Again, in the last week I have come across a few reports and news items which are worth passing on. These include first:
http://www.informatics-review.com/
“Improving Information Technology Adoption and Implementation Through the Identification of Appropriate Benefits: Creating IMPROVE-IT
This paper describes the objectives of a collaborative initiative, IMPROVE-IT, that attempts to provide the evidence that increased information technology (IT) capabilities, availability, and use lead directly to improved clinical quality, safety, and effectiveness within the inpatient hospital setting. This collaborative network has defined specific measurement indicators in an attempt to examine the existence, timing, and level of improvements in health outcomes that can be derived from IT investment. These indicators are in three areas: (1) IT costs (which includes both initial and ongoing investment), (2) IT infusion (ie, system availability, adoption, and deployment), and (3) health performance (eg, clinical efficacy, efficiency, quality, and effectiveness).”
The full paper can be found at:
This is a useful contribution which aims to foster careful research on the value contributed by Health IT towards healthcare system quality, safety and efficiency and effectiveness. The lack of a totally compelling integrated evidence set on this matter is a significant blocker of further investment in the area and the initiative is to be encouraged.
It should not be underestimated just how hard this task is and how complex gathering credible data can be in this area.
It would be good of some health service organisations in Australia could contribute to the research.
Second we have:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45023
Recent Releases | Issue Brief Examines How Personal Health Record Products Meet Needs of Underserved Minorities
[May 18, 2007]
"Personal Health Records: What Do Underserved Consumers Want?" Mathematica Policy Research: The issue brief describes features of personal health records -- paper- or electronic-based systems to record an individuals health information -- and looks at how those features meet the needs and wants of underserved minorities. According to the brief, based on focus groups conducted with underserved minorities from New Brunswick, N.J., people want PHRs that are portable, secure, private, simple and affordable. Minorities also would pay modest fees to set up and update the PHRs, but they would be reluctant to pay maintenance fees. The brief suggests that PHR developers might need to increase their efforts to assess their products' usability among low-income minorities who might have limited access to computers and low health literacy (MPR release, 5/17).”
The full issue brief can be found here:
http://www.mathematica-mpr.com/publications/pdfs/phrissuebr.pdf
It was interesting that the focus group participants, questioned by the study found that:
- All favoured a smart card, or other device as large as a credit card, that can be scanned by health providers to obtain their records;
- All wanted to choose who can access their PHRs, with restricted access to certain individuals and an audit trail to show who accessed the records and why;
- Most want basic personal health information in their PHRs, including demographic and health insurance information and lists of conditions, medications and allergies; and
- Many would pay setup fees of up to $30 and update fees of up to $5.
It is worth noting that even in a disadvantaged group there was considerable clarity about the need for the individual to control what happened to their information and that keeping it simple is probably the best way to start.
Third we have:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678
“Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care
Overview
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
Executive Summary
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.
Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes.
With the inclusion of physician survey data in the analysis, it is also apparent that the U.S. is lagging in adoption of information technology and national policies that promote quality improvement. The U.S. can learn from what physicians and patients have to say about practices that can lead to better management of chronic conditions and better coordination of care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to monitor chronic conditions and medication use. These countries also routinely employ non-physician clinicians such as nurses to assist with managing patients with chronic diseases.
The area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans. Nonetheless, the U.S. scores particularly poorly on its ability to promote healthy lives, and on the provision of care that is safe and coordinated, as well as accessible, efficient, and equitable.
For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving better value for the nation's substantial investment in health.”
This report is available to download from the web-site referenced above.
The slide pack of 130 or so comparative slides which is also available for download from the same site is an invaluable and carefully researched resource.
The report provides useful coverage of the adoption and use of Health IT in the countries analysed and is well work a download and review.
Fourth we have:
http://www.healthcareitnews.com/story.cms?id=7130
Home telemonitoring works, study claims
| By Richard Pizzi, Associate Editor | 05/10/07 |
MONTREAL – Home telemonitoring of chronic diseases appears to be a promising approach to patient management, says a team of Canadian scholars who reviewed more than 65 telemonitoring studies in the United States and Europe.
The study, entitled “Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base,” appeared in the May/June 2007 issue of the Journal of the American Medical Informatics Association.
Researchers at the University of Montreal in Quebec, Canada, searched the Medline and Cochrane Library databases for research studies on telemonitoring published between 1990 and 2006. The 65 papers they examined included studies on the home-based management of chronic pulmonary conditions, cardiac diseases, diabetes, and hypertension. Each of the studies employed various information technologies that were used to monitor patients at a distance.
The Canadian scholars, led by Guy Paré of the University of Montreal’s Health Administration department, concluded that home telemonitoring produces accurate and reliable data, empowers patients and influences their attitudes and behaviors, and may improve their medical conditions.
Paré and his colleagues claimed that the magnitude and significance of the effects that telemonitoring has on patients’ conditions still remains inconclusive. Nevertheless, the study’s results suggest that patients will comply with telemonitoring programs and appear to embrace the IT involved. This seemed to be true regardless of a patient’s nationality, socioeconomic status, or age.
…..
The complete article can be read at the URL above.
This is a very interesting systemic review that show the well planned telemonitoring initiatives can make a difference to the outcomes of patient care. Another brick in the wall showing the value of ICT in the health sector.
Lastly we have
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070514/FREE/70514003/1029/FREE
Peel brings privacy issues 'front and center': profile
By: Joseph Conn / HITS staff writer
Story posted: May 14, 2007 - 8:55 am EDT
Part one of a two-part series:
The telephone rang as Deborah Peel was driving to the airport outside Austin, Texas, a few weeks ago.
It was one of several long-distance calls she'd had that day with someone, though not a patient, who nonetheless was seeking Peel's help and support. For Peel, a physician trained in psychoanalytic psychiatry, her end of the conversation was a blend of delicate probing, empathic listening and full-bore affirmation.
When the phone call ended, Peel smiled, knowing that even though the problem was not yet fully resolved, her caller was in a better place.
"Everybody needs to be listened to," she explained. It's a phrase that isn't on Peel's business cards, but perhaps it should be.
According to Peel, 55, who is winding down her solo psychiatric practice of 30 years, today she's listening to far more patients than have ever been through her Austin office, with its Oriental rug, cloth upholstered couch and four glass-fronted bookcases stuffed with texts, including 23 light-blue volumes of the writings of Sigmund Freud.
…..
This is a useful pair of articles that describe the views of Dr Peel on the requirements for Health Information Privacy that are sought by the American public. The issue of the use of health information in data-mining is currently flying ‘under the radar’ in Australia but I would suggest this is likely to change as awareness of such practices on behalf of Medicare Australia and the Private Health Funds becomes more common.
More next week.
David.
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