Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, April 28, 2012

Weekly Overseas Health IT Links - 28th April, 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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EHRs Often Lack Clinical Best Practices

Clinical decision support vendor Zynx Health finds electronic health records fall short in treating heart failure, pneumonia.
By Neil Versel,  InformationWeek
April 17, 2012
Hospitals with electronic health records (EHRs) barely earn a passing grade when it comes to following best practices in treating heart failure and pneumonia, according to an audit by a clinical decision support content provider.
Only 62% of hospitals' EHRs included clinical processes that have been proven to reduce congestive heart failure patients' mortality, hospital readmissions, and overall costs; 67% included clinical processes for treating pneumonia. That is good for an overall grade of D or D-minus from Los Angeles-based Zynx Health, a unit of Hearst Publishing. Company officials believe the study to be the first of its kind. AdTech Ad
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iPad App Helps Kids With Autism Communicate

The older brother of a child with autism has released an iPad app designed to be a communication and therapy tool for people with autism.
AutisMate allows you to add your own pictures, videos and voice recordings to the app. The goal: to create visual scenes that help promote social skills and communication.
The app was created by Jonathan Izak to help his 10 year-old brother Oriel, and other children with autism who struggle with communication.
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HHS' updated infection-fighting plan stresses health IT

By kterry
Created Apr 20 2012 - 10:04am
In an updated draft of its national action plan for fighting healthcare-associated infections (HAI), the Department of Health and Human Services (HHS) highlights the role of health IT.
"Monitoring and measuring HAIs is a critical component of the overall strategy to prevent and reduce HAIs," the plan [1] says." Advances in information technology (IT), harmonization of disparate data standards, incentive programs designed to promote the meaningful use of electronic health records (EHRs), and capabilities to connect with and integrate multiple data types and sources all provide opportunities to enhance national capacity to monitor, measure, and prevent the occurrence of HAIs."
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Increased big data access could help lower health costs

By danb
Created Apr 20 2012 - 1:09pm
Continued efforts to use big data in healthcare and make it more widely accessible could play a significant role in lowering overall costs, the authors of a new report [1] published this week argue.
The report--rolled out by the Kansas City, Mo.-based Ewing Marion Kauffman Foundation, which promotes entrepreneurship--makes a number of specific recommendations, including points regarding data use in both patient care and medical research.
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6 keys to making better use of your data

By Michelle McNickle, Web Content Producer
Created 04/19/2012
Recently, big data has been garnering attention as a potential problem-solver for today's industry woes. But, before jumping into the new "data-driven paradigm" of leveraging big data, a recent report by CSC suggests organizations take a look at their basic, data-centered strategy.
"Most organizations have more data to work with than they realize, but they need to recognize the challenges and plan to overcome them," the report reads. "For example, the data landscape is constantly changing. The size, scope, and types of data available are rapidly evolving, and so are the tools needed to make sense of it all. To identify competitive advantages and achieve better command and control over their data, entrepreneurial healthcare executives need to recognize this evolution."  
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April 15, 2012

Crowd-Sourcing Expands Power of Brain Research

By BENEDICT CAREY
In the largest collaborative study of the brain to date, scientists using imaging technology at more than 100 centers worldwide have for the first time zeroed in on genes that they agree play a role in intelligence and memory.
Scientists working to understand the biology of brain function — and especially those using brain imaging, a blunt tool — have been badly stalled. But the new work, involving more than 200 scientists, lays out a strategy for breaking the logjam. The findings appear in a series of papers published online Sunday in the journal Nature Genetics.
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Patient data missing for 315,000 Emory patients

The Atlanta Journal-Constitution
7:00 p.m. Wednesday, April 18, 2012
Personal and health information for about 315,000 patients is missing, Emory Healthcare announced Wednesday. The hospital system has been unable to find 10 computer discs containing the data.
The missing discs held information on all patients who had surgery at Emory University Hospital, Emory University Hospital Midtown and The Emory Clinic Ambulatory Surgery Center between September 1990 and April 2007. The discs contained protected health information, including patient names, along with the diagnosis, the name of the surgical procedure and the surgeon. Approximately 228,000 of the patient records also included Social Security numbers.
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Health providers now have mobile access to e-health records

Better, quicker access means safer, higher quality care for patients
April 20, 2012 (Hamilton, ON) - Authorized health care providers can now use mobile devices to instantly and securely access their patients’ health information, accelerating the decision-making process and enhancing patient care, announced Murray Glendining, Executive VP, Hamilton Health Sciences Corporation and CIO of the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN).
"The combination of a highly mobile device like the iPad, and comprehensive patient data spanning many hospitals through ClinicalConnect, brings effective, fast, secure and safe decision-making ability right to the bedside at any time, day or night," said Dr. Rafi Setrak, emergency physician, Niagara Health System.
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EHRs increase malpractice risk

By mdhirsch
Created Apr 19 2012 - 11:04am
EHRs can wreak havoc on a practitioner's clinical documentation of patient care, exposing the provider to malpractice claims, warns HIT author Ron Sterling, in an article [1] posted on hitechanswers.net.
"Regardless of the legitimacy of care and treatment, the inappropriate use of EHRs and/or EHR design vulnerabilities are exposing physicians to questions on the quality of care and physician due diligence," he writes.
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Evidence that Meaningful Use dollars drive EHR adoption piles up

By mdhirsch
Created Apr 19 2012 - 11:20am
Another is a series of studies on what drives EHR implementation and use has found Meaningful Use incentives are driving adoption among primary care physicians.
A whopping 95 percent of respondents reported that they're adopting EHRs to achieve Meaningful Use. Meanwhile, 53 percent said they were doing it to improve patient quality of care, according to a survey [1] conducted by modermedicine.com.
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4 tips for leveraging big data

By Michelle McNickle, Web Content Producer
Created 04/17/2012
Cost savings are always key drivers of new initiatives. And in today's healthcare industry, as priorities continue to shift and pressure is added to increase revenues and improve outcomes, one element could be a key player in making it all happen: big data.
"We think it's going to separate winners from losers in many markets over the next five years," said Russ Richmond, MD, CEO of healthcare solutions and consulting company Objective Health. "The institutions that are capable of first understanding where the market is going … are going to have tremendous advantages over the ones who can't or won't do this. We believe that over time, it's going to become a core competency for hospitals, and it won't be something seen as extra or nice to have – it's going to become a core part of how they operate going forward."
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Top hospitals use more advanced IT: report

Posted: April 18, 2012 - 10:00 am ET
The hospitals named to Thomson Reuters' 100 Top Hospitals list use more advanced levels of information technology as compared with the broader U.S. hospital population, according to research conducted by a Healthcare Information and Management Systems Society subsidiary.
HIMSS Analytics, the organization's market-research arm, looked at hospitals that received the award in 2009 or 2010 and their HIMSS Analytics' electronic health-record adoption model scores.
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Top hospitals use more advanced IT: report

Posted: April 18, 2012 - 10:00 am ET
The hospitals named to Thomson Reuters' 100 Top Hospitals list use more advanced levels of information technology as compared with the broader U.S. hospital population, according to research conducted by a Healthcare Information and Management Systems Society subsidiary.
HIMSS Analytics, the organization's market-research arm, looked at hospitals that received the award in 2009 or 2010 and their HIMSS Analytics' electronic health-record adoption model scores.
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Epic Systems' Tough Billionaire

This is the expanded version of a piece that appears in the May 7, 2012 issue of Forbes Magazine.
More than 6,500 guests gathered in an overflowing auditorium at the Intergalactic Headquarters of Epic Systems this past September. The campus, nestled on 800 acres of farmland in tiny Verona Wis., was the site of an annual event for customers. The theme: “Once Upon A Time.” To loud applause, a dark-haired woman dressed in leather chaps with a bandana tied around her head strode on stage, where a Harley-Davidson a.k.a. gooseneck awaited. The modern-day Mother Goose in this fairy tale was Judith Faulkner–simply known as Judy in the health care galaxy, living up to her motto: “Do good, have fun, make money.”
She has made a fistful. From her remote midwestern outpost, Faulkner, 68, has quietly built Epic, which sells electronic health records into a $1.2 billion (2011 revenues) business—double four years ago. She has done it without outside capital, and no marketing. She remains the company’s single largest shareholder, rebuffing an attempt by her biggest client health care giant Kaiser Permanente to get a piece of equity, when Epic was much smaller. The company won’t disclose earnings, but says it’s profitable, and proudly proclaims to have zero debt. By next year, 127 million patients or nearly 40% of the U.S. population will have its medical information stored in an Epic digital record. Helping enrich Faulkner is also a piece of government legislation that subsidizes the adoption of electronic medical records, by paying millions to qualifying hospitals. (See Matthew Herper‘s story on Cerner here).
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AHIMA: The new role of privacy officer

The role of privacy officer has changed since it was mandated in 2003 by HIPAA. New regulations, technology and data-sharing initiatives have reshaped the landscape, according to Chris Dimick, staff writer for Journal of AHIMA, who outlined the new role of the privacy officer in the April edition.
“Protecting patient health information has become much more complex since 2003, when nearly all healthcare organizations used time-tested systems to protect paper records,” Dimick wrote. “In turn privacy officers now require an expanding set of knowledge and skills, and as regulatory pressures and technological initiatives have advanced, their roles have grown in strategic importance within their organization.”
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Global mobile health market worth $8B by 2018

By: Brian Dolan | Apr 16, 2012  
A recent report from Global Data pegged the global mHealth market as having a $500 million value in 2010 that will top $8 billion by 2018. The research firm argues that the rise of mobile health has been partially encouraged by the global financial crisis, which led to a focus on finding cost efficiencies in the system in addition to improved outcomes and quality of care.
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KLAS: Smart Pumps Must Learn EMR Integration

04/12/2012 By Anthony Guerra
KLAS Finds Smart Pump/EMR Integration Lacking
“Despite years of discussion and promises,” KLAS reports that fewer than 10 providers in the country are doing EMR integration with their smart pump vendors, even though over half consider it key to future pump selection.
Report author Coray Tate commented, “Providers are looking at EMR integration as the next big step to make infusions safer. Drug libraries catch most errors, but mistakes can still be made.”
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Commentary: How patient advocacy fortifies HIE

By Patty Enrado, Contributing Editor
Demand for healthcare information by patients and clinicians will help drive the business need for health information exchanges, according to Dr. Farzad Mostashari, national health IT coordinator. Clinicians and patients should ask for or seek relevant patient information whenever and wherever healthcare decisions are made. Mostashari's timely comments put a spotlight on the role of patient advocacy in care coordination and how that advocacy intersects and enriches health information exchange.
Used in a meaningful way by healthcare providers, health IT should help lower the cost of care, while improving the quality of care, patient satisfaction and the patient-provider relationship. Health IT in the form of personal health records or data-capturing devices for patients ideally should help them be knowledgeable of and manage their conditions. It should also empower them to be their own advocates in this complex healthcare environment. This is an ideal world and goals that the industry is trying to achieve.
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Fridsma highlights doubling of digital docs

By Bernie Monegain, Editor
Created 04/17/2012
BALTIMORE – The number of physicians using electronic health records has doubled over the past two years, Doug Fridsma, MD, told an audience at AHIMA's ICD-10 Summit Monday.
“We are making real progress on EHR adoption and we are developing a workforce that is beginning to be trained to support this progress,” said Fridsma, director of the Office of Standards and Interoperability, part of the Office of the National Coordinator for Health Information Technology (ONC).
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VC funding for health IT breaks record in Q1

By Bernie Monegain, Editor
Created 04/17/2012
AUSTIN, TX – Venture capital funding in the healthcare information technology sector for Q1 2012 totaled $184 million in 27 deals, the highest number ever recorded, according to Austin, Texas-based consulting firm Mercom Captal Group.
A total of 46 different VCs invested in Q1. Connecticut Innovations participated in multiple deals. The Health Information Technology for Economic and Clinical Health (HITECH) Act kick-started this larger implementation of IT in healthcare in the United States after it was passed in 2009, Mercom asserts.
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By: Brett Norman
April 16, 2012 10:29 PM EDT
An onslaught of mobile health technology has forced an arranged marriage between smartphone app makers and the Food and Drug Administration — because someone had to regulate them.
There’s just one problem: Many of the tech wizards aren’t used to FDA supervision. And now, both sides are struggling to figure out how to live with each other.
Last year, the FDA suggested some ground rules: If you make an app that claims to diagnose or treat a medical condition, then you need to show that it’s safe and effective before you sell it, just as other medical-device makers do.
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Glocs GPs paid £70 a telehealth patient

12 April 2012   Rebecca Todd
A £5m telehealth project in Gloucestershire has deployed less than a quarter of its 2,000 devices in its first ten months.
In June last year, Tunstall Healthcare and NHS Gloucestershire launched a project to provide telehealth to 2,000 patients with chronic obstructive pulmonary disease, chronic heart failure, chronic heart disease and diabetes.
The stated aim was to roll out the telehealth devices over 12 months, starting in the summer.
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Primary care faces 'app explosion'

13 April 2012   Rebecca Todd
A primary care IT specialist has predicted an “explosion” of cloud based and app technology in the sector over coming years.
Dr David Jehring, chief executive of Black Pear Software, will be sharing his thoughts at the Primary Health Info Conference 2012 running from April 23-25 in Warwick.
Dr Jehring trained as a GP but has been developing primary care software for the past 25 years.
Speaking to EHI Primary Care, he predicted a move towards more cloud-based and app-based delivery of IT services, driven by the financial incentive to push more care out into the community.
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Healthcare social media a 'moral obligation'

By danb
Created Apr 17 2012 - 1:37pm
As social media continues to grow as a communications medium, so too does its impact in healthcare. According to a report [1] published today by consulting firm PwC, patients increasingly are turning to social media sites such as Facebook and Twitter both to find and share medical information. What's more, of 1,060 surveyed consumers, 45 percent said that information obtained via social media could impact their decision to get a second opinion.
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Researchers create firewall for wireless medical devices

By: Brian Dolan | Apr 16, 2012
Researchers working at Purdue University and Princeton University have developed a proof-of-concept device, called MedMon, that blocks hackers from hijacking or interfering with wireless medical devices, like pacemakers, insulin pumps, or brain implants. The researchers were motivated to work on the problem after discovering how easy it was for hackers to break into current wireless medical systems.
The researchers believe that hundreds of thousands of people using wireless insulin pumps or wireless-enabled pacemakers are currently vulnerable. Other devices, not yet in the market, like brain implants that manage epilepsy and “smart prosthetics” could also be hacked. Despite the potential for hacking, the researchers admit the chances that any given would be hacked is low.
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Mayo Clinic doc’s real-time dashboard makes ER patient tracking easier

Waiting in the emergency room is not limited to patients.
Doctors and other ER staff are constantly waiting too — waiting to see if the X-Ray report is available, waiting to see whether lab results are back and waiting to see whether medication that was ordered was given to the patient.
And the only way to know whether any of this information is available is to go into each patient’s medical record individually and do a check. Repeat the same process for every patient that’s in the ER.
But Dr. Vernon Smith at the Mayo Clinic has come up with a real-time dashboard that is meant to take away all this repeated checking. It incorporates easy-to-understand icons — X for an X-ray, a drop of blood to represent lab results and mortar and pestle for medications – that are displayed on large computer screens throughout the emergency department.
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New Express Scripts product aims to predict, solve problems with prescription compliance

By Associated Press, Published: April 16

Express Scripts aims to help patients stay on their meds with a product that predicts who will stop taking prescriptions before the person actually does it.
The pharmacy benefits manager is launching ScreenRx, a program that uses a computer to sift through hundreds of factors that affect patients and forecast who is most likely to forget a refill or simply stop taking their drugs. The company then plans to contact those patients to help them stick with their doctor’s orders.
Express Scripts executives say their new program is focused on a big target.
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Researchers Develop Automated System to Improve Children’s Health

April 16, 2012
Researchers from Indiana University and the Indianapolis-based Regenstrief Institute have developed an automated system aimed at helping enable pediatricians focus on the specific health needs of each patient in the short time allotted for preventive care. The systems comes on the heels of a new study, “Automated Primary Care Screening in Pediatric Waiting Rooms,” in the May 2012 issue of Pediatrics which found personalizing and automating the patient screening process and then alerting the physician to positive results of risk factors enables them to direct attention to the particular needs of the individual child and the child’s family.
The automated system created by the Indiana University and Regenstrief researchers, called the Child Health Improvement through Computer Automation System (CHICA), aims to do exactly that.
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Da Vinci Robot Surgical Risks Detailed

Cheryl Clark, for HealthLeaders Media , April 17, 2012

When something goes wrong after robotic surgery with the da Vinci surgical system, it's most likely due to co-morbidities in certain patients that make the procedure riskier, not flaws in the robot's technology itself, according to a study of 884 surgeries published this week in the Archives of Surgery.
"After reviewing all these cases, we can say for sure that there is no specific morbidity connected with the robot by itself, and that its mechanical failure is very, very rare," says lead author Pier C. Giulianotti, MD, of the Division of General and Minimally Invasive Surgery at the University of Illinois at Chicago. "We can now say that the morbidity and mortality that occurred in these patients was connected to the risk factors in the patients."
The authors wrote that by understanding which patients are at greater risk for robotic surgery complications, surgeons eventually can develop a scoring system to measure quality of care among providers and hospitals.
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Safety Net Challenge Aims to Quash Readmissions

Scott Mace, for HealthLeaders Media , April 17, 2012

I've attended hundreds of Silicon Valley technology conferences, but last Saturday was the first one led by a hospital executive determined to disrupt how tech improves patient health.
Paul Tang, MD, is vice president and chief innovation and technology officer at the Palo Alto Medical Foundation (PAMF), a Sutter Health affiliate with 1,200 physicians in Palo Alto, CA.
What Tang is doing challenges our conventional thinking about how technology gets developed in healthcare, by borrowing from techniques that are all around Silicon Valley.
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Urgent care centers in the market for EMRs

By Bernie Monegain, Editor
Created 04/16/2012
OREM, UT – Thousands of urgent care centers are looking for an EMR to adapt to increasing patient volume, and providers are finding success with three different types of EMRs, according to a new report from research firm KLAS.
Of the more than 9,000 estimated urgent care centers, many report plans to increase in size or location in the next 12 months. Many need an EMR.
Options for urgent care centers include ambulatory EMRs, ED solutions, and best-of-breed urgent care EMRs, KLAS reports.
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Patient-centered care requires more than online technologies

By kterry
Created Apr 15 2012 - 10:56am
Patient-centered care is the mantra of the movement to reform the nation's healthcare delivery system. According to this credo, patients must be able to obtain copies of their medical records and visit summaries; they should have personal health records that they can share with their providers; they should have "patient-centered medical homes"; they should share in medical decision making; and, of course, the security and privacy of their personal health information must be rigorously protected.
All of this makes sense, both for the individual and for the healthcare system. Since about 90 percent of healthcare is self care, consumers must be involved--and must, in some cases, change their health behavior--to become healthier and reduce the overall cost of care. "Patient engagement" is also a key component of accountable care organizations, because ACOs' success depends on keeping patients healthy and out of expensive care settings. Only by educating patients and enlisting their cooperation can ACOs generate savings and remain within their budgets.
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Another view: Neil Paul

Our GP columnist would like a Star Cops-style personal assistant. Or failing that, some agreed definitions of data and a decent dashboard to display them on.
3 April 2012
Did you ever watch Star Cops in the late 80s? I don’t really remember any of the plots; just that it involved a policeman solving crimes on the moon accompanied by his amazing PDA.
He would simply talk to this marvellous device and it would wirelessly access loads of other computers and databases and find out things for him, drawing conclusions and unearthing clues based on very little input.
I’m pretty certain that this led me to buy a Psion and numerous other PDAs since, most of which haven’t lived up to the dream. It wasn’t until a few months ago, when Apple demoed Siri, that the fantasy almost became reality.
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Continua makes new design guidelines available to developers

By Mike Miliard, Managing Editor
Created 04/13/2012
BEAVERTON, OR – Hoping to drive more "plug-and-play" connectivity of personal health technologies, Continua Health Alliance has made available its most recent design guidelines as a free download for device vendors.
The design guidelines, called Adrenaline, aim to help technology developers build end-to-end systems more efficiently and cost-effectively by facilitating connectivity between personal connected health products such as smartphones, gateways and remote monitoring devices. They were previously available only to Continua members during interoperability testing.
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  • Updated April 16, 2012, 11:38 a.m. ET

Numbers, Numbers and More Numbers

Health-care players are finding that crunching the numbers can pay off in both better care and lower costs

By SHARA TIBKEN

Under pressure to do more with less, insurers, pharmacy benefit managers and health-care providers are all pushing data analysis to new heights.
Insurers have been crunching numbers for years to figure out which patients are most likely to generate high costs. Now other groups are gauging probabilities of relapses, and the likelihood of a patient's not taking his or her medicine. Using models that draw on massive troves of medical and other data, some are also focusing on seemingly healthy individuals, trying to prevent problems before they occur.
Several insurers, including UnitedHealth Group Inc. and WellPoint Inc., are seeking to pinpoint who will develop conditions such as diabetes. Pharmacy-benefit managers such as Express Scripts Inc. and CVS Caremark Corp. are working on programs to predict medication compliance. Care providers, meanwhile, are trying to identify who is most likely to be admitted—or readmitted—to a hospital, and are adjusting their care to prevent such return visits.
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Graying America gets wired to cut healthcare costs

WASHINGTON | Thu Apr 12, 2012 4:06pm EDT
(Reuters) - Baby boomers wired to their iPads and smart phones are giving U.S. health experts some new ideas about ways to cut the soaring costs of medical care in graying America.
Some of the ideas might sound like "Robo-Granny". An astronautical engineer at the Massachusetts Institute of Technology has made a skin-tight undersuit equipped with sensors that can constantly monitor the vital signs of its elderly wearer and feed the data into a computer that fires off health alerts. It was first designed for a landing on Mars.
There's also Paro, the robotic seal which has fur, big eyes and responds to voice commands, a low-cost companion that the AgeLab at MIT is testing to help calm elderly people with dementia. Then there is the magic carpet with a built-in sensor that monitors gait to check for risk of falling.
Other ideas are simpler and already are being tested by governments and private health insurers. Marilyn Yeats, 79, is suffering from congestive heart failure and uses a personal healthcare computer, Connect, provided by the health insurer Humana Corp. She calls it My Little Nurse for helping her keep track of her blood pressure, weight, temperature and whether she is taking her medicines on time.
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4.15.12 | Chris Seper

The electronic medical record as Yelp, OpenTable and Skype

How powerful is the electronic medical record? Practice Fusion will stretch the EMR’s muscles over the next year as it tries to incorporate patient-friendly tools and make the product more social. Think one part Yelp and another part Facebook with a dash of telemedicine.
On Sunday night the company will launch a physician review portal built on feedback in surveys from the patients of doctors using Practice Fusion’s Web-based electronic medical records system. Then later this week the company will release ChartShare, which will allow doctors in and out of Practice Fusion’s network to chat with one another similar to using Facebook chat (except it’s HIPAA compliant).
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UK Department of Health announces review into patient data protection

By Jamie Thompson, Web Editor
Created 03/21/2012
The Department of Health recently announced Dame Fiona Caldicott’s independent review into the protection of patient data. This announcement comes in response to the NHS Future Forum’s recommendation that the balance of patient protection and sharing of patient data needs to be addressed.
The last major review of the security of patient information occurred in 1997. Since then, there have been significant changes in the use and deployment of EHRs.
NHS is also undergoing a transformation in which electronic healthcare will become fundamental to every aspect of patient care. The radical reorganization of the NHS in England is giving local healthcare providers even more responsibility for their own EHRs, and for ensuring they are secure.
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Enjoy!
David.

Friday, April 27, 2012

A Serious Commentator Makes Some Smart Points About Responsibility and Consultation In E-Health System Delivery.


Joseph Conn - reporter and blogger at Modern Medicine in the US - who has been reporting on all this for decades has got a bee in his bonnet. I think he is spot on.
The first blog is here:

IT Everything

A witness to history in healthcare information technology.
By Joseph Conn

A bad blueprint for behavioral-health records

Earlier this month, the Colorado Regional Health Information Organization released what its authors must hope will become a blueprint for sharing behavioral-health records via health information exchanges.
I hope not.
The 34-page report, "Supporting Integration of Behavioral Healthcare through Health Information Exchange" (PDF), is part of CORHIO's Behavioral Health Information Exchange Project.
The project erroneously supposed that patient consent laws are "barriers" to exchange. In fact, these laws are the opposite. They're vital foundations to sharing accurate patient records.
For its project, CORHIO rounded up the usual "stakeholders" at six focus groups around the state. That’s how it's done—wrapping "consensus" around a policy—in this case, to eliminate patients' rights to control their behavioral health records.
The feds have quietly supported multiple efforts to wipe out state consent laws, but they want to do it without the clamor of seeking pre-emptive federal legislation. I'll talk about that tomorrow. In the CORHIO case, it meant ending Coloradans' control over the movement of their mental-health records.
Colorado once had a stringent privacy law in its Mental Health Practice Act. Like similar patient privacy laws in multiple states, it barred Colorado mental-health professionals from disclosing "any confidential communications made by the client, or advice given to the client" without patient consent.
More here:
Here is the second bite at the same issue.

More on the folly of removing patient consent protections

Previously, I blogged about the Colorado Regional Health Information Organization's blueprint on how patients' behavioral-health records might be linked to other medical records in health information exchanges.
The word "barrier" in the CORHIO report in referencing patient consent laws sounded familiar. A scan of our archives reminded my why.
In 2002, HHS rewrote the Health Insurance Portability and Accountability Act privacy rule, eliminating patient consent as a requirement for most healthcare records disclosures.
In 2005, HHS awarded a $17 million contract to RTI International and the National Governors Association with the aim, in part, to provide ammunition for then-Rep. Nancy Johnson (R-Conn.), whose health information technology bill called for federal pre-emption of state privacy laws in favor of one uniform federal law.
Johnson's bill enjoyed broad health IT industry support. I was in Washington in mid-2006 for a Healthcare Information and Management Systems Society-sponsored IT summit that dispatched more than 400 IT users to lobby their legislators for it. The bill included a HIPAA amendment to pre-empt state consent laws.
But pre-emption was stripped out by the House Energy and Commerce Committee, chaired by Rep. Joe Barton (R-Texas). Johnson's bill, and her political career, soon died.
Undeterred, RTI and the NGA pushed on with dozens of state committees, including one in Colorado. Each was presented with an RTI-delivered framework that presumed state patient consent laws were "barriers" to health information exchange and that tilted toward removing—not accommodating—them.
To be sure, improving health information exchange is a worthy goal, and the CORHIO folks, citing the opinions of its focus group members, listed the many advantages of adding behavioral health records to HIEs. The same benefits are so often cited by proponents of records exchange that they don't need repeating here.
Full blog here:
There are two important points here:
First - and less important to a degree are the comments on dodgy consultation in e-Health. Boy have we seen a lot of that here.
Second - and most important is this paragraph.
“Providing safe, high-quality, high-value healthcare services requires patient consent. For patients who have conditions that could stigmatize them, cost them a relationship or a job or prevent them from obtaining affordable health insurance if their medical records were not kept private, the right of consent is akin to the right of social and economic survival. Without security and control, patients will lie or withhold information even more than they do now, which is often.”
All I can say is never was a truer word written.  I hope the proponents of the NEHRS realise this is just as true in Australia as it is in the US.
Thanks Joseph!  Well put indeed.
David.

Thursday, April 26, 2012

I Wonder How This Fits With the Health Identifier Service? Are We Duplicating Things Again?

The following appeared a few days ago.

Roxon flags online identity checks

  • by: Karen Dearne
  • From: Australian IT
  • April 20, 2012 2:40PM
THE Gillard government is looking at introducing a real-time identity verification system, Attorney-General Nicola Roxon told the Commonwealth Lawyers Association regional conference in Sydney.
"Document verification may not sound particularly sexy, but it is now a critical tool to control the validity of online transactions," she said this morning.
"Just think of how your personal and financial security is reliant on secure transfer and validation of information from our banking and finance sectors, Australia's large superannuation sector and maritime and aviation security.
"And, in contrast, how verification could support the fight against money laundering, terrorist financing and other organised criminal activity."
The federal police have recently warned that fraudsters are targeting superannuation funds held by older Australians, using stolen identity information to gain access to personal accounts.
Meanwhile, the current parliamentary Joint committee inquiry into Cybersafety for Seniors was also told shopping site eBay and payments provider PayPal wanted the government to introduce a strong online identity verification regime.
Ms Roxon said the government "is looking closely at ways we can deliver a simple, affordable and real-time service" providing national coverage.
"Reducing the costs of client identification will allow business to invest more in their products and marketing, while reducing their exposure to fraud," she said.
More here:
What on earth is going on here? We now have a proposal to develop a proper Identity Verification System - as opposed to the rather less powerful IHI service - and somehow we don’t recognise that such a service would really help all sorts of e-Health initiatives.
All I can say is I hope Health and Attorney General’s are talking in the background to see how the ongoing costs of each of these services can be minimised and better identity service provided.
Seems like the old right and left hand not actually knowing what the other is doing again. Surely Ms Roxon must have noticed!
David.

Wednesday, April 25, 2012

Somehow A Good Idea Is Getting To Be Really Messy. Policy Seems To Be Off Track Again.

The following appeared over the weekend.

Plibersek defends script alert system

  • by: Karen Dearne, IT writer
  • From: The Australian
  • April 21, 2012 12:00AM
HEALTH Minister Tanya Plibersek has dismissed a Victorian coroner's concerns that a proposed $5 million electronic system to alert doctors and pharmacists to prescription-shoppers is flawed.
This is despite the fact that e-prescription software and exchange services offered by independent providers such as MediSecure and Pharmacy Guild-owned eRX can provide instant reporting.
Earlier this year, Plibersek promised to establish a national electronic recording and reporting of controlled drugs system to combat abuse of prescription medications.
Her department selected a system originally developed by the Tasmanian government as the state's Drugs and Poisons Information System (DAPIS), together with a web-based application, DAPIS Online Remote Access (DORA), to be available nationwide from July.
As reported in Weekend Health last week, Victorian coroner John Olle has described a tragic rise in deaths among painkiller addicts as a public health issue. He also called on the state's Health Department to introduce a real-time monitoring and alert system within 12 months.
But this week Plibersek's spokesman told Weekend Health that the DORA system would meet Olle's specifications.
"The decision to use the software was taken after a worldwide expression of interest was advertised through AusTender," he said.
"The Tasmanian system provided the best scalable solution to deliver real-time reporting as soon as possible, and the software is the best platform for building a nationally consistent system."
.....
Weekend Health understands DORA does not interface with doctors' desktop prescribing systems; nor does it provide alerts about patients who have obtained S8 scripts from other doctors.
More here:
This was a follow up of this report:

Electronic alert to end abuse

THE suicide of James - from an overdose of prescription morphine and diazepam he obtained during daily runs to various GPs and pharmacies - proved one tragic death too many for Victorian coroner John Olle.
Unusually, Olle has used his powers to recommend the state introduce a real-time prescription monitoring and alert system within 12 months to reduce the deaths and harm caused by such doctor-hopping or prescription-shopping by vulnerable patients.
At present, state and territory governments rely on monthly submissions of paper-based records of controlled (Schedule 8) drugs prescribed by doctors and dispensed by pharmacists. A move from manual to electronic recording, and then real-time reporting, will give providers the information needed to make clinically appropriate prescribing decisions.
But some critics fear a national alert system being developed by the Gillard government may not deliver the desired outcomes.
Meanwhile, courts must deal with cases like that of James, a 24-year-old Essendon man suffering from depression, anxiety and insomnia. He obtained scripts for S8 drugs from 19 doctors and picked up the medications from 32 pharmacies in the three years before his death in 2009.
"James developed an addiction to prescription painkillers he was unable to satisfy or overcome," Olle said in his inquest findings, delivered last February.
"His former partner recalls a normal day for James would involve prescription-shopping for several hours ...
"James would then attend work, return home and consume large quantities of medication during the late evening.
"James's family and friends were aware of his addiction, which resulted in several episodes of violent behaviour, relationship breakdown and job loss."
Olle found James actively tried to minimise the harm, storing his drugs overnight in a cabinet that was locked by a trusted friend, and attending residential drug and alcohol programs.
James was found dead in bed after his father asked police to conduct a welfare check. The young man had left notes indicating his decision to end his life and expressing love for his former partner and family members.
Olle found the issue is a public health problem, not a matter for law enforcement. The problem is such patients conceal the fact they doctor-hop and drug-shop.
"The medical practitioners whom James consulted were denied an opportunity to exercise clinical judgment with the benefit of the complete picture," he said.
Lots more here:
The issue attempted to be addressed here is how to make a prescriber aware when an individual has been receiving more than a reasonable amount of potentially addictive or dangerous medication provided by different prescribers (who are unaware of what their colleagues have prescribed).
The problem is conceptually very easy to address - all you need is a prescription database that can be searched by individual patient. With the internet and modern data-base tools there are no serious technical barriers - the devil is of course in the detail of addressing all the issues of consent, integration with work flow and prescribing and dispensing workstations, security of information, maintenance of privacy and so it goes on.
It is interesting that this problem is faced all over the world.
On Friday last week we even had it discussed in the US.
Friday, April 20, 2012

Ky. Lawmakers Consider Expanding Access to Rx Drug Tracking System

The Kentucky Senate is gearing up to vote on a bill (HB 1) that aims to crack down on prescription painkiller misuse by restricting ownership of pain clinics and increasing access to the state's prescription drug tracking database, the Wall Street Journal reports.
About the Database
Kentucky's database includes information about prescribers, recipients and dispensers of certain prescription drugs. The state's Cabinet for Health and Family Services and Board of Medical Licensure currently oversee the database.
Law enforcement officials seeking to obtain information from the database must submit a request to the Cabinet for Health and Family Services and prove that the information request is part of an active investigation.
About the Bill
Under the bill, oversight of the prescription tracking database would shift to the state attorney general's office. The change would provide the AG's office and local prosecutors with better access to the prescription drug tracking system, but police officers still would need to submit requests to obtain information from the database.
The proposed legislation also would require physicians to consult the database before prescribing certain painkillers.
More here:
From the articles above we see the Federal Government seems to want to extend a Tasmanian system which operates only in the hospital sector. The pros and cons of all this was discussed here:
The 13 comments are pretty interesting and revealing.
Reading the two articles above there is clearly concerns this - on the cheap - approach has a range of flaws.
An alternative being tried as one of the Wave 2 projects is Medview from Fred IT - a major provider of pharmacy dispensing software. You can read all about this here:
What is interesting about this project - being conducted in the area around Geelong - is that it uses just one of the two private prescription exchanges and on the web site there is hardly a mention of either NEHTA (except for the funny little e-Health logo) or the PCEHR (Just a 467 Million Govt. Program). In the background the Pharmacy Guild - who are a major sponsor of the eRX exchange - are strongly supporting this program for their own reasons.
As a tool to manage doctor shopping it has one rather large flaw. You have to consent to your data being uploaded and what seeker after pills is going to be silly enough to do that?
It also is claimed by the other prescription exchange they can provide a useful data base to do similar things.
Clearly what is needed is a strategic, standardised approach that builds on what is being done with both prescription exchanges, GP and Pharmacy Desktop Software and the relevant messaging providers to have something useful emerge in a co-ordinated and practical way.
It is not hard to do - but again there needs to be quality leadership and governance put in place to make the vision a working reality. Fragmented approaches too often fail.
David.
p.s. Since this was prepared more coverage interesting has appeared here:
http://www.theaustralian.com.au/australian-it/delayed-choice-for-prescription-alert-platform/story-e6frgakx-1226336572114

Delayed choice for prescription alert platform

HEALTH Minister Tanya Plibersek's $5 million plan to crack-down on prescription painkiller abuse, which was announced in February, was originally funded under the fifth community pharmacy agreement with the Pharmacy Guild in 2010. 
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The Brownian Motion around all this is just amazing and silly!

D.

Tuesday, April 24, 2012

This Seems To Be A Very Interesting And Innovative Approach. I Wonder Where It Might Lead.

The following summary report appeared a little while ago

SMART platform 'promising' for EHRs

By mdhirsch
Created Mar 21 2012 - 10:17pm
The Substitutable Medical Applications, Reusable Technologies (SMART) platform appears to be a "promising approach" to improve electronic health records now that phase one of the project has been completed, according to its developers.
The creators report [1] this week in the Journal of American Medical Informatics Association that unlike current proprietary EHR systems, the SMART platform operates as a standard base platform to which users can add or subtract modular third-party applications, similar to the methodology used by iPhone or Android.
The researchers noted that in just 14 months, they have developed "containers"--such as EHRs and health information exchanges and charter applications--to showcase the system's capability.
"With the cost of switching kept low, the platform enables a physician using an EHR, a Chief Information Officer running a hospital IT infrastructure, or a patient using a personally controlled health record (PCHR) to readily discard an underperforming app and install a better one. Competition on quality, cost, and usability is enabled, and the pace of innovation increases," the developers said.
More here:
Here is the direct link to the full free paper.
The abstract is as follows:

The SMART Platform: early experience enabling substitutable applications for electronic health records

  1. Kenneth D Mandl1,2,
  2. Joshua C Mandel1,3,
  3. Shawn N Murphy4,5,
  4. Elmer Victor Bernstam6,
  5. Rachel L Ramoni1,2,
  6. David A Kreda7,
  7. J Michael McCoy8,
  8. Ben Adida9,
  9. Isaac S Kohane1,2
  • Received 3 October 2011
  • Accepted 12 February 2012
  • Published Online First 17 March 2012

Abstract

Objective The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project seeks to develop a health information technology platform with substitutable applications (apps) constructed around core services. The authors believe this is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation.
Materials and methods The Office of the National Coordinator for Health Information Technology, through the Strategic Health IT Advanced Research Projects (SHARP) Program, funds the project. The SMART team has focused on enabling the property of substitutability through an app programming interface leveraging web standards, presenting predictable data payloads, and abstracting away many details of enterprise health information technology systems. Containers—health information technology systems, such as electronic health records (EHR), personally controlled health records, and health information exchanges that use the SMART app programming interface or a portion of it—marshal data sources and present data simply, reliably, and consistently to apps.
Results The SMART team has completed the first phase of the project (a) defining an app programming interface, (b) developing containers, and (c) producing a set of charter apps that showcase the system capabilities. A focal point of this phase was the SMART Apps Challenge, publicized by the White House, using http://www.challenge.gov website, and generating 15 app submissions with diverse functionality.
Conclusion Key strategic decisions must be made about the most effective market for further disseminating SMART: existing market-leading EHR vendors, new entrants into the EHR market, or other stakeholders such as health information exchanges.
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Here is the link for the abstract.
You can see the data model (so far) from this link:
The idea of developing iPad and Android like apps for a Health Information Source is an interesting one. If such an approach can generate one thousandth of the innovation we have seen in those apps in the Health Information space all our Christmases may have come at once!
Here is the core site to keep an eye on.
http://wiki.chip.org/smart-project/index.php/Developers_Documentation:_SMART_Data_Model
David.