Quote Of The Year

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

or

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

Monday, November 25, 2013

Weekly Australian Health IT Links – 25th November, 2013.

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

Well, there was a lot of work done last week to prepare submissions for the PCEHR enquiry - they closed on the 22nd November, 2013.
We have also seen further discussion on just what should happen next and I think we are seeing some interesting ideas emerge.
Other than that it was interesting to see more telehealth discussion, Senate estimates and lots of interesting apps for health.
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'We got screwed over': e-health GPs speak out

20 November, 2013 Paul Smith
"We got screwed over, didn’t we? We didn’t realise. We were there in the middle of it all trying to make it work, but we were like the woman with the abusive husband, thinking every tomorrow would be a sunny day.”
This is one voice of the many senior doctors who joined the National E-Health Transition Authority to create Australia’s personally controlled electronic health record (PCEHR) system.
It was envisaged that the system would help track patients’ labyrinthine journeys through the health system. One of its central aims was simply to save aeroplanes of patients from falling out of the sky as a result of the two million medication misadventures that happen each year.
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Doctors and hospitals barely using $1 billion e-health record

  • November 21, 2013 8:00PM
JUST one per cent of the patients who have signed up to the Government's $1 billion e-health scheme have a doctor's clinical summary on their record - which is the point of the initiative.
The scheme has been going for 17 months but some hospitals in Queensland and NSW have only been able to read the records in the past few weeks.
Despite the glacial uptake of the record Health Department chief Jane Halton says the progress being made "is reasonable".
The incoming Abbott Government has ordered a review of the expensive e-health system that is due to report next month.
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Underlying Issues for the pcEHR

Posted on November 17, 2013 by Grahame Grieve
There’s an enquiry into the pcEHR at the moment. As one of the small cogs in the large pcEHR wheel, I’ve been trying to figure out whether I have an opinion, and if I do, whether I should express it. However an intersection of communications with many people both in regard to the PCEHR, and FHIR, and other things, have all convinced me that I do have an opinion, and that it’s worth offering here.
There’s a lot of choices to be made when trying to create something like the pcEHR. In many cases, people had to pick one approach out of a set of equivocal choices, and quite often, the choice was driven by pragmatic and political considerations, and is wrong from different points of view, particularly with regard to long-term outcomes. That’s a tough call – you have to survive the short-term challenges in order to even have long term questions. On the other hand, if the short term decisions are bad enough, there’s no point existing into the long term. And the beauty of this, of course, is that you only find out how you went in the long term. The historians are the ones who decide.
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Patients okay with GPs' screen-time

20 November, 2013 David Brill
GPs have developed "sophisticated" strategies for maintaining rapport with patients while using the computer, a study finds.
The analysis of consultations in New Zealand found GPs spent 27% of their time interacting with the computer — and 12% focused exclusively on it.
But rather than necessarily damaging the doctor-patient relationship, computers were often a "benign force" that slotted in seamlessly, the University of Otago researchers concluded, after videoing 28 consultations with 10 Wellington GPs.
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Telehealth: The healthcare and aged care revolution that can pay for the whole NBN

Nick Ross ABC Technology and Games Updated 20 Sep 2013 
Australia will spend over $10 trillion on healthcare over the next thirty years - much of it on aged care. If the new NBN-related health applications make a tiny dent in that figure, they would pay for the whole NBN. And revolutionise healthcare for all.
In the toxic fact-free zone that represents the bulk of National Broadband Network discussion, most people would be shocked to know that the NBN is likely worth building for the healthcare benefits alone - especially for the old and infirm. And the NBN doesn't just offer a healthcare revolution, it's likely to save tax payers billions of dollars every year. Most important of all, however, is the notion that these new-generation 'Telehealthcare' applications are only viable using the current Fibre to the Home broadband policy and not the Coalition's alternative. Could it be that convalescing old ladies, who have never used a computer in their lives, are the pin-up girls for fibre-based broadband?
Meaningless phrases and numbers
Many people are sick of hearing nebulous terms like 'superfast broadband' and jargon like 'jigabits per second' and 'download speeds.'
Telehealthcare ignores all of that and treats the NBN like the infrastructure that it is - a network which provides a medical-grade, reliable connection to each home and a complete standardisation of equipment - i.e. 'one box and one interface for everyone' - instead of the hotchpotch, 'every-situation-is-different' situation that we have today.
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How new technology is changing access to health care in Australia

  • November 24, 2013 12:00AM
FROM a smartphone app that scans your vital signs to doctors treating their far distant patients through "face time" on their tablets or computers, technology is changing the way thousands of Australians access health care.
General Practitioner Ashley Collins is stationed more than 1000 kilometres from his patient but he can get a blood pressure reading without laying a hand on the company director.
Using a video link and a portable machine owned by the patient he can measure blood glucose, pulse rate, body temperature, cholesterol and even get an ECG measurement.
When he's completed his diagnosis he faxes a script to the chemist nearest his patient.
Dr Collins, from Temorah in central western NSW, uses a specialised computer to deliver this care but from next year he says patients will be able to do this from their mobile phone.
Already there are new devices including ultrasounds, ECG monitors, mirocroscopes and dermatascopes that can view skin cancers and blood pressure monitors that can be plugged into a smartphone.
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Health dept pleads for PCEHR patience

It won't happen overnight, but it will happen.

Senior health bureaucrats claim the uptake of personally controlled electronic health records is more promising than it appears.
Department secretary Jane Halton fronted senate estimates today claiming the rate of adoption nationwide is proportionally greater than it was when the Northern Territory embarked upon its much smaller quest to roll out shared health records in 2007.
These days, she said, NT has reached 90 percent coverage across its health system records.
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Contract negotiations underway for major Tasmanian eHealth system

With a new ICT strategy poised for signoff, Tasmania’s Department of Health and Human Services (DHHS) is already negotiating with vendors for several major new projects that will improve health outcomes, according to Deputy CIO, Tim Blake.
Blake was appointed deputy CIO of DHHS Tasmania this year after holding roles as  director of rural eHealth strategy and planning at NSW Health as well as senior IT positions at Oracle and PricewaterhouseCoopers.
“The tagline for our new ‘Connected Care’ strategy is ‘supporting ICT as a frontline service,’ which speaks to the growing importance of eHealth and the growing reliance on IT in everyday care,” he says.
He says that the new strategy, developed over the past year, is a progressive plan covering ICT for Tasmania’s Health and Human Services across the whole state.
One early project under the Connected Care banner will feed into the national PCEHR, he says.
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GPs' work growing more complex

19 November, 2013 Dr Elizabeth Lord
GPs are spending less time doing clinical work than a decade ago but are facing a more complex patient load, a national snapshot of general practice reveals.
The average number of hours involved in direct patient care decreased from 41 hours in 2003/04 to 38 in 2012/13, according to the University of Sydney's BEACH study.
However, GPs were now managing 155 problems for every 100 patient encounters, up from 146 problems 10 years ago, the annual study showed.
"As the population ages, chronic disease are accounting for an increasing proportion of GPs workload," said lead author Associate Professor Helena Britt.
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Senior Clinical Risk & Governance Manager

NEHTA - Sydney

Job description

Provide high level collaboration and coordination of clinical governance activities
Use your prior clinical governance and risk management skills to improve clinical useability of NEHTA’s products
At NEHTA, it is essential that all our products are clinically reviewed at appropriate points in the product lifecycle, thereby ensuring clinical useability of the resulting products. The Senior Clinical Risk & Governance Manager oversees this process by driving the Clinical Functional Assurance Management System and system wide clinical governance approaches. Working in consultation with the Clinical Governance Committee, this role will provide leadership, collaboration and coordination of clinical governance activities that support risk management, quality improvement and patient safety for all NEHTA’s eHealth products and services.
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IBM, Accenture are risk factors for IT disasters, claims TechnologyOne

news Australian technology vendor TechnologyOne has claimed that using major third-party systems integrators such as IBM and Accenture on major technology projects can add to the risk of “implementation disasters” such as the billion-dollar catastrophe with Queensland Health’s payroll systems overhaul.
In a media release issued this month, Queensland-headquartered TechnologyOne noted that nine of Victoria’s TAFEs had successfully rolled out TechnologyOne’s Student Management System, as part of the Victorian Government’s project to support its TAFEs’ transition to new contestable training markets.
The go live of the final TAFE in October 2013 marked the successful end of a nine-month implementation project rollout phase, which TechnologyOne began at the beginning of 2013, the company said. TechnologyOne’s solution approach and close working relationship with Victoria’s TAFEs has streamlined each implementation, according to the company, enabling the participating TAFEs to derive early value.
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Neuroscientists test IT team at Queensland Brain Institute

Genomics research generates 72 terabytes per row per genome, says IT manager
The IT team at the Queensland Brain Institute has to race to keep up with the technology demands of the research organisation’s neuroscientists, according to QBI senior IT manager, Jake Carroll.
QBI is “trying to discover the fundamental mechanisms that regulate brain function,” Carroll said.
Researchers are looking at a variety of areas related to the brain, including dementia and mental illness, he said.
Talking to Computerworld Australia at the Dell Enterprise Forum in Melbourne, Carroll described a vicious cycle that leads to ever-increasing demands on ICT infrastructure.
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Race to 100 winning app – Cloud Clinic

12th Nov 2013
GP Dr Kerry Pilcher, app competition winner, says Cloud Clinic “helps patients work through the strategies of CBT in a clear and simple way”.
WITH at least one million Australians currently affected with depression, the Cloud Clinic app is an important tool to know about.
It was developed by an Australian clinical psychologist alongside a consultant psychiatrist.
It offers a mobile cognitive behavioural therapy program that aims to improve mood and overall happiness.
Key features
The program not only allows the user to monitor their feelings with a mood diary, it provides an Activity Planner encouraging involvement in mood-boosting activities.
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10 great apps

11th Nov 2013
GPs across Australia sent in their favourite apps to help MO reach 100 Hot Apps in our iPad directory. Here are the competition runners-up.
Handy prompts for diagnostic decision-making 
Differential Diagnosis from the BMJ Group is a comprehensive resource tool to help healthcare professionals make diagnoses. The information in the app is based on the clinical websites Best Practice and Clinical Evidence by the BMJ Group.
Key features
This app enables the review of a vast range of differential diagnoses for particular symptoms, signs, test results and diseases. And it can be personalised by engaging the My Specialty function in the settings.
App: Differential diagnosis
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MyChemist eyes 8-inch Dell tablets for shop floor

Hardware refresh will see upgrade from Windows XP and move to 64-bit hardware
The pharmacy group that includes MyChemist and Chemist Warehouse may soon give Dell tablets to store staff as part of a planned hardware refresh, said the group’s CIO Jules Cardinale.
MyChemist is working with Dell to refresh all of the stores’ hardware over the next 18 months, Cardinale told CIO Australia in an interview at the Dell Enterprise Forum.
Existing hardware includes PCs that are used at the point of sale and for drug prescriptions at the company’s 350 locations across Australia, he said. Now, MyChemist is considering providing mobile devices for use by its 9,000 staff, he said.
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Final set of Australian Privacy Principles released for consultation

Deadline for replies is 16 December
The final set of draft Australian Privacy Principles (APPs) have been released for public consultation by the Office of the Australian Information Commissioner (OAIC).
APP 12 covers access to personal information. It will require organisations that hold personal details about an individual to give them access to that information on request.
APP 13 covers the correction of personal information. Organisations will need to take reasonable steps to correct personal information to ensure that it is up-to-date and not misleading. They will also be required to contact other organisations that hold the same information about a person so that they can update these details.
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10 things you didn't know about Windows 1.0

Many say Windows turned 30 this year, but it was actually 28 years ago this week that the first commercial version of Microsoft's signature operating system shipped.
  • Tim Greene (Network World)
  • 21 November, 2013 18:10
Many say Windows turned 30 this year, but it was actually 28 years ago this week that the first commercial version of Microsoft's signature operating system shipped.
The justification for calling it the 30th anniversary is that Windows was announced in 1983 but was in such dismal shape at that point that it took two more years to whip it into a product people might buy.
Here are 10 behind-the-scenes circumstances from that critical period that Microsoft faced before Windows launched, eventually to become the most popular PC operating system, as related by the product manager who brought the project to fruition.
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Enjoy!
David.

Sunday, November 24, 2013

The PCEHR Review Has Flushed Out Some Really Interesting Comments And Ideas.

The submissions to the PCEHR Review being conducted for the Health Minister (Mr Dutton) closed on Friday 22, 2013.
In the week leading up to that date I has conversations with quite a wide range of people regarding their proposed submission - with the obvious comment that many I chatted with had views not awfully different from mine - but often with quite difference emphasis.
Despite the following injunction to those officially invited to respond we have had some public comment.
“A submission to the review Panel becomes a panel document, and must not be disclosed to any other person or published by the submitter either in print or digitally. Unless you have requested that the submission remain confidential, it may be published, after the panel has received and examined it and authorised its publication.”
Among those who have blogged on the issue (and were not invited to submit) we have had these (excluding mine that went up last week).

PCEHR. How not to build an Information System

You would have thought the most obvious thing to do when building an Information System is to have at least some understanding of the information you want in it.
Not the PCEHR.
As I explained in my unsolicited submission to the PCEHR review team:
My opinion is that, in the case of the PCEHR, the root cause is a simplistic approach to the “problem” of Health Information. This problem has not been identified or analysed and its solution has not been defined. The PCEHR has been treated as an IT system not as a Health Information System. This is not unusual in large scale IT projects. The large costs are in the technology and the project and so they attract the attention of senior managers and project managers. To them information is just the stuff that goes into and comes out of the IT. There is no direct cost associated with information.
What senior managers and project managers fail to understand is that the value of the system lies in the information, how it is defined, managed and processed. There is no value in the technology, only cost.
It is worth examining the NEHTA document, High Level System Architecture, PCEHR, Final, v 1.35, November 2011. This is supposed to be a definitive description of the PCEHR system. Unfortunately it is silent on the topic of the Health Information that the system is supposed to be managing.
As an absolute minimum there should be an Information Architecture, Entity Relationship Diagrams and Data Flow Diagrams at both the conceptual and logical levels.
These documents should cover, not only the information within the PCEHR but the broader context including information in other systems and interface requirements including, but not limited to standards. There should also be discussions on information ownership, privacy, security, legal issues, data accuracy, data matching and a full description of the lifecycle of health information. Some, but nowhere near all, of these have been raised and discussed individually and from a technical perspective, but not in a comprehensive, holistic manner. Given that all these issues are inter-related, it is not possible to deal satisfactorily with them separately; they need to be considered holistically.
Without these artefacts the rest of the documentation is useless. The High Level System Architecture contains none of these, there are no references to other documents which might contain them and there is no evidence of any such documents on the NEHTA website or anywhere else.
As a highly experienced, professional system developer and an IT architect certified to international standards, my opinion of this document, and other architecture documents published by NEHTA, is that they are woefully inadequate and demonstrate a total lack of competence when it comes to understanding Health Information.
The lack of attention to Health Information means that an Information System has been created without an understanding of the information within that system. The consequences will (not might, but will) be significant rework as they try to correct for the failings in the fundamental design; errors in the system; a failure to meet the needs and requirements of users; and breaches of security and privacy.
This failure to understand what information problem the PCEHR is supposed to address is just one of many failings of this initiative; however it is the most important and is the one that will cause the most trouble, assuming that the PCEHR is not cancelled.
My full submission is here (Link now fixed)
The original blog is found here:
Second this was pointed out to me - by the author:

Underlying Issues for the pcEHR

Posted on November 17, 2013 by Grahame Grieve
There’s an enquiry into the pcEHR at the moment. As one of the small cogs in the large pcEHR wheel, I’ve been trying to figure out whether I have an opinion, and if I do, whether I should express it. However an intersection of communications with many people both in regard to the PCEHR, and FHIR, and other things, have all convinced me that I do have an opinion, and that it’s worth offering here.
There’s a lot of choices to be made when trying to create something like the pcEHR. In many cases, people had to pick one approach out of a set of equivocal choices, and quite often, the choice was driven by pragmatic and political considerations, and is wrong from different points of view, particularly with regard to long-term outcomes. That’s a tough call – you have to survive the short-term challenges in order to even have long term questions. On the other hand, if the short term decisions are bad enough, there’s no point existing into the long term. And the beauty of this, of course, is that you only find out how you went in the long term. The historians are the ones who decide.
So now that there’s an enquiry, we all get to second guess all these decisions, and make new ones. They’ll be different… but better? That, we’ll have to wait and see. Better is easier cause you have hindsight, and harder because you have existing structure/investment to deal with.
But it seems to me that there’s two underlying issues that need to be confronted, and that if we don’t, we’ll just be moving deck chairs around on the Titanic.
Social/Legal Problems around sharing information
It always seemed to me that in the abstract, the pcEHR make perfect sense: sharing the patient’s information via the person most invested in having the information shared: the patient. The patient is the sick one, and if they choose to hide information, one presumes that this is the same information they wouldn’t volunteer to their treating clinician anyway, so what difference would it make?
Lots more here:
The Australian Privacy Foundation has made their submission available here:
I have also heard there are a range of the usual stakeholders also contributing (MSIA, ACHI, HISA, CEA, CHF, some Medical Colleges etc.). From Senate Estimates we also know DoH and NEHTA will also be contributing.
With all this is am really hearing three main messages.
The first is that there are some real issues around the information integrity, reliability and quality of what is held in the PCEHR.
The second is the increasing recognition that it is very hard to be sure just who the PCEHR is actually meant to be used by and just what is actually meant to do given all the issues around usability, workflow, liability etc.
The third is increasing concern regarding the governance and performance of those who are managing the program.
The next issue will be to see if all the submissions get released and after that just what the panel concludes should happen.
For what it is worth there are very few people I have chatted with that do not see the need for major and rapid change - at a minimum. Time will tell I guess!
David.

AusHealthIT Poll Number 193 – Results – 24th November, 2013.

The question was:

Do You Believe The Report Of The PCEHR Review Should Be Made Public Promptly After Being Given To The Minister?

Yes - Obviously 91% (72)

Probably 5% (4)

No Hurry At All 1% (1)

It Should Remain Secret 1% (1)

I Have No Idea 1% (1)

Total votes: 79

A very clear response indeed!

Again, many thanks to those that voted!

David.

Saturday, November 23, 2013

Weekly Overseas Health IT Links - 24th November, 2013.



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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Denmark’s leading eHealth system still faces challenges

Denmark’s eHealth system is a world-leader, with all GPs and all hospitals having electronic medical records (EMRs), and communication and standards managed through a central network, MedCom, with ownership shared between national, regional and local government authorities.
In a case study published in last month’s issue of the International Journal of Medical Systems, Danish researcher Patrick Kierkegaard outlined the country’s key eHealth challenges – which revolve around the fragmentation of EMRs and difficulties of interoperability.
Denmark has a population of just 5.6 million and one of the highest per-capita incomes worldwide, with a tax-funded universal health care system and strong primary-care and hospital infrastructure.
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Status Check on Medical ID Theft: Going Up

Security research firm Ponemon Institute estimates that 1.84 million adult-aged Americans have experienced medical identity theft, with 313,000 becoming victims during the past year. That's a 19 percent increase compared with a 2012 Ponemon estimate of 1.52 million who have in recent years been victimized by medical identity theft, based on an annual survey conducted each March and April.
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Homeland Security has tip for healthcare

Posted on Nov 15, 2013
By Erin McCann, Associate Editor
Data breaches and cybersecurity threats in healthcare are going to happen. It's virtually unavoidable. What can be avoidable, however, are the messy consequences of substandard risk assessment strategies and inadequate threat response.
Department of Homeland Security's Jason Gates, an analyst in the industry, engagement and resilience branch within the Office of Cybersecurity and Communications, spoke at a virtual event Thursday about how healthcare organizations can work to mitigate the effects of a cybersecurity attack and lessen the risk of actually having one.
The take-home message? "Risk management never ends," he said. "New cyber threats, vulnerabilities and consequences require the constant modification of risk management strategy."
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CMS Eases Sharing Data with Researchers

NOV 14, 2013 2:45pm ET
The Centers for Medicare and Medicaid Services has announced a streamlined process for researchers to access and analyze the agency’s health care data. CMS is transitioning from preparing and shipping encrypted data files that have been requested, and now enables access from researchers’ own workstations with less cost to them and the agency. Here is the CMS announcement:
“In a move that advances the Obama administration’s work to make the health care system more transparent and accountable—and to help meet the pressing challenge of health care delivery system reform—the Centers for Medicare & Medicaid Services (CMS) today announced the launch of the CMS Virtual Research Data Center (VRDC) at the White House event Data to Knowledge to Action: Building New Partnerships.  Part of the President’s Big Data Research and Development Initiative, which aims to improve researchers’ ability to extract knowledge and insights from large and complex collections of digital data, the VRDC is a secure and efficient means for researchers to virtually access and analyze CMS’s vast store of health care data.  
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EHR copy and paste? Better think twice

Posted on Oct 08, 2013
By Erin McCann, Associate Editor
Who would have thought that something so simple as copy and paste could have such serious consequences?
Speaking at the October MGMA annual conference in San Diego, Diana Warner, director at AHIMA, confirmed the seriousness of inappropriately using copy and paste functions in electronic health records. And the government agrees -- it's no laughing matter. 
Seventy-four to 90 percent of physicians use the copy/paste function in their EHRs, and between 20 to 78 percent of physician notes are copied text, according to a September AHIMA report
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US and UK share health data via cloud

Posted on Nov 15, 2013
By Anthony Brino, Editor, HIEWatch
About half a century after epidemiology studies in Massachusetts and the United Kingdom helped build the world’s understanding of cardiovascular disease and health risks, public health and population data is being opened up by the U.S. and joining international datasets.
As part of the Obama Administration’s Big Data Research and Development Initiative, federal health agencies are contributing five-years worth of public datasets to a cloud-based research platform being used by life sciences researchers at universities and pharmaceutical companies to share population data along with other medical and biological data.
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Charging for data: What is too much?

Posted on Nov 13, 2013
By Mike Miliard, Managing Editor
As patient engagement gains momentum, and technology enables easier access to personal health information, many providers still charge money for copies of records. That's allowed under HIPAA and HITECH. But is it wise?  
At the recent AHIMA convention in Atlanta, Kim Murphy-Abdouch, clinical assistant professor at Texas State University, said it might be time to rethink policies and procedures related to patient access that may be holdovers from a paper-based way of thinking.
Even as "patients are becoming much more aware of their own healthcare, and much more savvy" about managing their health data, "cost could be a barrier to patient access," said Murphy-Abdouch.
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Lessons from an HIE pioneer

November 15, 2013 | By Susan D. Hall
It has taken multiple efforts, but the latest effort at health information exchange that Joe Heyman, M.D., has been involved with is close to success, reports Medical Practice Insider.
Heyman, formerly an Americal Medical Association (AMA) board chairman and president of the Massachusetts Medical Society, runs a solo gynecology practice two days a week in Amesbury, Mass. The rest of the time he focuses on the data exchange created by Whittier Independent Practice Association in Newburyport, Mass. Earlier this year it began combining data from disparate sources into a single record for each patient.
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IEEE, Continua Collaborate on Standards

November 13, 2013
IEEE Standards Association (IEEE-SA) and Continua Health Alliance have signed a strategic agreement to help accelerate and broaden the adoption of globally relevant standards-based technologies for the healthcare arena.
This collaboration brings together Continua, a Beaverton, Ore.-based organization dedicated to enabling end-to-end, plug-and-play interoperability for personal connected health, and IEEE-SA, the global standards-setting organization and developer of the IEEE 11073 family of standards designed for the entire healthcare continuum for personal health device communications.
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3D printing is new face of medicine

By Sally Davies
Inside the pistachio-coloured walls of a London hospital, 16 fake eyeballs sit gleaming on a shelf next to a collection of noses. A man holds up a slice of green silicone in the shape of an ear.
“It’s a very early sample,” says Tom Fripp, managing director of Sheffield-based design consultancy Fripp Design and Research. The company is the first to directly print an object in medical grade silicone, a substance whose pliable texture is well-suited to soft tissue prosthetics.
In the next room London dentist and implant manufacturer Andrew Dawood shows a 3D printed copy of the vascular system of conjoined twins. They were separated in 2011 after doctors used Mr Dawood’s model to practice the surgery beforehand, improving the odds of success and reducing the risky time the patients spent under the knife.
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HIMSS EHRA: Health IT framework needs more 'predictability'

November 12, 2013 | By Marla Durben Hirsch
Electronic health records, clinical decision support systems and health IT that focuses on transmission or storage of data should not be subject to traditional device regulation, but new risk-based oversight, according to the executive committee of HIMSS Electronic Health Records Association (EHRA).
That's one of the primary suggestions that EHRA made in a recent letter to U.S. Department of Health &Human Services Secretary Kathleen Sebelius regarding draft recommendations presented by the Food and Drug Administration Safety and Innovation Act (FDASIA) workgroup and approved by ONC's Health IT Policy Committee Sept. 4. EHRA also suggested that the new risk-based framework's criteria should be applied to health IT currently regulated to identify opportunities for more effective and appropriate oversight, and that health IT with lower or low risk should not be subject to additional health IT-specific oversight or regulation.
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Birmingham to offer PICS licence-free

11 November 2013   Lis Evenstad
University Hospitals Birmingham NHS Foundation Trust will offer its Prescribing Information and Communication System to the NHS on a licence-free basis instead of “open-sourcing” it.
EHI reported last week that NHS England is working with four different organisations, one of which is Birmingham, to put their products on a new open source electronic patient record systems framework.
The trust’s medical director, Dr Dave Rosser, told EHI that Birmingham would not be offering its PICS e-prescribing system open source because it is too risky.
“We think open sourcing PICS would be dangerous. It’s too complicated a programme with very complicated code,” said Dr Rosser.
“It would be risky to say the least. It has 600,000 lines of code and it is all interactive. It’s very easy to make a change in one part that changes something in another part that not even the programmers can predict.”
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ONC initiative looks to curb prescription drug abuse

November 14, 2013 | By Dan Bowman
A new Standards & Interoperability Framework initiative launched today by the Office of the National Coordinator for Health IT aims to create a common technical standard to allow prescription drug monitoring programs (PDMP) to share data with health IT tools used by providers for clinical decision support.
The initiative, described in a post to the Health IT Buzz blog, would be a boon to efforts to curb prescription drug abuse, writes Jennifer Frazier, a behavior health subject matter expert with ONC.
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Docs blame EHRs for lost productivity

Posted on Nov 14, 2013
By Mike Miliard, Managing Editor
Nearly 60 percent of ambulatory providers surveyed for a new IDC Health Insights report say they're unsatisfied with their electronic health records, citing frustrations with usability and workflow.
IDC's new study, "Business Strategy: The Current State of Ambulatory EHR Buyer Satisfaction," polled 212 ambulatory and hospital-based providers. It found that while the adoption of EHRs is widespread, the experience of most who use them "is one of dissatisfaction."
According to results, 58 percent of ambulatory providers surveyed were dissatisfied, very dissatisfied, or neutral about their experience with ambulatory EHRs.
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EHRs can't do everything

Posted on Nov 14, 2013
By Zack McCartney, Contributing Writer
Like many other industries, healthcare is becoming more consumer-focused. As Eric Wicklund and Mike Miliard have recently documented for Healthcare IT News, patients and doctors alike have spoken out against EHR solutions for interfering with rather than facilitating doctor-patient interactions. While thorough data collection and analysis, where EHRs offer great value, feeds research at the population level, it seems that the apparent failure of current EHRs to accommodate patients as unique cases has sparked this shift in attitude in the health IT industry.
The issue may not be so much the failure of EHRs, as their falling short of unduly high expectations -- expectations not only from the people who use them, but also the vendors themselves.
“I think it’s a myth that EHR vendors are going to be able to provide everything.  Every other industry has proven this wrong, says Joanne Rohde, CEO of Axial Exchange, in an interview with Healthcare IT News.  
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EMR Market to Grow 7.5% Annually Through 2016

Written by Helen Gregg (Twitter | Google+)  | November 13, 2013
The global market for hospital-based electronic medical records is expected to grow at a compound annual growth rate of 7.46 percent through 2016, according to a TechNavio report.
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Non-Profit Releases Education Material for Health IT-related Patient Safety

November 13, 2013
The National Patient Safety Foundation, a Boston-based non-profit organization, has released educational materials that aim to help healthcare professionals align their health information technology goals with patient safety.
The educational material, titled Health Information Technology through the Lens of Patient Safety, is geared towards physicians, pharmacists, nurses, and patient safety and health quality professionals.
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CMS Launches New Data Sharing Tool

November 13, 2013
The Centers for Medicare & Medicaid Services (CMS) has announced the launch of a new data sharing tool to help researchers virtually access and analyze CMS’ store of healthcare data.  
The tool—the CMS Virtual Research Data Center (VRDC)—was unveiled on November 12 at the White House event “Data to Knowledge to Action: Building New Partnerships” as part of President Obama's Big Data Research and Development Initiative.
Researchers using the VRDC will access CMS data from their own workstations and will be able to perform analyses and manipulate data within the VRDC.  Historically, CMS has filled researchers’ data requests by preparing and shipping encrypted data files.  However, given the rapidly-growing demand for timelier Medicare and Medicaid data, the agency needs a less resource-intensive means of responding to data requests from researchers.  The VRDC will help CMS meet these demands while also ensuring data privacy and security and reducing the cost of data access for most users, according to CMS officials.
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What's Wrong With Healthcare Quality Measures? Part I

Cheryl Clark, for HealthLeaders Media , November 14, 2013

We need to measure the hell out of healthcare to help us compare one organization or system with others. I believe measuring quality helps healthcare systems improve. But I also believe that we can measure healthcare quality a lot better than we do.

If you really think about it, the way we measure hospital quality of care is pretty darn primitive. That's what I've concluded after a few days contemplating today's methods and practice of measurement.
The way we think we know how good we are at providing high value care is really flawed.
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5 overrated, overpriced healthcare technologies

November 13, 2013 | By Ashley Gold
By Ashley Gold
There's never a shortage of companies and healthcare providers claiming to have invented the next big thing that will transform patient treatment and care as we know it. From new types of surgery, to multi-million dollar cancers centers and implantable heart devices, healthcare technology has the power to transform patient care.
But how does a consumer, hospital executive or physician clear the hype--and be able to tell what's really worth the money, and what's better off being left to traditional means? With that in mind, FierceHealthIT examined five overrated and overpriced healthcare technologies. From surgery to heart monitoring, we explore what brings value for its price tag.
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First National Physician-Owned HIE Launches

Written by Helen Gregg (Twitter | Google+)  | November 12, 2013
OnePartner HIE, the first nationwide, physician-owned health information exchange, has opened to physicians.
The HIE aims to connect providers with various electronic medical record systems and help physicians achieve the meaningful use stage 2 requirements for data exchange.
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IPhone App Wipes Out Population to Show Contagion Risks

November 11, 2013
The idea of Plague Inc. is to build a bug and exploit countries’ vulnerabilities -- climate, population density, poverty -- to help it spread. Source: Ndemic Creations via Bloomberg
The plague started in Indonesia. A viral infection, it spread quietly at first, making its way from person to person with coughing and sneezing its only symptoms. Then someone infected with the virus got on a plane.
As the disease spread around the globe, fever gave way to sweating, nausea, vomiting. Hundreds infected turned to thousands. The virus developed drug resistance. Thousands became millions.
It was all part of Ian Lipkin’s plan.
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The Wild West Becomes Less Wild: States Fill Privacy Gap Left by Congress

by Alice Leiter Wednesday, November 13, 2013
Every day, consumers introduce more and more personal health data into the commercial space -- through mobile applications, social networking sites and personal health records. Yet the U.S. does not have a comprehensive, baseline privacy law that protects such data. As a result, states are increasingly taking matters into their own hands, passing laws that both provide important protections for consumers and exacerbate the problematic patchwork of sometimes conflicting state laws that hamper easy, secure data sharing on a nationwide basis.
Although HIPAA is the nation's central, federal health privacy law, it applies only to covered entities (physicians, hospitals and health plans, for example) and entities providing services on their behalf. HIPAA's regulations were designed to protect patient privacy while still meeting the data collection and disclosure needs of health care providers and health plans. They do not address the unique privacy risks facing consumers and patients using health tools offered by commercial vendors. The vast majority of the digital health data zipping around the Internet are not protected by U.S. law, beyond the policies of individual companies and a handful of state laws.
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MU payments sail by $16 billion

By Diana Manos, Senior Editor
As of the end of September, the federal government now reports that a significant number of hospitals and eligible providers are now actively participating in the electronic health record incentive program, with 425,000 registered for the program and 325,00 unique providers having received some kind of incentive payment so far.
At the Nov. 6 meeting of the HIT Policy Committee, Rob Anthony, deputy director at the CMS Office of E-Health Standards and Service, said registration in September represents a slight decrease from other months, but this is expected. “This is the calm before the storm,” Anthony said. “We will continue to see an upward trend of these numbers as we move into January and February.”
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4 innovation trends shaping healthcare's future

November 12, 2013 | By Susan D. Hall
Meaningful Use, the switch to ICD-10, security and interoperability issues are consuming many healthcare IT leaders' attention, but they mustn't overlook trends that will shape healthcare in the future, according to an article at CIO.com.
The article examines four trends that will shape future advances in healthcare, based on discussion from last month's Center for Connected Health Symposium in Boston.
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Groups throw support behind MU legislation

Laura Pedulli
Nov 11, 2013
Nine specialty societies are expressing their support for legislation that would allow participation in clinical data registries to meet the quality reporting component of the Meaningful Use (MU) program.
In a letter to EHR Improvements Act (HR 1331) sponsor Rep. Diane Black (R-Tenn.), the Northern American Spine Society and eight other groups lauded the bill but suggested an expansion to allow all physicians who utilize certified EHR systems to participate in registries as having met the MU criteria.
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'Late Adopters'—How Small Hospitals Can Navigate Meaningful Use

Scott Mace, for HealthLeaders Media , November 12, 2013

Hospitals and health systems just now getting around to meaningful use have clearer guidance from CMS, a better selection of off-the-shelf EHR software, and the cautionary lessons learned from HMA.

Judging by last week's readership on HealthLeadersMedia.com, more than a few of you were keenly interested in HMA's $31 million giveback to the Centers for Medicare & Medicaid Services last week for failing to tell the truth about its meaningful use attestation.
While we ponder the fallout at HMA, how can you avoid being next?
The good news is, CMS now has a web page to help you navigate your way around (or through) a meaningful use audit.
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Health IT Could Reduce Demand For Physicians

Comprehensive use of IT in 30% of physician offices would have major impact, but that is not expected to occur for 5 to 15 years, says study.
If health IT were fully implemented in 30% of community-based physicians' offices, the gains in efficiency would reduce demand for physicians by 4% to 9%, according to a new study in Health Affairs.
Using health IT to support the delegation of work from physicians to midlevel practitioners and from specialists to primary care doctors could reduce demand for physicians by 6% to 12%. And increasing the amount of IT-enabled remote care and asynchronous care could cut the percentage of overall care that physicians provide by 2% to 5% and 4% to 7%, respectively, the study found.
If 70% of office-based physicians adopted comprehensive health IT -- including interoperable EHRs, clinical decision support, provider order entry and patient Web portals with secure messaging -- the impact on physician workforce requirements would be twice as large, the study said.
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One big HIE hurdle still stands

Posted on Nov 11, 2013
By Anthony Brino, Editor, HIEWatch
Interoperability among disparate systems continues to be one of the biggest challenges facing health information exchanges today, according to the findings of a new industry survey. 
"Despite the incorporation of new meaningful use policies, it is clear that interoperability issues are still stifling organizations' ability to connect," the Washington-based eHealth Initiative wrote in its 10th annual HIE survey. "The survey results reveal that interoperability remains a great hurdle with little relief in sight."
The of 199 health information exchanges around the country also revealed that HIEs do have large opportunities to support health reform, and many already are, but to do that they have to support patient portals and self-service -- an area HIEs and hospitals too are lagging in.
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Look at app

Ten years ago, Shawn Larson, then an agency radiographer at St Thomas’s Hospital, had the idea of creating a software application to allow medical professionals to practise using x-ray equipment in a 3D environment.
28 October 2013
 “I saw a need for something to address the basic psychomotor skill of moving the table and moving the equipment,” he says.
“I thought: ‘There has to be a better way of doing this than learning on the job, on real patients, using radiation, when there are so many simulators around. When you think of games like Tomb Raider, they provide a learning element, so why not transfer that to something real?’”
After developing a version for PC in 2003, Larson returned to the idea a few years later, and Virtual Cath Lab was launched as a mobile app in 2011. It has now been downloaded 10,000 times from Apple’s app store, in countries as far away as Vietnam and Mexico, as well as the UK.
Feedback has been positive, says Larson. “It delivers the basics. It gets you to the stage where you can operate the real equipment, and look at the anatomy with some intelligence, and hit the ground running.”
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Blue Button Plus, other identifiers can reverse 'information asymmetry'

November 11, 2013 | By Susan D. Hall
Providing patients with access to their own information and reasserting the primacy of the physician-patient relationship can reverse the "information asymmetry" that favors big healthcare corporations at the expense of patients and individual physicians, according to a post at The Health Care Blog.
Adrian Gropper, M.D., chief technical officer of the nonprofit Patient Privacy Rights writes that information asymmetry drives $3,000 in annual waste per citizen amid a health IT "certification" process that seems designed to drive small vendors and open-source software out of the market.
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Therapeutic at-home 3D video game for stroke patients developed

By ANI | ANI – 19 hours ago
Washington, Nov 11 (ANI): Researchers have developed a therapeutic at-home gaming program for stroke patients who experience motor weakness affecting 80 percent of survivors.
Constraint-induced movement therapy (CI therapy) is an intense treatment recommended for stroke survivors, and improves motor function, as well as the use of impaired upper extremities. However, less than 1 percent of those affected by hemiparesis receives the beneficial therapy.
"Lack of access, transportation and cost are contributing barriers to receiving CI therapy. To address this disparity, our team developed a 3D gaming system to deliver CI therapy to patients in their homes," said Lynne Gauthier, assistant professor of physical medicine and rehabilitation in Ohio State's College of Medicine.
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EHR group weighs in on FDA work

Posted on Nov 08, 2013
By Bernie Monegain, Editor
The Electronic Health Record Association, which represents 40 EHR developer companies whose products are in use at a majority of hospitals and physician practices today, applauds an FDA workgroup recommendation that healthcare technology, such as EHR systems, should not be treated as medical devices and should remain unregulated.
However, the group, in a Nov. 6 letter to HHS Secretary Kathleen Sebelius, asked for clarification on a number of topics, including clinical decision support, medical device accessories, reporting of safety event and post-market surveillance and "Class 0."
"We are not convinced that most HIT not regulated as a medical device should receive a new 'Class 0' device classification by the FDA. Such a classification and application for a formal regulatory approach to HIT is not warranted in our view," stated the letter signed by the EHR Association Executive Committee members, whose chair is Michele McGlynn, senior director, strategy and operations at Siemens.
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EHR group weighs in on FDA work

Posted on Nov 08, 2013
By Bernie Monegain, Editor
The Electronic Health Record Association, which represents 40 EHR developer companies whose products are in use at a majority of hospitals and physician practices today, applauds an FDA workgroup recommendation that healthcare technology, such as EHR systems, should not be treated as medical devices and should remain unregulated.
However, the group, in a Nov. 6 letter to HHS Secretary Kathleen Sebelius, asked for clarification on a number of topics, including clinical decision support, medical device accessories, reporting of safety event and post-market surveillance and "Class 0."
"We are not convinced that most HIT not regulated as a medical device should receive a new 'Class 0' device classification by the FDA. Such a classification and application for a formal regulatory approach to HIT is not warranted in our view," stated the letter signed by the EHR Association Executive Committee members, whose chair is Michele McGlynn, senior director, strategy and operations at Siemens.
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Overrides of Clinical Decision Support Alerts Persist, Groups Try To Address Issue

by Bonnie Darves, iHealthBeat Contributing Reporter Monday, November 11, 2013
Efforts are underway to streamline electronic prescribing clinical decision support (CDS) systems to avoid over-alerting physicians, as alert fatigue results in clinicians overriding warnings. However, a recent study by Boston-based Partners HealthCare shows that the problem persists.
The researchers analyzed more than 157,000 CDS alerts involving more than two million medication orders and 1,718 outpatient providers and found that 52.6% of the alerts were overridden. Further, they found that 53% of those overridden alerts were clinically appropriate -- meaning that the particular drug combinations or patient factors, if overlooked, had the potential to cause patient harm.
The study's lead author Karen Nanji, an anesthesiologist and quality and safety researcher, said that the study's results confirm that the problem of alert overrides -- whether driven by alert fatigue or other factors -- persists and needs more attention.
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Enjoy!
David.