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."

Monday, February 20, 2012

Weekly Australian Health IT Links – 20th February, 2012.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Really a quiet sort of week with a couple of highlights. The first is the first statement I have seen from the opposition on the PCEHR as reported by e-Healthspace.org. The comparison with ‘pink bats’ does not seem to bode all that well.
The other big issue is the re-emergence of the incentive issue for GPs to assist patients with their PCEHR. This story certainly has some way to run!
Enjoy a quiet week as we are meant to hear from the PCEHR Senate Enquiry next week!
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Opposition votes for ehealth, slams PCEHR

The federal opposition has weighed into debate about the sector’s transformation, branding the $467 million Personally Controlled Electronic Healthcare Record (PCEHR) another example of the federal government’s “poorly implemented approach to blockbuster projects.”
Andrew Southcott, federal opposition spokesman on ehealth, told eHealthspace.org that while he supports the broader ehealth agenda, the PCEHR program was similar to other controversial Labor Government programs including the Building the Education Revolution and home insulation debacle.
Ehealth falls under Mr Southcott’s purview as shadow parliamentary secretary for primary healthcare. “Ehealth is an area where lots of money can be wasted, and we are starting to see some of the problems,” he said.
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AGPN calls for PCEHR incentives

14 February, 2012 Michael Woodhead
Incentives are needed to support individual GPs, practices and Medicare Locals to get the PCEHR up and running by and beyond, July 2012, says AGPN chair Dr Emil Djakic.
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Cash for GPs’ e-health role on agenda

13 February, 2012 Paul Smith
The Federal Government is considering a new funding plan to assist general practices in developing the $467 million e-health records system, due to be rolled out from July.
There have been long-running concerns about the additional workload for GPs signing patients up and ensuring the clinical information on the records is up-to-date and accurate.
Those GPs who opt to take part will be expected to ensure patients give informed consent for their information to be uploaded onto the system.
They will also be expected to “curate” the clinical data that appears on the shared health summaries — the electronic documents detailing diagnoses, allergies and medications that will be made accessible across the health system.
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PCEHR specification glitch identified: NEHTA

Written by Kate McDonald on 15 February 2012.
The technical issue that has held up the implementation of some components of the PCEHR has been resolved and is currently being tested before work restarts, the CEO of the National E-Health Transition Authority (NEHTA), Peter Fleming, said.
Mr Fleming told a Senate Estimates committee hearing in Canberra today that the technical fault was discovered in one of the Clinical Document Architecture (CDA) implementation guides.
He said there are 23 different bundles of specifications for each component of the PCEHR, and three different types of documents for each bundle. The error occurred when the Wave 2 sites were not given an updated version of some of the CDA specifications.
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E-health specifications back in testing

By Josh Taylor, ZDNet.com.au on February 16th, 2012
The National E-Health Transition Authority (NEHTA) is testing specifications and has almost recovered from its stumble that lead to it stopping e-health record trials, said NEHTA CEO Peter Fleming.
In January, NEHTA revealed that it had paused the implementation of primary care e-heath software at the e-health trial sites in North Brisbane, Melbourne, the Hunter, South Brisbane, Western Sydney, St Vincent's, Calvary, Cradle Coast, the Northern Territory and Mater. This pause was due to detected technical incompatibilities for specifications pushed out to the sites in November 2011.
Speaking in a Senate estimates hearing yesterday, Fleming said that the NEHTA was testing the revamped specification solution internally before pushing it out to the trial sites.
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Remote GPs embrace telehealth benefits

Emma Connors
14 February, 2012
West Australian GP Mike Civil is a big believer in telehealth.
While some remain unconvinced taxpayers will ultimately get value for money from the $35.9 billion national broadband network, early adopters suggest remote medicine is an application with big potential.
Since last year GPs have been able to claim Medicare rebates and incentives for linking specialists with their patients via a video link if they are located in a rural, regional or outer metropolitan areas.
About $620 million over five years has been set aside to help encourage consultations over video links.
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NSW government 'sitting on health report'

The computer system, known as FirstNet, continually makes hospital staff spend excessive time on data entry and is underfunded
  • AAP (AAP)
  • 13 February, 2012 09:15
The NSW government has come under attack for failing to release a report into problems with the computer system that runs emergency departments throughout the state.
The report by consultants Deloitte was obtained by Fairfax Media under freedom-of-information laws. It says the computer system, known as FirstNet, continually makes hospital staff spend excessive time on data entry and is chronically underfunded.
Staff are not adequately taught how to use the software and it does not provide an acceptable record of care received, according to the report.
"With some exceptions, FirstNet reporting is inadequate for effective governance of operations," the report states.
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NSW government accused of dodgy software cover-up

FirstNet: the First State's deadest duck
The buggy FirstNet emergency department software has become the subject of a political argument in NSW.
In one of those paradoxes of democracy, an opposition which, in government, was responsible for a now-despised implementation is now using the IT project as a stick to beat a government which was in opposition when the system was chosen.
Last week, the Sydney Morning Herald obtained a report into the system by Deloitte, under a freedom of information request. It says the Deloitte report criticises FirstNet because it is:
- Is chronically under-funded;
- Produces inadequate records;
- Was unreliable in delivering messages, and did not provide alerts when messages failed to reach their destination; and
- Demanded excessive amounts of screen time from clinicians.
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Death highlights need for script tracking

16 February, 2012 AAP
Moves to introduce a national real-time prescription monitoring system to stamp out "prescription shopping" have been backed by a Victorian coroner in the summing up of the death of a young man from prescription drugs.
The recommendation was made by Coroner John Olle at a summary inquest into the death of a Melbourne man who had visited 19 doctors and 32 pharmacies in the three years before he died from an overdose of prescribed morphine and diazepam in October 2009.
Mr Olle's comments come just days after Federal Health Minister Tanya Plibersek announced a $5 million national electronic records system to combat prescription drug abuse.
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Calls for alcohol inclusion in drug monitoring system

17th Feb 2012
Mark O’Brien 
THE nationwide expansion of Tasmania’s controlled drug monitoring system has led to calls for the system to include alcohol sales in supermarkets, while a Victorian coroner has recommended the state government monitor the sale of all prescription drugs.
Health Minister Tanya Plibersek announced this week the Electronic Recording and Reporting of Controlled Drugs system developed by the Tasmanian government would be made available to doctors, pharmacists and state and territory health authorities across Australia from 1 July.
The $5 million system will monitor the prescribing and dispensing of addictive drugs in real time, allowing practitioners and administrators to immediately detect people suspected of trafficking in painkillers, forging prescriptions and ‘doctor-shopping’.
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GPs tick real-time drug database

By Suzanne Tindal, ZDNet.com.au on February 17th, 2012
The Royal Australian College of General Practitioners (RACGP) has patted Health Minister Tanya Plibersek on the back for announcing a new $5 million e-health system to counter prescription-drug abuse.
On the weekend, Plibersek announced that the Federal Government will fund an e-health database for doctors, pharmacists and state and territory health authorities, which will allow real-time monitoring of the prescription and consumption of addictive drugs. The database will be available from 1 July.
Health professionals will be able to access the database, which will contain prescription records, over a secure network, and detect whether a person suspected of trafficking painkillers, forging prescriptions or doctor shopping is seeking medication.
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Medicines could be delivered by remote-controlled microchips in a 'Star Trek'-style program

  • From: AP
  • February 17, 2012 9:37AM
MEDICATION via remote-control instead of a shot? Scientists implanted microchips in seven women that did just that, oozing out the right dose of a bone-strengthening drug once a day without them even noticing.
Implanted medicine is a hot field, aiming to help patients better stick to their medications and to deliver those drugs straight to the body part that needs them.
But the study is believed to be the first attempt at using a wirelessly-controlled drug chip in people. If this early-stage testing eventually pans out, the idea is that doctors one day might program dose changes from afar with the push of a button, or time them for when the patient is sleeping to minimise side effects.
The implant initially is being studied to treat severe bone-thinning osteoporosis. But it could be filled with other types of medication, said co-inventor Robert Langer of the Massachusetts Institute of Technology.
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Andrew Took: Access essential for e-health cards

THE Personally Controlled Electronic Health Record (PCEHR) system to be introduced in Australia from 1 July is consumer-centric in its design.
Not only is it an opt-in model and a completely voluntary scheme, but consumers will be able to access all their health information stored on the PCEHR and, by setting advanced access controls, can exclude parts of their medical history from being accessed by treating practitioners.
Much has been said that unless we adopt an opt-out model, take up rates will be poor and the vision of better health outcomes for Australians will remain illusory.
Ideally, a consumer’s PCEHR will enhance their medical treatment by providing a consolidated summary of his or her health information. It does not — and never will — replace the doctor’s clinical records.
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US and China may have to store our medical data

AUSTRALIAN medical research is to be boosted by the country's most powerful supercomputer, but there is rising concern that a shortage of mathematical and programming skills will eventually force discoveries and developments offshore.
The Victorian Life Sciences Computation Initiative, based at Melbourne University, has signed a deal to acquire an IBM Blue Gene/Q supercomputer that will have the power of more than 20,000 desktop computers.
It will allow researchers to crunch the vast amounts of data generated in areas such as genetic coding to target and personalise treatments based on an individual's genetics.
But VLSCI director Peter Taylor said that while the hardware would come online, Australia faced a looming shortage of skilled mathematicians and programmers to guide the research, because too few students studied high-level maths at school and university.
In the future, he warned, the genetic information of Australians that would underpin the personalised medical treatments of the future could end up being mapped, analysed and kept in countries such as the US and China.
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IBM supercomputer to boost health research in Victoria

The Blue Gene/Q supercomputer should be operational in June this year
The University of Melbourne (UoM) has acquired one of the world’s fastest and greenest supercomputers to help further the study of human diseases.
The IBM Blue Gene/Q supercomputer — expected to be operational in June this year — will provide 836 teraflops of processing power, which is the equivalent of more than 20,000 desktop computers.
The supercomputer will be installed at the Victorian Life Sciences Computation Initiative (VLSCI), which was established by the Victorian government in conjunction with UoM and the IBM Research Collaboratory for Life Sciences, in Melbourne for $100 million to advance biotechnology by enabling scientists to improve diagnostics, find new drug targets and refine treatments.
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Feb. 17, 2012, 8:35 a.m. EST

MMRGlobal and VisiInc Sign Agreement to License MMR Australian Patent Portfolio on the Road to HIMSS

LOS ANGELES, CA, Feb 17, 2012 (MARKETWIRE via COMTEX) -- MMRGlobal, Inc. MMRF 0.00% ("MMR"), a leading provider of Personal Health Records ("PHR"), MyEsafeDepositBox storage solutions and electronic document management and imaging systems for healthcare professionals, today announced that the Company and VisiInc PLC in Australia signed an agreement to license MMR's Australian patents for "Method and System for Providing Online Medical Records" for use in MMR and Visi(TM) consumer and professional health IT products and services, including the MyMedicalRecords Personal Health Record. The Agreement calls for minimum performance royalty guarantees of nearly one million dollars. The Agreement also calls for VisiInc to start selling the services in Australia starting June 1, 2012. In addition, the Agreement contains an understanding allowing the companies to utilize each other's consumer and professional products and services. VisiInc is also seeking rights to sell MMR products in additional territories such as in Eastern Europe where VisiInc already does business.
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Health Industry Exchange Case Study

Health Industry Exchange Case Study
Health Industry Exchange (HIE) achieved NeHTA’s Health Identifiers (HI) Compliance, Conformance and Accreditation via the KJ Ross NATA accredited ICT test laboratory for its ‘HIE Synch’ software. Download the PDF version of this case study here.

PROJECT OVERVIEW

HIE aimed to be one of the first clinical information software systems vendor and developer, to obtain NeHTA’s HI Compliance, Conformance and Accreditation (CCA) via the K. J. Ross & Associates (KJ Ross) NATA Accredited Test Lab. HIE is an Australian company developing eHealth software infrastructure for the primary care sector. The company is the developer and vendor of ‘HIE Synch’ software, which is employed by health professionals and medical institutions, it was a critical requirement for HIE Ltd to have this software accredited to the NeHTA HI conformance specifications and Australian standard.
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Enjoy!
David.

AusHealthIT Poll Number 109 – Results – 20th February, 2012.

The question was:
Would Requesting Detailed Reports From The AGIMO And ANAO Assist The Senate Enquiry Into The PCEHR and NEHTA?
Not At All
-  19 (51%)
Possibly
-  8 (21%)
Probably
-  1 (2%)
You Bet!
-  9 (24%)
Votes: 37
Very interesting result - I would love to know why there is so little confidence in the oversight agencies.
Feel free to post a comment PLEASE on why the scepticism.
Again, many thanks to those that voted!
David.

Sunday, February 19, 2012

I Think It Is Time To Say What The Senate Enquiry Into The PCEHR Legislation Needs To Answer. My Questions Still Seem To Be Current.

In my submission to the Senate Enquiry into the PCEHR Legislation and related matters I asked that the Committee address six questions to come to grips with what should happen next with the Bills, the PCEHR and the future of e-Health in general.
Here is what I said:
“The perspective I am adopting in preparing this submission is that of a clinician who has been actively involved in ‘e-Health’ for over two decades. It seems to me that it is important to step back from the Bills and ask the following.
1. Is the proposal for the PCEHR the ideal approach for Australia to be adopting in seeking to move the Health Reform Agenda forward - and if not what might be a better approach?
2. Is the PCEHR proposal an evidence based intervention that has a significant chance of actually improving healthcare outcomes in Australia?
3. Are DoHA and NEHTA ideally led and governed to succeed with such a complex and sensitive initiative and has DoHA, NEHTA and the Government really assessed the risks associated with the PCEHR proposal?
4. Has a Business Case / Cost Value Analysis specifically of the PCEHR proposal been undertaken (rather than generic analyses of ‘e-health’ benefits) and what were the findings from this work to support the present PCEHR plans?
5. What has been put in place to ensure that clinical practitioners will actually use the proposed PCEHR and ensure what is presently planned is successful?
6. Have DoHA and NEHTA taken on-board the very useful US Institute of Medicine Report entitled "Health IT and Patient Safety: Building Safer Systems for Better Careand ensured the issues raised - and especially the risks of harm to patient care and safety – have been fully addressed?
I would argue strongly that the answer to all six questions is a resounding no and the rest of my submission will develop the arguments to support this view.
I am firmly of the view that without radical re-design and re-scoping, the PCEHR Program will be seen by history as a profoundly flawed initiative which was badly executed and continuing a sorry line of similar initiatives as recounted in the Parliamentary Library report mentioned above.”
Before going any further I need to point out the Senate Web Site has been revamped and all the links have changed. Here is the current link to the enquiry page:
And here are all the submissions and two documents tabled at the Enquiry.
Well, after he hearing and the questions that were placed on notice it seems to me the topics I raised of patient safety and National e-Health governance are still right up there and really need to be properly addressed.
Of recent time we have seen the incentive issue re-emerge (at Senate Estimates and in the press) so I would now argue that the unaddressed elephant in the room is the evidence base and business case supporting moving on and continuing to fund the PCEHR. From Senate Estimates we see some funding is intended - but the quantum allocated will be a strong signal - in my view regarding the level of commitment. Less than $200Million per year will start to maybe signal a change of direction.
Given that there are essentially no funds presently in the Forward Estimates I wonder might it be that there is a plan to merge DoHA E-Health and NEHTA into a new government entity / unit as some wags are rumouring. There would be some sense in a move of that sort. Of course the risk of FOI requests against the old NEHTA might act as a bit of a constraint!
As far as an outcome of the enquiry is concerned it might be that we see acceptance of a continuing status quo or some minor tinkering around governance, consent and so on. Despite my personal hope for something more I fear we will see little more emerge - as much as I would like a clearer and more action orientated outcome. It might just be that the momentum towards the inevitable ‘train wreck’ cannot be overcome.
I certainly hope not!
I really do see this as a bit of a test of our system of Government. If we do not see a robust and well-crafted response to submissions and hearing I will suspect even more strongly we have a serious problem!
David.

Saturday, February 18, 2012

Weekly Overseas Health IT Links - 18th February, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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February 7, 2012 | Research

A Therapist in Your Pocket

New smart phone, a virtual therapist and other novel technologies to treat depression
By Marla Paul
CHICAGO --- Brooding in your apartment on Saturday afternoon? A new smart phone intuits when you’re depressed and will nudge you to call or go out with friends.
It’s the future of therapy at a new Northwestern University Feinberg School of Medicine center where scientists are inventing web-based, mobile and virtual technologies to treat depression and other mood disorders. The phone and similar projects bypass traditional weekly therapy sessions for novel approaches that provide immediate support and access to a much larger population.
Also in the works at the National Institutes of Health-funded center: a virtual human therapist who will work with teens to prevent depression; a medicine bottle that reminds you to take antidepressant medication and tells your doctor if the dosage needs adjusting; a web-based social network to help cancer survivors relieve sadness and stress.   
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Digital Doctoring

The digital revolution can spur unprecedented advances in the medical sciences, argues Eric Topol in "The Creative Destruction of Medicine."

By SCOTT GOTTLIEB

Among the most common reasons why people come to an emergency room are bouts of heart failure or pneumonia. Sometimes they have a touch of both. When I was doing my residency 10 years ago, we often struggled to distinguish swiftly one illness from the other. We ended up treating a lot of people for both ailments, until we could sort out later which was the primary culprit.
Over the past decade, the way that doctors approach this common clinical dilemma has been transformed with a simple innovation. A blood test for B-type Natriuretic Peptide (BNP), which is secreted by weakened heart muscle, can help distinguish between the two conditions. Another improvement in recent years: Doctors are replacing their stethoscopes with inexpensive, hand-held ultrasound scanners that can detect a failing heart right in the ER.
Such innovations are just the beginning of a transformation of medicine, says Eric Topol in "The Creative Destruction of Medicine." Dr. Topol, a prominent cardiologist and geneticist, envisions a technology-enhanced future where new tools are integrated into diagnosing and treating patients, transforming the handling of common medical problems.
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Survey: Shifts May be Coming in CMIO Demographics

A survey of chief medical information officers, with respondents tilted toward multi-hospital organizations in the South, finds that CMIOs are getting a little younger and the ranks of women are growing.
CMIO magazine conducted its third annual Compen$ation Survey between Nov. 21 and Jan. 6, garnering 217 responses. “Changes in salary since last year are minor, according to our survey,” the magazine notes. “The number of those on the highest end of the scale remained about the same as last year, but there was a shift in the lower pay categories. Slightly more earn a salary of $100,000 or less (14 percent compared with 12 percent last year). Seventeen percent make a salary of $300,000 or more, a number unchanged from last year. Twenty-six percent earn salaries between $100,000 and $200,000 compared with 24 percent last year; and 43 percent make between $200,000 and $300,000 compared with 47 percent last year.”
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2/09/2012 @ 12:27PM

The Future of mHealth: Healthcare Apps to Lower Insurance Costs

Healthcare insurers are using apps to streamline patient-care systems, by connecting with and educating members, and ultimately reining in spiraling costs.
The Future of mHealth is our series that explores opportunities and challenges of mHealth, which aims to put widespread access to healthcare within the reach of those who need it most.
Several large U.S. health insurance companies, including Aetna, WellPoint and UnitedHealth Group, currently offer mobile apps that help members find network providers and perform other simple functions.
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eHealth Initiative releases recommendations for accountable care

By Diana Manos, Senior Editor
Created 02/10/2012
WASHINGTON –  The eHealth Initiative (eHI) issued a report on Thursday, providing health IT recommendations to support accountable care organizations.
Key recommendations from the report, titled “Support for Accountable Care: Recommended Health IT Infrastructure,” include:
  • A health IT infrastructure that is flexible to support the changing needs of an accountable care organizational model;
  • An infrastructure that supports the secure transfer, collection and storage of personal health data;
  • A patient-centered system to engage and educate patients and caregivers; and
  • A system that supports care coordination across the healthcare team and the patient.
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eRx makes steady gains in California, report shows

By Diana Manos, Senior Editor
Created 02/08/2012
EMERYVILLE, CA – Electronic prescribing is continues to grow steadily in California, potentially increasing the safety of the prescribing process, according to a new report from Cal eConnect. 
About 25 percent of the state's physicians are sending prescriptions electronically, the report estimates, compared with 3 percent in 2007. At the same time, just 16 percent of eligible prescriptions are routed electronically, despite the fact that most community pharmacies are set up for ePrescribing.
"While much has been done to move California forward on ePrescribing, much more work is ahead," said Ron Jimenez, MD, co-chair of the Cal eConnect ePrescribing Advisory Group and a practicing pediatrician."The collaborative environment among health plans, providers and pharmacies is impressive and momentum is building toward improved, safer care for patients."
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Health technology for astronauts has earthly potential

By danb
Created Feb 10 2012 - 2:29pm
Two new healthcare technologies developed with astronauts in mind also show promise as real-world applications. The first, a biocapsule developed by NASA scientist David Loftus, has the ability both to diagnose and treat astronauts instantaneously. The second, an augmented reality unit developed by the European Space Agency, offers 3D guidance for diagnosing problems or performing do-it-yourself operations using a head-mounted display.
The biocapsule, Gizmodo reported [1], is composed of carbon nanotubes, and was initially developed for treating radiation effects on astronauts. Future treatment capsules are expected to have the ability not only to treat heat, exhaustion and sleep deprivation, but eventually diabetes and cancer, as well.
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More than 1.2 million patients in Eastern Ontario to benefit from two new ehealth solutions

February 8, 2012 (Ottawa, ON) - The Ottawa Hospital (TOH) and Hawkesbury & District General Hospital (HGH) today announced two innovative ehealth projects designed to better serve more than 1.2 million patients in Eastern Ontario.
In a provincial first, patients of The Ottawa Hospital are now benefitting from access to Ontario laboratories information system (OLIS) data through their clinicians thanks to the myTOH viewer. This means that important patient information will be available for clinicians to make treatment decisions within minutes or seconds compared to the previous hours or days.
OLIS is a cornerstone information system that connects hospitals, community laboratories, public health laboratories and practitioners to facilitate the secure electronic exchange of laboratory test orders and results. The ability to electronically share this information helps health care providers make faster and better patient care decisions.
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Are EHRs being used to stifle physicians?

By mdhirsch
Created Feb 9 2012 - 10:02am
Many physicians have been reluctant to embrace electronic health record systems [1], with concerns about their costs, usability and impact on workflow.
But is physician Adam Sharp, chief medical officer at healthcare start-up par80 and former CMO for online physician network Sermo, correct in stating that the real reason physicians should be leery of EHRs is that the technology is being thrust on physicians to control how doctors practice?
The goal of EHRs is to "wrestle control of healthcare away from the doctor-patient relationship into the hands of third parties who can then implement their policies by simply removing a button or an option in the EMR," he writes in a blog post [2].  
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Why (some) doctors hate EHRs

By mdhirsch
Created Feb 9 2012 - 9:48am
Physicians realize that EHRs are inevitable. But many of them are still resisting adoption because they don't want the systems to come between them and their patients, according to a recent blog post by Adam Sharp, M.D.
In the post [1], he offered his take on why the adoption numbers of EHRs remain low despite the lure of incentives by the government. According to Sharp, founder of physician advocacy group Par 80, EHRs are unwieldy, expensive and inefficient; they don't improve productivity and don't necessarily lead to better outcomes.
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5 simple ways to realize ROI from your EHR

By Michelle McNickle, Web Content Producer
Created 02/08/2012
The steep cost of electronic health record systems in today's market makes seeing a return on investment that much more important. Luckily, there are a few basic ways to see financial gains after implementing an EHR. Heidi Jannenga, co-founder and COO, and Paul Winandy, CEO of physical therapy software WebPT, outline five basic ways to get ROI from your EHR. 
1. The ability to see more patients. Once the implementation stage is over, the time typically spent on documentation with paper records can now be spent seeing more patients. And according to Jannenga and Winandy, an important part of seeing ROI by spending less time on documentation is workflow.  “The workflow [needs to] match that of a practicing therapist or physician,” said Jannenga.  
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Measuring ROI key to EHR success, adoption

By Loraine Lawson
Created Feb 10 2012 - 2:35pm
Measuring a return on investment for electronic health record systems is not just key to showing the project paid off, it also can be critical to the project's success and adoption, experts say. But it's not just about achieving ROI--it's about identifying the right metrics.
Typically, discussions winning over doctors to EHRs focus on quality of care issues. While that's important, Sherri Mesquita, an EMR/EHR consultant and project manager at Community Health Systems Inc., says doctors also care about other issues, including a system's ROI and its financial bottom-line impact.
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Millennium fug

The first Southern trust to go live with Cerner Millennium went live in 2005. Nearly seven years on, EHealth Insider takes another look at the “Live 7” deployments to see what – if any - benefits have been realised so far.
9 February 2012
Cerner Millennium has been back in the news in recent weeks, as local newspapers have reported significant problems at Oxford and North Bristol; the latest trusts to deploy the system as part of the National Programme for IT in the NHS.
The trusts say the introduction of such a big electronic patient record system is a massive operational change - and that while any short-term disruption for patients is regrettable, the long-term benefits will mean patients get better care.
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Cerner sites to report benefits

9 February 2012   Rebecca Todd
A series of 2011 benefits analysis reports for Cerner Millennium implementations at Southern trusts have been submitted to the Department of Health.
The reports will feed into an updated statement of benefits for the National Programme for IT in the NHS, and the £2.7 billion that it has spent on care records systems so far.
The DH was supposed to submit the update to the Commons’ public accounts committee by September last year.
Its failure to do so was criticised by the PAC, when it held hearings on the National Audit Office's third report on the programme last summer.
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CPOE reduces preventable adverse drug events

By danb
Created Feb 9 2012 - 3:17pm
Despite one recent study's findings that electronic health records are lacking in adverse drug event (ADE) detection [1], another study on computerized physician order entry systems came to the opposite conclusion.
The latter study [2], published in the Journal of General Internal Medicine, determined that CPOE systems can indeed reduce preventable adverse drug events. According to senior author David Bates, M.D., senior vice president for quality and safety at Brigham and Women's Hospital, researchers saw a 34 percent reduction in such drug events across five community hospitals in Massachusetts over a five-year span from January 2005 to September 2010. Two-thousand total charts were reviewed during the study.
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5 stages of EHR maturity and patient collaboration

By Michelle McNickle, Web Content Producer
Created 02/07/2012
By now, it’s apparent EHRs need to grow up. But, as patient-centered business models become increasingly popular, the EHR is also shifting into a vital part of the success of these organizations. 
“The new ‘patient team’ business models, like ACOs, will require that EHRs mature into real-time care coordination and collaboration platforms that can help move organizations … from basic independent care into accountable care,” said Shahid Shah, software IT analyst and author of the blog The Healthcare IT Guy.  
“But care coordination and collaboration aren’t just about adding patient messaging and simple health records sharing— in fact, they must become managers of digital biology and digital chemistry and be able to use that new data to help physicians across patient care teams better comprehend what is happening inside the patient so that they can actually improve health outcomes.”
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CSC plans massive job losses

2 February 2012   Rebecca Todd and Lyn Whitfield
CSC is about to announce massive job losses among staff working on its NHS account.
The move strongly suggests that the company is unlikely to win an advantageous new deal for the North, Midlands and East of England; or any deal at all.
However, in a statement confirming the news broken by eHealth Insider this afternoon, the company said "the action is mainly because we have now substantially completed many key development activities and are moving away from a focus on development work.
"This action is independent of contract negotiations. These are ongoing and we are therefore unable to comment on them."
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MU stage 2 to focus on sharing, patient engagement, CSC report says

By Mary Mosquera
Created 2012-02-08 12:54
Healthcare providers should double down on developing capabilities to coordinate care, engage with their patients, and electronically capture the data needed for quality reporting. They are likely to be required in the proposed rule for stage 2 of meaningful use, expected later this month.
The abilities of hospitals and physicians to enable patients to view and download their information and transmit summary of care records when patients move among care settings remain the most challenging to meet the next stage of meaningful use, according to a report from IT vendor CSC.
“The importance of these requirements goes beyond meeting the incentives for meaningful use,” said report authors Erica Drazen, managing director, and Jane Metzger, principal researcher, CSC’s Global Institute for Emerging Healthcare Practices.
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Getting serious about ICD-10: Lessons from the field

By gshaw
Created Feb 8 2012 - 12:45pm
To be honest, I can't quite remember the first time I heard the term "ICD-10." But I'm confident that when I did, I dismissed it as a "coding thing" that wouldn't be of interest to my audience of CIOs and other healthcare execs.
Reporting from last year's Healthcare Information and Management Systems Society conference, I referred to ICD-10 as "semi-looming" and made jokes about putting ICD-10 on the "middle burner." I posed the riddle "What's the opposite of sexy?" and almost everyone I tried it out on answered correctly: ICD-10.
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The imminent industry-association war over ICD-10

By Tom Sullivan, Editor
Created 2012-02-06 08:38
Just as the seceding South Carolinians firing on the Union Ship “Star of the West” became recognized as the first shot in the Civil War, the American Medical Association’s delegates voting to vigorously oppose ICD-10 may one day been seen as the salvo that set a conflict over coding sets in motion. 
The stage is set for a war over U.S. adoption of ICD-10. Indeed, such a fight could pit industry associations that stand to profit from the code set against those representing the providers who have to actually implement and pay for the ICD-10 conversion.
Less than a week after AMA revealed the voting results, in fact, AHIMA CEO Lynn Thomas Gordon struck back with a public statement maintaining that “there are countless benefits that will come from the use of a 21st century classification system."
Then, the AMA’s second shot, a late-January letter calling on U.S. House Speaker John Boehner to block ICD-10, again drew fire from AHIMA, in the form of a warning that healthcare entities should continue keep proceeding with ICD-10.
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CSC Report Looks Ahead to Stage 2 Meaningful Use

A new report from Computer Sciences Corp. examines the lessons learned from attesters during Stage 1 of the electronic health records meaningful use program, and looks at criteria changes that could be in Stage 2.
The report includes a summary of Stage 1 criteria side-by-side with Stage 2 criteria proposed by the HIT Policy Committee, which advises the Department of Health and Human Services. HHS expects to soon publish a proposed rule for Stage 2.
The report, “Moving Ahead with Stage 2 of Meaningful Use,” also examines menu, or optional, Stage 1 requirements that large majorities of attesting providers deferred using.
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EMIS unveils new patient.co.uk

2 February 2012   Rebecca Todd
EMIS has re-launched its patient information website with a new look and plans for a a series of apps; including one that will let patients book an appointment from their smartphone.
Patient.co.uk receives 5m unique visits a month. The number of people viewing it on a mobile device rose from 8.6% to around 21% between January and December last year.
The re-launched site has a sleeker, more modern look and simpler navigation. A free patient.co.uk app also went online two days ago and has had 1,000 downloads already.
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IT 'super users' ease hospital culture change

By danb
Created Feb 7 2012 - 2:15pm
The employment or internal training of IT "super users"--individuals who are ahead of the curve when it comes to technology use--is becoming a common practice at hospitals looking to change their IT culture, according to an article [1] in the February CMIO magazine.
For instance, Michigan State University recently implemented a program to train 22 physician super users and 17 staff super users in using electronic medical records to meet Meaningful Use. The super users receive 26 hours of classroom training, according to CMIO, then tasked with providing support for other providers at the hospital. The trained super users are paid an $80-per-hour stipend for the classroom time and receive an additional 10 percent paid time for helping to train other providers, MSU chief medical information officer Michael Zaroukian told the magazine.
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Physician-patient emails: The debate rages on

By gshaw
Created Feb 7 2012 - 1:17pm
The question of whether or not physicians and patients should exchange emails seems fairly straight-forward. It is, after all, a simple yes or no question. But everywhere you look--from articles in the Wall Street Journal [1] to surveys [2] and research papers [3] to personal blog posts and tweets--the debate continues unabated.
Robert Sadaty, M.D., is among the latest to weigh in. Writing a blog post [4] for KevinMD.com, he explains why he gave up on email exchanges with patients--and why, he adds, will never go back.
"For sure, most patients loved using email," he writes.  "The option to report any symptom or concern at any time of the day without having to bother with telephone menu prompts or dealing with the hassles of making appointments proved to be tremendously convenient. And for those questions that were straightforward and consisted of hardly two sentences at most, email at times was a definite time saver."
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What If Your Car Cared About Your Health?

Jim Molpus, for HealthLeaders Media , February 7, 2012

When I first heard that Ford and other auto manufacturers were researching how to build health monitoring devices and interfaces into cars, my thoughts immediately turned to how my good ole boy mechanic would fix the darned thing.
"Well, Jim, yer valves are gonna need a good cleanin.' I can turn them brake rotors one more time but that there glucose monitor, that's a fac'try part and be about next Tuesday before I can get that in."
I have a well-earned distrust of gadgets and have learned that the best-engineered machines excel at the task for which they are designed reliably and simply. So a car that needs few repairs, is comfortable, gets good mileage, and lasts longer than the payments do is fine by me. But Ford sees a larger opportunity to add the car to those places where you are concerned about your health, specifically in monitoring it.
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Health IT Managers Say Tablets Can Cause Problems

IT managers at healthcare organizations say tablets pose challenges for entering data into enterprise healthcare applications and can raise IT support costs.
By Nicole Lewis,  InformationWeek
February 03, 2012
As the popularity of tablet use among physicians continues to grow so too has the challenges that come with integrating these devices into the health IT enterprise. That’s what a new study that polled 100 health IT managers reveals, with 74% of respondents saying tablets such as the iPad present challenges for entering data into enterprise healthcare applications and 66% say they believe providing technical support on consumer-grade tablets raises IT costs.
Published this week, the study--Diagnosis Danger: Governance & Security Issues Cause IT Concerns About iPad in Healthcare Setting--was conducted by BizTechReports, an independent research and reporting agency, in collaboration with Panasonic. The study gauged the perceptions of IT managers toward tablets as an increasingly vital tool that physicians use to enter medical data, access clinical applications, and view medical images.AdTech Ad
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Microtest users guided by Guru

6 February 2012   Rebecca Todd
Microtest has launched a clinical data-sharing tool that enables remote access to GP patient records held in its Evolution system.
GURU means that GPs can log-in to see details about a patient they are treating in the community - such as medication, allergies and medical history - with all information live and updated.
Microtest managing director Chris Netherton said GURU had been in development for 18-24 months.
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Humber wants mobile Lorenzo

31 January 2012   Shanna Crispin
Humber NHS Foundation Trust has put its hand up to be one of the first to trial the mobile version of Lorenzo.
The trust is yet to go-live with the patient administration system, but its project team has told CSC it wants to be an early adopter of the additional mobile component of the system when it becomes available.
Humber is due to implement Lorenzo as part of the National Programme for IT in the NHS.
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GE releases patient portal

Written by Luke Gale   
February 2, 2012
GE Healthcare has launched a new web-based patient portal, the Centricity Patient Online 13, which healthcare consumers can use to schedule appointments, pay bills, manage health information, send secure messages and receive reminders from providers.
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Natural language processing could eventually change medicine

By kterry
Created Feb 5 2012 - 11:35am
In a recent post on his Disease Management Care Blog [2], Jaan Sidorov, a physician with a keen eye for trends, speculated that natural language processing (NLP) might be used to pick up missing diagnoses from free text and perhaps even predict problems before physicians spot them. He cited a Mayo Clinic study [3] that found that the use of an NLP program to scan free text in encounter records was nearly as accurate as lab tests in showing whether patients had the flu.
This is not a new idea. The University of Utah School of Medicine has been conducting studies [4] of NLP for nearly a decade. But NLP is starting to become more capable, as shown by its growing use in computer-assisted coding. A VA study found [5] that the use of NLP with free text identified post-operative complications more accurately than claims data did.
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Monday, February 06, 2012

Meaningful Use in Year Two and Beyond: Informing the Efforts of RECs

by Christopher Harle and Nir Menachemi
Physicians and other eligible health care professionals have shown broad interest in the meaningful use incentive program. As we enter year two of the program, it is informative to look back at first-year participation to inform efforts aimed at increasing electronic health record adoption in future years. According to CMS, in 2011, 29,344 eligible professionals received a total of $570,350,910 in incentive payments through either the Medicare or Medicaid incentive programs. Participation ramped up at the end of the year, with 50% of all eligible professionals receiving their payments in November and December of 2011.
Of note in the CMS statistics is that nearly 173,000 providers registered for the program, indicating far more interest than actual participation thus far. This is not necessarily surprising given the many known obstacles to successful EHR adoption. The well-documented barriers extend beyond the commonly cited financial obstacles that the meaningful use program tries to address. The non-financial barriers include time and information constraints, environmental and organizational factors, as well as social and psychological obstacles. Therefore, an important policy question is how can these non-monetary barriers be overcome as the meaningful use program evolves?
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Enjoy!
David.

Friday, February 17, 2012

This Paper Poses Some Interesting Questions About Heath Information Exchange. National Scopes Might Not Be a Great Idea?

The following appeared a little while ago.

Health Information Exchanges and Megachange

The Brookings Institution
February 08, 2012 —
Editor's Note: In this paper, Darrell West and Allan Friedman study how state-level health information exchanges (HIEs) are implemented, where there are opportunities for action and who drives policy change. This paper looks at the current climate for organizational change and study the challenges faced by HIEs and how new technology is moving forward to overcome them; the scholars argue that for these megachange efforts to be effective, policymakers must present a clear vision, achieve consensus on key objectives, overcome organizational and market fragmentation, and work effectively with a range of different constituencies. In particular, this paper addresses the effectiveness and viability of HIE’s in Indiana, Massachusetts, New York, Tennessee, and California and explores why Massachusetts and Indiana are most successful across a number of metrics. CTI also hosted a forum on HIEs to discuss the paper.
Executive Summary
The United States faces a number of large-scale policy challenges. Economic development, job creation, deficit reduction, tax reform, health care, immigration, and national security all represent areas of high political, policy and organizational complexity. Each one faces enormous contentiousness over vision, goals, strategies, and tactics. There is little agreement on basic approaches to these policy subjects, and there are multiple organizations and government jurisdictions involved in administration and implementation. The sheer complexity of action in these areas makes it difficult to resolve conflict and implement effective solutions.
In this paper, we analyze state health information exchanges (HIEs) as an example of what MITRE researcher John Piescik calls “megachange” challenges.[ii] According to the U.S. Department of Health and Human Services, HIEs are “efforts to rapidly build capacity for exchanging health information across the health care system both within and across states.”[iii] This includes insurance information for those without coverage and clinical and medical data in order to connect health care providers and payers. The goals are to increase the flow of information across relevant organizations and improve the efficiency and effectiveness of the health care system.
These organizational innovations are an interesting example of policy change in a big and complex area. Health care represents nearly one-sixth of the overall economy and has costs that are growing well beyond the inflation rate. There are multiple actors such as patients, physicians, hospitals, vendors, payers, and advocacy organizations that are important to health care. It generally has been difficult to forge policy agreements among the various constituencies who are involved in this domain.
To develop a better understanding of megachange and health care, we look at a variety of questions. Using interviews, case studies, and documentary research, we study how state-level HIEs are implemented, what drives policy and organizational change, what the opportunities for action are, what barriers come up, and how HIEs are moving forward to overcome particular problems.
Briefly, we find that state health information exchanges have made progress in establishing organizational frameworks, building technology-based connections, and bringing relevant groups to the table for discussion.  However, barriers remain in terms of governance, financing, and policy vision.  Many states and localities have experienced difficulties in producing consensus on strategies and approaches, and identifying consistent revenue streams.  Some question whether the state level is the proper unit for HIEs given natural marketplaces centering on localities or regions.  Until those problems are overcome, it will be impossible for HIEs to achieve their full potential.
These findings have ramifications for U.S. efforts to bring large-scale change to many different policy areas.  Our analysis suggests that for megachange efforts to be effective, policymakers must present a clear vision, achieve consensus on key objectives, overcome organizational and market fragmentation, and work effectively with a range of different constituencies.  There needs to be adequate financial resources and sustainable business models to support proposed changes and public and private leaders must have incentives to work well together in relationships based on mutual trust.
References
[i] Kent Weaver, “But Will It Work?:  Implementation Analysis to Improve Government Performance,” Issues in Governance Studies, February, 2010.
[ii] John Piescik, “Megachange:  Leading Change Across Multiple Large Organizations,” McLean, Virginia:  MITRE Center for Enterprise Modernization Technical Report MTR070320, November, 2007.
[iii] U.S. Department of Health and Human Services, “State Health Information Exchange Cooperative Agreement Program,” August 10, 2011.
This page is found here:
This report runs to about 50 pages and there are a few features I thought were very interesting.
The first was that the report came from a group studying governance and that utterly implicit in what the report contains in an acceptance of the importance of underlying governance frameworks to success and sustainability of these efforts.
The second was the recognition of the scale of change involved in implementation.
The third was that the correct size for a Health Information Exchange implementation is just not really known while also reporting HIE’s that grew to fill other natural boundaries appeared to be the most successful.
PCEHR Program Team take note!
David.