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, September 22, 2012

Weekly Overseas Health IT Links - 22nd September, 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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Interoperability ‘not the goal’

By John Andrews, Contributing writer
Created 09/14/2012
Connectivity between healthcare providers has been a sharp focus for IT initiatives since 2004, and the concept has assumed many forms
An idea can change a lot over eight years and while the intent of interoperability remains essentially the same, its application has split off in various directions since 2004, when the Bush administration called for establishment of electronic health records, universal connectivity between healthcare providers and named David Brailer, MD, as national health information technology coordinator.
EHRs remain a work in progress, though Brailer is long gone from his post and interoperability has meandered down divergent paths of connectivity. Over that time, new initiatives have sprung up as well, such as meaningful use, accountable care organizations and ICD-10 conversion. The lofty regional health information organization concept originally proposed has been largely scaled down to smaller health information exchanges.
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Wednesday, September 12, 2012

Markle Foundation Releases Blue Button Video to Show Promise and Potential of Consumers Access to their Own Health Information

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Top 5: Data breach winners and losers by state

By Erin McCann, Associate Editor
Created 09/13/2012
In an epoch of Web hackers, procedural slackers, unauthorized users and viewers, PC pinchers and server swindlers, it’s a hard knock life for patient privacy.
Nearly 20 million patient health records have been compromised since the Aug. 2009 Breach Notification Rule, which requires that HIPAA-covered groups give notification following a data breach involving 500 or more individuals. And breach numbers haven't shown signs of waning any time soon.
In fact, according to a 2011 Redspin report, which collected data from the Department of Health and Human Services (HHS), the total number of records breached jumped 97 percent within a single year. Moreover, according to some reports, data breaches can cost the healthcare industry, on average, $6.5 billion annually.
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Tailoring Treatment for Cancer

Joe Cantlupe, for HealthLeaders Media , September 13, 2012

This article appears in the September 2012 issue of HealthLeaders magazine.
When then President Richard Nixon in 1971 called for a "cure for cancer," he envisioned a crusade akin to the efforts that developed the atomic bomb and led to the moon landing.

But more than 40 years later, it has proven to be an elusive goal, and one that has changed dramatically over the decades. Now, the vision has transformed from seeking a singular cure for cancer to finding a multitude of cures for a complex disease that differentiates into the hundreds of types. The emerging singular focus now in the so-called war on cancer is personalized medicine, which involves tailoring drugs for each patient to attack that person's individual kind of cancer. Some have dubbed it one pill for one patient, or even named it individualized medicine. Others have a different take, describing it more as precision medicine, narrowing treatment for groups with certain ailments.
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Telepharmacy Really Does Make A Difference

Rural hospitals can use telepharmacy to review orders when a pharmacist is unavailable, says study.
Patient safety improves when telepharmacy services backstop clinicians in rural hospitals when their pharmacists are not on the premises, according to a new study. In a baseline sample, 30% of hospitalized patients had one or more errors in medications ordered after hours. But when orders were faxed to and screened by pharmacists at the University of California Davis Health System, the study found, the pharmacists caught errors in medications ordered for 19.2% of the patients.
"Telepharmacy represents a potential alternative to around-the-clock on-site pharmacist medication review for rural hospitals," concluded the paper in the journal Telemedicine and e-Health. AdTech Ad
In fact, researchers from the UC Davis and the University of Utah Schools of Medicine noted that less than half of rural facilities have full-time pharmacists on staff; unsurprisingly, rural and critical-access hospitals have a higher incidence of medication errors than do other hospitals.
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Officials downplay insurance exchange hack

September 14, 2012 | By Dan Bowman
The web portal for the Utah Health Exchange was hacked and littered with "graffiti" last month, rendering the site useless for a little more than a week, the Salt Lake Tribune reported this week. The attack is the second this year for a statewide healthcare entity, but is unrelated to the breach last March that jeopardized medical information for hundreds of thousands of Medicaid patients, according to a state official.
Mike Sullivan, a spokesman from the Governor's Office of Economic Development, told the newspaper that the graffiti consisted of "garbled" words and "blurred" headlines, but only on informational pages for the website. He added that no criminal investigation would be conducted, comparing the incident to a "kid who spray paints your mailbox."
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Providers Seek Consulting Firms For Smaller EHR Projects

With EHR installation a done deal, many health providers look to consulting firms for smaller Meaningful Use projects, KLAS study shows.
Healthcare organizations seeking to meet Meaningful Use Stage 1 requirements are much less inclined to hire consulting firms to fully install an electronic health record (EHR) and more likely to turn to these firms to help with smaller projects that enhance the features and functionality of their EHRs, a new KLAS report reveals.
Rapid Growth of Meaningful Use Consulting: Why Providers Are Reaching Out examines the performance of third-party firms during the last two years. These firms are involved in preparing providers to attest to Meaningful Use Stage 1 requirements, which health providers must meet before they can qualify to receive payments under the federal EHR Incentive Programs. AdTech Ad
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Devices and desires

BYOD – bring your own device – has been a hot topic in the IT industry for months; but the idea has been slow to catch on in the NHS. Chris Thorne asks why; and whether that’s about to change.
6 September 2012
‘Bring your own device’ is a phrase that seems to strike an equal measure of excitement and fear into the hearts of those working in the NHS.
By all accounts, clinicians are starting to hammer on the door of their IT departments, demanding access to flashy tablet devices such as Apple’s iPad and Samsung’s Galaxy range.
But in a cost-cutting, ‘Nicholson challenge’ NHS environment, the idea that trusts will be able to supply £400 devices to every member of staff is unrealistic, bordering impossible.
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Groups warn of safety threat when health IT 'rights' go wrong

September 13, 2012 | By Gienna Shaw
We've all heard the "rights" that define successful use of health IT: Getting the right information to the right person at the right time. But when one of those rights is wrong, it can put patients in danger, warns the Society of Hospital Medicine.
Despite CMS' "celebratory declarations" that 2012 is the year of Meaningful Use, experts are concerned that the use of HIT "falls short of its promise--and might even endanger patients--due to shortcomings in system interoperability, safety, accountability, and other issues," according to an article in the society's The Hospitalist.
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PACS market set for slow but steady growth

September 13, 2012 | By Gienna Shaw
The market for picture archiving and communication systems is set for slow but steady growth in coming years as healthcare organizations replace legacy systems and adopt new image and information management platforms, according to a Frost & Sullivan analysis.
The radiology informatics market lost ground between 2009 and 2011 due to factors such as market saturation and a focus on electronic health records and chasing Meaningful Use incentives.
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IT Critical To New Health Learning System

U.S. healthcare system needs to transform itself into a "continuous learning machine" that uses technology to provide doctors with timely information, says Institute of Medicine report.
For America to consistently deliver reliable performance and improve patient outcomes, providers must apply computing capabilities and analytical tools that allow clinicians to share real-time insights from routine patient care. In short, the entire U.S. healthcare system must transform itself into a continuous learning machine that drives efficiency and curbs costs, a new study released by the Institute of Medicine (IOM) concludes.
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America says the healthcare industry, unlike the banking, airline, and auto industries, lags far behind in its ability to establish the practices and procedures that raise its performance level. Furthermore, the report said the industry has not done enough to provide patients and clinicians with timely, relevant, and useful information, and added that inefficiencies in healthcare have cost the nation in lives and treasure. AdTech Ad
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5 ways voice recognition tech cuts costs

By Steff Deschenes, New Media Producer
Created 09/12/2012
Many may think of data in terms of numbers and text, but not only does voice documentation have a place in the array of data collection tools that can be used by healthcare companies, it offers financial benefits. 
Documentation with voice isn't just about capturing information, which is historically how people have thought about it. "It's now doing it in such a way that the document can be reused throughout an organization's downstream for other efforts like billing, quality assurance functions and medical and utilization reviews," explained Mike Raymer, senior vice president of solutions management at M*Modal, a company that provides clinical transcription services, documentation workflow solutions and unstructured data analytics. "Voice is about turning information into a language of understanding," he said. "It takes unstructured text and brings meaning to it that's transferrable from system to system."
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AHIMA unveils tool to spur PHR use

By Erin McCann, Associate Editor
Created 09/12/2012
CHICAGO – Officials at the American Health Information Management Association (AHIMA) announced Tuesday a new online guide to help spur patient understanding of their medical records. 
The Understanding Your Medical Record guide was posted to myPHR.com, a resource for seniors, caregivers, physicians and parents. AHIMA launched the myPHR.com website in 2006 as a resource for consumers interested in maintaining their own personal health records.
The guide was announced at the second Consumer Health Summit facilitated by the Office of the National Coordinator for Health Information Technology (ONC)
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ONC chief urges vendors to go for Blue Button ASAP

By Mary Mosquera, Contributing Editor
Created 09/12/2012
WASHINGTON – Farzad Mostashari, MD, the national health IT coordinator, has challenged vendors to make it easy for consumers by early 2013 to view, download and transmit to another party their health information in the form of a Blue Button feature.
The Office of the National Coordinator for Health IT has established a Twitter hashtag of #VDTnow for companies and organizations to post their commitment to establishing the feature.
Implementing the functionality for view, download and transmit (VDT) to a third party, “I think, is underappreciated for how significant that’s going to be to the concept of consumer-mediated health information exchange,” Mostashari said at a Sept. 10 ONC summit on consumer health IT.
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Free Privacy/Security Training Game Available for Practices

SEP 12, 2012 12:09pm ET
The Office of the National Coordinator for HIT has launched a free Web-based health information security training application.
Called CyberSecure: Your Medical Practice, the game walks a user through multiple privacy and security challenges that come up in practices. These include a co-worker needing to borrow a password to access information and help a patient waiting on the phone; and a subordinate requesting to take her laptop home tonight to catch up on billings for last week.
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Winchester switches off Cerner in ED

10 September 2012   Rebecca Todd
The Royal Hampshire County Hospital in Winchester has switched off Cerner Millennium in A&E and moved to Patient First.
The electronic patient record system will also be switched off for theatres and order communications at the old Winchester and Eastleigh Healthcare NHS Trust.
Basingstoke and North Hampshire NHS Foundation Trust merged with Winchester and Eastleigh in January this year to form Hampshire Hospitals NHS Foundation Trust.
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Meaningful Use Stage 3 may require multi-factor authentication

September 11, 2012 | By Marla Durben Hirsch
The healthcare industry is getting a peak at what Stage 3 of Meaningful Use may look like. The Office of the National Coordinator for Health IT's HIT Policy Committee voted Sept. 6 to accept the Privacy and Security Tiger Team's recommendation to require multi-factor authentication in certain cases involving remote access to patient protected health information, Healthcare Info Security reports.
The situations that would require such multi-factor authentication, according to the Tiger Team, include:
  • Access from outside of an organization's/entity's private network
  • Access from an IP address not recognized as part of the organization/entity or that is outside of the organization/entity's compliance environment
  • Access across a network any part of which is or could be unsecure (such as across the open Internet or using an unsecure wireless connection).
The multi-factor authentication would need to meet National Institute of Standards and Technology Level of Assurance 3, NIST 800-63-1, according to the article.
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Patients open to data sharing if they control access

September 12, 2012 | By Susan D. Hall
The state of New York requires patient consent to have their data accessed through health information exchange, and a majority surveyed are willing to have their data stored automatically, as long as they can retain control over it. The study published in the Annals of Family Medicine was based on a 2008 telephone survey of 170 residents.
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ONC's new dashboard tracks health IT progress

Posted: September 11, 2012 - 2:15 pm ET
Want to know how many folks have enrolled in health information technology training programs at U.S. community colleges under the American Recovery and Reinvestment Act?
It's 28,096.
How many of those IT students have graduated?
So far, 14,400, with another 3,080 currently enrolled.
Where is the closest community college to you offering the federally subsidized training?
Check the map and see.
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AHRQ project cuts bloodstream infection in ICU by 40 percent

By Bernie Monegain, Editor
Created 09/11/2012
WASHINGTON – A nationwide patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ) reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units by 40 percent, according to the agency's preliminary findings.
The project, billed as one of the largest one to date, used the Comprehensive Unit-based Safety Program (CUSP) to achieve its results that include preventing more than 2,000 CLABSIs, saving more than 500 lives and avoiding more than $34 million in healthcare costs, according to AHRQ.
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ICD-10: Time's Up; No More Excuses

Scott Mace, for HealthLeaders Media , September 11, 2012

As worrisome as the final deadlines for use of ICD-10 codes are, it's time to devote significant resources to getting ready for them.
Belittled in some quarters as a make-work, vendor-enriching government regulation, ICD-10 actually gets right to the heart of improving the quality of care.
Don't take my word for it, even if you read my recent story in HealthLeaders magazine. Listen to Sharon Korzdorfer, director of information management at St. Luke's Hospital of Kansas City.
St. Luke's is a not-for-profit, acute-care, tertiary academic teaching institution with more than 600 beds. It is one hospital out of an 11-hospital health system. Eight of the facilities run McKesson EMRs, and the three critical-access hospitals use CPSI, a platform designed specifically for critical access hospitals, with a completely different billing process to McKesson's.
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Tuesday, September 11, 2012

Health IT Promotion Goes Direct-To-Consumer

by Jane Sarasohn-Kahn
Most U.S. physicians are in the process of implementing electronic health records, motivated by the incentives provided through the HITECH Act.  As physicians use EHRs more meaningfully, engaging with patients and their data is a primary goal for the investment of roughly $40 billion worth of taxpayer dollars.
But as physicians and IT workers continue to build the national health information infrastructure, will patients engage in turn? Many people in the U.S. aren't aware that their health data are indeed "theirs." Without patient engagement in their health data and knowing their numbers, people don't achieve optimal health outcomes, driving more intense health care resource utilization and costs downstream.
The Office of the National Coordinator of Health IT addressed this challenge in a video released last month. Think of this as direct-to-consumer promotion of health IT.
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ONC scraps plan for NwHIN 'rules of the road'

By Mary Mosquera, Contributing Editor
Created 09/10/2012
WASHINGTON – The Office of the National Coordinator for Health IT has dropped pursuit of a regulation for establishing “rules of the road” for the nationwide health information network (NwHIN) based on feedback it has received.
Commenters from industry and the public made it clear that federal regulation could slow development of health information exchange just as those activities are starting to emerge and pick up steam, “perhaps more than is widely appreciated,” according to Farzad Mostashari, MD,national coordinator for health IT.
ONC issued a request for information (RFI) in May to collect public comment on a possible approach for rulemaking to spell out “conditions of trusted exchange,” including safeguards and technical and business practices. ONC wanted to receive broad input before issuing a proposed rule, he said.
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Scant mention of health IT in party platforms

By Tom Sullivan, Government Health IT
Created 09/10/2012
WASHINGTON – It’s a joke without a punch line: Both Republican and Democratic national party platforms make sparse mention of health IT.
To be certain, there’s plenty of focus on the broader healthcare issues. The GOP platform, in fact, dedicates its first two sections to ‘Saving Medicare for future generations’ and ‘Strengthening Medicaid in the states’, while the Democrats also address the issue early on with a section about healthcare as part of ‘The middle class bargain’ and another on ‘Social Security and Medicaid.’
As for any particulars of health IT, well, that’s another matter. Quite literally, each party offers up a single sentence on its intentions for health IT.
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Diabetics closer to a life without needles via nanosensors

September 10, 2012 | By Jeff Byers - Contributing Writer
Diabetics may soon be able to focus on tissue fluids such as sweat or tears rather than blood when checking blood glucose levels. Recently developed biosensor technology in nano-form from Fraunhofer Institute for Microelectronic Circuits and Systems (IMS) is offering the chance of a non-invasive approach via digital biometric analysis that can be radioed to a mobile device.
With the ability to continuously measure glucose levels using tissue fluids including sweat or tears rather than blood, this technology could serve as relief to patients with the desire to stop sticking themselves with sharp needles as part of their daily routine. This announcement adds to a string of news offering the promise of a needle-free life for diabetics. In August, research from Purdue University's Birck Nanotechnology Center and the U.S. Naval Research Laboratory discussed a new material for glucose monitoring can detect minute levels from saliva, tears and urine. What's more, in July 2011, researchers from Northeastern University in Boston announced an iPhone add-on using LED lighting and nanosensors that could help detect the presence of the compound in a patient's bloodstream.
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Lack of ROI, quality metrics jeopardizes HIE sustainability

September 10, 2012 | By Susan D. Hall
Health information exchanges must develop metrics to gauge their impact on quality improvement and show return on investment to continue to convince stakeholders of their value, researchers say in a study published at Perspectives in Health Information Management.
Though health information exchanges provide a "necessary foundation" for accountable care organizations, the long-term sustainability of many organizations is not clear--and the tech market for HIEs remains in flux as it's all being sorted out.
"The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level," the authors say.
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It's not the size of your data--it's what you do with it

September 10, 2012 | By Gienna Shaw
I've heard a variation on this story at least a dozen times: A hospital gathers data from all corners of the organization, recruits doctors and nurses to supplement it by filling out forms and checking all kinds of little boxes. Then they run reports slicing the data this way and that way and send them to the doctors and nurses--and department heads and board members and whomever else they can think of.
And then nothing happens.
The thing is, just having access to the massive amounts of data that lies in electronic medical records, monitoring and other medical devices, health information exchange warehouses and public and private databases isn't enough. In fact, gathering all that data and using it to run reports isn't enough, either.
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UPMC Invests in IBM Intelligent Infrastructure for Personalized Medicine

September 7, 2012
UPMC, the 20-plus academic hospital system in Pittsburgh, Pa., is investing $120 million over the next four years in data intelligent infrastructure from theArmonk, N.Y.-based tech giant, IBM. The goal of UPMC is to change the way that treatments are designed for individual patients by effectively using massive volumes of patient and research data.
“UPMC is keenly focused on creating new models of effective and affordable care, supported by good science and smart technology. Extending our long partnership with IBMis a key part of that strategy,” UPMC CIO Daniel Drawbaugh said in a statement.
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FDA offers four-pronged plan to strengthen postmarket device surveillance

By Rene Letourneau, Editor
WASHINGTON – In a report released Thursday, the FDA outlined a four-step plan to intensify its postmarket medical device surveillance system.
According to the report, “Strengthening our National System for Medical Device Postmarket Surveillance,” the plan is designed to bolster the agency’s efforts to better monitor and report on the effectiveness and safety of medical devices.
“Although the United States has a robust postmarket medical device surveillance system, we believe our system can be strengthened by implementing four key changes to our existing program. It bears emphasizing that modernizing medical device postmarket surveillance is a long-term effort. Our proposed strategic changes are intended to complement our existing programs,” FDA officials said in the report.
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Cancer Care Portal Connects Docs To Patients

Oncologists can use the tool to help meet Meaningful Use regulations on patient engagement.
Oncologists are looking for ways to meet Meaningful Use requirements that call for them to facilitate patients' access to their medical information online. Navigating Cancer has announced a tool to help accomplish that goal. Its patient portal has signed up more than 500 oncology providers across the country, enabling them to provide a more coordinated, patient-centered approach to care.
At the same time, the Seattle-based company's product, the Patient Engagement Portal, will help patients build their own online personal health records (PHRs) to manage their care and access medical information from their providers. AdTech Ad
Company officials said Navigating Cancer hit the milestone of adding 500 oncology practices to the patient portal in mid-August and has signed up several large practices including Advanced Medical Specialties in Miami, Michiana Hematology Oncology in Northern Indiana, and the Center for Cancer and Blood Disorders in Fort Worth, Texas.
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ONC releases draft 2014 test procedures for EHRs

Posted: September 7, 2012 - 5:15 pm ET
The Office of the National Coordinator for Health Information Technology released the first draft of a set of test scripts to be used for the testing and certifying electronic health-record systems against the recently released 2014 Edition of standards and certification criteria for the federally funded EHR incentive payment programs.
The draft test procedures will be posted "in waves" on the ONC's website, HealthIT.gov, according to a news release.
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Enjoy!
David.

Friday, September 21, 2012

The Scale Of The Mess That Is The US Health System Is Barely Believable. Sadly It Is Real However.

The following report appeared a few days ago:

IOM report: Informatics, transparency and data to fix healthcare crisis

By Erin McCann, Associate Editor
Created 09/06/2012
WASHINGTON – The U.S. healthcare system has long been laden with growing inefficiencies, heightened costs and increasing complexities, all of which have stymied industry progress, according to a new Institute of Medicine (IOM) report.  
However, report officials also noted existing knowledge, transparency, and new informatics tools wield the potential to mend the  –  some say broken  – healthcare system to achieve continuous improvement and better quality care at lower costs. 
In a Thursday morning live webcast of the IOM report release, Mark Smith, MD, president and CEO of California HealthCare Foundation and committee chair said two fundamental issues are currently facing the U.S. healthcare system: cost and complexity. Thus the mission of the report was “to find the foundational characteristics of a system that is efficient,” said Smith. 
According to the report, the costs of the system's current inefficiencies underscore the urgent need for a system-wide transformation. The committee calculated that approximately 30 percent of health spending in 2009 – roughly $750 billion – was wasted on unnecessary services, excessive administrative costs, fraud and other problems.  
The U.S. pays some of the highest costs for healthcare, but “at the same time, we do not attain the results in health outcomes and performances that others are able to achieve,"  said IOM President Harvey Feinburg, MD, in the live webcast. “How do we face up to that reality?”
Smith added that a “30 percent increase in income has been effectively eliminated by a 76 percent increase in healthcare costs,” leaving the U.S. healthcare system full of “wasted opportunity.”
Moreover, inefficiencies can potentially lead to patient suffering.  By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.
Incremental upgrades and changes by individual hospitals or providers will not suffice, the committee said. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health system into a "learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery.  
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The report was sponsored by the Blue Shield of California Foundation, Charina Endowment Fund, and Robert Wood Johnson Foundation.  
Read the full awful story here:
Wasting $750 Billion is really quite something!
Here is another report with a link to the free pre-publication draft:

New IOM Report Seeks a New Path for Health Care

SEP 6, 2012 4:40pm ET
The American health care system is in deep trouble and needs a “systemwide transformation,” of which better use of data is a major component toward improvement, according to a new report from the Institute of Medicine.
The report concludes that the health care system is too complex and costly to continue business as usual. Authors contend 30 percent of health care spending in 2009 was wasted, and cite a rough estimate that 75,000 deaths could have been averted in 2005 if every state delivered care at the quality level of the best performing state.
The ways that providers train, practice and learn new information cannot keep pace with new discoveries and technological advancements. And care delivery and payment practices lead to inefficiencies and may hinder improvement. “The threats to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck,” says Mark Smith, president and CEO at the California HealthCare Foundation.
Better use of data would facilitate better treatment of 75 million patients with more than one chronic condition by improving care coordination and having quick access to best practices, according to the report. “For example, it took 13 years for the use of beta blockers to become standard practice after they were shown to improve survival rates for heart attack victims.”
.....
The report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, “demonstrates how a health care system that delivers the best care at lower cost is not only necessary, but also possible,” says Harvey Fineberg, M.D., president of IOM, in a foreword. The report is available here in a free pre-publication version.
 The full article is found here:
Lastly this article summarises the recommendations:

IOM Urges 10 Major Healthcare Fixes

Cheryl Clark, for HealthLeaders Media , September 7, 2012

The U.S. healthcare system operates like an ATM machine that takes days to release cash. It functions like a home construction project whose carpenters and plumbers use different blueprints. And it does business like a store that prices items depending on who is making the purchase.
It fails to contain wasteful spending, estimated at about $765 billion in 2009 alone, largely from unnecessary and inefficiently delivered services, excess administrative costs and overpricing, and in fraud and missed prevention opportunities.
Those are some of the findings from a 382-page report the Institute of Medicine released Thursday calling for a major overhaul to remove inefficiencies and other barriers to quality care.
The report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," was prepared by a 17-person committee chaired by Mark Smith, President and CEO of the California HealthCare Foundation.
"We tried to address a big-deal problem in a way that is very comprehensive, because we feel much of what has been said to this point has been in bits and fragments," says Gary Kaplan, MD, a member of the authoring committee as well as Chairman and CEO of Virginia Mason Health System in Seattle. Providers, payers, patients, funders, the government—everyone—has to see quality, outcomes, technology, fraud and waste in a holistic fashion.
Kaplan adds that the committee hopes "that the first thing to come from this is awareness. Too many providers are saying to themselves, 'We're alive and well; we know change is coming, but we're banking that change will be glacial, so we don't have to do much right now. We're profitable.' "
A case in point is the transition to electronic health records and the attainment of meaningful use attestation. While some providers may see these moves largely as big expenditures, for which they may recoup some federal incentive payments, they may overlook the enormous potential of using EHRs to gather real-time data on inappropriate, unnecessary or incorrect use of expensive hospital resources.
"We can know for the last 100 patients who had X procedure, we have this percent of complication. We know that in real time, not through 18-month-old data. This is not an abstraction, and can provide us with early warning signs and places where we may intervene."
The report issues 10 recommendations to improve quality of care, and use healthcare resources better.
Read the 10 recommendation here:
All you can say reading this is that they have a very hungry tiger by the tail and that is looks like sensible use of Health IT will be a major contributor to fixing it over the next 20 or so years!
One really has to wonder how it got as bad as it now seems. A ‘boiling frog’ issue I suspect.
David.

Thursday, September 20, 2012

Yet Again We Find Truth Getting In the Way Of A Good Story. E-Health Is A Lot Harder Than It Seems.

The following appeared a few days ago.

Study: EHR data for research often incomplete, inaccurate, unreliable

September 10, 2012 | By Marla Durben Hirsch
Current methodologies for using electronic health records for research are inadequate and result in "significant bias" when used "naively," according to an article in the Journal of the Medical Informatics Association.
At present, EHR research involves an approach that first involves phenotyping/feature extraction, which transforms raw EHR data into clinical relevant features. Those feature are used for research tasks. According to the article's authors, however, EHR data currently is incomplete, inaccurate, variable, and highly complex, rendering such research unreliable.
The authors, from Columbia University, suggest that the research process be improved, particularly by improving the current phenotyping process to make it more accurate and data driven. They recommend that researchers take a "radical shift in approach" and study EHRs themselves, not just the data, to see how EHRs are used and how data is recorded.     
"We must mine the EHR data to learn the idiosyncrasies of the healthcare process and their effects on the recording process," the authors state.
.....
More here:
You can go directly to the abstract from this link:
JAMIA article's abstract
The full text will be available in a few months for free from Pub Med.
What is being said is, however, pretty clear. We have a lot to learn about how information is held in EHRs - let alone secondary systems like the NEHRS - before we can make any trustworthy use of the information.
Since they have not done the research NEHTA, DoHA and all have no idea if what they have done will be any use for all those research uses.
David.

Wednesday, September 19, 2012

The Recently Concluded Listed Company Reporting Season Threw Up A Ripper in the E-Health Space.

The following was filed on the very last possible day of the reporting season by Global Health Pty Ltd. (GLH:ASX)
As I had the misfortune to own a few shares in the company a few years ago I thought I would have a browse of the Annual Report.
You can have your copy from here:
Unless I badly miss the mark this is an extremely sick little puppy we have here.
First we note:
RESULTS FOR ANNOUNCEMENT TO THE MARKET
Revenues from ordinary activities down 21% to 4,148,000
Loss from ordinary activities after tax attributable to members up 194% to (658,000)
Loss for the period attributable to members up 204% to (657,000)
Dividends (distributions) Nil
Net tangible assets per ordinary security (0.63)¢ Prior Period (0.15)¢
Additionally we can note that the investment in support and maintenance has fallen while marketing costs have risen.
And guess what we are then told:
“Despite a 45% increase in sales and marketing expenditure to approximately $1.35M (2011: $0.926M) over the period, the expected return in new sales was not achieved.
The sales effort was directed to the business development of the Company’s:
  • MasterCare Shared electronic Medical Record,
  • ReferralNet connectivity platform, and,
  • LifeCard Personal Health Record;
to support the improved management of population health outcomes within geographical regions.”
The reasons were given as:
There were two major reasons for the lack of sales closure across the non-acute customer segment:
  •  the delivery of National e-health Infrastructure provided through government agencies was directed at vendors of GP software and trials at 12 “Wave” pilot sites. The 12 pilots were selected from 91 tenders submitted by Health Agencies. Global Health platforms were involved in 16 out of 91 submissions but  were not among the successful tenders. This effectively curtailed demand for our e-health platforms from the public sector;
  •  the government announced the establishment of 61 new Medicare Locals nationwide which replaced funding previously provided to 120 Divisions of General Practice. The new Medicare Locals, which are regional clusters representing General Practice, Specialists and Allied Health providers, were progressively operational from July 2011, January 2012 and July 2012. These new regional entities will determine demand for the Company’s eHealth platforms for population health. However, there have been significant delays in the time taken to confirm the new organizational structures and funding conditions. Consequently, demand for the Company’s eHealth platforms have slipped.
The level of sickness is clear from here:
“FORWARD OUTLOOK
Business development through organic growth is extremely sensitive to the pace and success of the government’s Health Reform agenda.
The operating profile of the Company has been adjusted to reflect the existing lack of scale and difficulty in engaging with public sector health providers especially given the poor outlook on the financial status of the three largest states – NSW, VIC & QLD and the general uncertainty of the business environment.
The results reinforce the Directors view that the Company’s lack of scale is the major impediment to improving shareholder value.
Consequently, the Company has engaged in preliminary discussions with a variety of parties to consider merger and amalgamation opportunities that can achieve the necessary tipping point in terms of scale that will rectify the current lack of shareholder value and enable EBITDA growth into the future.”
Translation - we are dead ducks and are up for sale to anyone who can help.
This view is rather confirmed by the fact that cash on hand as of June 30, 2012 was a fabulous $ 11,659.
I have to say this company really looks like a mining explorer. It has not much cash, is spending more than it earns and has taken over $20 million of funds from investors in its life. If ever something was run to pay management and staff salaries and not shareholders this is it!
It will be interesting to see what happens next. Pity they did not agree to be bought by iSoft a few years ago when it was rumoured that was on the cards.
The last point to be made about all this is just how damaging working with Government can be. It is clear at least part of the problem is government delay etc.!
Glad I sold out a good few years ago! Really pretty sad the way things have gone especially since at least some of their software seems to work pretty well.
David.

Tuesday, September 18, 2012

Weekly Australian Health IT Links – 18th September, 2012.

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

General Comment

Really a very quiet week in e-Health but in the sector there is a fair bit happening. Biggest news is NSW following Queensland in taking an axe to the staffing levels in the State Health System.
It will only with time will we see what impact all these job cuts will have on overall service levels and especially e-Health. The cuts certainly seem to be pretty draconian.
The broader political situation of the populace wanting increasingly expensive services but not being prepared to pay for them (via tax etc.) will clearly become unsustainable over time -if it hasn’t already. The point was widely explored by George Megalogenis on Insiders a day or so ago. See here:
http://www.abc.net.au/insiders/content/2012/s3591072.htm
The impact on e-Health is likely to be pretty large over time I suspect.
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E-health

A major focus of the Australian Government’s "eHealth" agenda is the personally controlled electronic health record system (PCEHR system).  On 1 July 2012 the PCEHR system became available for online registration for individuals.  The PCEHR system allows an individual to access their own health information and nominate which of their healthcare providers  obtain access to that information. 
An overview of the PCEHR system
The Personally Controlled Electronic Health Records Act 2012 (Act) provides the legal framework for establishing a voluntary national system of internet-based personal medical records.  The aim of the PCEHR system is to improve the co-ordination of individuals' health information by making it more readily available and ensuring the most up to date information is used to assess the individuals' treatment.  In addition the PCEHR system aims to reduce the risk of adverse medical intervention or the duplication of treatment. 
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DORA software rollout lagging

13th Sep 2012
THE rollout of software giving GPs patient prescription histories in real time, aimed at cutting doctor shopping, is moving at a slow pace with bureaucratic hurdles delaying the process by months.
GPs had been expecting the software, known as DORA, to be made available nationwide from July following a successful trial overseen by Tasmania’s Alcohol and Drug Services.
The program was to be delivered by state governments with a $5 million contribution from the Commonwealth. But last week the federal health department confirmed licensing agreements with each state and territory were still being negotiated.
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E-health education program

10 September, 2012 Pharmacy News staff
A new national education program, funded through the Fifth Community Pharmacy Agreement,will commence in October to support community pharmacies in increasing their understanding and awareness of electronic transfer of prescriptions.
The Electronic Transfer of Prescription (ETP) Education Program aims to educate the community pharmacy workforce about electronic medication management, and specifically the role of ETP in Australia’s e-health landscape.
ETP is a means by which community pharmacy can participate in a quality use of medicines initiative that will reduce medication errors and enhance health outcomes for consumers. In addition ETP will enable community pharmacy to reinforce its record as leaders in health-related innovation.
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ACT Launches Online Medical Information Pilot Project

In order to provide easy availability of medical facilities to Canberra residents, the ACT has come up with a scheme in which they will be providing online access to health information. In order to see the success of the project, the ACT has launched the scheme in the form of a pilot project, which will be combined with the PCEHR.
The system is known as My eHealth system and will allow users to have a look at their medical reports. Not only this, it will also allow users to manage their profiles as well medical appointments. The system is based on the Orion Health's consumer portal technology.

ACT pilots e-health records portal

Patients to register separately for PCEHR.

The ACT Government is trialling a new health information portal designed to deliver personal health information to consumers securely.
Health minister Katy Gallagher launched the 'My eHealth' portal this week with a pilot group of consumers from the Health Care Consumers Association and 40 chronic care patients.
The portal was designed to complement and integrate with the national Personally Controlled Electronic Health Record (PCEHR) system.
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Health budget slashed by $3b

Date September 14, 2012 - 9:35AM

Sean Nicholls

Sydney Morning Herald State Political Editor

Thousands of jobs may be axed from the NSW health service as part of deep budget cuts confirmed by the NSW Health Minister, Jillian Skinner.
Just days after the Education Minister, Adrian Piccoli, announced a $1.7 billion funding cut in his department, Mrs Skinner confirmed this morning that $3 billion will be cut from NSW health over the next four years.
This includes $775 million from the imposition of a "labour expense cap" announced for every government department in this year's budget.
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NSW Health cuts deeper into staff costs

NSW Minister for Health Jillian Skinner has confirmed the government’s healthcare reforms will require its local health districts (LHDs) to cut $775 million in staffing costs over four years.
The announcement is the latest in a series of changes targeted at reducing NSW Health’s head office, administration and management expenses by 25 percent.
The minister explained in a statement LHDs can choose how the savings will be achieved and suggested telehealth and other ehealth technologies may deliver efficiencies.
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Can we talk? Elderly needs drive face of future conversation

MEET the new face of human interaction: Telenoid the robot.
He's small, white and bears an eerie resemblance to Casper the Friendly Ghost but his creator, artist and academic Hiroshi Ishiguro, says soon he will be in every household and nursing home.
Ishiguro and his robotic friend are visiting Melbourne as part of RMIT Gallery's Experimenta -- 'Speak To Me' exhibition, featuring works from 30 international and Australian artists as part of the 5th International Biennial of Media Art.
Ishiguro's robot is -- basically speaking -- Android-Skype.
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Passwords could be replaced with the wave of your hand

Date September 14, 2012

Noel Randewich

Prepare for your print to be your password

From the developers forum in California, Intel shows how palm recognition technology can work in practice.
Passwords for online banking, social networks and email could be replaced with the wave of a hand if prototype technology developed by Intel makes it to tablets and laptops.
Aiming to do away with the need to remember passwords for growing numbers of online services, Intel researchers have put together a tablet with new software and a biometric sensor that recognises the unique patterns of veins on a person's palm.
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Bad medicine takes toll on Australians

  • Lisa Cornish and Sue Dunlevy
  • News Limited Network
  • September 15, 2012 12:04AM
THE top ten drugs used by Australians were linked to 2925 adverse events and 67 deaths in the last five years, an exclusive analysis of the adverse events data base of the national drug watchdog has found.
Information provided by the Therapeutic Goods Administration, collected from patients, consumers, health professionals and sponsors of medicines, reveal the risks Australians are exposed to on a daily basis.
Women are slightly  more prone than men to adverse effects, and the elderly are involved in more than 60 per cent of recorded cases.
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FHIR Report from Baltimore Meeting

Posted on September 14, 2012 by Grahame Grieve
Well, the Baltimore HL7 Working Group Meeting has (finally) come to end. It’s been an extremely busy meeting, and HL7 is certainly facing some new and difficult challenges in the near future.
Now that it’s over, here’s my FHIR progress report.
Ballot
Prior to the meeting, we held a draft for comment ballot. Combined with the issues list from the connectathon, and a few other late submissions, we around 130 issues on the list. These range from questions about the scope of FHIR write down to typographical errors. I thank everyone who contributed to this list greatly – it will help us improve the quality of the specification greatly. I hope that we can get all the issues resolved to everyone’s satisfaction prior to the release of the next ballot.
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Astounding CT scan tech takes a quantum leap inside the human body

Summary: Astounding CT scan tech makes possible to scan the human body quickly, constructing Star Trek-like, 3D images of the inner workings of a living patient's body.
By Denise Amrich for ZDNet Health | September 10, 2012 -- 01:52 GMT (11:52 AEST)
Scott Bakula is one of my favorite actors, mostly because of the parts he's played. He's taken a Quantum Leap back in time, and gone years into the future as the first captain of the Enterprise.
But another Bakula, Robert Bakula, is an elderly patient who's taking a quantum leap of his own. A guy who was born in the last century is being treated with technology that seems transported from the future.
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Get with digital 'or risk disaster'

A LARGE portion of Australia's $1.4 trillion economy faces severe, near-term disruptions due to the rise of the digital era, economics consultants Deloitte Access Economics says.
Business sectors representing up to a third of the economy are on course for major revenue disruptions within the next few years, the company says in a report released yesterday.
Finance, retail and media were singled out as the sectors facing the most severe short-term impact -- what Deloitte calls "short fuse, big bang".
It predicts that the three sectors could lose more than 35 per cent of their revenue within the next two years.
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Digital disruption: it’s not about to stop

Negar Salek
11/09/2012
Australian companies have between two and five years to master the onset of digital disruption if they are to avoid the troubles that have rocked the retail and media industries, a Deloitte report has found.
Education, government services, agriculture, health, transport, and utilities are expected to suffer significant disruption to their business models, the report states, but over a longer time frame than their counterparts in information technology, finance, and retail, which face a more imminent threat.
Miners, construction groups and many manufacturers have longer to prepare and face less incremental disruption. Education and health are also expected to have more time to plan their responses.
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The Australian Law Council says Labor's data retention plans go too far

FEDERAL government plans to make telcos store records of their customers' internet habits for two years would breach Australian cultural boundaries, the Law Council says.
Speaking on behalf of the council at a Senate committee hearing on the proposed laws today, Philip Bolton SC said the proposed laws were out of proportion to problems faced by law enforcement agencies.
He also criticised what he saw as a lack transparency on the part of the government regarding the new laws at the hearing.
The proposed package of laws are designed to address serious law enforcement challenges created by internet-based communications and require major reforms to Australia's telecommunications interception and intelligence legislation.
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Curiosity ready to roll again

  • From: AP
  • September 13, 2012 12:38PM
THE Mars rover Curiosity is preparing to roll again after it completes its health checkups, project managers say.
Since landing in an ancient crater near the Martian equator on August 5, the car-size rover has trekked more than the length of a football field, leaving wheel tracks in the soil.
The most high-tech rover sent to the red planet, it spent the past month testing its instruments before embarking on a mission to examine whether the environment could have been hospitable to microbial life.
Mission manager Jennifer Trosper said the six-wheel Curiosity has "performed almost flawlessly" so far.
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Enjoy!
David.

Monday, September 17, 2012

A Totally Unrealistic Email Came Out from NEHTA Last Week. I Will Be Amazed If All This Actually Happens!

This little ripper was circulated last week.
Sent: Wednesday, September 12, 2012 2:23 PM
Subject: PIP eHealth Incentive - Pre-release webinar for the Medical Software Vendor Community - Slide pack
Dear all,
Thank you for joining our Practice Incentives Program eHealth Incentive - Pre-release webinar for the Medical Software Vendor Community.
The slide pack from yesterday’s discussion is enclosed for your review and distribution as appropriate. Please note that this document will also be posted on the NEHTA website.
As a recap, the key messages are:
-      The PIP eHealth incentive, announced in the 2012-13 budget, aims to encourage general practices to keep up to date with the latest developments in eHealth
-      The five requirements and associated compliance dates are:
o   1. Integrating Healthcare Identifiers into Electronic Practice Records - February 2013
o   2. Secure Messaging Capability - February 2013
o   3. Data Records and Clinical Coding - February 2013
o   4. Electronic Transfer of Prescriptions - February 2013
o   5. Personally Controlled Electronic Health Records - May 2013
-    The PIP eHealth Product Register is intended for Practices to check if they have compliant software
-    More information will follow shortly on how vendors can list their products on the PIP eHealth Product Register. In the meantime we encourage you to peruse the information enclosed in the slide pack.
Please do not hesitate to contact Industry@nehta.gov.au if you require further assistance.
Thank you.
NEHTA Industry Communications
----- End E-Mail.
So what we have from those people who could not deliver the National Authentication System for Health after 5 years of trying demands that - for apparently no money - suddenly all this NEHTA compliance is to appear out of thin air is slightly over six months.
Of course we know the IHI service is hardly fit for purpose and that no-one is relying on it as the sole identifier.
More amazing still there are no standards for Electronic Transfer of Prescriptions so the vendor systems has to be able to use a commercial non-NEHTA non-standard compliant provider!
Equally it is totally unclear just what coding is to be used - and on the relevant slide SNOMED is not even mentioned.
I have no idea how all this is going to play out but my suggestion would be for the system providers to say to the GPs who want to claim the very substantial payments (up to $50,000 per practice) for software compliance that the costs of our software will be ½ of the PIP payment you can claim until such time as our development costs are re-couped.
I can’t see anywhere where the same demands for compliance are being placed on the State Jurisdictions for their computer systems - or have I missed the announcement.
You can download the amazing document from here:
The NEHRS can be months late but it seems the private sector has to fit in with nonsense deadlines and work through the holiday period in January to boot.
David.

AusHealthIT Poll Number 136 – Results – 17th September, 2012.

The question was:

Do You Think The Unreliability and Instability of The NEHRS Should Result In Sanctions Against Those Responsible?

For Sure 69% (29)
Probably 10% (4)
Possibly 10% (4)
No Way - They Are Trying Hard 12% (5)
Total votes: 42
Very interesting response. Essentially about 70% there should be some accountability for the way the NEHRS project has been made operational ?
Again, many thanks to those that voted!
David.