy Act as are some Small Businesses and Employee Records held by an employer (for reasons I don’t understand).

There was a review of the Privacy Act in 2008. You can read all about it here:

http://www.alrc.gov.au/publications/report-108

There is a lot on EHRs and Health Information but to date there has not been any real decisions taken in this area.

The following sections are the most relevant:

· 60. Regulatory Framework for Health Information

· 61. Electronic Health Information Systems

· 62. The Privacy Act and Health Information

· 63. Privacy (Health Information) Regulations

· 64. Research: Current Arrangements

· 65. Research: Recommendations for Reform

· 66. Research: Databases and Data Linkage

There is also more information here:

http://www.privacy.gov.au/business/health

The impression one gets looking at these various sources is that we still have a regulatory patchwork (for example State Government Health Facilities are exempt from the Commonwealth Privacy Act) and that with the plans for the PCEHR seemingly steaming ahead a nationally consistent and agreed set of laws and regulations is vital.

It is interesting that the Government has announced some interest in a review of Media and Privacy some three years after the Law Reform Commission recommended a statutory right to privacy be created. Maybe Health Information Privacy could have a similar kick along!

Those who are interested may wish to visit here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr-legals

and provide their view on the proposed legal framework for the PCEHR (Submissions close August 3^rd, 2011.)

The bottom line to all this unless we have a complete and clear privacy framework that is formally agreed by all major stakeholders we will really doom the PCEHR or anything similar.

It seems to me there are formidable obstacles in getting to that state with differing approaches in a number of the States and the Commonwealth yet to really declare its full hand - and legislate it - on Health Information Privacy and protection.

Have a look here to see the proportion of the US public that are really worried about their health information privacy.

http://www.fierceemr.com/story/your-emr-privacy-policy-first-and-foremost-should-be-practical/2011-07-20

I would expect a similar breakdown in Australia at a slightly lower level.

David.

The Clinical Document That Can Really Make A Difference - We Need To Be Sharing Them Electronically More Often!

This is a draft article for a magazine - comments and suggestions welcome!

-----

At its core e-Health is, as most will agree, trying to use technology in a way that best facilitates the flow of information between the various actors in the Health System, be they consumers, care providers or information sources such as pathology labs etc.

It is often said that a key goal of e-Health is to get the right information to the right person at the right time in the hope that the decisions made when in possession of all the facts will be the best possible. Good provider systems and secure clinical messaging can achieve this outcome.

For practical reasons, and maybe a lack of imagination, most e-health services and applications aim to replicate, to a greater or lesser degree, the presentation of information to the practitioner in the familiar way of looking in as many ways as possible like the paper records that they are replacing. To this end we have electronic replications of all sorts of documents such as referrals, prescriptions, clinical results and so on.

At its simplest level e-Health undertakes the pretty basic tasks of preparing, managing, organising storing and communicating these clinical documents. In this basic context I want to suggest that there is one document which we see not enough sharing of and which to my mind is greatly undervalued. That document is the specialist letter the specialist writes back to the referring GP when the patient has been seen, assessed, investigated and treatment initiated or updated.

Before discussing why I think the specialist letter is so important it is necessary to point out that I in no way minimise the difficulties that may arise in having successful sharing of detailed clinical information, however I would point out that of all the shareable documents the specialist letter may be the simplest to share successfully, being essentially just a header and a test file typically.

The reasons I especially highlight the importance of the specialist letter are as follows.

First, such correspondence is created in a calm, unhurried and focussed environment where there is time to give careful thought to what is being planned and said. Inevitably this maximises the quality, value and trustworthiness of the document.

Second, especially if created by a consulting physician, it will typically have a very clear statement of the patient’s clinical history, previous major health issues, present therapy and so on as well as the reason for the present review and the associated conclusions and recommendations.

Third these days the document will virtually always be created in electronic form making it very straightforward for it to be provided in a very accessible form to a clinical messaging client that can then provide the appropriate security and encryption prior to the letter going directly to the referring clinician.

Fourth, from my experience in both Critical Care and Emergency Care situations, I found these letters to be the single most useful paper document contained in a record and always made a practice of looking for such documents before beginning work assessing the other more detailed components of the record. Indeed, a recent well considered specialist letter was often able greatly speed up the assessment and treatment process in the emergent situation.

A single caveat I would put on all this is that, as the communication back to the GP is critically important so is the effort put in by the GP in developing a referral that explains clearly what is needed from the consultant and provides as much current relevant information as possible.

The National E-Health Strategy, developed for the Council of Australian Governments in 2008 and agreed that same year by COAG, laid out a range of priorities of National E-Health initiatives. The highest priorities were to improve the quality and usage of the IT systems used by providers and to improve clinician to clinician communications via secure messaging. It was also felt that these steps and the creation of appropriate e-health infrastructure (terminologies, health identifiers etc.) offered the best platform from which to then evolve into more advanced e-Health applications such as shared Electronic Health Records.

In both these two top areas there has been steady progress with a range of GP system providers gradually improving the quality and usability of their offerings and the emergence of a number of secure clinical messaging providers who now have very considerable geographic reach and are able to facilitate effective document exchange. Interestingly, very little of this progress can be attributed, at least so far, to NEHTA or the Commonwealth Department of Health who, despite claims to the contrary, have not funded the National Strategy and have proceeded to commence work on the Personally Controlled Electronic Health Record (PCEHR) and telehealth initiatives (involving a total expenditure of close to a billion dollars) which were not mentioned as top priorities in the Strategy. Additionally, while NEHTA has done considerable work on developing e-referral specifications, there is little apparent emphasis on ‘closing the loop’ with the return specialist letter.

The specialist clinical letter is, in my view, a much undervalued document where electronic clinical exchange could be quickly enhanced using services already in existence and at very low cost. I know many GPs are already getting such a service from many specialists but a concerted push to improve the level of penetration would be a very good thing - and would allow for incremental improvements in care while we all await the delivery of some useful e-Health applications from NEHTA and DoHA.

Adopting this suggestion can make a real difference, real soon!

-----

David.

A Site For Experts To Review and Comment on CDA and Information Content Packaging.

I have been asked to provide a link to this questionnaire.

Here it is:

http://www.healthintersections.com.au/?p=418

It will assist NEHTA and a range of others:

Here is the start of the blog:

Straw Poll: Choice of a CDA packaging specification

July 27, 2011 CDA / NEHTA

One of the more difficult issues facing the NEHTA CTI team is what to choose for a technical CDA packaging strategy. We need a coherent strategy because CDA documents have assorted attachments. These attachments can include things like:

• Images
• Alternative document format representations (such as pdf / rtf)
• Digital Signatures

The CDA specification itself says (section 3) that when a CDA document is transferred from one place to another, all components of a CDA document must be able to be included in a single exchange package, including if the transfer is across a firewall, and that there is no need to change any of the references in the CDA document.

----- End Extract.

If this is your expertise please respond.

David.