Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.
First we have:
Five Lessons From Seattle On Adopting Electronic Medical Records
By Julie Appleby
Third of an occasional series on health information technology.
SEATTLE — Atop a hill here, three of Washington state’s pre-eminent hospital systems sit within blocks of each other, equipped with state-of-the-art electronic medical record systems that track test results, send warnings about dangerous drug interactions and provide medical histories.
But a patient crossing the street from one hospital to another would be wise to bring paper records: The systems, made by different manufacturers, can’t talk to each other.
For much of the country, linking the electronic records of doctors, hospitals and clinics remains an elusive goal. Even in this tech-savvy city, “no one is quite there yet,” says Jim Bender, medical director for health information at Seattle’s Virginia Mason Medical Center.
Among the reasons: cost, computer systems that aren’t compatible with rival systems, resistance among physicians and privacy concerns. Overcoming the obstacles, Bender says, “will take federal will and money.”
Money is on the way. Under the federal-stimulus legislation, the government plans to spend $32 billion on health-information technology over the next 10 years, and projects $13 billion in savings by doing so. Most of the money will go to doctors and hospitals.
But there are risks. Unless the money is doled out carefully, the money “may go down a rathole,” says Janice Newell, chief information officer for Swedish Medical Center, another major hospital here.
That’s one of the lessons of Seattle’s experience, here are more:
More here with a list of key points:
http://www.kaiserhealthnews.org/Stories/2009/August/10/seattle-health-info-tech.aspx
A useful list of lessons to consider.
Second we have:
Electronic Reminders Keep Hearts Healthy
Study Shows Health Advantage for Patients Who Use Electronic Medical Records
WebMD Health News
Reviewed by Elizabeth Klodas, MD, FACC
Aug. 7, 2009 -- Electronic reminders can help heart patients stay healthy and on their medications even though they are no longer being closely monitored, new research shows.
The study is among the first in the U.S. to show that electronically maintained health records can improve outcomes among heart patients and possibly even lower health care costs.
Researchers followed 421 patients with coronary artery disease enrolled in the Kaiser Permanente Colorado managed care health plan. Medical records for the patients, including physician visits and laboratory and pharmacy data, were kept electronically.
The patients were participants in an intensive pilot intervention program designed to keep them on cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes.
The program -- which linked patients to teams of cardiologists, pharmacists, nurses, and primary care doctors through electronic health records and direct counseling -- resulted in high rates of patient drug compliance and attainment of goals for blood pressure and cholesterol levels.
More here:
http://www.webmd.com/heart-disease/news/20090807/electronic-reminders-keep-hearts-healthy
This is another brick in the wall showing how EHR technologies can assist.
More details are here:
http://www.medindia.net/news/view_main_print_new.asp
Electronic Health Record Links Care Givers And Cardiac Patients
The report is found here:
http://www.ajmc.com/issue/managed-care/2009/2009-08-vol15-n8/AJMC_09aug_Olson_497to503
Third we have:
P4P helps safety net hospitals boost care in just three years
August 07, 2009 | Bernie Monegain, Editor
WASHINGTON – New analysis shows that safety net hospitals have improved patient care through a nationwide pay-for-performance demonstration project, even without the help of information technology.
The Premier healthcare alliance released the results of its research on Thursday. Premier Senior Vice President of Public Affairs Blair Childs said the study included 250 hospitals of all types. The intent was to gauge whether certain types of hospitals performed differently.
Officials at two of the hospitals say the work of gathering the required information will be made much easier and faster once they role out an electronic health record.
"We do not have a fully integrated health information system," said Cathy Robinson, the corporate compliance officer and vice president of medical staff and support services at Rush Health Systems in Meridian, Miss.
Although hospitals like those in the Rush system and the Sinai Health System in Chicago, which serve a disproportionate share of indigent patients, performed below others at the outset, the research revealed that differences in quality lessened after three years in the clinical areas of heart attack, heart failure and hip/knee replacement.
Also after three years the under-representation of safety net hospitals dissipated for hospitals receiving awards that recognize facilities for performance in the top 20 percent of all participants.
The HQID project, or Hospital Quality Incentive Demonstration, is the basis for CMS' proposal to Congress for a national value-based purchasing (VBP) or pay-for-performance (P4P) program.
More here:
http://www.healthcareitnews.com/news/p4p-helps-safety-net-hospitals-boost-care-just-three-years
There is a press release and links to the detailed data found here:
http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp
CMS/Premier Hospital Quality Incentive Demonstration (HQID)
What is interesting is that this organisation is doing well and is wanting to do better with better IT.
Fourth we have:
Making the ‘Big Switch' to cloud computing
By Joseph Conn / HITS staff writer
Posted: August 10, 2009 - 11:00 am EDT
Part one of a two-part series:
It is an odd way to start a magazine story, by recommending that readers rush out and read books. And yet, that is precisely what Newsweek suggested a couple of weeks ago in its article, “Fifty books for our time.”
It is a recommendation repeated here for book No. 4 on that list, The Big Switch: Rewiring the World, From Edison to Google, by Nicholas Carr, first published last year. Newsweek said all of the books on its list “open a window on the times we live in.” In the case of The Big Switch, at least for healthcare information technology, it is more of a window on the times we are only now just beginning to live in, but that's likely to change significantly as time goes by, according to healthcare and IT industry experts contacted for this story.
The switch in question is what Carr, a former executive editor of the Harvard Business Review, sees as the inevitable conversion of most computing from the mainframe, client/server and local network technologies, overwhelmingly the dominant models in clinical healthcare computing today, to the next generation of off-site, remotely hosted and managed services via the “World Wide Computer.” That's a Carr coinage interchangeable with a more commonly used term: cloud computing.
Carr argues that we are on the cusp of a change in business and society as profound as at the end of the 19th century. Back then, industrialists made the big switch of that era, converting their factories from the motive forces of the water wheels and steam plants they owned to a vastly larger-scale, electrical power grid they did not own but used as customers of a utility. Computing, he argues, is being commoditized just as electricity was a century or so ago.
Lots more here:
http://www.modernhealthcare.com/article/20090810/REG/308049977
Second part of the article is here:
http://www.modernhealthcare.com/article/20090811/REG/308119991
These two part provide a good discussion of the place of Cloud Computing in Health IT.
Fifth we have:
States urged to start now on health exchanges
- By Alice Lipowicz
- Aug 10, 2009
State governments should start planning now to foster health information exchanges and adoption of electronic health records in their states, according to new guidance released by the State Alliance for eHealth, which the National Governors Association sponsors.
The Health Information Technology for Economic and Clinical Health (HITECH) Act contained in the economic stimulus law provides at least $2 billion for health information exchanges and up to $45 billion in incentive payments to doctors and hospitals for digitizing their patient records. The law sets a goal of 2014 to dramatically increase the number of providers who are using electronic patient records and participating in health exchanges.
“States must immediately begin planning how they will support this new direction and lead the way for broad deployment and use of Health Information Exchange,” the guidance states. “The role of states in modernizing the health care system was already substantial, but it will dramatically expand as the HITECH Act is implemented.”
Much more here:
http://fcw.com/articles/2009/08/10/states-should-begin-work-now-on-hies.aspx
For a copy of the 32-page guidance, "Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange," click here.
Given the scale of the funding it is worth reading what is being suggested.
Sixth we have:
11 August 2009
eHealth Worldwide
:: Africa: East Africa: Sea Cable Ushers in New Internet Era (23 July 2009 - AllAfrica)
A privately-funded consortium, Seacom, commissioned its Sh59 billion ($760m) undersea cable in Kenya, Tanzania, Mozambique, Uganda and South Africa with Rwanda set to be linked up in the next two weeks. This effectively means that Kenya is now part of the global information superhighway and will be able to compete on a more level platform with more established economies.
More detail here:
http://www.who.int/goe/ehir/2009/11_august_2009/en/index.html
There is a full report with 20+ links found at the URL above.
Second last we have:
Electronic Health Records: Facing the Issues
Richard Raysman and Peter Brown
New York Law Journal
August 12, 2009
Over the past decade, electronic transactions have slowly supplanted paper-based systems in many industries. For example, individuals and Wall Street brokerage firms employ electronic trading; federal and state taxpayers increasingly e-file their returns; and attorneys e-file pleadings and federal court documents. However, a physician jotting notes on a paper chart, which will then be stored in a large filing cabinet, remains the norm.
In February, President Barack Obama signed a $787 billion economic stimulus bill, the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-005, 123 Stat. 115 (2009), which contains the Health Information Technology for Economic and Clinical Health Act encouraging health care providers to adopt electronic medical records. With billions of dollars allocated toward the digitalization of health care, the era of electronic medical records has begun in earnest.
Much more here:
A useful run through the issues from a US legal perspective.
Lastly we have:
EHRs among top concerns for group practices
By Andis Robeznieks / HITS staff writer
Posted: August 12, 2009 - 11:00 am EDT
The top concerns among medical group practices this year were operating costs rising faster than revenue, maintaining physician compensation while reimbursement declines, and choosing and implementing an electronic health record, according to a study released by the Medical Group Management Association.
Those were the same top concerns listed in last year's survey. In this year's survey, the fourth-highest concern was collecting from self-pay patients and those with high-deductible health plans and health saving accounts. For the second year in a row, practices ranked managing finances in the face of uncertain Medicare rates as the fifth-highest concern. Recruiting physicians was the sixth-ranked concern, down from fourth last year.
More here :
http://www.modernhealthcare.com/article/20090812/REG/308129988
The link to the report is in the text. Interesting that moving to EHRs is on the list of major concerns.
Enough goodies for one week!
Enjoy!
David.
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