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, August 04, 2012

Weekly Overseas Health IT Links - 4th August, 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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Hospitals' Adverse Event Reporting Systems Inadequate

Cheryl Clark, for HealthLeaders Media , July 26, 2012

An Office of Inspector General's report last week again poked holes in the credibility of the nation's hospital patient harm reporting system. After analyzing clinical records for Medicare beneficiaries treated by 189 hospitals, the agency determined those hospitals had reported only 1% of adverse events.
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Kaiser: Data Transparency Key to Optimizing Analytics

JUL 26, 2012 9:33am ET
Using data in a transparent manner has enabled Kaiser Permanente to create a culture of high performance, according to Bernadette Loftus, M.D., associate executive director in the Mid-Atlantic States for Permanente Medical Group.
Analyzing performance data and making it available to all physicians--a competitive bunch--lets each physician and their peers know how they are doing in achieving specific quality measures. “People change their ways when they walk down a hallway, see scores on the wall, and someone they know is doing better than them,” Loftus told attendees of Health Data Management’s Healthcare Data Analytics Symposium in Chicago.
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Dashboards Make a Good First Step in Analytics

JUL 26, 2012 9:26am ET
There are perceptions of how well a health care organization is operating and then there is the reality of data presented in a manner that is easy to find and understand. Presentation is the beauty of dashboard technology for executives, according to Andrew Proctor, M.D., senior director of business intelligence in the medical operations division of Cleveland Clinic.
And while the clinic has lots of money, business intelligence is a journey that is doable even for small organizations over time, Proctor said during Health Data Management’s Healthcare Analytics Symposium in Chicago. The clinic started its journey toward better understanding operational indicators in 1993, but it wasn’t until getting dashboards in 2006 that the indicators became really useful.
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AHIMA unveils online tool for health information professionals

By Erin McCann, Associate Editor
Created 07/26/2012
CHICAGO – Officials at the American Health Information Management Association (AHIMA) announced Thursday the unveiling of an interactive Web-based career development tool aimed at assisting students and health information professionals find and track relevant career paths. 
AHIMA officials say the Health Information Management (HIM) Career Map was designed in response to the rising demand for qualified health information management professionals in this rapidly changing field. The first career tool of its kind for the healthcare profession, HIM Career Map was unveiled at the Assembly on Education meeting in Orlando, Fla. 
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Thursday, July 26, 2012

Community Health Map: A Geospatial And Multivariate Data Visualization Tool For Public Health Datasets

From the abstract: "Trillions of dollars are spent each year on health care. The U.S. Department of Health and Human Services keeps track of a variety of health care indicators across the country, resulting in a large geospatially multivariate data set. Current visualization tools for such data sets make it difficult to make multivariate comparisons and show the geographic distribution of the selected variables at the same time.
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Health IT VC hits highest level since 2010

By Kate Spies, Contributing Writer
One can practically hear it buzzing: A recent report from global consulting firm Mercom Capital Group shows the healthcare IT sector was a hive of activity in quarter 2 of this fiscal year.
Based on Venture capital (VC) funding levels, deal totals, and merger and acquisition (M&A) activity, in fact, the sector is experiencing its highest levels of economic bustle since 2010.
In the quarter months of April, May and June, “Venture capital funding continued to scale new heights,” stated Mercom’s managing partner Raj Prabhu.
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AP News

Cerner falls despite larger 2Q profit, revenue

Posted on July 26, 2012
KANSAS CITY, Mo. (AP) — Cerner Corp. posted solid second-quarter results and raised its full-year net income and revenue estimates Thursday, but shares of the health care technology company slumped in aftermarket trading.
Cerner, which makes medical software systems, said its net income rose 36 percent in the second quarter, and excluding one-time costs, the result surpassed Wall Street expectations. The company also raised its 2012 profit and revenue outlook. But shares of Cerner plunged $7.54, or 9.7 percent, to $70.50 in aftermarket trading as investors appeared unimpressed with revenue growth that was slightly shy of expectations.
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Remote Patient Monitoring Market To Double By 2016

Tight budgets and emergency room overcrowding will contribute to the uptick in remote and wireless patient monitoring systems to track vital signs. By 2016, the U.S. market will top $20 billion, new research says.
The U.S. market for advanced patient monitoring systems has grown from $3.9 billion in 2007 to $8.9 billion in 2011 and is forecast to reach $20.9 billion by 2016, according to a study by Kalorama Information. Efforts to reduce costs in healthcare, avoid emergency room overcrowding, and prepare for a growing number of elderly patients in the years to come are a few of the drivers for the adoption of these systems.
In Kalorama Information's recently published report, "Remote and Wireless Patient Monitoring Markets", researchers predict the U.S. healthcare system faces "a looming healthcare crisis of unseen proportions," and there will be fewer healthcare personnel and funds to address the industry's growing needs. AdTech Ad
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Nurses, PAs use health IT more than physicians

July 26, 2012 | By Marla Durben Hirsch
Ancillary providers, such as nurses and physician assistants, not only use EHRs and other digital technology significantly in their work, but they do so more than physicians, according to a new study by Manhattan Research.
The annual study of 1,019 advanced practice registered nurses, registered nurses and physician assistants found that they relied on EHRs, smartphones and other technology extensively in performing their duties.
The study found, among other things, that the ancillary providers spent more time online for professional purposes than do physicians, logging in 14-16 hours a week versus 11 for physicians.
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Six Southern procurement groups formed

26 July 2012  
Six collaborations involving 21 Southern acute trusts have been formed to invest in a variety of new IT systems including e-prescribing, clinical portals and clinical documentation.
The trusts, which got nothing from the National Programme for IT in the NHS, are hoping to secure central funding for the systems.
Four of the six want e-prescribing, four want clinical documentation and three are after a clinical portal.
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Survey: Providers Prioritize Health IT Consumer Engagement, But Lack Clear Definition

Written by Kathleen Roney | July 25, 2012
While consumer engagement in health information technology is high on the list of priorities for providers, many lack clarity in their definition and approach, according to the "Consumer Engagement with Health Information Technology Survey" conducted by the National eHealth Collaborative.
The survey was designed to build an understanding of consumer engagement strategies currently underway and planned for the future. It was distributed to 450 members of NeHC's Health Information Exchange Learning Network. The survey asked how organizations define consumer engagement, how they use health IT to engage consumers and what challenges they have encountered.
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Thursday, July 26, 2012

Health IT Integration Key To Reducing Medication Errors

Medication errors have been a problem for decades, but national concern has escalated since the Institute of Medicine in 1999 estimated that they kill at least 7,000 Americans annually, with preventable medication errors adding about $2 billion in additional costs each year to hospitals across the nation.
Medication errors not only cost us precious lives, they drain budgets and detract from investments that could otherwise be used to treat patients and enhance the quality of care. According to a follow-up study by IOM in 2006, each preventable medication error adds at least $8,750 to the cost of a hospital stay. Overall, medication errors cost insurers and health care providers in the nation up to $77 billion each year.
The continued proliferation of medication errors is an endemic problem. Despite the ongoing evolution of health care technology and the federal push to institutionalize health IT through the meaningful use program, the costs of medication errors continue to permeate health care.
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Direct Project Guidance Issued

Recommendations for Implementing Secure Messaging

By Marianne Kolbasuk McGee, July 23, 2012
The Office of the National Coordinator for Health IT has issued new guidance to health information exchanges and others for how to implement Direct Project secure messaging in a standard way.
The guidance addresses what ONC portrays as inconsistencies in the use of the Direct Project protocol for secure peer-to-peer clinical data exchange.
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ICD-10 Deadline Uncertainty Breeds Healthcare Procrastination

American Hospital Association says if the government issues a final rule and deadline on the new diagnostic code set, reticent healthcare groups will work hard to meet it.
The American Hospital Association (AHA) would like the Centers for Medicare and Medicaid Services (CMS) to, as quickly as possible, issue a final rule that includes a firm deadline for ICD-10 implementation so that providers will have enough time to be ready by that date, AHA officials told InformationWeek Healthcare. The Department of Health and Human Services (HHS), which includes CMS, proposed in April that the deadline for shifting to the new diagnostic code set be postponed for one year, from Oct. 1, 2013, to Oct. 1, 2014.
Because of the uncertainty about the deadline, hospitals' focus on ICD-10 is starting to waver, said Chantal Worzala, director of policy for AHA. "We are in an environment where the demands on providers are really great," she said. "So there is a natural tendency to prioritize among all the things you have in front of you. We asked CMS to finalize its rule as quickly as possible so we can go back to a state of certainty about the date." AdTech Ad
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iRobot’s in-hospital robots to link doctors, patients

The Boston Globe
July 24, 2012|Dan Adams
Military and consumer robot manufacturer iRobot Corp. in Bedford will unveil a new product Tuesday intended for the health care industry as it diversifies its product line in preparation for looming defense cuts.
The 5-foot-4-inch, 140-pound “telemedicine” robot will be produced in partnership with InTouch Health of Santa Barbara, Calif., a maker of in-hospital robots, and is designed to help patients with health emergencies get more rapid treatment from specialists — especially at night, when hospital staff levels are lower, the company said.
“Telemedicine is about getting the right expertise to the right place at the right time,” said InTouch chief executive Yulun Wang. “If a patient has a stroke and comes into the emergency room, you better get a stroke neurologist there quickly. Otherwise, through sheer delay, it can be a matter of life or death.”
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5 keys to HIEs and the changing market

By Michelle McNickle, New Media Producer
Created 07/24/2012
A recent study by ICD MarketScape evaluated 16 vendors and concluded the HIE landscape is shifting from "connecting the ecosystem with exchange data and meaningful incentives," to transforming data into "actionable information."
"HIEs hold a unique position in the evolving HIT ecosystem to support the shift to actionable data," said John Stanley, principal with Impact Advisors. "[The] integration of independent but cooperative organizations and information systems place [HIEs] in the position to be mutual gateways for data management and workflow integration among participating organizations."


Stanely outlined five keys to HIEs in this changing market.
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5 things to know about CCD

By Michelle McNickle, New Media Producer
Created 07/23/2012
It's common knowledge that the Continuity of Care Document (CCD) specification is a healthcare standard EHRs will use to exchange data, based on requirements outlined in meaningful use. But Rob Brull, product manager at Corepoint Health, says there's more to know about the spec, and how it will impact organizations' MU efforts in the months ahead.
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EHRs call for tech etiquette in the exam room

July 24, 2012 | By Susan D. Hall
Just as a teenager zoned out on texting instead of listening can drive parents crazy, doctors who ignore tech etiquette in the exam room do so at their peril, according to an article at amednews.com. And no, it's not OK to respond to texts during a patient visit. 
The way a physician handles the disruption caused by consulting an EHR "can absolutely make or break the relationship between doctor and patient," said Larry Garber, MD, an internist and medical director of informatics at the Reliant Medical Group in Worcester, Mass.
Suffice it to say that the doctor's focus should be on the patient, not a PC or tablet. 
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  • July 20, 2012, 5:18 PM ET

Philips Recalls Flawed Patient Data System

Philips Healthcare recalled a defective patient data exchange system after finding it could transmit incomplete reports on heart tests, which the company said could lead to “misdiagnosis” and “incorrect treatment decisions.”
The company issued the recall of 226 customer systems in June, three months after a healthcare facility reported to the Federal Drug Administration that the Xcelera Connect product was sending incomplete cardiology reports into patient records. No patient was known to have been harmed by the issue, a Philips spokesman said.
The recalled system, which transmits ultrasound cardiology lab reports into patient electronic medical records, was in use at around 200 healthcare facilities in over a dozen countries, including the United States. “When we identified the problem we took action and fixed it,” said Bryan Schnepf, a senior marketing manager at Philips. Philips Healthcare is a unit of Philips, in Amsterdam.
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ACC-based software boosts appropriateness of heart scans

American College of Radiology guidelines aren't the only ones being used to develop software to rein in inappropriate utilization. A new decision-support tool based on American College of Cardiology (ACC) appropriateness criteria demonstrated its value in reducing unnecessary cardiac imaging exams in a recently completed pilot project.
The investigational multimodality tool increased physicians' use of the right tests over time, concluded a new study from Weill Cornell Medical College and several other U.S. institutions.
The prospective trial involved 100 doctors and almost 500 patients scanned over eight months. Use of the software tool to gauge appropriateness increased the proportion of appropriate tests from less than half in the first two months of the study to more than 60% in the last two months, while inappropriate studies dropped from 22% to 6%.
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EPS R2 benefits NHS but not GPs - report

23 July 2012   Rebecca Todd
The Department of Health has restarted the process for primary care trusts to be able to deploy the Electronic Prescription Service Release 2.
However, a new report evaluating the impact of EPS R2 says there are few strong incentives for general practices to adopt it, so it is unlikely to have a swift and smooth national uptake.
PCTs need to have ministerial authorisation before prescribers can use EPS R2, but the authorisation process was suspended last March because of slow progress from system suppliers.
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A Call for Intuitive EMRs

Scott Mace, for HealthLeaders Media , July 24, 2012

I've previously remarked that software can't do it all—resolve all antiquated workflows or figure out stumbling blocks in people and politics. Unfortunately, that's just what EMR software is about to be asked to do.
Software is a funny thing. Done well, it anticipates the needs of human beings, or other software, and responds in flexible, flowing harmony.
Done poorly, software epitomizes everything wrong with modern society: impersonal, inflexible, regimented, mundane, boring, even maddening.
Where does your electronic medical record software wind up on that spectrum? Chances are, it doesn't look so good in comparison to your searching experience on Google or your shopping experience on Amazon.
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Patient-Centered Outcomes Research Institute seeks input on draft methodology report

By Diana Manos, Senior Editor
Created 07/23/2012
WASHINGTON – The Patient-Centered Outcomes Research Institute (PCORI) announced Monday the start of a public comment period for its landmark draft Methodology Report, which proposes standards for the conduct of patient-centered outcomes research (PCOR).
Feedback received during the 54-day comment period, which ends at 11:59 p.m. ET Friday, September 14, will be analyzed for potential incorporation into a revised version of the report that is to be considered for adoption by the PCORI Board of Governors at its November 2012 public meeting in Boston.
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80% of docs say technology improves provider-patient communication

July 23, 2012 | By Susan D. Hall
Eighty percent of physicians in a MedPage Today survey say technology has improved communication with their patients. That's significant, after a white paper from the American Hospital Association's Physician Leadership Forum recently named communication one of the biggest gaps in physician competency.
More than two-thirds of the 214 physicians surveyed spend three or more hours on a computer each day, and one in four spends more than three hours on a mobile device. Their number one reason to use both computers and mobile devices was to look up medical news, according to the survey, "Today's Physician: Managing Change."
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Monday, July 23, 2012

'Age Is Just a Number' -- Does It Hold True for EHR Adoption?

Older physicians are less likely to use an electronic health record system than their younger counterparts. A recent Health Affairs study found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.
There are several reasons for the lower EHR adoption rates among older physicians. Some older physicians might not be as technologically savvy as younger doctors and thus are reluctant to transition to an electronic-based workflow. In addition, older physicians are more likely to work in solo or small practices, which face greater financial barriers to EHR adoption. Further, some older physicians say they'll be ready for retirement by the time they start to see any return on investment from EHR adoption.
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Enjoy!
David.

Friday, August 03, 2012

In Case You Thought The US Was Slackening The Pace in E-Health Here Is What Is Going On!

The following appeared recently.
Monday, July 16, 2012

Federal Gov't Continues With Health IT Activity in Q2 2012

The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the second quarter of 2012. Below is a summary of key developments and milestones achieved between April 1and June 30. 
Highlights
The second quarter of 2012 saw a number of important developments:
  • ONC Seeks Public Comment on NwHIN Governance RFI. On May 15, the Office of the National Coordinator for Health IT released a request for information soliciting feedback from the public on options for governance of the Nationwide Health Information Network. ONC defines NwHIN as a set of standards, services and policies that enable secure health information exchange over the Internet. ONC included in the RFI a number of proposed "rules of the road" to govern NwHIN; the centerpiece of the proposal is a voluntary program under which entities that enable electronic health information exchange could be validated (i.e., formally recognized) for meeting ONC-established "conditions for trusted exchange." Comments on the RFI were originally due June 14, but the deadline was extended to June 29. 
  • ONC Creates Two New Offices. On May 16, ONC announced the creation of the Office of the Chief Medical Officer and the Office of Consumer eHealth. The Office of the Chief Medical Officer will address health IT issues relating to safety, usability, clinical decision support, meaningful use policy development and quality. The Office of Consumer eHealth will continue ONC's work to engage patients and families in their health, including overseeing ONC's pledge program, a nationwide campaign to encourage health care providers to make it easier for individuals and their caregivers to have electronic access to their health information.
  • ONC Releases Health IT Dashboard. On May 9, ONC launched a website highlighting national progress toward the nation's health IT adoption goals. ONC strategy, information on health IT grant programs and data from regional extension centers are examples of the information available to the public through the new website.
Health IT Policy & Standards Committees
Health IT Policy and Standards Committees Submit Comments on Medicare and Medicaid EHR Incentive Program Proposed Rules and NwHIN Governance RFI
During the second quarter of 2012, the Health IT Policy Committee and Health IT Standards Committee were largely focused on developing comments on the Stage 2 meaningful use and electronic health record standards and certification criteria proposed rules and on the NwHIN Governance RFI. The Policy Committee's various work groups also began work on Stage 3 meaningful use criteria during the month of June.
EHR Certification
ONC Releases Updated Certified Health IT Product List
On June 26, ONC released version 2.1 of the Certified Health IT Product List, which lists all the EHRs and EHR modules that have been certified by ONC's Temporary Certification Program. Version 2.1 lists 1,700 EHRs and EHR modules approved for meaningful use.
If you are not already tired there is lots more here:
And here is an earlier quarterly report.
Thursday, April 19, 2012

Federal Health IT Activity Continues in First Quarter of 2012

During the first quarter of 2012, the federal government continued to implement the HITECH Act, enacted as part of the American Recovery and Reinvestment Act.
Highlights
The first quarter of 2012 saw the following high-level developments:
  • HHS Released Proposed Rules on Stage 2 Meaningful Use and EHR Certification Criteria -- On Feb. 23, CMS released a proposed rule setting forth the requirements that health care providers must meet to achieve meaningful use of certified electronic health records under Stage 2 of the Medicare and Medicaid EHR Incentive Programs. On Feb. 24, the Office of the National Coordinator for Health IT released a companion proposed rule related to the associated standards and certification criteria for EHRs.
  • White House Selected Todd Park as New Chief Technology Officer -- On March 9, the White House announced that President Obama had selected Todd Park as the new U.S. Chief Technology Officer. Park previously served as CTO of HHS.
Medicare and Medicaid EHR Incentive Programs
CMS Released Incentive Program Provider Participation Data
In March, CMS released February data highlighting health care provider participation and incentive payment totals since the EHR Incentive Program launched in January 2011. According to CMS, over 211,500 total eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) had registered for the Medicare and/or Medicaid EHR Incentive Programs. Over 62,000 EPs, EHs and CAHs had been paid a total of more than $3.8 billion for successfully participating in the programs.
EHR Usability
NIST Released EHR Usability Evaluation Protocol
On March 20, the National Institute of Standards and Technology released guidance for evaluating, testing and validating the usability of EHRs. According to NIST, the proposed usability protocol "encourages a user-centered approach to the development of EHR systems" and "provides methods to measure and address critical errors in user performance before those systems are deployed in a medical setting." On Feb. 14, NIST also published a notice in the Federal Register seeking vendors to supply EHR systems for NIST to use to develop a framework for assessing the usability of health IT systems and performance-oriented user interface design guidelines for EHRs. Interested vendors were required to submit a request and Letter of Understanding by March 15.
Health Information Exchange
ONC Published Article on HIE Strategy
On March 28, ONC leaders published a Health Affairs article outlining the federal government's strategy for advancing health information exchange. The article discusses the federal government's progress to date in establishing the "essential building blocks" for health data exchange. It also describes ONC's plans to "develop additional policies and standards that will make information exchange easier and cheaper and facilitate its use on a broader scale."
ONC Released CONNECT 3.3
On March 16, ONC released version 3.3 of CONNECT, which is open-source software that supports health information exchange and relies on Nationwide Health Information Network standards. The new CONNECT version includes additional features, performance improvements, maintenance fixes and software updates. Of note, CONNECT 3.3 complies with NwHIN specifications approved in July 2011 and creates backwards compatibility between the January 2010 and July 2011 specifications and among CONNECT versions. 
Vastly more details and links are here:
Reading this I have to say I just feel tired. The pressure is really on to make this all work and it can only benefit us all in the long run.
David.

Thursday, August 02, 2012

There Is A Real Point Here That Needs To Be Thought About. Not Sure I Have The Answer!

The following appeared a little while ago.

A Call for Intuitive EMRs

Scott Mace, for HealthLeaders Media , July 24, 2012

I've previously remarked that software can't do it all—resolve all antiquated workflows or figure out stumbling blocks in people and politics. Unfortunately, that's just what EMR software is about to be asked to do.

Software is a funny thing. Done well, it anticipates the needs of human beings, or other software, and responds in flexible, flowing harmony.

Done poorly, software epitomizes everything wrong with modern society: impersonal, inflexible, regimented, mundane, boring, even maddening.

Where does your electronic medical record software wind up on that spectrum? Chances are, it doesn't look so good in comparison to your searching experience on Google or your shopping experience on Amazon.

"We need the EMR that's going to intuitively know the way our physicians practice and know the difference—and not every time a physician wants a change, we get a call, and we say we'll take that to the team, and the team will analyze it, and then the team will take it to the programming team, and in about a month, we should have your change put in our system," says Pamela G. McNutt, senior vice president and CIO of Methodist Health System in Dallas, Tex.
"'EMR 2.0,' as I call it has to be intuitive. It has to adapt to the physician workflow without an army of 200 people in IT behind it trying to change the code," McNutt says. "That is not a sustainable model for us to have that many people behind the scenes creating all these boxes and screens. It has to be intuitive but we're all busy dotting I's and crossing T's.

"Even the 'Cadillac' systems for physicians and hospitals are nowhere near EMR 2.0 that I envision for the future," she adds.

McNutt hopes for some "dark-horse" software from an as-yet unseen vendor, maybe from Europe or sitting in some incubator deep inside MIT, to leapfrog the capabilities of current systems. "I could make a fortune if I could figure out who this is that's going to do that," McNutt says with a laugh.

Unfortunately, software innovators—the Amazons and Googles—only come along once in a great while. Healthcare CIOs appear to be stuck living with our current generation of imperfect software.

Another option kicked around, even more unrealistically, is to hope that clinicians adopt some kind of standardized workflow. That would help software immensely, because today's software has been constructed with layer upon layer of options to accommodate different workflows. This complexity in turn adds to the complexity of the software, of training for the software, and of trying to keep the training for the software inside one human head once training is completed.
Lots more here:
I am quite sure I don’t know how to fix this problem - but I certainly know it needs to be fixed. Just consider the NEHRS if you want an example of the worst sort of “impersonal, inflexible, regimented, mundane, boring, even maddening” software.
One thing is certain - the Health IT Industry needs help from all sorts of experts from other domains to do better than what is typically delivered!
David.

Wednesday, August 01, 2012

NEHRS Clinical Safety Is Apparently Assured. But How Are We To Know?


NEHTA has deigned to provide an update on the clinical safety of the NEHRS. For context here is the page on which the report is found - with links.

Clinical Safety

The national eHealth system will improve clinical outcomes, and to do that it needs clinically safe and efficient foundations. That’s why the clinical safety and integrity of NEHTA’s products guides everything NEHTA does as an organisation.
There are three key clinical quality and safety processes in NEHTA, the Clinical Safety Unit; the Clinical Safety Working Group and the Clinical Governance Review Board, each ensuring safety.
  • The Clinical Safety Unit comprises clinicians with specialist training and experience in eHealth and risk management as well as system safety.
  • The Clinical Safety Working Group works with the clinical and programme leadership for the PCEHR and for products and solutions constituting the component infrastructure of the PCEHR. Their work is to validate the evidence that forms the ‘Clinical Safety Case’ for the PCEHR. This includes identifying risks, recommending the controls to address the potential risks and evidencing these in operation.
  • The Clinical Governance Review Board has an advisory role to support existing NEHTA product development and implementation and provides expert and systemic clinical and safety advice.
NEHTA works with organisations such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the University of New South Wales Centre for Health Informatics to ensure the clinical safety and governance of the PCEHR and eHealth products.
The page is found here:
Cutting right to the chase - here is the conclusion from page 4 of the comprehensive 8 page document.

1.3 Overall Risk Assessment


NEHTA has made an assessment that there are no clinical hazards identified in relation to the Consumer Release – 1 July 2012 that are classified as a High or Medium Clinical Risk, which leaves a Justifiable Residual Risk Classification as per Appendix A, Table 4.

NEHTA therefore considers that there are no Unacceptable Residual Risks present in Consumer Release – 1 July 2012.

NEHTA Clinical Safety Unit has determined one generic hazard, defined according to the NEHTA Clinical Safety Management System, as important to the analysis of clinical safety residual risk, specifically the Consumer Release - 1 July 2012. This generic hazard is listed below and summary analysis, including an outline of pertinent mitigating controls, is provided in Section 1.8:

  • Clinical information is presented inappropriately or in a manner that its context is misleading or cannot be ascertained

What this means is found here:

1.8 Summary analysis of priority Clinical Hazards & Mitigating Controls

Clinical Information is Presented Inappropriately or in a Manner that its Context is Misleading or Cannot be Ascertained
There is the ability for consumers to enter their own health information in the PCEHR through Personal Health Notes, which will never be visible to providers, and the Personal Health Summary, which will be visible to providers. There may be an assumption on behalf of consumers that providers will regularly refer to, read and act upon information in the Personal Health Notes and or Personal Health Summary. This assumption may lead to incorrect, delayed or no care being provided. This potential risk will be reviewed when provider access is enabled in a subsequent release of PCEHR.
While consumer generated health information is currently exchanged between consumers and providers and is variable in quality, the PCEHR Personal Health Summary (designed for sharing with providers) presents a potential amplification of any disconnect between consumers¡¦ expectations of providers using this health information.
In the context of the Consumer Release - July 1 2012, no consumer generated data will be available to providers.
The control for this risk is:
  •           A note is displayed to consumers, indicating that Providers will not have access to Personal Health Notes, on the page that consumers enter the note.
Additional recommended controls include:
  • Consumers are to be educated that a provider cannot access health information in the Personal Health Notes and that any information that is related to their care in the notes should be discussed as per usual methods e.g. General Practitioner or Specialist appointment
  • Guidelines are to contain information on the functional limits and constraints of the PCEHR, including roles and responsibilities

1.9 The Way Forward

The CSU will continue to work closely with the NEHTA PCEHR team as the staged delivery of provider and consumer functionality is made available. A fundamental aspect of this work is to seek specific evidence as to the effectiveness of mitigating controls, both system specific and those relating to non-functional end user, process and policy elements of the PCEHR in operation that impact safety. Verification of these mitigations in operation will allow elaboration of the PCEHR Clinical Safety Case Report and act as evidence of the continuous clinical safety management and assurance.
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What this seems to be saying is that, confusingly there are both Personal Health Notes and a Personal Health Summary for former of which a healthcare provider won’t be able to see the latter the provider will always be able to see.
With all this said what is unsaid is way more than what is said. There is no discussion of the methodology beyond giving it a name and the approach to risk identification, prior to the assessment of each of the risks. Again we seem to have another one of these ‘trust us’ documents and are provided with essentially no reason to do so.
Not being provided with the range of risks that have been assessed leaves us all in the dark as to how seriously NEHTA’s claims as to safety. I note we are not told what actions have been taken to remedy the issues identified in the earlier case report (linked above).
NEHTA need to do a good deal better than this.
David.

Tuesday, July 31, 2012

The Saga Of Under-Testing and Glitches With the NEHRS Seems To Just Be Endless. When Are We Going To See Some Accountability and Transparency?

The following article appeared yesterday.

Secret report finds bugs in new ehealth system

Date July 30, 2012

Mark Metherell

Mark Metherell is health correspondent

Glitches in patient identity details for Australia's new ehealth system have been found in about one third of cases nationally, according to a report the federal health department refuses to publish.
The secret report shows that patient identity information held by state public hospitals frequently fails to match the data which Medicare Australia holds on the same individuals. Differences in the spelling of names or other variations can pose a significant obstacle as the system requires an exact match before individuals can gain ehealth access.
The department has refused a request by Fairfax to release the report under the Freedom of Information Act, stating that the report was subject to confidentiality undertakings, given by the IBM company which prepared the document. The confidentiality undertakings are understood to have been made to state and federal agencies; no individual patient records were involved.
Insiders with some knowledge of the project say the refusal to reveal the information has more to do with avoiding government embarrassment about more setbacks in the problem-plagued ehealth development. A department spokeswoman said the report ''does not show up problems in relation to security and safety'' of the new personally-controlled electronic health record system, the PCEHR.
More here:
This outcome is utterly predictable and clearly, to me at least, the root problem lies in the fact that, at present, the Health Identifier Service is not being used as intended by the State Jurisdictions (i.e. States and Territories) who are reported as saying they will need up to three years to have their key systems using the Health Identifier Service. See here:

States not ready for e-Health system

GENERAL practitioners will have to wait up to three years to receive secure discharge summaries digitally signed by hospital doctors following more delays to the Gillard government's e-health system.
State and territory health departments say they are not ready to use healthcare providers' 16-digit unique identity numbers created for the national system to verify the identity of doctors or other medical staff creating a patient's discharge summary.

Healthcare providers individual identifiers - dubbed HPI-Is - were created and assigned to all registered doctors two years ago as part of the Healthcare Identifiers service launch, which also saw unique 16-digit identifiers allocated to every Australian enrolled on the Medicare database.

Use of local hospital or state health agency identity numbers instead of a uniform national identifier will impact their use for authentication and audit purposes within the personally controlled e-health record system.
Much more here:
Of course we must not lose sight of a Victorian Health Department assessment that the use of the IHI as a single identifier was just unsafe:

Sunday, February 13, 2011

NEHTA Releases A Set of Documents Describing Integration of the Health Identifier Service With the HealthSMART Program in Victoria. Not There Yet!

The most interesting to me is this document of the release is this one:
The document is one of a series of specifications and so on produced as part of a IHI Pre-Implementation Project between NEHTA and HealthSMART.
The full blog is here:
All in all this is shaping up as a bit of a mess. Just how all this is going to be resolved in a way that makes clinical documents developed in Hospitals (and GP surgeries) seamlessly and safely find their correct home in the NEHRS is feeling like a work in only very early progress.
It would be great to get hold of the IBM Report to be able to see just what it says and what other issues have been identified.
It really seems to be a bit of a shambles. It is interesting how there is a steady flow of these issues emerging. I wonder is this co-ordinated or whatever?
David.