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Time for hard HITECH reboot
Posted on May 29, 2014
By John W. Loonsk, MD, CMIO, CGI and Johns Hopkins Center for Population Health IT
So, you dropped a huge chunk of change on a new IT system. Now you are frustrated and have buyer’s regret. The “installation requirements” are very complex. And although you just bought it, the system already needs to be updated. It only seems to run one application – “EHR version 1.0,” but you want to do many other things too. EHR v1 is not very user friendly and sure makes you do your work differently. And there is more. This expensive new system doesn’t seem to connect to anything. Sure, there is a basic email application available, but you also want to look for information and get what you need when and where you need it. Isn’t that what the Internet enabled years ago?
If this is the metaphorical world of HITECH, here’s to giving Karen DeSalvo, the new national coordinator for Health IT, all the support she needs to do a full and hard HITECH reboot. More than 30 billion dollars have been spent. And while it is reasonable that many HIT outcomes are still unfulfilled, the path forward seems murky. EHR adoption has surged, but much of what has been broken about health IT in the United States still remains. And the leverage of the HITECH funds is dwindling fast.
Now there is yet another independent report, this time from the JASON group which, like the report from the President’s Council of Advisors on Science and Technology before it, suggests the need for a major architecting effort for health IT nationally. The Government Accountability Office reports that there is a lack of strategy, prioritized actions, and milestones in HITECH. HIT interoperability is recognized as being limited at multiple levels. And resultantly, the benefits of HIT that depend on a combination of adoption, interoperability, and health information exchange as table stakes are elusive.
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CEO resigns amid troubled EHR rollout
Posted on May 30, 2014
By Erin McCann, Associate Editor
A system-wide EHR rollout is no walk in the park. With poor management and implementation plans, it can sap worker morale and deter long-term success. This appears to be what has transpired this week at the Athens Regional Health System in Georgia after staff unanimously voted "no confidence" for the system's CEO, who has effectively announced his resignation.
Staff and clinicians of the health system had reportedly expressed several concerns over the "aggressive" rollout of its Cerner electronic health record system, which started beginning of May, according to a report in the Banner-Herald. The report cited a letter sent to CEO James Thaw, signed by more than a dozen clinicians, recounting cases of medication errors, misplaced orders, "emergency department patients leaving after long waits; and of an inpatient who wasn't seen by a physician for (five) days."
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Docs' views of EHRs sharply divided
May 27, 2014 | By Marla Durben Hirsch
Doctors' opinions of electronic health records vary significantly, in large part based on their personal experiences, according to a new article in Medscape Business of Medicine.
The article, part of a special report on EHRs, flagged that many physicians have decried EHRs for creating a barrier between physicians and patients, making records unnecessarily complex and annoying, and turning physicians into data entry technicians, with computers telling them how to practice medicine.
It then expressed surprise at the contrasting views that physicians actually hold regarding the systems, evaluating 700 comments made by physicians and other providers to other recent Medscape articles.
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Practice Fusion creates national healthcare database
May 28, 2014 | By Marla Durben Hirsch
San Francisco-based Practice Fusion has launched a new national real-time healthcare database, comprised of a de-identified subset of more than 81 million electronic patient records. The tool, called Insight, is the nation's largest such database, according to Practice Fusion.
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CDC: Only 18% of office-based docs may meet Meaningful Use
May 25, 2014 | By Marla Durben Hirsch
The number of office-based physicians using electronic health records continues to rise, but only 18 percent of them may be eligible for Meaningful Use incentives, according to the Centers for Disease Control and Prevention's latest National Health Statistics Report.
In 2012, 71.8 percent of office-based physicians were using any type of EHR system, according to the report, up from 34.5 percent in 2007. Almost one-fourth, 23.5 percent, had a system with features meeting the criteria of being "fully functional" in 2012, up from 3.8 percent in 2007.
There was also a difference in adoption of a fully functional system between physicians in practices of 11 or more doctors compared to solo practitioners; the gap between the two jumped from 10.4 percent in 2007 to 30.6 percent in 2012.
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Are You Measuring Your Security Program’s Effectiveness?
MAY 28, 2014 1:49pm ET
The old adage, "You can't manage what you don't measure," still applies--and even more so today with healthcare organizations facing a number of external and internal security challenges.
Externally, breach announcements seem to make the weekly news cycle bringing information security issues to the forefront of public awareness. Federal regulations designed to protect patient information are now being actively enforced. Growth in technology and the electronic health record continues to integrate into the delivery of healthcare.
Internally, the job of providing security is complicated by a variety of pressures, including the difficulty of managing competing priorities with limited resources, such as conducting incident investigations vs. implementing encryption on mobile devices.
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Online Course: Health Informatics 101
Description:
This 40-hour, 8-week, online training program was designed to provide both clinical and non-clinical staff with a common foundation in Health IT to advance health informatics in large healthcare organizations. The training program will enhance competencies in health information technology, particularly for the design, configuration, use, and maintenance of informatics interventions that improve health care delivery.
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Online Training: Health IT Foundations for IT Professionals Certificate Program
Description:
This Health Information Technology certificate program is composed of three courses, each 11-12 weeks in length. They include Healthcare Fundamentals (55 hours), Health IT Data Standards (55 hours), and Health IT Application (55 hours). The purpose of the program is to provide experienced IT professionals with the knowledge and skills they need to transition to a healthcare environment. Successful participants typically also have some higher education experience.
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Is Electronic Charting Less Efficient Than Paper Charting?
Operational performance was similar before and after computerization at 23 community emergency departments.
The federal government has provided $17 billion in incentives to computerize healthcare. The potential benefits include improved error checking, decision support, better billing, and more data for research. However, some research has suggested that going paperless adversely affects productivity.
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Physicians, Hospitals Size Up Value-Based Healthcare
5/29/2014 09:06 AM
Physicians are wary of new healthcare payment models emphasizing quality and efficiency metrics, but hospitals are likely to prove resilient.
Many healthcare providers now participate in value-based payment models, which most see as the wave of the future, but few of them are happy about it.
"Value-based" is a catch-all label for Accountable Care Organizations (ACOs) and other ways of restructuring healthcare around payment for value delivered, as measured by metrics of healthcare quality or the aggregate health of a population rather than by the volume of visits, procedures, or hospital stays a healthcare organization records. In other words, it's a highly data-driven vision of healthcare reform, intended to improve quality and efficiency while reducing costs.
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- May 28, 2014, 7:30 AM ET
Report: Health-Care Sector Ranks Below Retail in Cybersecurity
The health-care sector is the worst-performing industry in terms of cybersecurity according to a new study released Wednesday. The report, conducted by startup BitSight Technologies, found the industry plagued by a high number of security incidents and slow response times to those events. But health care’s woes don’t translate to immunity for other industries. A separate cybercrime report, released by PricewaterhouseCoopers and CSO Magazine, found risky security behavior rampant in companies throughout all industries.
The BitSight report looked at four industries – financial services, utilities, retail and health care, including pharmaceutical – within the S&P 500 Index. BitSight issues cybersecurity ratings on companies that are similar to consumer credit scores, ranging from 250 to 900. The financial services industry with the highest median score of 782 indicates a better security posture than health care, which earned a median score of 670.
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Virtual Sepsis Unit Aids Early Detection
by David Wild
A “virtual sepsis unit,” constructed from ones and zeros, may help speed the identification of severe sepsis or septic shock in patients outside the ICU, new findings suggest.
During a three-month pilot study conducted at Mercy Hospital St. Louis, in Missouri, the telemedicine-based system identified all hospitalized patients who developed the complication, according to the researchers, who presented the findings at the 2014 annual meeting of the Society of Critical Care Medicine (poster 1026).
Brian M. Fuller, MD, a sepsis expert who was not involved in the study, called the system “striking in its accuracy and in its ability to promptly detect patients. Electronic screening aids such as this could have a very positive impact, especially given the increasing number of sepsis patients, the abundance of data that clinicians are asked to interpret on a daily basis and the unacceptably high mortality rates for sepsis,” said Dr. Fuller, assistant professor of anesthesiology and emergency medicine in the Department of Anesthesiology at Washington University School of Medicine, in St. Louis.
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ONC realigns organizational structure
May 30, 2014 | By Dan Bowman
National Coordinator for Health IT Karen DeSalvo, in an internal memo sent to ONC staffers and emailed to FierceHealthIT late Friday, announced a slew of organizational changes at the agency. The changes also are set to appear in the Federal Register on June 3.
DeSalvo said the changes will enable ONC to better meet the needs of the future, saying that the realignment will improve effectiveness by "combining similar functions, elevating critical priority functions and providing a flatter and more accountable reporting structure."
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PCAST report calls on HHS to develop national health data infrastructure
May 30, 2014 | By Dan Bowman
The U.S. Department of Health and Human Services must lead efforts to develop a "robust" national health information infrastructure via provider adoption of interoperable electronic health records, according to a new report from the President's Council of Advisors on Science and Technology (PCAST).
The report, published May 29, calls for better systems engineering to improve the U.S. healthcare system and makes several recommendations, including:
- Accelerating the alignment of payment incentives and reported information with better outcomes for individuals and populations
- Providing national leadership in systems engineering by increasing the supply of data available to benchmark performance and examine more broad regional or national trends
- Increasing technical assistance to providers and communities in applying systems approaches
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Systems reengineering to improve care
Posted on May 30, 2014
By Mike Miliard, Managing Editor
A strategy most often applied to industries such as manufacturing and aviation might unlock the potential for better care at lower cost, according to a new report from the President's Council of Advisors on Science and Technology.
Systems engineering, common in other sectors of the economy, is an interdisciplinary approach to analyzing, designing and managing complex systems, with the aim of improving their efficiency, reliability and productivity.
For example, the PCAST report, "Better Health Care and Lower Costs: Accelerating Improvement Through Systems Engineering," points out that, "by using tools such as alerts, redundancies, checklists, and systems that adjust for the human factor, U.S. commercial airlines have reduced fatalities from hundreds in the 1960s to approaching zero now, with the risk of dying now at 1 in 45 million flights. They have also been used in fields as diverse as manufacturing, space stations and satellites, and education."
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Insider access to patient data top worry
Posted on May 29, 2014
By Bernie Monegain, Editor
Identity management and unauthorized data access by employees present the biggest threat to security and privacy of patient data, according to healthcare providers across the country.
Researchers from Orem, Utah-based KLAS spoke with 106 providers to find out where they felt the most at risk for breaches and to see which third-party firms they were turning to for assistance.
The results are detailed in a new KLAS report, "Security and Privacy Perception 2014: High Stakes, Big Challenges," and they seem to line up with the findings in a recent healthcare security report from Verizon, which indicated that theft and loss of unencrypted devices were among the biggest security problems in healthcare.
The Verizon report revealed that the healthcare sector also recorded its second highest numbers for insider misuse, with 15 percent of healthcare security incidences attributed to insider misuse – higher than 13 other industries.
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InterSystems shakes up the EPR market
InterSystems’ recent wins on Teeside and in the South of England mark a significant shift in the supplier market, argues EHI editor Jon Hoeksma.
29 May 2014
The selection of InterSystems’ TrakCare by three trusts in the South of England marks a major shift in the supplier landscape for electronic patient records.
Gloucestershire Hospitals NHS Foundation Trust, Northern Devon Healthcare NHS Trust, and Yeovil District Hospital NHD Foundation Trust, known as the SmartCare consortium, will replace their legacy EDS Swift and Cerner systems with an integrated, remotely-hosted clinical information system from the company.
The win is the second for InterSystems in a few weeks. In February, it was announced that North Tees and Hartlepool NHS Foundation trust had signed a contract for TrakCare, which it described as a new patient administration and electronic patient record system and a replacement for its 26 year-old iExpress PAS.
The two wins inject some much needed, additional choice into the hospital supplier landscape, which has been moribund in the South since the wheels came of the National Programme for IT with Fujitsu’s exit as local service provider in 2008, and which is still dominated by the remains of the CSC LSP deal in the North, Midlands and East.
They also make InterSystems one of the leading, new market entrant EPR suppliers in the English NHS market, joining a pack that includes Oasis, Silverlink, IMS Maxims, Cambio, Meditech, Allscripts and Epic in aiming to challenge the current market leaders CSC, Cerner and McKesson.
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South acute group picks InterSystems
29 May 2014 Sam Sachdeva
A group of three acute trusts in the South Local Clinical Systems programme have chosen InterSystems to provide them with a clinical information system worth up to £60m.
The collaboration of Gloucestershire Hospitals NHS Foundation Trust, Northern Devon Healthcare NHS Trust and Yeovil District Hospital NHD Foundation Trust, known as SmartCare, chose InterSystems’ TrakCare from a shortlist of three suppliers.
In a statement, a Gloucestershire Hospitals spokesman told EHI that TrakCare had been chosen as the preferred supplier following a “thorough and detailed” procurement process.
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Healthcare IT Security Worse Than Retail, Study Says
5/28/2014 08:00 AM
Bad news for healthcare community: New study shows retailers like Target and eBay are more secure than many healthcare organizations.
Healthcare organizations are rife with insecurity, and it's only a question of when a Target-like attack puts millions of patient health information (PHI) files on the black market, a new study suggests.
A large-scale attack within the healthcare industry could put patients' safety and lives at stake, cautioned Stephen Boyer, CTO of security rating firm BitSight Technology, in an interview. Despite increasing awareness about these risks, healthcare organizations far behind their peers in other vertical markets, Boyer said, citing a BitSight study titled Will Healthcare Be the Next Retail?, released May 28.
Of four industries the study analyzed, healthcare saw the largest surge in attacks and was slowest to respond, taking more than five days to remediate security issues. By comparison, finance took about 3.5 days, and retail and utilities combatted issues within approximately four days. Some healthcare organizations led the market, using best practices and adequate resources, but as a sector, healthcare is weaker than others.
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Mayo's tricks of the trade for portals
Posted on May 28, 2014
By Erin McCann, Associate Editor
Working on the patient portal portion of Stage 2 meaningful use? Officials at Mayo Clinic can offer some valuable insight into their own portal rollout – challenges that have arisen, privacy concerns and how to do it right.
Enterprise-wide, Mayo Clinic, with locations in Rochester, Minn.; Jacksonville, Fla.; and Scottsdale, Ariz., has more than 400,000 patients who now have online portal accounts (the clinic sees some 1.1 million unique patients each year.)
"In terms of the view, download and transmit, we think that we'll be doing well from that perspective," said Mark Parkulo, MD, vice chair, meaningful use coordinating group, who will be speaking at the HIMSS Media/Healthcare IT News Privacy and Security Forum June 16 in San Diego.
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Physician Email Notification System Improves Patient Care
Greg Goth
MAY 27, 2014 9:08am ET
Researchers at Brigham and Women's Hospital and Partners Healthcare in Boston have discovered that notifying a patient's physicians of the results of tests pending at discharge can markedly improve physician awareness of patient status and improve care.
"Physician awareness of the results of tests pending at discharge (TPADs) is poor," according to researchers in an article published in the Journal of the American Medical Informatics Association. "We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results."
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Cost benefits
Monitor is continuing to push for the introduction of patient level information and costing systems. But are trusts responding? Would a focus on outcomes be a better idea? And are trusts that have PLICS seeing the benefits? Jennifer Trueland investigates.
According to Monitor, the healthcare sector is at a critical stage in the development of costing.
Understanding the real cost of patient care is crucial, the regulator says, and accurate costing has the potential to deliver higher quality care to patients and better value to the NHS.
Monitor, which along with NHS England, is responsible for the pricing of NHS services in England, is partly pinning its hopes on patient level information and costing systems, or PLICS.
Calling the data collected via PLICS “a rich source of information that could be very valuable for pricing purposes”, the regulator hopes, in the long term, to be able to collect patient level cost data from all providers.
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3 mistakes that cause health IT hazards
May 27, 2014 | By Dan Bowman
While health technology--including electronic health records--no doubt has the potential to streamline and improve patient care, providers must proceed with caution when using the latest clinical innovations. A recent Health Data Management article outlines several examples of how such tools can turn hazardous.
Here are three:
1. Faulty implementation: Last fall, an advisory from the Pennsylvania Patient Safety Authority reported that design and implementation problems accounted for errors connected with improper use of default values for medication order sets in more than 300 EHRs. Erin Sparnon, a senior patient safety analyst with ECRI--which published the advisory--told Health Data Management that hazards often occur due to "a misalignment between system configuration and clinician workflows."
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Big data lacks demonstrated 'real-world' value
May 28, 2014 | By Susan D. Hall
Big data will not reduce costs or improve care unless the industry overcomes challenges around standards and methods, according to a report from the national health policy institute Network for Excellence in Health Innovation (NEHI).
"Big Data has not ... addressed the dilemma of how our healthcare system can allow for real-world demonstration of the value of innovations while controlling costs," Thomas E. Hubbard, principal author and vice president of policy research at NEHI, said in an announcement.
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10 Mistakes to Avoid When Using EHRs
While electronic health record design flaws exist, individual physicians and their practices also often make mistakes that can add to the frustration of working with EHRs, according to a Medscape Business of Medicine report.
Here are the 10 biggest mistakes that physicians make when using EHRs:
1. Purchasing an EHR without making a site visit to a similar practice using the same EHR.
2. Signing an unvetted contract.
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Cardiac Practice Guidelines Have High Turnover
Published: May 27, 2014 | Updated: May 28, 2014
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Action Points
- One in five cardiology class I clinical practice guidelines published since the late 1990s have been downgraded, reversed, or omitted.
- Point out that after accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was three times greater for recommendations based on opinion or on one trial or observational data versus recommendations based on multiple trials.
One in five cardiology class I clinical practice guidelines published since the late 1990s have been downgraded, reversed, or omitted, with recommendations not supported by strong clinical trial evidence the most likely to get the axe, an analysis of more than 600 guidelines found.
Among recommendations with available information on level of evidence, 90.5% (95% CI 83.2%-95.3%) supported by multiple randomized studies were retained versus 81% (95%CI 74.8%-86.3%) supported by one randomized trial or observational data, and 73.7% (95% CI, 65.8%-80.5%) supported by opinion (P=0.001), wrote Mark D. Neuman, MD, of the University of Pennsylvania in Philadelphia, and colleagues, in the May 28 issue of the Journal of the American Medical Association.
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Nurses' union knocks EHRs hard
Posted on May 27, 2014
By Bernie Monegain, Editor
National Nurses United, which bills itself as the largest organization of nurses in the country, is in the midst of a campaign to spotlight the potential risks of patient harm spurred by what the group calls, "an unchecked proliferation of unproven medical technology and sharp erosion of care standards."
The NNU campaign, announced on May 13, includes radio ads from coast to coast, video, social media, legislation, rallies and a call for public action. Its slogan: "When it matters most, insist on a registered nurse."
In its press statement launching the campaign, the NNU questioned the use of EHRs – and other medical technology.
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West Cornwall to pilot record sharing
27 May 2014 Sam Sachdeva
Cornwall GPs will share patient data with A&E and out-of-hours services
Eight practices in West Cornwall will pilot a data sharing scheme using Microtest’s Guru to allow local A&E clinicians and the local out-of-hours GP service with access to patients’ GP records.
Penzance GP Dr Matthew Boulter, who is leading the project on behalf of NHS Kernow Clinical Commissioning Group, said the pilot comes from GPs’ frustrations at their patients being unnecessarily admitted to hospital due to a lack of information sharing.
“A GP puts in place what we thought were pretty detailed plans to avoid admittance, only to find out they’ve been admitted because the admitting physician didn’t know about the plans, and had no way to find out.”
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Texting aids adolescents in chronic disease management
May 26, 2014 | By Judy Mottl
Texting helped teenage chronic disease patients to be more efficient in managing their condition, according to new research out of the University of California, San Diego.
For the study, researchers examined 81 adolescents with chronic disease, ages 12 to 20 years, over the course of eight months. The participants participated in an intensive web-based and text intervention program, in which they were given disease management and skill-based intervention, as well as access via the mobile text program to a healthcare team.
The results indicated that teens using text messaging took a more active role in their care, communicated more with caregivers and were better equipped to transition from pediatric to adult-oriented healthcare systems.
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Addressing Social Determinants of Health Key to Improving Health, Health Care
Tuesday, May 27, 2014
We hear a lot about the economic drain of health care, but what we may be seeing is the actual confirmation of the economic power in providing health care. In economic terms, there's a very high opportunity cost to sickness and death. Preventing them can return dividends for society in real economic terms.
We learned more about how access to health insurance and health care can benefit well-being as a whole with a recent Annals of Internal Medicine study of the Massachusetts health care system -- the system on which the Affordable Care Act was based.
Between 2000 and 2010, mortalities decreased by 3% among Massachusetts residents ages 20 to 64, prime working ages in the U.S., after the health plan was implemented. (The study was controlled by comparing the state with similar counties outside of Massachusetts).
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HIT Development is Tough Work. So What?
Scott Mace, for HealthLeaders Media , May 27, 2014
Why is it that so few healthcare providers take information technology software and services vendors to court when projects run late, yield incomplete results, or fall below the assurances of a contract?
When car repairs go poorly, customers can and do regularly sue auto mechanics. When surgical procedures go poorly, patients or their families can and do sue surgeons and hospitals. It happens all the time.
Given that software development and deployment is so much more complex than fixing a car or even doing an appendectomy, why is it that so few healthcare providers (or corporate IT customers in general) take software and services vendors to court when projects run late, or yield incomplete results, or fall below the assurances of a contract?
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Enjoy!
David.
