Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
PHR Project Moves Forward With User-Centric Health IT Applications
by Colleen Egan, iHealthBeat Editor
The race is on to unite technology with personal health maintenance. Last July, nine teams were chosen from more than 165 team applicants to develop personal health record tools to help people manage individual medical issues, and now, researchers are going to try to get approval from their toughest critics: consumers.
Robert Wood Johnson Foundation's PHR initiative program -- called Project HealthDesign -- has two phases. In the first, six-month phase, the teams created "user-centered personal health applications that address specific health challenges faced by individuals and families," according to the project's Web site. Teams are now in the second, 12-month prototype phase, in which the designs are tested in certain populations. The projects target a variety of groups, from sedentary adults to teenagers learning to take an active role in their health to children with chronic illnesses.
The program's goal "was not to be constrained by the world as it is but rather to think about the world as it could be," Mark Frisse, director of the Vanderbilt University project, said.
…..( see the URL above for full article)
This is fascinating as it describes the wide range of specialised areas that the PHR might address and how such focussed systems might make a difference in the care of individual patients. Useful links are included in the article.
Second we have:
http://www.healthcareitnews.com/story.cms?id=7389
Government launches healthcare IT standards compliance web site
Healthcare IT News
By Diana Manos, Senior Editor 07/02/07
WASHINGTON – The federal government announced last Friday the launch of a new web site to help vendors test their products for compliance with standards needed for participation in the National Health Information Network (NHIN).
The web site, developed in partnership by the Certification Commission for Healthcare Information Technology (CCHIT), Healthcare Information Technology Standards Panel (HITSP), the National Institute of Standards and Technology, and the Office of the National Coordinator for Health Information Technology “provides HIT implementers with access to the tools and resources needed to support and test their implementation of standards-based health systems,” said a HITSP email to its members and stakeholders.
…..( see the URL above for full article)
This is a really important move to bring together in a “one stop shop” all the information, resources and tools needed to make sure the best interoperability possible as the National Health Information Network is developed. This is the next step beyond just developing a standards catalogue.
The new HITSP web site can be found at http://xreg2.nist.gov/hit-testing/
A visit to this site is recommended for all involved in this area to consider the usefulness of this approach and how it may be replicated in Australia.
Third we have:
http://www.ehiprimarycare.com/news/item.cfm?ID=2827
BMA votes for non co-operation on central records
29 Jun 2007
Doctors have voted for a public inquiry into NHS Connecting for Health (CfH) and have called on the BMA to advise doctors not to co-operate with the centralised storage of medical records.
The National Programme for IT was the subject of strong criticism at the association’s annual representative meeting (ARM) this week where doctors claimed the NHS IT project was doomed to failure unless a grip was taken on the project and that patient information held on the NHS Care Records Service (NCRS) was not secure and confidential.
Dr Charlie Daniels, a GP in Torquay and chairman of Devon Local Medical Committee (LMC), told colleagues that patients and doctors would be the biggest losers if there was no public inquiry to into NPfIT.
…..( see the URL above for full article)
Here is an invaluable lesson on what happens if you don’t take the clinicians along with you. I hope NEHTA, the Boston Consulting Group NEHTA Review and AHIC take careful note and move to ensure the same does sort of thing is not replicated here – assuming anything significant actually get started.
For those who have on-line access to the British Medical Journal – the following is also more than mandatory reading and very concisely put touching on the same general topic area.
BMJ Volume 334(7608), 30 June 2007, p 1373
How to avoid an e-headache
[VIEWS & REVIEWS: PERSONAL VIEW]
Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA, ash@ohsu.edu
The scope and boldness of the National Health Service’s Connecting for Health initiative are unprecedented. While nations worldwide have set health information technology as a high priority to combat medical errors and increase efficiency, England has outlined the most courageous goal of this kind, aiming towards a national electronic health record service. Implementing systems nationwide, or even regionally, is extremely difficult, yet England is making admirable progress and essential iterative adjustments. Ongoing evaluation efforts, such as those described in Hendy and colleagues’ study in this week’s BMJ, are necessary to guide such adjustments. Temporary setbacks are inevitable and we must learn from them.
Why is implementation of health information technology such a universally difficult process? It is because we are transforming health care through information technology rather than simply automating old processes. Workflow and work life must change, which means people must adapt. Such change is deeply disruptive. The related personal and organisational challenges are enormous, yet efforts to manage change receive inadequate attention and funding.
How can we succeed in such implementations of information technology? Firstly, we must define success explicitly and understand that our goal is long term, and that we will inevitably stumble along the way. Many, perhaps most, successful implementations of clinical systems have been preceded by suboptimal ones, yet these are too often concealed. We must begin to share these experiences openly and cherish these opportunities to learn how to improve implementation efforts. Boldness breeds occasional blunders, which can teach us much about what is required for eventual success.
….. (continued at the BMJ Site)
Fourth we have:
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070705/FREE/70705004/1029/FREE
HIPAA, privacy discussions divide AHIC testimony
By: Joseph Conn / HITS staff writer
Story posted: July 5, 2007 - 12:22 pm EDT
Whether the federal privacy rule under the Health Insurance Portability and Accountability Act of 1996 is adequate to the task of protecting privacy of patients in the new environment of electronic health-information exchange is a matter of divided opinion, according to oral and written testimony before an HHS work group last month.
The answer was "no" for privacy advocates and an information technology vendor who testified, and "yes" for representatives of an existing healthcare data exchange and a coalition whose members include providers, pharmaceutical manufacturers and distributors. The June 22 meeting of the American Health Information Community's work group on confidentiality, privacy and security lasted most of the day.
Much of the testimony centered on responses to a "working hypothesis" put up for public comment by the work group in May and its underlying assumption, that the HIPAA privacy rule—particularly its current scope—is inadequate to today's health IT needs.
As it stands, the privacy rule HHS first produced in 2000, and amended profoundly in 2002, does not give patients control of the use and transmission of their sensitive healthcare information, and the privacy restrictions that do apply only pertain to three classes of "covered entities" specified under HIPAA: payers, providers and claims clearinghouses. Those two privacy rule limitations were the focus of much of the discussion in the testimony.
One element of the work group's hypothesis is that there should be one or more "enforceable mechanisms" to ensure that privacy and security requirements are met. Under the exiting rule, enforcement is delegated to HHS' Office for Civil Rights. The office had received more than 27,000 complaints of possible HIPAA privacy rule violations through April. In three years of privacy oversight, the civil rights office has not issued a single fine against a HIPAA violator. HIPAA provides no individual cause of legal action against privacy violators.
Another working hypothesis posits that all organizations that handle protected health information "should be required to meet privacy and security criteria at least equivalent to any relevant HIPAA requirements" and that the rules apply to them directly, not through "business associate" agreements with covered organizations, as is the case today.
…..( see the URL above for full article)
While this debate is happening in the US context there are parallels here in Australia where few citizens know just what happens to all the data collected by Medicare Australia and the private Health Funds for good or less publicly acceptable reasons. The move to have Health Funds rebate an increasing range of services separate from Government may indeed bring un-anticipated challenges in the future.
Lastly we have:
http://www.bizjournals.com/eastbay/stories/2007/07/02/daily46.html
Kaiser Permanente records 2.7 million patient e-mail messages, 8 million visits to online features
East Bay Business Times - 2:57 PM PDT Friday, July 6, 2007
by Chris Rauber
Kaiser Permanente released results late Thursday of what it called "the largest study to date" on how e-mail changes the way patients access medical care, showing that millions of Kaiser members are using e-mail and other online features to replace office visits and phone calls.
The Oakland-based health care giant said more than 1.4 million enrollees have signed up to use the KP HealthConnect online service, generating more than 2.7 million e-mail messages since September 2005. And 1.9 million of those messages -- or 70 percent -- were generated by Kaiser enrollees in high-tech-happy Northern California, said Holly Potter, an Oakland-based Kaiser spokeswoman for the HealthConnect program.
"We are also seeing steady increases in the number of members registered and using these features each month," Potter told the San Francisco Business Times. "In the month of May alone (the latest month for which numbers are available) 191,661 messages were sent by members in Northern California."
The HealthConnect service is available in seven of eight Kaiser regions nationwide, said Potter, and will roll out to 150,000 Kaiser enrollees in Ohio in October. Overall, Kaiser has 8.7 million enrollees in nine states and the District of Columbia; three-quarters of them reside in California.
Potter said the relatively low usage rate of e-mail so far -- about two messages per registered online user -- is actually good news, because "one of physicians' fears is that they'll be overwhelmed" by patients' e-mail.
…..( see the URL above for full article)
This is fascinating to see the level of adoption by the Kaiser Permanente patients of the on-line services. This really is a HealthConnect!
Finally a must not miss report found by Dean Sittig of the Health Informatics Review.
The Value of Information Technology-Enabled Diabetes Management
Free report from the CITL: Their analysis demonstrates that all forms of ITDM improve processes of care, prevent development of diabetic complications, and generate cost-of-care savings. Technologies used by providers seem to be the most effective in improving the lives of patients with diabetes, and diabetes registries appear to be the most effective of all. Based upon the current evidence, our analysis indicates that patient-centered technologies offer the least potential for benefit. We believe that an integrated provider-patient platform, which adds patient-centered technologies to a registry and reminder system, would add benefits beyond a registry alone.
The report can be downloaded from the following URL:
http://www.citl.org/_pdf/The_Value_of_IT_Enabled_Diabetes_Management.pdf
Indeed I must say the present issue of the Health Informatics Review (for July 1, 2007) has an excellent range of topical material.
Go to the following URL and enjoy!
http://www.informatics-review.com
All in all quite a truly fascinating week!
More next week.
David.
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