Again there has been just a heap of stuff arrive this week.
First we have:
Audit Scotland flags concerns with ECR
21 Apr 2009
Scotland’s national audit body has raised concerns about the scope and quality of the country's Emergency Care Summary.
In its latest report on medicines management, Audit Scotland says that nine out of ten health boards have now implemented the ECR in Accident and Emergency departments.
The ECR contains information from GP records and is intended to help staff manage patients when they do not have access to their full medication records.
However, Audit Scotland says nine health boards have reported problems with the records. A significant number of staff in seven boards have complained that the records are inaccurate or out of date.
And a significant number in five boards have complained they do not contain information about over the counter medicines or medicines prescribed by staff other than GPs. However, the report also says staff are alerted to the limitations of the system and the data in it.
Audit Scotland last examined medicines management in 2005. Since then, it says the management of medicines in hospitals has improved. However, it says the NHS in Scotland still needs better information to improve both cost-effective prescribing and safety.
More here:
http://www.ehiprimarycare.com/news/4763/audit_scotland_flags_concerns_with_ecr
This is a major issue with shared EHRs which needs to really be sorted out before such systems are implemented in any scale. NEHTA take note! If the information that is found is not very trustworthy the systems simply will not be used!
Second we have:
Big Challenges Await Health-Records Transition
By JACOB GOLDSTEIN
The physician in charge of the federal government's massive push to move health care to electronic records from paper files faces "huge challenges" as he starts his new job in Washington this week.
That phrase comes from a paper David Blumenthal himself published recently in the New England Journal of Medicine. He cited low adoption rates, high costs, technical complexities, and physician and patient concerns about privacy.
Some other experts have warned that systems that are poorly designed or badly run can jeopardize patient safety. They are calling for more regulation or stricter standards for certification, arguing that the risks are heightened by limited public oversight of the systems.
"They do far more good than harm, but we can't sit here and blindly believe that they are error-free," says Dale Sanders, chief information officer for a group of more than 600 physicians associated with Northwestern University.
Dr. Blumenthal said Monday that problems can arise from trying to install systems too quickly and without proper support. He called technical assistance a "critical factor" in reducing risks.
Dr. Blumenthal and other health IT proponents argue that electronic systems are essential to containing costs and improving the quality of health care. The systems include not only the basic information currently stored on paper records in doctors' offices and hospitals, but also safety features such as alerts that warn doctors if a patient is being prescribed two drugs that can interact in a dangerous way. Eventually, the systems are supposed to allow information to be shared electronically between doctors' offices, hospitals and public agencies.
Proponents say the systems reduce wasteful spending, such as by reducing redundant tests, and generate information on how doctors and hospitals fare on quality measures such as giving appropriate tests at the right time. But most doctors and hospitals have yet to adopt the systems, which can cost tens of thousands of dollars for a single physician and millions of dollars for a hospital.
More here (subscription required):
http://online.wsj.com/article/SB124027664223937475.html
I would take this as the e-Health understatement of the century!
Third we have:
Microsoft, Mayo Clinic Launch Online E-Health Records Service
Mayo Clinic Health Manager is Microsoft's bid to get consumers to tap into its HealthVault platform for managing personal health records online.
By Marianne Kolbasuk McGee, InformationWeek
April 21, 2009
The Mayo Clinic and Microsoft are unveiling to consumers free online personal health records that provide customized health recommendations based on patients' medical conditions.
The new Mayo Clinic Health Manager is built on Microsoft's HealthVault Web-based personal health record platform, which Microsoft unveiled in 2007.
The release of Mayo Clinic Health Manager is considered Microsoft's big splash for mass-market consumers to begin tapping into HealthVault's tools for collecting and managing their personal health records online, said George Scriban, senior global strategist for Microsoft's consumer health platform.
Reporting continues here:
http://www.informationweek.com/news/showArticle.jhtml?articleID=216900387
The competition is clearly stepping up at quite a pace
Fourth we have:
FTC Unveils EHR Security Rule
John Commins, for HealthLeaders Media, April 17, 2009
The FTC's proposed interim rule governing security for electronic health records expands responsibility for maintaining patient confidentiality to include third-party vendors, enhances patient notifications for breaches, and sends a clear signal that the federal government will crack down on violators.
"It's a tremendous scare," says Tom Green, senior director of sales and marketing for Premier Insurance Management Services Inc., a subsidiary of Premier Inc. "If patient health information is not properly safeguarded or encrypted or they don't have the necessary policies and procedures in place to ensure safe-keeping, you are opening yourself up to significant civil fines and penalties in addition to some potential lawsuits, not to mention the public relations issues you could be facing."
In addition to providing about $36.3 billion to offset hospitals' and physicians' costs for installing interoperable EHR, the stimulus package also includes mandates to strengthen privacy and security protections. The FTC and HHS are drafting a report due next February that will establish threshold requirements. Until then, the FTC will operate under the proposed interim rule, which was unveiled last week for a public comment period that ends June 1.
More here:
One of a few articles that follow about aspects of planned privacy and security upgrades in the US.
Fifth we have:
FTC’s hard-line enforcement may shock industry
By Joseph Conn / HITS staff writer
Posted: April 20, 2009 - 5:59 am EDT
Part two of a two-part series (Access part one):
The government took another step last week toward closing a legal loophole in federal privacy and security rules for emerging Health 2.0 information technology applications by issuing proposed rules aimed at covering an estimated 900 companies and organizations offering personal health records and electronic systems connected to them.
The Federal Trade Commission was careful to point out its new interim proposed rule on federal breach notification requirements for the developers of electronic PHR systems did not apply to covered organizations or their business associates as defined by the Health Insurance Portability and Accountability Act of 1996, heretofore the key federal privacy and security regulation. The FTC, operating under new authority given it by the American Recovery and Reinvestment Act of 2009, noted that its new rule seeks to cover previously unregulated entities that are part of a Health 2.0 product mix.
FTC staff estimates that about 200 PHR vendors, another 500 related entities and 200 third-party service providers will be subject to the new breach notification rule. The staffers estimate that the 900 affected companies and organizations, on average, will experience 11 breaches each per year at a total cost of about $1 million per group, per year. Costs include investigating the breach, notifying consumers and establishing toll-free numbers for explaining the breaches and providing additional information to consumers.
More here:
http://www.modernhealthcare.com/article/20090420/REG/304209941
I think it will soon become vital for PHR providers to be covered by privacy regulations. It is amazing there are 200 PHR providers in the US. Consolidation must come!
Sixth we have:
Telemedicine device may help docs save lives
Phoenix Business Journal - by Jan Buchholz
A small Scottsdale company hopes to revolutionize emergency medicine with a product it will unveil later this month at the American Telemedicine Conference in Las Vegas.
GlobalMedia, which began as a teleconferencing firm for general business and has attracted Jerry Colangelo as an investor, is turning its attention to medical applications — specifically, the Transport AV.
The device, which is being manufactured at a 26,000-square-foot warehouse in Scottsdale, is expected to generate interest from a variety of users, including trauma centers, ambulance operators, municipalities, nursing homes and rural medical facilities. The project was designed to help minimize the time it takes for a doctor to see, diagnose and prescribe treatment for a critically ill or injured patient.
“Time is of the essence, and we believe Transport AV will give doctors an edge for saving patients,” said GlobalMedia Sales Director Jay Culver.
Weighing in at about 30 pounds, the battery-operated Transport AV transmits images and medical data to doctors and medical personnel in real time. It can be placed on a mobile cart, enabling remotely located medical personnel to monitor patients continuously at the site of the incident, during the ambulance or helicopter ride, and in the emergency room.
“It allows a doctor to see the patient and the area of concern,” said GlobalMedia founder and General Manager Joel Barthelemy. “It provides doctors with clear images and data remotely, so they can be there and yet not be there.”
Lots more here:
http://www.bizjournals.com/phoenix/stories/2009/04/20/story3.html?b=1240200000^1812852
This sounds like a sensibly thought out package that could really make a difference.
Seventh we have:
HHS Guidance Covers Breach Notification
April 17, 2009
The U.S. Department of Health and Human Services on April 17 issued guidance on technologies and methodologies to secure health information by rendering data unusable, unreadable or indecipherable to unauthorized individuals.
The guidance was required by April 18 under the American Recovery and Reinvestment Act. The Act mandates the notification of patients when their protected health information is breached, and the guidance is in advance of rules to be issued this summer.
Lots more (with links to the guidance) here:
http://www.healthdatamanagement.com/news/breach-28072-1.html
This is important stuff. Pity we don’t seem to be able to get our Health IT Privacy act together!
Eighth we have:
E-health now a reality!
Monday 20th April 2009
The St Jan hospital of the historic city of Bruges, Belgium, has always been ahead of its time when it comes to cooperation with primary care. In fact, their primary care physicians have had access to a well-secured health portal since 2005. Using this network, they are able to easily follow the stays of their patients and access information like test and lab results, PACS images and discharge letters.
Today, St Jan has taken this one step further. Now online referrals and online appointment bookings are also available. And not just to physicians, but to patients as well. Via UG Broka, integrated in the health portal, referring physicians have access to a number of "referral paths". Depending on the specifics involved and the information provided, these can lead to an online and automatic referral authorisation for a specific appointment type, saving a lot of time when the patient calls for his/her appointment.
Full article here:
Good to see Belgium is on the move!
Ninth we have:
Remote Monitoring of the Heart
Wearable, wireless technology detects early signs of heart failure.
By David Talbot
A 15-centimeter wireless sensor patch, recently approved by the FDA, holds the promise of reducing hospitalizations by allowing automated early detection of heart failure. The noninvasive device, which is taped to a patient's chest, monitors indicators of heart health--including heart and respiration rates, levels of patient activity, and even the accumulation of body fluid--as patients go about their daily lives.
Part of a technology platform now being marketed by Corventis, a startup in San Jose, CA, the waterproof sensor patch beams data to a special cell-phone-like gadget in the patient's pocket or home. From there, the data is wirelessly transmitted to the company's servers. Algorithms detect anomalies and trigger alerts to doctors, who could then view the data from the Web or from their own mobile devices.
"We can transmit data from a patient to servers that can process the data--all without the patient knowing about it--24-7," says Ed Manicka, the company's president. "Your patient could be in Singapore, could be in Brussels, or could be across the room from you. And you can look at data from a website, or from an iPod. Our system allows the computer to watch a patient all the time, not requiring the physician to continually look at data and act on it."
Much more here:
http://www.technologyreview.com/biomedicine/22519/?nlid=1961
This sounds pretty amazing. Innovation continues despite the GFC!
Tenth we have:
Carestream Health's eHealth Managed Services Now Manages More Than 10 Million Imaging Studies
Tuesday, 21 April 2009
Carestream Health, Inc., announced that its CARESTREAM eHealth Managed Services (eMS) now manages 10 million imaging studies - representing more than 500 terabytes of data - worldwide. The company operates eight data centers in five countries to service healthcare providers throughout North America and Europe.
"Outsourcing clinical data management to a service provider allows multiple healthcare facilities to leverage and share a common data center platform and pay only a fraction of the total cost based on their own utilization," said Patrick Koch, Worldwide Business Director, eHealth Managed Services. "Our eHealth Managed Services offering also equips healthcare systems with a smooth and easy way of selectively and securely sharing information among multiple locations within their enterprise."
He added that contracting with an outside data services company is becoming an increasingly popular way for healthcare providers to reduce capital expenses since hardware, software, maintenance, monitoring, upgrades and obsolescence management are included as part of the service.
More here:
http://www.ehealthnews.eu/content/view/1577/26/
That sure is one pile of outsourced data management!
Eleventh for the week we have:
Cerner commits to acting locally
21 Apr 2009
Cerner has started working with NHS trusts on a new, local implementation model that is designed to prevent the repitition of past mistakes, and focus on clinical benefits.
The company says that through its NHS contract it still has the potential to transform the entire healthcare economy, but says that while holding on to the big picture benefits it will now work locally.
In an exclusive interview with E-Health Insider, Jeff Townsend, vice president of R&D and the most senior Cerner executive responsible for the company’s National Programme for IT in the NHS contracts, said lessons have been learned from a “difficult” 12 months.
Implementations of Cerner’s Millennium care records system at first Barts and the London NHS Trust and then at the Royal Free Hospital Hampstead NHS Trust went badly wrong, with delays to patient care and lost revenues.
More here:
http://www.e-health-insider.com/news/4767/cerner_commits_to_acting_locally
This is very good news indeed! I think the HealthSMART project in Victoria could benefit from discussions with those involved in the UK!
Twelfth we have:
Public Questions Digital Fix For Health Care
Morning Edition, April 22, 2009 · There's a big disconnect between American opinions about fixing the health care system and the view of experts and politicians, according to a new poll by NPR, the Kaiser Family Foundation and the Harvard School of Public Health.
The poll shows several areas of possible conflict as Democrats in Congress and the Obama administration forge ahead with their plans to reform the health system.
Last week, for example, President Obama said health care is a "pillar" of economic recovery, with electronic medical records at the center of his health plans. A system of electronic medical records would link doctors, hospitals and other health care providers so they can share medical records. Obama argued that putting records online would "save money and lives and reduce medical error." The new poll shows that many Americans accept the president's argument, but only to a point.
Robert Blendon, who runs polling programs at the Harvard School of Public Health, says people in the poll accept the president's argument that if medical records could be shared online, the quality of health care would improve. "The fact that one physician would be able to have all the information that another had entered, that appears to make a lot of sense to people," Blendon says.
In the poll, 72 percent said if records were computerized, their own doctors were likely to do a better job of coordinating their care; 67 percent believed that the overall quality of medical care in the country would be improved; and 53 percent say there would be fewer medical errors.
Lots more here with graphics:
http://www.npr.org/templates/story/story.php?storyId=103322780
This is an important guide to American public opinion. Given the total lack of political push in Australia I suspect we would find worse results than these.
Thirteenth we have:
Improving Medical Dictation
Dictation and speech recognition being used successfully by physicians at Mass General.
Dictation and speech recognition successfully being used at Mass General.
Jeffrey D. Hart, MS
If you're thinking that your current dictation or transcription systems need replacement, or that you might want to try speech recognition software, now could be the right time. In the past few years at Massachusetts General Hospital (MGH), we have implemented both back-end (server-based) and front-end (PC-based) speech recognition systems. Both have significantly reduced costs, improved workflow, and decreased the time in which a dictated encounter becomes viewable in our electronic patient record systems.
We use Nuance's Dragon Naturally Speaking (Medical) for our front-end speech recognition technology and Nuance's Dictaphone iChart for the back end. Both technologies use a similar speech recognition engine that will continuously adapt and essentially learn about a user's speech; it will become increasingly accurate each time he or she uses it.
Much more here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=198171
From this it sounds like the technology is close to being ready for prime time after all these years!
Fourteenth we have:
Blues Plan Pushes Medical Home Model
April 23, 2009
Blue Cross Blue Shield of Michigan has launched what it calls the largest program in the nation to promote the medical home model of care.
The program involves more than 1,000 physicians in nearly 300 primary care practices located across the state. Under the medical home model, primary care practices serve as the focal point for patient care coordination. The model advocates extensive use of information technology to document and coordinate care across all providers and settings, support evidence-based medicine through decision support tools and conduct performance measurement.
The Blues plan has worked with thousands of physicians since 2004 on testing criteria for the new Patient-Centered Medical Home program. About 3,800 physicians are focusing on at least one element of the program. Now, 1,000 early adopters who have made the most progress will be designated as Patient-Centered Medical Homes practices.
Much more here :
This is an important initiative and needs to be closely watch given the role EHRs play.
Fifteenth we have:
Friday, April 24, 2009
Telemedicine Successes Outweigh Bad Press, Advocates Say
by George Lauer, iHealthBeat Features Editor
In its steady march toward widespread acceptance as a valuable new tool, telemedicine last week encountered a bump in the road: a Colorado physician was sentenced to nine months in jail for illegally prescribing a drug online to a college student who later committed suicide.
As the American Telemedicine Association prepares to host the largest turnout ever for its annual convention this month in Las Vegas, telemedicine proponents say stories of telemedicine's successes, growth and innovations overshadow the criminal case.
"Telemedicine has grown beyond the stage where something like this can have a big impact," Jonathan Linkous, CEO of the American Telemedicine Association, said.
"There's always concern about overreaction, but in this case, it's pretty clear -- this case didn't really involve telemedicine and the doctor violated the law. It's bad publicity, certainly, but I don't think a case like this will have any serious repercussions," he said.
Much more here:
A useful review of the state of discussions – with links.
Sixteenth we have:
Tech that translates doctors' orders
Natural language processing helps convert physicians' verbal instructions into electronic records.
Anna Kattan, contributor
April 17, 2009: 10:47 AM ET
NEW YORK (Fortune) -- Everyone seems to think electronic health records are a great idea: going digital cuts down on paper storage, makes it easier to transfer patient information from one provider to another, and ultimately will enable the medical industry to create immense clinical databases. Electronic health records are a key component of the Obama Administration's stimulus plan, and dozens of corporations claim they are lined up to create more jobs when the government releases funds for digitizing medical files and other improvements to healthcare information technology.
Who could quibble with that?
One group that's not so keen on going paperless is physicians, who often find the current generation of electronic records rigid and counterintuitive. Most doctors prefer to type detailed clinical notes, rather than codes that identify a diagnosis or procedure.
Much more here:
http://money.cnn.com/2009/04/17/technology/natural_language_tech.fortune/
It is good to see advances in areas like this. Anything that makes adoption easier is welcome!
Fourth last we have:
The Dubious Promise of Digital Medicine
GE, Google, and others, in a stimulus-fueled frenzy, are piling into the business. But electronic health records have a dubious history
By Chad Terhune, Keith Epstein and Catherine Arnst
Neal Patterson likens the current scramble in health information technology to the 19th century land rush that opened his native Oklahoma to homesteaders. Cerner (CERN), the large medical vendor Patterson heads, is jockeying for new business spurred by a $19.6 billion federal initiative to computerize a health system buried in paper. "It's a beautiful opportunity for us," the CEO says.
The billions in taxpayer funds—part of the $787 billion economic stimulus—also have energized tech titans General Electric (GE), Intel (INTC), and IBM (IBM), all of which are challenging Cerner and other traditional medical suppliers. Microsoft (MSFT) and Google (GOOG) aim to put medical records in the hands of patients via the Web. Wal-Mart (WMT) is teaming with computer maker Dell (DELL) and digital vendor eClinicalWorks to sell information technology to doctors through Sam's Club stores.
Vastly more here:
We always put both sides on this blog!
Third last we have:
Wednesday, April 22, 2009
Searching for the Benefits of Google Health
Amid a growing emphasis on electronic health records, one patient tests online health services.
By Emily Singer
Makers of personal electronic health records, including Google and Microsoft, are partnering with a growing number of pharmacies, health-care providers, and online services in an effort to better integrate these tools with other aspects of patients' medical information. The push coincides with the recent $19 billion in federal stimulus funding designated for electronic health records. Despite the increase in activity, however, it's still not clear how the government incentives to digitize doctors' data will affect patients' efforts to collect and curate their own health records.
At present, most patients who want to create a personal health record have to get a copy of their medical records and then manually enter the information, including conditions, medications, test results, and procedures. However, last summer, my insurer, Blue Cross Blue Shield, became the first insurance company to sign on with Google Health, allowing me to directly upload medical records into the program. (As of now, this functionality is limited to patients at Beth Israel Deaconess Medical Center, in Boston; the Cleveland Clinic, in Ohio; and a network of physicians in Washington State.)
I decided to test the two best known programs, Google Health and Microsoft's HealthVault, to get a preview of what the growing number of users might face. (Today I'll focus on Google, and Friday on Microsoft.) Both are free applications that allow users to store, organize, and share medical information online. Both have collaborated with well-known medical centers--Google with the Cleveland Clinic, and HealthVault with the Mayo Clinic--to try to fine-tune their programs. And both partner with a number of pharmacies, allowing patients to download their medication regimens and search for potential interactions and alternatives.
Much more here:
http://www.technologyreview.com/computing/22526/?nlid=1964&a=f
Useful to get reaction to the major offerings in the PHR space from an informed lay point of view!
Second last for the week we have:
Net benefits?
With more than 16m patients now using health sites each month in the UK, knowing where to go for reliable health information has never been more important.
A 2008 study by Microsoft suggested that self-diagnosis via search engines can lead to worryingly high incidents of ‘cyberchondria’, as patients lead themselves down digital blind alleys. Dr Gordon Brooks, site director of the EMIS owned www.patient.co.uk website, is keen to see a more regulated landscape.
He said: “We’ve seen from our own surveys that the internet can be a hugely empowering tool for patients looking for details of diseases, treatments, self help and mutual support – but there are still risks attached.
“General-purpose search engines have no medical oversight. Their results are skewed towards websites that have commercial arrangements with the search engine company or which have optimised their content for search engine algorithms. These sites are not necessarily the ones offering the best clinical guidance.
“This bias means patients won’t get a balanced set of results when checking out symptoms - which can lead them to jump to the wrong diagnostic conclusion or to purchase unsuitable treatments.
“No doctor would attempt diagnosis based on a few typed words – and that’s after applying their years of training, background knowledge of humanity, language and intelligence.”
Moving towards information supplier accreditation
www.patient.co.uk has always advised users to stick to a few reputable British websites, and to make sure that a site’s content is up-to-date, supported by robust evidence and is independent of commercial funding arrangements.
Much more here:
http://www.e-health-insider.com/Features/item.cfm?&docId=292
This looks like a useful initiative to provide consumers with reliable health information.
Last for this week we have:
Germany’s electronic health card stalls
17 Apr 2009
The introduction of electronic health cards in Germany has been stalled because doctors are refusing to buy the necessary equipment to read them.
Health insurance companies say that they are ready to roll-out the cards to their 80 million members but will not do so unless doctors and pharmacies install the equipment.
The aim of Germany’s electronic health cards is to improve communications among all sectors of German healthcare providing better data exchange throughout the industry. The cards will initially be used to identify patients and improve the processing of health insurance claims.
Doctors, hospitals, pharmacies and service providers in the health system have a matching professional card allowing them to view the patients’ data when given the patients’ card.
More here:
http://www.ehealtheurope.net/news/4757/germany%E2%80%99s_electronic_health_card_stalls
Looks like a bit of bad planning here. Hardly Germanic!
There is an amazing amount happening. Enjoy!
David.
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