Wednesday, July 23, 2014

A Word To The Wise In E-Health. If You Want To Shape The Future Ask Hard Questions At Consultation Sessions

We now know the Department is trying to constrain the scope of consultation re: the Future of the PCEHR - positive or negative by the questions they are asking.

There are much more fundamental issues re: this Program that need to be discussed and addressed. The initial PCEHR Review was quite inadequate and constrained, as everyone knows given it lasted on 6 or so weeks and had no genuine e-Health experts involved.

If you have a view on the future of the PCEHR etc., Deloitte needs to know, at a live session, or via e-mail!

This looks line a good place to start!

"The Department will also continue to receive any feedback on implementation issues until 1 September at pcehrreview@health.gov.au.

Get to it to get a real consultation happening!

David.

This Is An Obvious But Important Finding! Discharge Summaries Need To Arrive Promptly.

This appeared last week:

Late discharge letters frustrate GPs

16 July, 2014 Michael Woodhead
The frustration GPs feel over late-arriving hospital discharge letters is justified, according to a new study that shows tardy communication impairs patient management.
Researchers in WA have measured the additional burden created by delayed discharge letters, finding that GPs are unable to adequately manage a discharged patient's problems until they receive the all-important discharge information.
The study showed that a timely but brief discharge letter was preferable to a longer letter that arrived after a discharged patient had attended their GP.
And delayed discharge letters often meant that patients had to revisit their GP.
More here:
Here is the abstract:

BMJ Open 2014;4:e005475 doi:10.1136/bmjopen-2014-005475

A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice

  1. Moyez Jiwa1,
  2. Xingqiong Meng2,
  3. Carolyn O'Shea3,
  4. Parker Magin4,
  5. Ann Dadich5,
  6. Vinita Pillai1

Abstract

Objective To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs).
Trial design GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems.
Results Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information... see link below for details
Conclusions Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed.
Here is the link:
If ever there was a clear justification for using electronic messaging to get discharge summaries into the hands of GPs this is it. They need to be done on discharge and then transmitted directly. If the patient has a PCEHR they can go there as well - but the vital step is to use the secure message transmission to the GP that is already in place for results etc. in many, many practices. We know it works so it is hard to understand why it is not happening everywhere - other than the distraction that has afflicted us with the PCEHR Program.
It is interesting to note that simple and quick is seen as better than long but slower!
David.

Tuesday, July 22, 2014

PCEHR Consultation: Here Is The Sort Of Issue We Need To Make Sure Is Discussed And Addressed!

This appeared a few days ago:

EHR Systems Falling Short in Improving Patient Safety

Greg Slabodkin
JUL 18, 2014 9:21am ET
Health information technology, such as electronic health records, has the potential to dramatically improve patient safety. Nevertheless, a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks.
“Most hospitals, even those with EHR systems, do not know their own rates of adverse events,” testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, on July 17 before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. “They don’t know how often they harm patients. However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
Jha argued that if automated patient safety monitoring was made a key part of certification for the EHR meaningful use program, it would have a dramatic effect on the EHR vendor industry. “The EHR products now being built would scan clinical data and provide real-time surveillance information to doctors, nurses, pharmacists and other healthcare providers about potentially bad events that might be happening to patients,” he said. “It would allow hospitals to intervene quickly, and track their own progress over time.”
Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, argues that “the federal government and healthcare organizations have spent hundreds of billions of dollars on health information technology with little to show for it.”
“The promised improvements in safety have not been realized and productivity has decreased rather than increased,” said Pronovost. “Moreover, the usability of most HIT is poor.” For example, to obtain the meaningful use incentives, Johns Hopkins implemented a technology approved by the Office of the National Coordinator for Health IT.
However, he said that shortly after the technology was turned on, clinicians raised concerns that it made care less safe. “After thousands of hours of work, we essentially turned all the supposed ‘safety’ functions for the tool off and had the doctors type the patient’s medications into the tool, allowing us to receive the financial incentives for meaningful use, hurting clinician productivity and failing to improve safety.”
More here:
The link to a very recent RAND report on the topic is here:
Two extracts from the Executive Summary say it all.
Discussion
The challenges and lessons identified in this pilot project point to several opportunities to  increase the safe use of health IT systems. We draw several conclusions about the current state of  health IT safety risks:
1. With few exceptions, awareness of the safety risks introduced by health IT is limited.
2. The traditional departmental “silos” between risk management, IT, and quality and safety management may impede the ability of organizations to recognize and respond to health IT safety risks.
3. External facilitation appears to be important to hospitals and practices; however, the model for providing consultation and technical assistance requires further elaboration.
4. Most ambulatory practices lack the risk management, IT, and quality and safety expertise that is available in hospitals.
5. There is an urgent need for tools and metrics to enable project teams in hospitals and ambulatory practices to detect, mitigate, and monitor health IT safety risks.
6. The current structure of the EHR marketplace, and the low awareness of the risks introduced by health IT systems, lead to weak incentives for EHR developers and providers to invest in the type of joint effort required to reduce health IT safety risks.
And here:
Conclusion
The investment that is converting the U.S. health data infrastructure into a 21stcentury enterprise has the potential to improve care for patients in countless ways. However, “digitizing” the health system also has the potential for harm. In this project, we worked with 11 hospitals and ambulatory practices to evaluate a process improvement strategy and tools developed to help health care organizations diagnose, monitor, and mitigate health IT–related safety risks. While many of the health care organizations (especially the hospitals) had expertise in process improvement, we found a general lack of awareness of health IT–related safety risks (especially in ambulatory practices) and concluded that better tools are needed to help these organizations use health IT to improve care and to optimize the safety and safe use of EHRs. The SAFER Guides provide an excellent beginning, but until health care organizations have a better understanding of the safety risks posed by EHR use, tools like the SAFER Guides may not be used to their full potential. There may also be a need for additional tools and metrics (and further usability study of existing tools and metrics) to better support the needs of health care organizations as they use health IT to improve the quality and safety of patient care.
---- End extracts (Report is 77 pages)
I raise all this to express a desire that the pathetic non-consultation we saw on the PCEHR does not recur and that we see fundamental issues discussed rather than a discussion of how best to apply the lipstick to the pig.
The PCEHR has largely failed through lack of engagement with relevant stakeholders and a ‘tin ear’ from NEHTA and DoHA as well as a failure of recognition that e-health is a lot harder than they are prepared to admit. Most who read here know a lot better.
If we are not to squander more money and effort other perspectives are crucial. If we don’t have safety definitely sorted how dare anyone plan to move forward?
Put up your hand all those who think we do!
David?

Monday, July 21, 2014

Weekly Australian Health IT Links – 21st July, 2014.

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

Another quiet week with the big news that there is to be some consultation between many stakeholders and Deloittes on the future of the PCEHR. Will be very interesting to see where this points and how deep a dive the consultation actually takes and how searching the questions asked of stakeholders will be.
Enjoy browsing the articles!
-----

Realising the benefits of eMM at St Vincent’s

St Vincent’s Hospital, a 320-bed facility in inner Sydney, has had significant success with its electronic medications management system, based around CSC’s proprietary MedChart software.
According to Kate Richardson, a pharmacist in eMedicines Management at St Vincents, the system has proven successful since it was installed in 2005, nine years ago.
“The main reason we put it in is because of safety,” she says. “And it’s in terms of safety that we have seen the main benefits accrue from the system. 
-----

Late discharge letters frustrate GPs

16 July, 2014 Michael Woodhead
The frustration GPs feel over late-arriving hospital discharge letters is justified, according to a new study that shows tardy communication impairs patient management.
Researchers in WA have measured the additional burden created by delayed discharge letters, finding that GPs are unable to adequately manage a discharged patient's problems until they receive the all-important discharge information.
The study showed that a timely but brief discharge letter was preferable to a longer letter that arrived after a discharged patient had attended their GP.
And delayed discharge letters often meant that patients had to revisit their GP.
-----

Novartis says Google’s smart lens is part of key growth area in health

  • Andrew Morse
  • The Wall Street Journal
  • July 16, 2014 10:10AM
GOOGLE has joined forces with drug company Novartis to work on a smart contact lens that monitors blood-sugar levels and corrects vision in a new way, the latest in a series of technology products designed to monitor body functions.
The two companies said Novartis’s Alcon eye-care division would license and commercialise “smart lens” technology designed by Google[x], a development team at the search engine giant. Financial details of the partnership weren’t provided.
The smart lenses, which Google unveiled in January, are part of a growing number of wearable technology and software products used to monitor health and fitness. Last month, Google debuted its Google Fit platform to track health metrics, such as sleep and exercise, on devices running its Android mobile operating system. Apple unveiled a similar platform called HealthKit.
The lenses contain a tiny sensor that relays data on glucose contained in tears via an equally tiny antenna. In a news release earlier this year, Google described the electronics in the lenses as being “so small they look like bits of glitter” and said the antenna is thinner than human hair.
-----

Start-up DoseMe adds a measure of medical safety

Fran Foo

Technology Reporter
Sydney
BRISBANE technology start-up DoseMe is on the cusp of cracking the global market for safer medical prescriptions, estimated to be worth hundreds of millions of dollars a year.
DoseMe has developed software for medical professionals that can prevent overdosing in individual patients, potentially saving lives. It is estimated that one in 10 general admissions around the world are because of adverse drug events.
DoseMe comes in the form of an iOS app but also works on the web and has a mobile site. It creates a personalised dosing profile that ensures medication is prescribed accurately by medical practitioners.
The platform can be used for 13 medications across four therapeutic areas: anti-microbial, chemotherapy, anti-coagulants and pro-coagulants.
-----

Guide to Health Informatics 3rd Edition

July 15, 2014
It’s now almost 20 years since I started to write the first edition, and over 10 years since I wrote the second. I’m very happy to announce that the text for the updated third edition is now completed and is being sent off to the publisher for them to do their magic.
The book will come both in paper and e-book editions, and is already available for pre-order on Amazon, and presumably other bookstores. The book is showing a September release date but I am not sure if this is going to slip or not.
-----

#FHIR Connectathon 7, Chicago Sept 13-14

Posted on July 19, 2014 by Grahame Grieve
We will be holding the next FHIR connectathon in Chicago on Sept 13/14 associated with the HL7 Plenary Meeting. Once again, anyone interested in implementing FHIR is welcome to attend.
-----

Pap smear reminder system fails

11 July, 2014 Michael Woodhead
Almost a thousand women and their GPs in Queensland are being contacted after the Pap Smear Register failed to send out reminders about follow-up tests for low-grade abnormalities.
Chief Health Officer Dr Jeannette Young said a problem with the register's automatic mailing system meant that 980 women who had a Pap smear with a low-grade abnormality did not receive a reminder letter to have a follow-up
Dr Young (pictured) said the Pap Smear Register was "merely a back-up reminder system" that only sent a follow-up letter if a test result was not received.
"GPs and other Pap smear providers have primary responsibility for following up with their patient as they are advised directly by pathology companies of the outcome of their patient's results," she said.
-----

Nominations for IHTSDO Standing Committees

Created on Wednesday, 16 July 2014
As the official Australian member of the IHTSDO, NEHTA is inviting expressions of interest from Australian clinical informaticians to be nominated as independent experts on the IHTSDO Standing Committees.
The four Standing Committees advise the Management Board on the development and maintenance of SNOMED CT. We are looking for candidates for the following Standing Committees this year:
  • Content 
  • Implementation and Education
  • Quality Assurance
  • Technical
For application forms and more information please email christine.borthwick@nehta.gov.au
-----

Practice kept medical records in garden shed

15th Jul 2014
A MELBOURNE medical practice that stored nearly 1000 patients’ records in a garden shed has escaped the threat of prosecution and heavy fines because of the timing of the offence.
The Pound Road Medical Centre (PRMC) kept the paper records of about 960 patients in a locked garden shed at its former site in Narre Warren South from around October 2012 until an intruder broke into the structure in November 2013. 
The Australian privacy commissioner opened an investigation in December 2013, after media reports revealed that boxes of medical records had been compromised at the site.
In an announcement today, Commissioner Timothy Pilgrim noted the seriousness of the breach because of the sensitive personal information in the records, including patients’ full name, address, date of birth, Medicare number and treatment details.
-----

Practice stored medical records in garden shed

15 July, 2014 Antonio Bradley
A practice that stored 960 patient records in a garden shed is in trouble with the Privacy Commission after burglars broke in and raided the private material.
Melbourne's Pound Road Medical Centre moved the files into the shed in 2012, so it could renovate its old premises in order to sell it.
But the records were still there a year later, in November 2013, when burglars broke into the shed, gaining access to the patients' names, addresses and dates of birth, along with the results of medical investigations, discharge summaries and correspondence with other practitioners.
-----

Financial System Inquiry recommends mandatory data breach notification

Report says mandatory notifications could help Australians regain control over personal information
A Financial System Inquiry has recommended the adoption of mandatory data breach notification in Australia in order to help consumers keep control over their personal and financial information.
According to the Inquiry, which was published today, the growing amount of data stored and used by firms can bring many benefits to consumers, businesses and government agencies.
“However, it also creates the risk of a data breach exposing amounts of sensitive customer information, especially given the increased sophistication and frequency of cyber attacks,” said the report.
Where data breaches involve personal information, there are no mandatory requirements to report the incident to the Office of the Australian Information Commissioner (OAIC) or notify affected individuals under the Privacy Act, the report said.
-----

Scientific skinful - health and electronic tattoos

Chris Griffith

Senior Technology Journalist
Sydney
THESE days we’re used to seeing the extensively tattooed bodies of our pop stars, footballers and Olympians.
In a couple of years, these stars could also be wearing tattoos of a much more advanced sort. Electronic tattoos on different areas of their bodies will collect data about their heartbeat, muscular output, breathing and hydration levels.
And it may be possible for coaches to know at an instant the condition of any player on the ground in real time.
Indeed, the human body may soon mimic the modern car, which uses on-board computers to monitor engine performance and diagnose problems.
Technology journalists invariably are asked to predict “the next big thing” in tech. While wearable devices such as the iWatch and Google’s when-will-they-ever-sell-it Glass spec­tacles are hotly anticipated, my money is on electronic tattoos. They will profoundly enhance our personal capabilities, and monitor everything about our bodies.
-----

Crackdown on doctors’ rorts cost millions

18th Jul 2014
MEDICARE officials have revealed there was no risk system in place to avoid the haemorrhage of millions of dollars in a loss-making crackdown on doctors’ rorts.
An Australian National Audit Office report earlier this year found an expanded four-year Medicare compliance program not only fell $128.3 million short of its savings target but was delivered at a net cost to government.
The Increased Medicare Compliance Audits (IMCA) initiative received funding of $77 million in the 2008–09 budget to step up audits of Medicare providers from 500 per year to 2500. 
While the budget projected the measure would raise $147.2 million, the Department of Human Services identified only $49.2 million in debts and recovered just $18.9 million as a result of Medicare compliance audits between 2008–09 and 2012–13.
-----

Cloud clues to Alzheimer’s

Chris Griffith

Senior Technology Journalist
Sydney
AUSTRALIAN researchers have developed cloud computing software that interprets brain scans and offers insights into diseases such Alzheimer’s disease, strokes and traumatic brain injuries.
Users soon will be able to upload a scan and within 15 minutes receive a one-page quantitative report showing a diagram of the brain with colour-coded values compared with what’s normal.
“By the time a diagnosis of Alzheimer’s disease can be made using current techniques, the patient is likely to be experiencing significant loss of brain function,” Australian research body CSIRO said in a blog post.
-----

AHA applauds cloud service

Jennifer Foreshew

Technology Reporter
Sydney
ALLIED Health Australia sought a more cost-effective infra­structure that could scale to its ­future needs and free it from the cost of in-house management of equipment.
AHA has provided workplace health and safety support and services to organisations in NSW for more than 15 years.
It works closely with organisations and their employees to ensure injured workers are supported and able to return to their role after workplace incidents. When this is not possible, the group works to find new positions where their skills can be best used.
With a large proportion of staff working in the field, having remote access to a reliable IT infrastructure for case files, medical records and administrative resources was vital.
-----

Allan Fels slams NBN shield

Annabel Hepworth

National Business Correspondent
Sydney
FORMER competition chief Allan Fels has slammed a key legal shield for the $41 billion ­National Broadband Network as “the biggest anti-competitive ­arrangement ever in Australia”.
In a submission to the government’s review of competition policy, Professor Fels takes aim at the high-speed network having exemption to aspects of the Competition and Consumer Act.
“This has no part in competition law,” the submission says.
“It is the biggest anti-competitive arrangement ever in Australia, as far as I can see. A competition committee needs to review this. It cannot go down in history as having turned a blind eye to this.”
-----

NBN: Lengthy wait for outcomes of FTTB, FTTN trials

So far no end users connected via FTTN
The outcomes of NBN Co's trials of fibre-to-the-node (FTTN) technology will shape the future of the National Broadband Network rollout, but what exactly those outcomes are won't be known for quite some time, according to the government-owned company's CEO.
No end users have been connected in NBN Co's trials of FTTN technology, the company's executives revealed today at a hearing of the Senate's NBN committee .
It's also "early days" for NBN Co's trial of fibre-to-the-building technology, according to Bill Morrow, although there are end users on the network connected via FTTB. NBN Co has been running the FTTB trial in conjunction with iiNet, M2, Optus and Telstra in eight high-rise buildings in Melbourne.
-----

Leaked 'Windows 9' screenshot shows new start menu

Date July 15, 2014 - 10:03AM

Pete Pachal

We know that at some point in the future, Microsoft will bring the Start menu back to Windows. What we don't know is when, but some leaked screenshots of a future version of Windows might offer a clue.
Screenshots allegedly showing the new Start menu have leaked on an internet forum. The menu looks similar, but not identical, to what Microsoft showed publicly at its Build developer conference in April.
The size and format of the menu is the same, but the tiles themselves are different, suggesting the image was generated by an early build of the new Windows.
-----
Enjoy!
David.

Sunday, July 20, 2014

Deloitte Have Been Engaged To Consult On Stakeholder Views On The PCEHR. Is This A ‘Claytons’ Consultation?

An e-mail came in from the Health Department a few days ago.
The gist of the e-mail is as follows.
“As previously advised, the Department will be undertaking a range of consultation activities to consider issues relating to the implementation of the Review recommendations. The Department has engaged Deloitte to support it in undertaking these consultations.
Consultation activities will include face-to-face meetings and a survey. Deloitte is currently finalising dates and venues for the meetings and will be writing to you directly to advise the details.
…..
An online survey will also be made available to capture stakeholders' views.  This survey will be made available shortly and can be accessed until 1 September via http://www.ehealth.gov.au.  These details will be included in Deloitte's letter to you.  
The Department will also continue to receive any feedback on implementation issues until 1 September at pcehrreview@health.gov.au.
----- End Extract.
Deloitte have sent out a number of e-mails which suggest what the focus of the consultation is to be:
These include:
-----
“It is very important that we talk to the right stakeholders to ensure that key issues are heard and understood, key ideas are incorporated and that the recommendations that arise from the consultation program are well informed. Therefore we would like to talk to members/staff of your organisation about the recommendations of the Review, with a particular emphasis on:
·         The adoption of an opt-out rather than opt-in model for consumer participation in the PCEHR – including information and education needs; security, privacy and usability issues and expectations
·         Records that should be included in the system
·         Record information access control and notification of access to the system.
The views expressed through the consultation process will contribute to advice to the Government on how best to implement the recommendations of the Review.”
-----
And addressed to a different stakeholder:
-----
“These discussions will have a particular emphasis on:
·         The adoption of an opt-out rather than opt-in model for consumer participation in the PCEHR – including information and education needs; security, privacy and usability issues and expectations.
·         The core clinical records that should be included in the system.
·         Record information access control and notification of access to the system.
·         How vendors work with Government to deliver PCEHR compliant software for clinicians
·         Recommendation 10 of the review – ‘Establish a regulatory body that monitors and ensures compliance against eHealth standards that are set and maintained by ACeH.’
The views expressed through the consultation process will contribute to advice to the Government on how best to implement the recommendations of the Review.”
-----
I find all this rather worrying as it seems that what has gone on here is the Deloitte have been engaged to ask around stakeholders with a set of constraining assumptions regarding what should happen next.
I really want to see the really fundamental questions asked of stakeholders - e.g. who is the PCEHR for, what is it really for, can it be made to be seriously useful for clinicians and is what we have done so far actually fixable to deliver what is intended?
Unless we can be assured that whatever is being planned will deliver quality, safety and efficiency in the health system this may be an expensive waste of time and effort.
I have a strong feeling the questions above were not asked during the initial design phase and I fear the way the Department has set this consultation up the fundamentals won’t get properly reviewed and it will be assumed that the PCEHR is a good thing that basically needs to roll on!
One gets the sense that the Department wants all this wrapped up by September 1, 2014. If this is indeed the case then this may be what is usually described as a ‘Claytons’ consultation.
It does not look good to me!
David.

AusHealthIT Poll Number 227 – Results – 21st July, 2014.

Here are the results of the poll.

How Damaging Is The Continuing Lack Of Government Response To The PCEHR Review To E-Health In Australia Overall?

Very Damaging 58% (25)

Slightly Damaging 16% (7)

Not Damaging 16% (7)

I Have No Idea 9% (4)

Total votes: 43

It seems most think the dithering is not helping anyone's interests!

Again, many thanks to all those that voted!

David.

Saturday, July 19, 2014

Weekly Overseas Health IT Links - 19th July, 2014.

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.
-----

NHS maps out 100K genomes medicine plans

8 July 2014   Lis Evenstad
NHS England expects to have contracts in place with providers by January 2015 for its ambitious project to sequence 100,000 genomes and link the results with a national database of electronic patient records.
-----

New informatics program for pathologists

Posted on Jul 11, 2014
By Mike Miliard, Managing Editor
The College of American Pathologists, along with the Association of Pathology Chairs and the Association for Pathology Informatics, has launched a new graduate medical education curriculum for clinical informatics.
Pathology Informatics Essentials for Residents is meant to prepare pathologists for an evolving healthcare landscape where electronic health records are changing the way providers interact with lab data.
"Training pathology residents in clinical informatics is 'a must' to build the skills required now and in the future," said APC President-Elect Donald S. Karcher, MD, chairman of the Department of Pathology at George Washington University in Washington, DC, in a press statement. "We designed PIER with the residency programs in mind and have created a flexible curriculum, which can be integrated throughout residency training."
-----

Clinical informatics: data in action

Posted on Jul 11, 2014
By John Andrews, Contributing Writer
If there is one emerging pattern within the clinical informatics field, it is the quest to make data "actionable" for users. With all the technology infrastructure development over the past decade to facilitate electronic health record installation in healthcare facilities, providers are finding that the data generated often can't be used in a timely and constructive manner.
The obstacle to achieving this level of manageability, summed up succinctly by Dan Riskin, MD, is this: "It's hard." Riskin, co-founder and CEO of Menlo Park, Calif.-based Health Fidelity, may be a bit glib about the challenge of harnessing the magic of clinical data, but he says the juncture where healthcare finds itself requires more deep contemplation about how to proceed from here.
In explaining the high degree of complexity involved in transforming clinical data from being an inert body into a vehicle for quality care, Riskin dissects the challenge this way: "The problem fits into two buckets – risk and quality. Risk is a market need today for value-based healthcare in risk-based payment models and requires a fundamental understanding of what it means. There is also a lot of talk about quality and the same technology is needed for both. The base content is full clinical data – claims data plus narrative data. This is complete clinical data, providing the full picture."
-----

EHR Implementation Still Troubling Docs, Survey Finds

July 10, 2014
Electronic health record (EHR) adoption and implementation issues were ranked as the most pressing IT problems by physicians for the second straight year, according to the Physicians Practice 2014 Technology Survey.
As more physicians and medical practices work toward meaningful use of an EHR, getting the technology seamlessly integrated into daily work flow continues to be a main concern. Seventeen percent of the 1,442 respondents to this year's survey said getting an EHR onboard and fully operational at their practice was their top concern, followed closely by lack of interoperability between EHRs (16 percent) and costs to implement and use new technology (13 percent). It does seem, however, due to meaningful use incentive payments or other factors, that cost is becoming less of a concern, having dropped 4 percentage points from the 2013 survey.
-----

Predictive analytics in healthcare: Are they safe?

July 11, 2014 | By Dan Bowman
While hospitals--such as Boston Children's Hospital and El Camino Hospital in Mountain View, California--increasingly are turning to predictive analytics to improve patient care and safety efforts, some worry about the legal and ethical implications of using such technology.
For instance, researchers from Harvard Law School, the University of California, San Francisco and the University of Texas Southwestern Medical Center say in an article published this month in Health Affairs that predictive analytics models may make care recommendations that suggest withholding potentially effective treatments from patients based on probability statistics. What's more, they say, docs who rely on such models could face an increased risk of liability.
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HIT safety barriers for hospitals include staffing, funds

July 11, 2014 | By Dan Bowman
Health technology safety efforts often are forced to compete with other "priorities" at provider organizations, including business growth and quality of service, according to a recent research report from RAND and the ECRI Institute published on behalf of the Office of the National Coordinator for Health IT. The report was touted in a July 10 Health IT Buzz blog post and involved 11 organizations and six case studies.
The report's authors found that securing resources--both in terms of staff effort and funding--has been the "most frequently cited barrier" to the success of health IT safety efforts. For instance, they noted, in many cases examined, employees charged with health IT safety maintenance divided their time between managing risk and working on Meaningful Use or the ICD-10 transition.
-----

Patient portals raise concerns for data privacy, security

July 11, 2014 | By Katie Dvorak
As more health data becomes available, many issues will arise regarding patient security and privacy of information, Micky Tripathi tells Healthcare Information Security in an interview.
One of the biggest privacy issues, according to Tripathi, who co-chairs the Privacy and Security Tiger Team, which advises the HIT Policy Committee of the Office of the National Coordinator for Health IT, is sharing of patient information on patient portals--and who has access to what data through them.
Tripathi also serves as president and CEO of the Massachusetts eHealth Collaborative.
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6 ways big data can lower costs

Posted on Jul 10, 2014
By Mike Miliard, Managing Editor
Brigham and Women's Hospital has put forth a new report showcasing a half-dozen ways to lower healthcare costs through the use of big data.
With electronic health records now common across the U.S., the amount of clinical data ripe for research and analytics is on the rise. This is opening big opportunities to arrive at insights that could improve the value of patient care, say B&W officials.
A new study published in the July issue of Health Affairs shows how big data analytics is helping pave the way toward reduced costs.
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Patient-centered data opens door for more individualized care, research

July 10, 2014 | By Katie Dvorak
More than ever, patients are having a say in their healthcare--and their input will be an important part of big data collection to create a more "unified story of health and healthcare," according to an article in July's Health Affairs.
Researchers at Duke University looked at the impact of aggregating real-world data right from patients as an alternative to randomized controlled trials. The researchers said directly capturing patient data is growing, with the information being used to help physicians understand the factors that affect health outcomes.
The researchers said that as the use of electronic health records and monitoring devices grows, it opens more doors for data collection and analysis. Full implementation and interoperability of EHRs remains a work in progress for many providers, however.
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Docs cite EHRs as top IT concern; shun telehealth, social media

July 10, 2014 | By Katie Dvorak
When it comes to implementing electronic health records into daily workflow, 17 percent of physicians responding to a newly published survey say it is their top IT concern.
For the second straight year, the adoption of EHRs is the most pressing tech problem physicians face, according to the Physicians Practice 2014 Technology Survey, conducted by Kareo.
Of the 1,442 respondents to the survey, lack of interoperability between EHRs also was a pressing issue--with 16 percent calling it a major concern, according to an announcement on the study.
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Why Hackers Are Targeting Health Data

CIO: 'Today It's a Totally Different Kind of Attack'

By Marianne Kolbasuk McGee, July 7, 2014. Follow Marianne @HealthInfoSec
Two years ago, a Utah Department of Health server was breached, allegedly by Eastern European hackers, and 780,000 individuals were impacted.
Last month, the Montana health department confirmed a server breach impacting up to 1.3 million individuals.
And now the State of Vermont confirms that a development server of the Vermont Health Connect, the state's health insurance exchange under the Affordable Care Act, experienced a cyberattack last December, in which hackers allegedly accessed data 15 times. The attack, which was tracked to a Romanian IP address, went undetected for about a month.
In this latest case, because the server was only a development system that did not contain any production data, there was no breach, Lawrence Miller, Vermont's chief of healthcare reform, tells Information Security Media Group.
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'Most Wired' 2014 hospitals big on data

Posted on Jul 09, 2014
By Mike Miliard, Managing Editor and Erin McCann, Associate Editor
This year's class of 'Most Wired' hospitals are diving "deeper into data analytics and population health management," according to Hospitals & Health Networks.
The 16th annual survey, conducted by H&HN in partnership with the American Hospital Association, CHIME, McKesson and AT&T, finds that these 375 organizations are also using information technology to bridge gaps to outpatient providers, the report finds. In addition to highlighting the Most Wired, HHN also recognized hospitals in the 'Most Improved,' 'Small and Rural' and 'Most Wired Advanced' categories (see next page.)
Two-thirds of the hospitals on the list share critical patient information electronically with specialists and other care providers.
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CMS reports paltry numbers for Stage 2

Posted on Jul 09, 2014
By Tom Sullivan, Editor, Government Health IT
When CMS and ONC revealed the latest statistics on Tuesday morning, showing that 1 percent of eligible providers and 3 percent of eligible hospitals have attested to Stage 2 to date, Elisabeth Myers of CMS' Office of e-Health Standards and Services was careful to point out that the data is early -- so much so, in fact, that “it’s dangerous to apply interpretations” to those numbers.
The 1 percent figure includes EPs who have installed a 2014-certified EHR by Jan. 1 of this year, completed the reporting period ending April 1, and attested as of July 1. That's an aggressive timeline for healthcare entities so naturally the first wave was small, though few expected it to be as low as 1 and 3 percent.
CMS will start seeing second quarter attestations coming in July 1, Myers added. Whereas previous years' reporting periods could be conducted in any 90-day stretch, 2014 is the first time CMS required it to be done according to calendar quarters.
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Crafting a Next Generation IT strategy

Posted on Jul 09, 2014
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
During my 16 years as CIO, I've witnessed the transition from client server to web, from desktops to mobile, and from locally hosted to cloud.   
As Beth Israel Deaconess merges and acquires more hospitals, more practices and more care management capabilities, what are its strategic IT choices?
I will not even mention "best of breed", because I think the industry has abandoned such a strategy as unworkable in an era when everyone needs access to everything for care coordination, population health, and patient/family engagement.
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Hopkins Tweaks CPOE, Saves $1.25 Million

Greg Goth
JUL 8, 2014 9:25am ET
Researchers at Johns Hopkins Bayview Medical Center, Baltimore, used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain, and to achieve a large decrease in patient charges.
The team provided information about testing guidelines and made changes to the computerized physician order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.
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Electronic transmission: not so simple

Posted on Jul 09, 2014
By Mike Miliard, Managing Editor
On paper, it sounds easy. Eligible hospitals that refer patients to another care setting must electronically transmit "a summary of care record for more than 10 percent of such transitions and referrals."
The twelfth of Stage 2 meaningful use's 16 core measures requires that such a summary of care be either transmitted to another recipient using certified electronic health record technology, or with help from an organization that's either an "NwHIN Exchange participant or (operates in) a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network."
Turns out that's easier said than done.
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Health Affairs - July 2014; Volume 33, Issue 7

Using Big Data To Transform Care

From The Editor-in-Chief

Big Data In Health: A New Era For Research And Patient Care

    • Alan R. Weil
Health Aff July 2014 33:1110; doi:10.1377/hlthaff.2014.0689
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Big data tools help CMS transform healthcare

July 9, 2014 | By Jane Antonio
New developments in data architecture, storage and analysis are helping the Centers for Medicare & Medicaid Services make better use of data to transform the healthcare system, according to a new article outlining the agency's efforts published this month in Health Affairs. CMS is using technology to convert mountains of raw data into actionable information and share it securely.
In the past, it was difficult for CMS to manage the high volumes of data it collects since such data often is housed in incompatible systems, the authors--including CMS Administrator Marilyn Tavenner and Acting Director of CMS' Offices of Enterprise Management Niall Brennan--noted. Types of data contained include Medicare and Medicaid claims information, patient assessments and surveys along with data on quality, Medicare Advantage encounters and prescription drug events. Now, however, CMS can integrate its systems "to link billions of transactional data records from disparate sources at the desired unit of analysis (such as the beneficiary or the provider) and look across time and programs," the authors said. That, they added, yields a more holistic view of patients and providers in various care settings over time.
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ONC committee endorses Health IT Safety Center

July 9, 2014 | By Dan Bowman
Governance, function and focus recommendations for a proposed Health IT Safety Center presented by a safety task force on behalf of the Office of the National Coordinator for Health IT won the endorsement of the agency's Health IT Policy Committee on Tuesday.
At the committee's monthly meeting, the task force--chaired by David Bates, senior vice president for quality and safety at Brigham and Women's Hospital in Boston--called for a public/private governance structure funded both by the ONC and via private means. It also reiterated the need for the center's activities to simultaneously avoid duplication and complement ongoing efforts, key tenets of the proposed health IT risk-based regulatory framework from which the safety center has materialized.
Another recommendation from the task force included the creation of an executive board comprised of 10 to 12 "decision-making" members that, within two years, could expand to be a larger, more inclusive entity. The board would include representation from all parts of the health IT spectrum, including consumers, hospital IT leaders and vendor institutions.
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Mt. Sinai offers iPads to patients to track their stay

By: Jonah Comstock | Jul 8, 2014
New York City-based Mt. Sinai Medical Center has begun offering iPads to patients to keep track of their hospital stay. The central feature of the app, Patient Itinerary, allows patients to stay informed about when they are scheduled for surgeries, lab tests, and consultations.
“If you have a patient that’s here for five or six days, they really don’t know what’s going to be happen during the course of their day,” Michael DeCarlo, director of health IT at Mt. Sinai, told MobiHealthNews. “So that was really the driver behind creating the patient itinerary.”
The Mayo Clinic implemented a similar pilot in an outpatient context for patients recovering from heart surgery. That app included an assessment component, but also equipped users with a schedule and to-do list for the day. DeCarlo said that pilot was an inspiration for Mt. Sinai, but that they’re applying the same ideas to an inpatient context. Currently, about 50 iPads are deployed across six units in the hospital.
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The 4 Health Systems With the Most Stage 7 Hospitals

Written by Helen Gregg (Twitter | Google+)  | July 08, 2014
In total, 172 hospitals have been recognized HIMSS Analytics' Stage 7 Award, the highest level of electronic medical record progress a hospital or health system can attain.
Many of these 172 hospitals are part of larger health systems. The following four health systems boast the largest numbers of stage 7 hospitals:
Kaiser Permanente (Oakland, Calif.): 37 hospitals
Banner Health (Phoenix): 21 hospitals
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Millions of Electronic Medical Records Breached

July 7, 2014
This story first appeared in the Orange County Register and the Los Angeles Register.
Thieves, hackers and careless workers have breached the medical privacy of nearly 32 million Americans, including 4.6 million Californians, since 2009.
Those numbers, taken from new U.S. Health & Human Services Department data, underscore a vulnerability of electronic health records.
These records are more detailed than most consumer credit or banking files and could open the door to widespread identity theft, fraud, or worse.
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Advanced EHRs Save 10% Per Patient, Study Says

John Commins, for HealthLeaders Media , July 9, 2014

A large study of electronic health records systems, which includes automation of ancillary services such as clinical data repository, pharmacy, and laboratories, shows that they save money for third-party payers and patients, but not necessarily for hospitals.

A sweeping examination of more than 5 million inpatient records at 550 hospitals during 2009 identified savings averaging 9.6% per patient – or $731 – from the 19% of hospitals that used advanced electronic health records when compared with hospitals that did not.
The findings from researchers at the Medical University of South Carolina in Charleston were published in the most recent issue of the American Journal of Managed Care. Abby Swanson Kazley, an associate professor at MUSC's college of Health Professions, and a lead author of the study, spoke with HealthLeaders Media Tuesday.
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Patient Engagement Platform Sees Explosive Growth

Greg Goth
JUL 8, 2014 7:19am ET
"Patient engagement" is a popular term currently, but the practice of providing consumers with relevant data about the clinical and financial aspects of their care is still in its infancy. Health Data Management talked with Doug Ghertner, CEO of Nashville-based engagement and education platform vendor Change Healthcare, about what the industry needs to do to tie users, providers, and payers together on applications everybody can understand and make use of.
If the statistics behind the firm's growth are any indication, it would appear employers and health plans are more than ready to provide such platforms to their consumers. Ghertner says Change Healthcare started 2013 with 200,000 users on the company's Software-as-a-Service platform; by year's end there were 5.5 million, and by early June, 2014, 7.7 million.
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ONC Launches Challenge for Improving Hypertension

Greg Slabodkin
JUL 8, 2014 7:36am ET
The Office of the National Coordinator for Health IT has a new challenge to providers: To develop electronic health records tools to improve treatment of hypertension.
The goal of the EHR Innovations for Improving Hypertension Challenge is to “seek practices that have used clinical decision support (CDS) to implement the most clinically successful examples of an evidence-based blood pressure treatment protocol, gather details about these tools and their implementation, and then drive widespread implementation of those tools by other providers.”
The ONC-led challenge is part of Million Hearts, a national initiative to prevent 1 million heart attacks and strokes by 2017. “Heart disease and stroke are two of the leading causes of death in the U.S. and there are many healthcare providers who employ clinical decision support tools, like standardized treatment approaches or protocols to control hypertension among their patients. This challenge helps us find the best examples of those efforts and scale them up,” says National HIT Coordinator Karen DeSalvo, M.D.
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Top 10 Government Health IT stories of 2014 thus far

By Tom Sullivan, Editor
When setting out to assemble this lineup it was, but perhaps should not have been, surprising that even after weeding out now-old news articles that have lost relevancy half of the top 10 most popular stories would be about ICD-10. 
Other favorite topics this year include accountable care organizations, Big Data, interoperability, patient privacy issues. 
And here they are:
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CDC on EHR errors: Enough's enough

Posted on Jul 08, 2014
By Evan Schuman, Contributing Writer
The Centers for Disease Control and Prevention does not routinely get involved in telling hospitals how to run operations, but with increasing reports of EHR deployment problems, the Atlanta-based operation now sees the need to act.
"Some hospital laboratories have legacy information systems that do not even have the ability to use current coding," said Megan Sawchuk, the lead health scientist for CDC's office of public health scientific services, which is in the division of laboratory programs, standards and services.
The problems, though, go way beyond outdated software. There are also issues involving staff time and expertise. One key example is the huge number of codes and the maddening fact that different medical facilities use different codes for the same tests. This is particularly problematic for physicians who work in multiple hospitals and practices. "We have to develop a simpler coding system that balances the clinician’s need to consistently order the right test with the laboratory’s need to show unique aspects of testing when necessary," Sawchuk said. "There are pros and cons on each side, but ultimately we want to make it easy for clinicians to order and interpret the right test for the patient."
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HIT stakeholders raise concerns with FDASIA framework

July 8, 2014 | By Dan Bowman
Several healthcare industry groups are raising concerns in new comments submitted this week to the U.S. Food and Drug Administration about the health IT risk-based regulatory framework it published in April in conjunction with the Office of the National Coordinator for Health IT and the Federal Communications Commission.
For instance, the American Hospital Association, in a letter to Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, remarks that the report only distinguishes various types of health IT based on "descriptions of the technology as it is currently used." The AHA also worries that the "functional approach" within the report fails to capture three important facets of health IT: interoperability of information across data sources; product usability; and accurate patient matching.
"We recommend that the final report include all three of these factors as considerations in the assessment of health IT by level of risk," the letter states.
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Report: CPOE market poised for growth

Laura Pedulli
Jul 07, 2014
The computerized physician order entry (CPOE) market is expected to grow 6.5 percent, or from $938.4 million in 2013 to $1.28 billion in 2018, according to a report from Texas-based research firm MicroMarket Monitor.
Government initiatives are spurring a number of technological advancements in CPOE and extensive usage of CPOE systems by emergency healthcare service providers, hospitals, nurses and office-based physicians also is fueling market growth, according to the report.
Key market players include Cerner, Allscripts, Epic, McKesson, GE Healthcare, Athenahealth, Meditech, Zynx Health and Emdeon.
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MU Slides into Summer of Discontent

Scott Mace, for HealthLeaders Media , July 8, 2014

If the top dog in the EHR food chain is feeling like he is dragging regulatory chains around, then we have a technology modernization program that is, at best, troubled, and at worst, in crisis.

The federal government's EHR certification program is in disarray and may not be able to achieve its most important outstanding aim—to provide interoperability between different vendors' EHRs—anytime soon.
This despite CMS's meaningful use audit program striking terror in the hearts of even the staunchest healthcare CIOs, who fear an overlooked detail will lead to hefty givebacks of EHR incentive payments.
ONC's distracting effort to push forward with a 2015 set of EHR standards itself has generated a massive amount of negative feedback, and accusations that the organization hasn't incorporated three years of extensive public feedback into a troubled program. Now the program is facing considerable budgetary limitations as its original Congressional funding runs out.
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Hospital IT execs: Patient safety results should define CPOE success

July 7, 2014 | By Dan Bowman
The success of a computerized physician order entry implementation project should be defined by improvements to patient safety, according to Chris Snyder, a hospitalist and chief medical information officer at Peninsula Regional Medical Center, a 288-bed acute-care facility in Salisbury, Maryland.
Snyder (pictured right), who spoke on the recent FierceHealthIT webinar "Boosting physician adoption of CPOE to maximize its benefits," said that while adoption is challenging, it ultimately opens up doors for stronger governance structures. That, in turn, leads to faster decision-making, which boosts the quality of patient care, he said.
"The speed of it is remarkable," said Snyder, whose rural facility first implemented CPOE 10 years ago and is about to make another transition. "The capability to visualize information and to stop the Swiss-cheese model before it gets to the pharmacy--before it gets to the nurse and definitely before it gets to the patient--has shown to be enormous at our institution."
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CMS Seeks Mandated Certified EHRs for Chronic Care

JUL 6, 2014 10:42pm ET
The government is proposing that physician practices furnishing chronic care management services to Medicare beneficiaries use electronic health records certified to at least 2014 Edition meaningful use requirements.
The meaningful use program has been voluntary, although eligible professionals not participating face reduced Medicare reimbursements. The program remains voluntary, but the possibility now looms that an exception may be made for chronic care.
The possible mandate of certified EHRs to care for the chronically ill is in a proposed rule setting the Part B physician fee schedule for calendar year 2015. The rule from the Centers for Medicare and Medicaid Services is available here and being published July 11 in the Federal Register.
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Navigating the Intersection of Medical Devices, Health IT To Boost Patient Safety

by Bonnie Darves, iHealthBeat Contributing Reporter Monday, July 7, 2014
One of the many Holy Grails in health care -- trailing somewhat behind the perennial pursuit of lower costs -- is the notion of interlinking the sometimes disparate components of medical devices, clinical systems, information systems and communication platforms to streamline care and make the entire delivery universe safer for patients.
We're getting closer, but because of the notoriously fragmented arena that constitutes the U.S. health care system, progress is, well, painstakingly slow. The good news is that the parties that need to be invested in making this interconnectedness happen are talking -- and collaborating.
These parties include device makers and information system vendors, FDA, the Office of the National Coordinator for Health IT, the Federal Communications Commission, standard-setting bodies and a slew of interested independent organizations. The latter group ranges from the Healthcare Information and Management Systems Society to the ECRI Institute, and from the MD PnP (Medical Device Plug-and-Play) workgroup to the recently formed Integrating the Healthcare Enterprise (IHE) and CE-IT Community. All are engaged, separately or jointly, in efforts to propel device-and-system interoperability while improving health IT-associated patient safety.
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Enjoy!
David.