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."

Tuesday, October 23, 2012

E-Health Gets Some Interesting Coverage From The Mainstream Press Again. Government Transparency Seems To Be Missing in Action.

The Australian has two related articles on e-Health in the IT Section today.
First we have:

No risk guarantee on e-health

THE Department of Health and Ageing has refused to guarantee that its much vaunted e-health record system is risk-free after more than 140 risks were identified before it went live on July 1.
The Gillard government's personally controlled e-health record system, developed by Accenture, contained a staggering 142 risks of which 32 were rated extreme, 77 high and 33 medium.
The detailed risk assessment study, obtained by The Australian, was prepared by the National E-Health Transition Authority (Nehta) and submitted to the Health Department and other relevant parties about two months before the July go-live date.
The department did not directly respond when asked to confirm that all the risks were resolved by July 1.
However, a spokeswoman said: "By July 1 we had safeguards in place to avoid those risks we identified from occurring.
"For example, to safeguard against security breaches, we have put in place strong encryption and firewalls and implemented all of the recommendations from (Defence's) information security manual," she said.
One severe risk cited in the report was individuals being granted access to health information they were not entitled to if the PCEHR registration process did not adequately authenticate a user.
The five consequences of such access included a user's safety being compromised or, worse, inappropriate medical treatment being given to an individual.
The report did not spell out that this could lead to death, but it is well known that people can pay a high price when they receive wrong medical advice or treatment. Another adverse result could be that an individual's privacy would be compromised.
The report also said that under these circumstances the Health Department could be exposed to legal action and penalties if deemed to be negligent.
Lots more here:
Second we have:

Medical agency blocks request for report's release

THE Department of Health and Ageing has refused to release details of a crucial risk-assessment study conducted by Ernst & Young on the personally controlled e-health record system.
The department's e-health division head, Matthew Corkhill, ruled that it was against the public interest to release the 21-page report, Assessment of PCEHR Information Security Threat and Risk Assessments, in response to a Freedom of Information request lodged by The Australian in July.
Mr Corkhill said the report, which recommends strategies to mitigate potential vulnerabilities in the PCEHR program, continued to inform the ongoing operation and management of the program.
He said it was prepared for the sole use of the department to provide advice and proposals in relation to information security risk-management processes for the PCEHR system.
More here:
Dealing with the second report first it seems to me that at the very least the Government should be releasing a summary of the findings with a summary of what has been done to remedy each of the issues identified. To just bat the whole thing away leaves the public with the sense that something is being hidden and this will only result in a lack of trust in the overall system. Openness is clearly the best policy in areas like this in my view.
On the first article again openness would have said - yes we had a lot of problems prior to ‘go live’ and here is how each of them has now been addressed. Given the rocky start from the ‘go live’ for the first few months it seems unlikely we are being provided with the whole truth on the status just prior to ‘go live’ and since that the date the silence has been deafening. We are no in the situation where really no-one outside Government has a clue as to what is going on.
David.

Non E-Health - But Just Wonderful!

Go here and just be amazed.

http://www.htwins.net/scale2/

Best web site I have seen in I can't remember how long.

You do need to click the Start Button and then use the scroll bar!

David

Monday, October 22, 2012

Weekly Australian Health IT Links – 22nd October, 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

The most amusing news this week came from the Senate Estimates hearing last week where your humble blogger was described by the Secretary of the Department of Health as ‘infamous David More’ and by a Senator as a ‘serial blogger’ - whatever that means!

What I see as good about all this - and we can do without the name calling - it that clearly the blog and the comments made are being read by the ‘powers that be’ - so if you have a serious point to make it is possible to make it pretty directly. For serious points probably using your real name might be a good idea!

Reports of the details from Senate Estimates will hopefully be provided later this week.

The other big news is that this is the week when Window 8 is to drop on us all. See last item. It seems the new has more than a few a little nervous. I for one think I might wait for version 8.1 before updating!

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Patient sign-up to PCEHR steady

19 October, 2012 Kate newton
Uptake of Australia’s new e-health system is gradually increasing, with more than 12,500 people signed up for a personally controlled electronic health record by mid-October.
However, the number is still a long way short of the 500,000 target the Federal Government has set for 1 July 2013.
There are also 68 individual health practitioners and 86 health organisations — including hospitals and practices — signed up to access the e-health system, which was launched this year on 1 July.
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E-health ramp-up awaits GP software

Summary: The Australian government is banking on the roll-out of software for GPs to boost uptake of e-health records from 13,000 today to 500,000 at the end of June 2013.
By Josh Taylor | October 19, 2012 -- 03:37 GMT (14:37 AEST)
The Department of Health and Ageing has said it is pleased that 13,000 Australian residents have signed up for e-health records since July 1, and has downplayed the original forecast that 500,000 will be signed up by the end of June 2013.
Since the federal government's AU$466.7 million personally controlled e-health record (PCEHR) system launched on July 1, take-up has been slow. But the government has stated that a slow take-up was the aim.
In the 109 days since the launch (to October 17), there has been a total of 13,340 sign-ups for the records either online, on the phone, or in writing — an average of 122 people per day. On this average, just over 44,500 people will have signed up for the service by the end of June next year. A total of 791,764 documents have been uploaded to those records.
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PCEHR targets depend on new medical software

Half a million users registered by June still feasible, Health officials claim.

The most important factor in getting more consumers to use the Government’s Personally Controlled Electronic Health Record (PCEHR) will be medical provider-friendly software that will be released by the end of October, a Senate Estimates Committee has been told.
Heath & Ageing secretary Jane Halton told the Committee yesterday that she was "delighted" with the early numbers of consumers registering for the $628.3 million initiative since it launched on July 1.
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US cyber crime sparks concern for PCEHR

17th Oct 2012
WARNINGS from a leading internet fraud investigator that e-health crime is the fastest growing crime in the US and is spreading have sparked renewed criticism of the security of the government’s personally controlled e-health record system (PCEHR).
Detective Superintendent Brian Hay from Queensland’s Fraud and Corporate Crime Group has told MO that doctors in Australia are unprepared for cyber attacks on their business computer files.
His comments follow a series of attacks on Australian medical centre business file servers in recent weeks in which hackers blocked access to patients’ data and demanded $1000 ransoms.
“Over 21 million medical files have allegedly been stolen since 2009 in America. It’s been reported that a medical file can sell for $50. It’s already a US$10.5 billion dollar industry.
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Mandatory privacy breach paper should become law: Pilgrim

Privacy Commissioner Timothy Pilgrim supports federal government's discussion paper, says data breach incidents that may go unreported are concerning.
The federal Attorney General’s discussion paper, Australian Privacy Breach Notification should be considered by all Australian organisations and passed into law, according to Privacy Commissioner Timothy Pilgrim.
The paper covers a number of discussion questions including the possible introduction of mandatory data breach notification laws, the kind of breaches that should trigger notification requirements and how a data breach notification requirement should be enforced.
“Privacy breach notification is an important issue that needs community debate, and I’m sure there will be a wide range of views expressed on whether this notification should be mandatory.” Pilgrim said in a statement.
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Consumers irked by pharmacist access to medical records

15 October, 2012 Nick O'Donoghue
Most health consumers do not feel comfortable with the idea of pharmacists or practice nurses having access to their medical records, a study reveals.
Australian research into pharmacists’, GPs’ and consumers’ views on integrating pharmacists into general practice found there was overall support for the move.
However, the majority of patients (63 per cent) did not want pharmacists to have access to their medical files, despite 73 per cent of consumers saying that pharmacists should have a role within general practice.
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National E-health Transition Authority (NEHTA) and the Personally Controlled Health Record (PCEHR)

Posted on October 18, 2012 by Amy Wong
The National E-Health Transition Authority (NEHTA), in association with Cor Mentes Health Consulting, has recently delivered a series of 23 interactive information sessions in hospitals around Australia to help Doctors in Training understand the Personally Controlled Health Record (PCEHR), the National eHealth Records System (NEHRS) that supports this, and how Doctors in Training – so often on the patient front line in hospitals – will be able to interact with them.
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AARNet helps students and staff cut the cable in Qld hospitals

AARNet providing wireless access to online resources from multiple healthcare facilities across the state
Australia’s Academic Research Network (AARNet) has expanded its “eduroam” high speed wireless network in several hospitals across Queensland.
The wireless service enables staff and students at the University of Queensland to gain access to the institution’s online resources from multiple healthcare facilities across the state.
It is the result of a five-year initiative between AARNet, Queensland Health and Queensland universities, under the Queensland Regional Network Organisation.
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NeHTA Conformance

Wed, 10/10/2012 - 12:15pm
We are pleased to announce that we have passed all four of the National eHealth Transitional Authority (NeHTA)’s CDA (Clinical Document Architecture) conformance tests.
The CDA is a standard developed by HL7 that defines the format and semantics of clinical documents (eg, progress notes and discharge summaries) that are to be exchanged between health services. Now that we are compliant, this means that Communicare can send, receive and unpack any CDA message and display these within Communicare.
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Raising standards to save lives: Klaus Veil

It can be difficult to imagine a clear connection between someone clinging to life in an emergency room and the interoperability standards governing the use of healthcare technology.
Yet for Associate Professor Klaus Veil, one of the nation’s leading experts on interoperability standards and long time ehealth educator, the link is too important to overlook.
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Redefining medicine with apps and iPads

Date October 14, 2012

Katie Hafner

Dr Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level.
As a third-year resident in internal medicine, Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain swelling, seizures or even death.
Rajkomar had been on-call for 24 hours and was exhausted, but the clinical uncertainty was "like a shot of adrenaline", he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his iPhone.
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Using Your iPhone To Detect Ear Infections Also Keeps The Doctor Away

Andrew Liszewski 13 October, 2012 1:30 AM
Forget that daily apple. Researchers at Georgia Tech and Emory University have developed the Remotoscope, an accessory that turns the iPhone into an ear-inspecting otoscope so doctors can diagnose and treat kids remotely in the event of an ear infection.
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Bench test : putting medical apps through their paces

NAME: iQuit ItPUBLISHER: FlexibleCodeCOST: Free (previously $1.99)PLATFORM: iPhone
PURPOSE: It claims to assist in weaning people off various addictions by recording the date when quit attempts will begin and allowing users to register when they have been tempted or relapsed.
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Media Release
Senator the Hon Stephen Conroy
Minister for Broadband, Communications and the Digital Economy
Deputy Leader of the Government in the Senate
Minister Assisting the Prime Minister on Digital Productivity

Construction begins on $12.5 million rural medical training facility in Armidale

The Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, today officially started construction on a new medical training facility at the University of New England.
The Tablelands Clinical School, which is part of UNE’s School of Rural Medicine, will provide medical training, deliver rural health care, and promote medical research for regional and rural Australia.
“The Gillard Government is proud to be contributing $10.5 million dollars to build this wonderful new facility, which will be at the forefront of training medical professionals here in regional Australia,” Senator Conroy said.
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Tasmanian health agency gives external contractors the flick

Tasmania’s Department of Health and Human Services uses technology to upgrade its core services in-house and plans to create shared services for use by all agencies across the state
Tasmania’s Department of Health and Human Services (DHHS) has saved hundreds of thousands of dollars by using technology to upgrade its enterprise software in-house rather than spend vital funds engaging costly external IT consultants.
In the 2011/2012 financial year DHHS – Tasmania’s largest government agency which delivers services through 300 health-related facilities –needed to achieve $100 million in savings within a $1.8 billion budget.
It also needed to decentralise its operations by establishing three regional statutory authorities called Tasmanian Health Organisations as part of the National Health Reform agreement.
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Only 6400 NBN fibre connections so far

Just over 25,000 premises now connected to NBN
NBN Co has hooked up just shy of 6400 fibre broadband connections to the National Broadband Network. Of the 25,495 NBN-connected premises, “just under 6400 are fibre, just under 600 are fixed wireless and just over 17,000 are for satellite,” Jim Hassell, head of product development and sales at NBN Co, told a Senate Estimates committee yesterday.
Of those 17,000 satellite connections, around 8000 were new customers and 9000 were customers who were previously on the Australian Broadband Guarantee (ABG) for more than three years, the committee heard.
The ABG ended in June last year and was designed to help residential and small business premises access broadband services regardless of where they were located.
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Early look at Windows 8 baffles consumers

  • By Peter Svensson
  • AAP
  • October 20, 2012 5:08PM
THE release of Microsoft's Windows 8 operating system is a week away, and consumers are in for a shock.
Windows, used in one form or another for a generation, is getting a completely different look that will force users to learn new ways to do things.
Microsoft is making a radical break with the past to stay relevant in a world where smartphones and tablets have eroded the three-decade dominance of the personal computer.
Windows 8 is supposed to tie together Microsoft's PC, tablet and phone software with one look. But judging by the reactions of some people who have tried the PC version, it's a move that risks confusing and alienating customers.
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Enjoy!
David.

Today’s Mini Budget Has Implications for Telehealth, and Private Health Insurance.

On page 231 we read:
“The Government will restrict telehealth services to those patients for whom distance is the most significant barrier to accessing specialist care.
This is estimated to save $134.4 million over four years. This restriction will align eligibility to Medicare Benefits Schedule (MBS) telehealth items with the Australian Standard Geographical Classification Remoteness Area (ASGC-RA), the standard remoteness classification used by the Australian Bureau of Statistics. From 1 January 2013, geographic eligibility criteria for MBS telehealth services will be amended to exclude patients in outer metropolitan areas and major cities of Australia, in accordance with the ASGC-RA. The amendment to geographical eligibility will not affect services that are provided to patients of an Aboriginal Medical Service or care recipients of a residential aged care facility.
Savings from this measure will be redirected to partially offset the cost of the Dental
Health Reform package announced on 29 August 2012.”
You can see the whole document here:
There has also been a rather complex change to the Private Health Insurance rebate:

Private health insurance takes another hit

The federal government will cut another $700 million from private health insurance (PHI) as it attempts to shore up its budget position.
In the mid-year fiscal update released on Monday, Labor announced it will no longer pay the PHI rebate on people’s entire premiums when they rise more than the consumer price index (CPI).
From April 2014 “the premium to which the rebate is applied will move in line with CPI or the commercial premium increase, whichever is lower”, Treasurer Wayne Swan said in a statement on Monday.
In April this year, health fund premiums rose an average of 5.06 per cent. In 2011, they rose 5.56 per cent across the board.
In the year to June, the CPI was just 1.2 per cent.
“This measure will save approximately $700 million over the forward estimates helping ensure that the PHI rebate remains on a sustainable footing,” Mr Swan said.
Full article is here:
More broadly health expenditure seems to be only taking small other changes as far as I have spotted to date.
I could not find any e-health or ehealth changes. Let me know if you spot any.
David.

AusHealthIT Poll Number 141 – Results – 22nd October, 2012.

The question was:

Are The Plans DoHA Has For Rolling Out The NEHRS / PCEHR Using Medicare Locals Realistic? See amlalliance.com.au For All The Details - Under Support Tab.

They Are Great 12% (5)
Need A Bit Of Work 14% (6)
Need A Great Deal Of Work 26% (11)
Simply Won't Work 49% (21)
I Have No Idea 0% (0)
Total votes: 43
Very interesting.  Many are a very sceptical this will work without major change. (75%)
Again, many thanks to those that voted!
David.

Sunday, October 21, 2012

A Colleague Provides An Unsolicited Clinician’s Impression on The NEHRS. Not Really Thrilled!

A physician mate (Terry Hannan) was approached by a more senior colleague after having had a try of the NEHRS. Here is what the colleague wrote (quoted with permission of both).

“Greetings Terry,

I thought that I would write to you out of interest, knowing that you are interested in this sort of thing, now that I have established an eHealth record, having got a bit confused about it all and to detail my experiences.

I had always rather thought that it was a good idea and my application was following the receipt of a pamphlet put out by the Government "The health record that works for you".

Being a more or less retired 71 year old physician, I thought it would be good to get my data into it. Although I need no eHealth record as things stand as I can account very well for all my health facts to any doctor while travelling, but noting that in due course old age our infirmity will get one in the end, like the colo-rectal surgeon, I should set it up and I could provide a better than average medical record for the system.

Now my troubles began. In spite of having better than average computer skills, and much better than average for a 71 year old, I could not get any really meaningful data into this record.

The setting up was cumbersome, having to set up an Australian Government number and then linking it to other accounts, in my case the Centrelink account, finding that I now have two separate Australian Government Numbers to add to the confusion, but in due course, after becoming duly passworded against that number, I had to go through the security set up, cumbersome, but perhaps necessary. It was a bit tricky to set up and use, and in using it, I found that it was not case sensitive, but absolutely strict as to what one put in as an answer. For instance if one put in the name of the street in which line was raised, one had to get the whole lot correct, and in retrospect I wish I had used simpler criteria. For instance, If one put in Bluegum Street, one could not satisfy the security by just typing in "bluegum".

But the real problem came in trying to input data.

I could get in my medications and allergies and next of kin and contact details without any great stress, but when it came to the important stuff, like putting in my medical history, I could find absolutely no way of doing it. There was no editing function so the whole things remains a waste of time for me as things stand. I could get no other medical data from any of those doctors whom I have seen, presumably because they are not on the system, but i will find out.

I could access and add data to my "personal notes", but that is mort really any use as I know all that stuff and health professionals cannot access it anyhow. The more important shared details zone would not let me into it to add details.

Quite separately, it gives a list of PBS Pharmaceutical supply dates, but one can get no details as to what was supplied, which is a pity.

On checking access to Medicare benefits services, one can get detail of who provide the basic service by going into a complicated sub-menu, but the initial presentation on the list mentions only dates, not the service supplier, which means it very difficult and time consuming to actually discover who did what when. This surely could be easily redesigned as the data is all there.

Anyhow, to date is it is all a waste of time and effort for me until the situation is jigged up.

Can you tell the powers that be that a 71year old physician wants to be a serious user but cannot be.

Best wishes,

John.

Dr.J.M.Sands
Email: doxanz@nixanz.com”

I think this really says it all. The system as it presently exists is really not suitable for even a computer literate clinician who is in a target demographic (The over 60’s).

Pretty sad and yet another reflection of the way all this was designed and rushed without real consumer or clinician input.

What is described here is the ‘lived experience’ (as the Government likes to call it) of all who have tried the system. It is tedious, clunky and simply not fit for purpose - whatever that was - at present.

You really wonder how long it will take for reality to dawn. Somehow I suspect the description of one wag might come true. “NEHRS: Never Ending Health Record Scandal”.

Right now there does not seem to be any understanding of a need for change.

David.

Saturday, October 20, 2012

Weekly Overseas Health IT Links - 20th October, 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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Group’s Big Goal: Make HIE Plug-and-Play

OCT 11, 2012 5:26pm ET
A large coalition of providers, software vendors, health information exchanges, states and public agencies has launched a program to develop test standards to certify electronic health record and HIE products that use a standardized method for exchanging health information.
The goal is plug-and-play HIE, with initial benefits expected to be seen within nine to 12 months. The initiative will expand work done by the Nationwide Health Information Network Exchange, a program within the Office of the National Coordinator for HIT that brought together stakeholders to test a common set of specifications for information exchange.
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Record Matching Algorithms: Close Isn’t Good Enough

OCT 11, 2012 3:24pm ET
From the Medicare/Medicaid EHR incentive program to ACOs and HIEs, information exchange is the centerpiece of nearly every initiative designed to bend the health care quality and cost curves. The ability to access real-time clinical data wherever a patient encounter takes place drives these improvements by informing care decisions, avoiding preventable adverse events, eliminating diagnostic and therapeutic duplications and shortening lengths of stay.
Ensuring the integrity of the data upon which this transformation depends is paramount to success, both at the individual hospital level and health care system-wide. But as more systems are interfaced, significantly higher volumes of data are flowing into patient records and other clinical, administrative and financial systems. An error at any point along the way--an incorrect birth date, transposed digit in a Social Security number, missed middle initial or misspelled name --quickly snowballs as the information feeds from one system to the next.
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Electronic checklist improves accuracy of medication histories

October 12, 2012 | By Susan D. Hall
A small study conducted at a suburban Central Texas hospital suggests that using an electronic medication checklist at admission can reduce medication errors for elderly patients taking multiple drugs.
The researchers, from Texas State University-San Marcos published their work at Perspectives in Health Information Management. The study involved eight nurses taking medication histories from 64 patients, ages 65 or older, all of whom were taking at least five medications. The patients were hospitalized for at least a week, and three days before discharge were interviewed about medications they were given. They then were divided into two groups: one interviewed first using paper records, then again using the electronic record; and the second group interviewed in the opposite order.
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Incorporate DNA sequencing data into EHRs, ethics panel says

October 12, 2012 | By Julie Bird
A presidential commission studying privacy issues related to more readily available DNA sequencing recommends integrating whole genome sequence data into health records for research purposes.
In a report issued Thursday, the Presidential Commission for the Study of Bioethical Issues said that electronically exchanging DNA sequencing data through standardized EHRs and infrastructure would provide more data to researchers for genome-wide analysis that can advance clinical care.
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Hospital execs: CPOE implementation requires communication, structure

October 12, 2012 | By Dan Bowman
While the market for computerized physician order entry systems is expected to reach $1.5 billion by 2018, according to at least one assessment, meeting the requirement for such technology has proven to be a big hurdle for hospitals striving to achieve Meaningful Use. In a recent panel discussion with Hospitals & Health Networks, several hospital IT executives talked about their CPOE challenges and offered advice for adoption.
Edward Koschka, CIO of Indianapolis-based Community Health Network, said that the biggest barrier was following up on and enforcing adopted policies. "The medical staff executive committee needs to make CPOE a priority," Koschka told HHN. "The efforts at The Indiana Heart Hospital have been diffused, as not all specialists coming into the hospital use CPOE routinely in other hospitals, so there is not a consistent workflow across the five network hospitals."
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CMS violated data breach notification requirements

October 11, 2012 | By Julie Bird
The Centers for Medicare & Medicaid Services failed to meet federal notification requirements when its Medicare patient database was breached, or offer much help to beneficiaries whose protected health information was compromised, an audit by the Department of Health & Human Services' Inspector General found.
CMS had 14 breaches of protected health information (PHI) between Sept. 23, 2009, and Dec. 31, 2011, affecting 13,775 Medicare beneficiaries, according to the HHS Office of the Inspector General (OIG). The beneficiaries were notified, but CMS failed to meet several notification requirements detailed in the American Recovery and Reinvestment Act, OIG found.
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Friday, October 12, 2012

Health 2.0: Searching for Meaning in Health Data

The vast amounts of health care data coming online must be meaningful, accessible and actionable, according to speakers at the 6th annual Health 2.0 Conference held in San Francisco this week.
The question is how to do that while adhering to regulatory requirements, supporting evidence-based medicine and satisfying providers, patients and payers.
It's a tall order. This pursuit was on display with the dozens of applications, websites, devices and other tools showcased at the conference, which had about 1,500 attendees.
Kaiser Permanente offered a glimpse of its vision of seamlessly incorporating data into people's lives and nudging them towards better health.
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Dueling Health Information Exchanges Thwart Patient Care

Competition between Michigan HIEs on different platforms illustrates a growing national problem, says expert.
Competition among Michigan's regional health information exchanges has hampered the development of a statewide HIE, according to an article in Crain's Detroit Business.
In 2006, the piece notes, then Michigan Governor Jennifer Granholm adopted a plan to encourage the growth of "sub-state" HIEs, of which there are now six in Michigan. It was expected that these exchanges would have interconnected through a statewide HIE by this year. Instead, the two largest HIEs are each trying to win enough market share to become statewide exchanges themselves. AdTech Ad
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Nationwide exchange stands on its own

By Tom Sullivan, Government Health IT
Created 10/11/2012
WASHINGTON – Marking a bridge’s beginning, ONC on Thursday made it official: eHealth Exchange is standing on its own as a non-federal, non-profit entity.  
The mammoth project formerly known as NwHIN-Exchange created enough buzz throughout the year, in certain circles at least, that the news might be taken as almost anticlimactic. In terms of demonstrable progress that the healthcare industry is advancing information interoperability while furthering the business case for exchange, however, the fact that ONC delivered eHealth Exchange is anything but.
Today, 28 partners share health information across eHealth Exchange, a mix of private and public organizations that includes CMS, DoD, SSA and VA as well as industry heavyweights Kaiser Permanente, Marshfield Clinic, MedVirginia. And Idaho Health Data Exchange, in late September, became the newest member.
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'Sophisticated' EHR use by docs boosts preventive care rates for women

October 10, 2012 | By Dan Bowman
Women whose healthcare providers use electronic health records are more likely to receive preventive care, according to a study published this week in the Journal of the American Medical Informatics Association. What's more, more sophisticated use of such tools also led to an increase in preventive care.
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EHI acute survey: grim, with a few bright spots

EHealth Insider’s second survey of acute sector IT suggests that trusts and their IT services are grimly getting to grips with the NHS reform and financial agendas. Lyn Whitfield reports.
9 October 2012
After two years of anxious speculation about the scale of the financial challenge facing the NHS and the impact of the Lansley reforms, trusts are starting to get a handle on the policy and business challenges ahead of them.
That, at least, is the impression given by eHealth Insider’s second annual survey of IT directors and others working in and with acute sector IT.
Last year’s survey found large numbers of respondents expecting their trusts to have to make very large savings of 20% or even 30% of their income – and to shed very large numbers of staff in response.
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BT bets on ‘cloud’ for future health

9 October 2012   Jon Hoeksma
BT Health has pinned its future NHS strategy on developing a portfolio of secure health cloud-based services based on a new health cloud built over the past nine months.
The first to be launched is a pay-as-you-go medical transcription service able to handle patient identifiable data (PID), already said to have three early NHS customers. The medical transcription service is being delivered in conjunction with 3M Healthcare.
This will be followed by pay-as-you-go services for medical imaging, both services will be launched in the next few months.
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Hunt emphasises IT in first major speech

10 October 2012   Rebecca Todd
The technology revolution has “barely touched” patient experience in the NHS, health secretary Jeremy Hunt told the Conservative Party conference in Birmingham yesterday.
The new health secretary used his first major speech since replacing Andrew Lansley in the cabinet reshuffle last month to highlight the important role of technology in improving patient experience of healthcare.
“The final challenge I want to mention today is the technology revolution, something that in terms of patient experience has barely touched the NHS,” he told attendees.
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Joe's view of the Summary Care Record

Joe McDonald has built his own SCR on an iPhone. But he wants the NHS to do the job properly; even if it means taking on the tribes that fight information sharing.
9 October 2012
You find me busy preparing conference presentations. I’m speaking at the first CCIO Leaders Network Annual Conference, which is running alongside EHI Live 2012 (3.30pm on 7 November).
And I’m up at the National Mental Health Informatics Network event of the year the following week. So I look forward to seeing you in the flesh soon.
Perhaps we could debate the future of the Summary Care Record? I read in these pages that there will be 40m SCRs by 2015.
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Federal HIT Advisors Seek Advice on Verifying Patient ID

OCT 9, 2012 10:49am ET
The HIT Policy and Standards Committees are seeking public comment on best practices for verifying patient identities--confirming they are who they say they are--in electronic communications.
That issue is particularly pertinent as requirements in Stage 2 of the electronic health records meaningful use program require more than 5 percent of patients to view, download or transmit their health information, and to conduct secure messaging with physicians.
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User feedback is key to improving EHR systems

A report by an Institute of Medicine panel calls for a central, public database featuring insights from health information technology users.

By Pamela Lewis Dolan, amednews staff. Posted Oct. 10, 2012.
Practices shopping for an electronic health record system or seeking to improve an existing system should have a central clearinghouse of reviews, feedback and tips from other users, says an Institute of Medicine discussion paper.
The paper, published in September, is intended to foster discussion of a recommendation the IOM made in an earlier report that examined ways EHRs can be improved. The institute recommended that the Dept. of Health and Human Services’ Office of the National Coordinator for Health Information Technology work with public and private sectors to make comparative EHR user experiences publicly available.
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Twitter official offers caveats for healthcare use

October 11, 2012 | By Susan D. Hall
Health-related tweets are up 51 percent in 2012, Melissa Barnes, Twitter's head of agency and brand advocacy, told attendees at the Health 2.0 conference in San Francisco this week. And while the company wants to encourage healthcare marketers' use of the microblogging service, she offered some caveats as well, reports GigaOM.
For instance, Twitter can't support pharmaceutical advertising and it can't give legal advice, she said, so marketers must determine their own effective strategies.
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Decision support tools could better align research, practice

October 11, 2012 | By Susan D. Hall
In an article published this month in Health Affairs on the reasons why scientific evidence often has little effect on clinical practice, technology played a role--though not necessarily in a good way.
The authors, from the Rand Corp., examined six studies on comparative effectiveness research and its effects on practice. Among the problems cited were limited use of clinical decision support tools that could provide better alignment.
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Multistate coalition to test for interoperability of HIEs

October 11, 2012 | By Dan Bowman
A coalition of 15 states, 37 technology vendors and 34 health information exchanges is coming together to enable the exchange of health data for more than half of the U.S. population. The public-private partnership, which is led by both the EHR/HIE Interoperability Workgroup and Healtheway, created a testing program that will be able to determine a system's capability to exchange data with several other systems. The Certification Commission for Health Information Technology has been tasked with conducting the testing.
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5 benefits of natural language understanding for healthcare

By Benjamin Harris, New Media Producer
Created 10/09/2012
Ten years ago, Juergen Fritsch, chief scientist at Franklin, Tenn.-based M*Modal, was a postgraduate student at Carnegie Mellon, working on research for the government. “We were focused on a project eavesdropping calls," says Fritsch. "What emotional state [people] were in, and so on. We learned a lot about how people talk about things."
Since then, Fritsch and his colleagues have taken what they learned and developed this into natural language understanding (NLU) technology for healthcare. In a nutshell, NLU refers to a computerized system that can turn spoken and typed words in to structured data.
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Patients want texts and emails, in sickness and in health

By Mike Miliard, Managing Editor
Created 10/09/2012
SEATTLE – A new survey finds that patients' expectations for healthcare providers have evolved. A majority expect their doctors to communicate with them proactively - even when they're well - via texts, emails and proactive smartphone alerts.
Sponsored by Seattle-based communications firm Varolii, the survey polled 1,001 adults across the U.S.
Its findings may come as a surprise to some busy physicians. Nearly 80 percent of respondents say it's their doctor's job to keep them healthy - not just to treat them when they're sick. And they wish there was more communication when they're feeling OK: 70 percent of respondents say their doc has never checked on them when they weren’t sick in order to help them stay healthy.
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Health information management pros must champion big data use

October 10, 2012 | By Susan D. Hall
Health information management professionals play an integral role in determining whether their organizations embrace big data and use it effectively, according to an article in the October issue of the Journal of the American Health Information Management Association.
HIM pros, according to the authors, should urge key stakeholders to seize on data analysis as a strategic asset that that can improve care, create efficiencies and cut costs for providers, researchers and management.
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Redefining Medicine With Apps and iPads

By KATIE HAFNER
SAN FRANCISCO — Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level.
As a third-year resident in internal medicine, Dr. Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain swelling, seizures or even death.
Dr. Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was “like a shot of adrenaline,” he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his iPhone.
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More voices raised against EHR incentives

By Diana Manos, Senior Editor
Created 10/09/2012
ST. PAUL, MN – The Citizens' Council for Health Freedom (CCHF) has added its voice to those of four Republican lawmakers who recently called for a temporary halt to meaningful use incentives until the program is revamped.
But, unlike the lawmakers, CCHF wants federal involvement in EHRs eliminated altogether, according to Twila Brase, president of the CCHF.
CCHF, a non-profit organization based in St. Paul, Minn., does not want electronic health records pushed forward by a federal program at all, but rather supports the market leading the way. “[The] HITECH [Act] could go away as far as we’re concerned,” Brase told Healthcare IT News.
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EHRs linked to higher quality care, study says

By Erin McCann, Associate Editor
Created 10/09/2012
NEW YORK – The findings of a new study underscore the positive correlation between high quality care in physician practices and the use of electronic health records (EHRs). Experts say the study is one of the first to examine and subsequently validate the clinical value of EHRs.
Officials say the study, published in the October issue of The Journal of General Internal Medicine, demonstrates that the significant investment in EHRs by both the federal government – which has already invested some $29 billion in meaningful use incentives – and physicians who use them will result in better care.
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Natural language processing improves computerized disease tagging

October 9, 2012 | By Susan D. Hall
Researchers in The Netherlands are claiming success with a computer system that applies natural language processing to biomedical text to link relevant concepts to sources that contain further information, a process needed to help computers extract useful information from free text.
In their paper, published this week in the Journal of the American Medical Informatics Association, the researchers compared the effects of NLP on two biomedical concept normalization systems--MetaMap and Peregrine--which were used on the Arizona Disease Corpus.
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Northrop Grumman steering big data analytics toward health agencies

By Tom Sullivan, Editor
With an eye on the mountains of health data that federal and state health agencies are collecting, Northrop Grumman is developing a customizable platform to tie the data sources together and, ultimately, analyze it for the betterment of public and population health.
Known as iHAP, short for Integrated Health Analytics Platform, this early-stage solution is “a way to encapsulate the concepts of large-scale structured and unstructured data, provide the analytical tools, then be able to visualize it so we can provide tailored views,” said Morgan Crafts, director of technology in the civil systems division of Health IT at Northrop Grumman Information Systems. 
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Study: EHR Usage Leads to Better Quality Care

October 8, 2012
According to a new study from the Hudson Valley Initiative, a Fishkill, N.Y.-based healthcare reform effort from three providers: Taconic IPA, Taconic Health Information Network and Community, and MedAllies, the use of EHRs in an physician office leads to better quality care. The study, "Electronic Health Records and Ambulatory Quality of Care," found that physicians using EHRs scored significantly higher on quality of care for four screening measures for diabetes, breast cancer, Chlamydia, and colorectal cancer.
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Where the Money Is: Healthcare Technology

Scott Mace, for HealthLeaders Media , October 9, 2012

As the November election approaches, money isn't flowing only into the political campaigns. Last week, healthcare seemed to be swimming in money in motion, all of it having to do with investing in technology initiatives.
The Health 2.0 conference, which began yesterday, has doubled in size in the past two years, after growth had slowed for a few years. The halls of the San Francisco Hilton are thronged by a fast-talking crowd. Deals are being made in corridors and every third person you meet seems to be a doctor with a dream and some startup capital talking to an investor looking to get in the game.
The bad news for many healthcare systems is that a lot of this money doesn't presume the continuation of the current hospital-oriented care system as we know it. Calculating the new Medicare penalties for 30-day readmissions are even the subject of a startup's website (whose URL I won't give here because the first thing the site asks for is an email address). But some hospitals will be desperate enough to take the bait, just to see how bad the news is.
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Tuesday, October 09, 2012

Blue Button for Patients: More Than Just a Lapel Pin

In 2010, patient advocate and social media rock-star e-Patient Dave (Dave de Bronkart) walked over to me at a medical conference and handed me a small pin. It was blue and white with a downward pointing arrow. He smiled his mischievous Dave grin and said, "You are going to want one of these. Blue Button is a big deal."
So for the last two years, I have worn this symbol on my jacket and painted it into many paintings. Some folks have asked me why I use this image, "Isn't Blue Button just some idea from the Department of Veterans Affairs and the Markle Foundation?" I respond, "That is where it started." At this point more than one million patients have used Blue Button to access their data. VA, CMS, the Department of Veterans Affairs and the Federal Employee Health Benefits Program all have adopted the initiative.
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October 8, 2012, 11:22 am

E-Health Opportunities for Seniors

By JANE E. BRODY
Are you among the 47 percent of older Americans who have not yet entered the digital age? If so, you're likely to be missing out on a lot of e-health opportunities available to help you live well despite chronic ailments and encroaching physical limitations.
Americans over 65, whose health stands to benefit the most from modern digital technology, are the least able and least likely to use it. As of April, according to the Pew Research Center's Internet and American Life Project, 53 percent of Americans 65 and older were using the Internet or e-mail, but after age 75, use dropped off significantly, to 34 percent. By contrast, nearly 90 percent of younger adults are digitally connected.
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Physician Groups Warming Up to HIEs

Jacqueline Fellows, for HealthLeaders Media , October 8, 2012

As electronic medical records systems make their way into healthcare's regular workflow, two recent, but separate surveys show that physicians may be buying into the value of joining health information exchanges.
Last week, Doctors Helping Doctors Transform Healthcare, a non-profit group focused on using technology to improve the healthcare quality, issued Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care, a 30-page report on how and when physicians say they want to use electronic health information.
Perhaps what is significant about this survey is not what it shows, but what it doesn't. The barriers to using and exchanging health information electronically are no longer rooted in maintaining the status quo. The fear of change that often accompanies shifts from manual systems to digital processes seems nearly gone.
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Study finds clinicians still facing data exchange barriers

By Erin McCann, Associate Editor
Created 10/05/2012
WASHINGTON – Additional standards that meet with broad industry agreement and consistent implementation are critical to spur the exchange of health information and value-based care, according to a new report conducted by the Bipartisan Policy Center (BPC).
The study's findings include clinician perspectives on barriers preventing them from exchanging health information with other providers, with some 71 percent of clinicians citing the lack of interoperability and HIE infrastructure as the biggest challenge.
The report also highlights the “fragmented nature” of healthcare delivery today, with BPC officials pointing to Medicare patients – who currently see seven different physicians, on average, across four different group practices. This fragmentation can significantly decrease the quality of a patient’s care, the report suggests, as it can lead to duplications, misdiagnoses and overtreatment.
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3 big trends for the EHR cloud

By Bernie Monegain, Editor
Created 10/08/2012
A recent Markets and Markets report forecasts cloud computing in healthcare to grow at a compound annual growth rate of 20.5 percent from 2012 to 2017. Although cloud computing offers significant advantages to healthcare organizations and other stakeholders, security of patient information, interoperability and compliance with government regulations are some of the factors that are slowing down the market, according to the report.
Yet, these factors are also driving many healthcare providers to the cloud, particularly physician practices and community hospitals, says Jamie Coffin, vice president and general manager, Dell Healthcare & Life Services.
“They don’t have the IT expertise to run these things,” Coffin says. “With the new security and privacy regulations around things like HIPAA compliance and new things like you have to encrypt every drive and the things they’re having to deal with now are astronomical for a physician practice to have to deal with it.”
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New mHealth app set to tackle anxiety disorders

By Erin McCann, Associate Editor
Created 10/04/2012
ROCHESTER, MN – A new mobile health application developed by mental health professionals has set its sights on the estimated 40 million people in the U.S. currently living with anxiety. 
Officials say the Anxiety Coach app was created as a self-help tool to help people reduce a variety of fears and worries, ranging from extreme shyness to obsessions and compulsions.
“The reason we created [the app] is because anxiety disorders are one of the most, if not the most common mental health problem faced by both kids and adults, and only approximately 30 percent of people receive treatment," says Stephen Whiteside, director of the Pediatric Anxiety Disorders Program at Mayo Clinic, psychiatrist and co-developer of the application, to Healthcare IT News. “And even though that’s a small number, even a smaller number receive the most effective treatment, which is exposure-based cognitive behavior therapy.”
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Prioritizing drug alerts could improve effectiveness of CPOE

October 4, 2012 | By Julie Bird
Physicians often feel that computerized physician order entry systems with computerized decision support are basically crying wolf by issuing too many unimportant adverse drug event alerts, causing many to defeat the purpose by overriding the alert function, a new study reports.
In the study published online this week in BMC Medical Informatics and Decision Making, researchers theorized that alert overload could be minimized if drug safety alerts were tailored to specific clinical situations. They set out to see what type of context physicians would need to prioritize drug safety alerts.
More than 230 physicians surveyed at four European hospitals identified four factors that could be used to filter out low-priority alerts, selected from a potential list of 20.
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Enjoy!
David.