Here are a few I have come across this week.
Note: Each link is followed by a title and a paragraph or two. 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 payment.
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http://govhealthit.com/newsitem.aspx?nid=73730
White House cyber security plan to cite e-health
By Mary Mosquera
Wednesday, May 12, 2010
The White House has begun developing a strategy for securing online transactions and stemming identity fraud that pays particular heed to the importance of building a trusted arena for electronic healthcare transactions.
Howard Schmidt, the nation’s cyber security coordinator, said this week that the administration wants to make online commerce more secure so that government, industry and consumers will feel comfortable doing more of their business to the Internet.
The plan to develop a strategy will focus on ways to improve identity management, Schmidt said at a May 11 conference on privacy and security sponsored by the Health and Human Service Department’s Office of Civil Rights and National Institute for Standards and Technology.
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Guerra On Healthcare: Health IT Safety Needs Serious Attention
Growing questions about risks can't be brushed aside.
By Anthony Guerra, InformationWeek
May 13, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224701470
Psychologists say people don't research problems to find solutions, but rather to support the solution they've already decided upon.
To cite a recent political example, many said the Bush administration "cherry picked" intelligence to foster support for a war that it was already committed to. In addition to the selection side, this type of analysis entails ignoring or discounting information that casts doubt upon the intended course.
I fear that the Office of the National Coordinator--the newly minted federal agency overseeing the implementation of the HITECH legislation--is falling into this trap. In my opinion, ONC can't be relied on to objectively evaluate and respond to growing concerns that electronic health records, in their current state of sophistication, bring with them as many patient safety risks as improvements.
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Experts: Train Employees Not To Snoop; Fire Those Who Do
Dom Nicastro, for HealthLeaders Media, May 10, 2010
Patient-record snooping is inevitable, but with the advent of electronic health records (EHRs), it took "a new twist," says Kate Borten, CISSP, CISM, president of The Marblehead Group.
"The fact that e-records can be accessed from anywhere is both a blessing and a privacy and security curse," Borten says.
Borten says facilities should consider not only blocking access to PHI for employees who don't need it, but also to have strict policies and penalties in place for those who snoop at patient records.
Says Borten: "Today the standard approach–after technically blocking access from those who don't need it, of course—is to have a policy prohibiting snooping and sanctions for violations, workforce training that makes this crystal clear, and then follow-through with technical and manual auditing and disciplinary action."
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http://www.modernhealthcare.com/article/20100514/NEWS/100519962
Where does VistA, Veterans Affairs go from here?
By Joseph Conn / HITS staff writer
Posted: May 14, 2010 - 11:45 am ET
Part four of a four-part series (Access part one, part two and part three):
If the Veterans Affairs Department chooses to pursue an open-source software development scheme to upgrade its VistA clinical information technology system, a key decision must be made. What database software will be used in the redeveloped VistA system?
To the VistA outsider, the question—if not the choice—seems simple enough. To members of the burgeoning community of VistA insiders, however, the battle for the answers is shaping up to be a holy war for the digital soul of the software. And, as sometimes happens in soulful battles, there is a lot of money at stake.
Brian Lord is a former VA programmer who is now CEO of Sequence Managers Software, a Durham, N.C., developer of open-source VistA systems.
In reading the report released last week by the Industry Advisory Council, or IAC, of the American Council for Technology advising the VA on a way forward for VistA, Lord said he was “thrilled to see that they even went so far as to say, if you're going to make it open-source, you have to create a community, you have to have a bill of rights to what this community is going to be. I've never seen open-source characterized so well in any political document. That's unheard of.”
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There Is No ‘One-Size-Fits-All’ in Building a Nationwide Health Information Network
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
May 14, 2010
Private and secure health information exchange enables information to follow the patient when and where it is needed for better care. The Federal government is working to enable a wide range of innovative and complementary approaches that will allow secure and meaningful exchange within and across states, but all of our efforts must be grounded in a common foundation of standards, technical specifications, and policies. Our efforts must also encourage trust among participants and provide assurance to consumers about the security and privacy of their information. This foundation is the essence of the Nationwide Health Information Network (NHIN).
The NHIN is not a network per se, but rather a set of standards, services, and policies that enable the Internet to be used for the secure exchange of health information to improve health and health care. Different providers and consumers may use the Internet in different ways and at different levels of sophistication. To make meaningful use possible, including the necessary exchange of information, we need to meet providers where they are, and offer approaches that are both feasible for them and support the meaningful use requirements of the Centers for Medicare & Medicaid Services (CMS) Electronic Health Record Incentives Programs. As with the Internet, it is likely that what is today considered “highly sophisticated” will become common usage. Moreover, users may engage in simpler exchange for some purposes and more complex exchange for others.
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http://www.european-hospital.com/en/article/7178-E-health_advances_in_Austria.html
E-health advances in Austria
Report: Michael Krassnitzer
Like many others, Austria is in the process of introducing electronic patients’ records (EPRs) for use in and by all healthcare facilities. After a drawn out preparation phase, a company was founded to implement the project and ELGA (Elektronische Gesundheitsakte) is underway. ‘E-health will come, step by step, but inexorably’, said Austrian Health Minister Alois Stöger.
With the launch of the public health portal www.gesundheit.gv.at, the first ELGA milestone has now been reached.
ELGA is a searchable database that contains all health data about a patient, no matter when and where they were collected – i.e. in healthcare institution. The data can be accessed anytime by everybody who has the necessary access privileges. ‘A reliable system of strict access privileges is a crucial issue,’ said Dr Susanne Herbek, managing director of ELGA-GmbH. ‘Privacy and patient autonomy have to be guarded under all circumstances.’
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http://www.ihealthbeat.org/features/2010/personal-health-records-may-not-be-so-personal.aspx
Friday, May 14, 2010
Personal Health Records May Not Be So Personal
by Kate Ackerman, iHealthBeat Senior Editor
Personal health records often are touted as a way to engage patients by giving them control over their own health care. However, it turns out that personal health records might not be so personal.
A recent study published in the Journal of the American Medical Informatics Association found that PHRs aren't as patient centered as perhaps they should be. Researchers at Beth Israel Deaconess Medical Center assessed the patient centeredness of PHR systems at seven large early adopter organizations in 2007.
The study, which was supported by the Commonwealth Fund, found that while most of the organizations offered some patient-centered functions, there is still plenty of room for improvement.
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Wisconsin governor creates statewide HIE
May 13, 2010 — 12:39pm ET | By Neil Versel
Wisconsin Gov. Jim Doyle this week signed into law a bill establishing a statewide network for health information exchange. The bill puts into use $9.4 million in HIE money the state received from the federal government under the American Recovery and Reinvestment Act, and each state is required to create an entity to oversee the allocation of such funding.
"If someone from La Crosse gets sick in Milwaukee, they should be able to access all of their own personal medical information electronically," Doyle said in prepared remarks. "Without it, doctors have to run tests that have already been done, raising both the costs and possibility of errors. Creating an electronic exchange where medical records can be safely shared and patients' privacy rights can be protected is a critical part of reforming health care in America."
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GLOBE EDITORIAL
Digitize medical records; waiting puts lives at risk
May 7, 2010
WHEN IT COMES to switching from paper to electronic records, medicine trails many other professions — even though study after study has shown that computerization will save not just money but lives. Even with the incentive of billions of federal dollars to cover much of the cost of the transition, doctors and hospitals have been slow to take even the first steps toward conversion. Apparently, they feel little or no responsibility for symptoms that get misdiagnosed because of inadequate information about a patient’s past medical care, let alone the tests that get repeated because no one has a record of the previous results.
In addition to offering the carrot of billions of dollars in stimulus-bill subsidies, the Obama administration is wielding the stick of reduced Medicare payments to doctors who do not make the change by 2015. Already, some medical professionals believe that date is too soon. But if anything, the deadline gives medical providers too much time to put off the inevitable. Under no circumstances should the administration backtrack on its threat.
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http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/
EHR Software Market Share Analysis
Posted on May 14, 2010 at 8:39 am
Calculating market share for the electronic health record (EHR) market is no easy task. There are over 300 software vendors, many market segments (consider: size of practice served, specialties services, inpatient/outpatient) and very “fuzzy” sources of data.
Nevertheless, the team at Software Advice set out to see what numbers we could pull together. We limited our analysis to the outpatient EHR software market. Moreover, we decided to measure market share based on the number of physicians users, rather than vendor revenue or other metrics. We tried to keep it simple. It’s not.
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http://www.fierceemr.com/story/ehr-implementations-open-cans-compliance-worms/2010-05-13
EHR implementations open 'cans of compliance worms'
May 13, 2010 — 1:07pm ET | By Neil Versel
In case hospitals didn't have enough to do while implementing EHRs in time to earn federal stimulus money, EHRs can open up "brand-new cans of compliance worms," reports AIS' Health Business Daily.
It's well known that the systems they buy have to be certified--according to standards that aren't yet final. And, of course, providers have to demonstrate "meaningful use" of EHRs. That term, likewise, hasn't been fully defined. But the HITECH Act portion of the American Recovery and Reinvestment Act also requires hospitals to define the patient's legal medical record.
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http://www.fierceemr.com/story/looking-value-phrs/2010-05-13?utm_medium=nl&utm_source=internal
Looking for value in PHRs
May 13, 2010 — 11:44am ET | By Neil Versel
Let's get one thing straight: It's not that I don't like the idea of personal health records. I simply don't like the breathless hype around products with virtually zero market traction, and thus don't think there's much news in stories like the Mayo Clinic making a deal with Dossia.
Where I do see news is in stories that attempt to show the value of PHRs as a component in a much more connected health system, where data flows from multiple sources into a patient-accessible record, without requiring data entry by patients themselves.
In that spirit, I offer kudos to Canadian Healthcare Technology for providing a realistic argument in favor of PHRs. "Ideally, the test results for patients should be forwarded to a secure Patient Health Record (PHR), where they can be collated for future reference. It's a way of creating a unified record for care-givers, too, who want to see the records of patients who have been treated at other clinics and hospitals," writes CHT editor Jerry Zeidenberg. The key word here is "ideally." We certainly don't live in an ideal world when it comes to heath information.
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http://www.healthcareitnews.com/news/survey-personal-health-information-less-secure-2010
Survey: Personal health information less secure in 2010
May 10, 2010 | Molly Merrill, Associate Editor
SAN FRANCISCO – Forty-seven percent of IT security professionals believe their personal healthcare information is less secure than it was a year ago, according to a recent survey.
The online survey, by San Francisco-based nCircle, a provider of automated IT security and compliance auditing solutions, polled 257 security professionals between Feb. 4 and March 12, 2010.
IT professionals ranked insider threats as the most serious security issue facing healthcare organizations. Alex Quilter, healthcare security strategist with nCircle, said he was surprised by this finding, but suggested that it could be the result of putting patient care before patient privacy.
"This prioritization is correct but should not come at the expense of patient privacy," Quilter said. "This is compounded by the large network of business partners that require access to patient data as part of the healthcare supply chain. As the push for electronic health records intensifies security professionals and many consumers feel that their personal health information is less secure than ever."
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http://www.healthcareitnews.com/news/work-begins-converting-new-york-docs-digital-records
Work begins on converting New York docs to digital records
May 07, 2010 | Bernie Monegain, Editor
NEW YORK – Two health IT extension centers in New York state have begun work helping primary care physicians convert from paper to digital records.
The centers, which received $48.2 million of federal stimulus money, are among 60 across the country that will offer providers step-by-step help implementing electronic health record systems in their practices. The implementation and use of digital records will position the practices to be eligible for federal incentives of up to $63,750.
"Our goal is to help approximately 10,000 primary care providers in the State of New York adopt EHRs within two years to enhance patient care and the efficiency of their practices," said David Whitlinger, executive director of the New York eHealth Collaborative, one of the state's two extension centers.
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Health IT Savings May Reach $261 Billion
Innovative health IT systems that go beyond electronic health records to provide better analytics and drive greater efficiency could save billions over a decade.
By Nicole Lewis, InformationWeek
May 10, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224701400
As the healthcare system braces for a new age, using technology to develop interoperable, patient-centered health IT systems could yield billion of dollars in savings, a report predicts.
The report, "A 21st Century Roadmap for Advancing America's Health: the Path from Peril to Progress," highlights the role HIT will play in re-engineering healthcare through the adoption of electronic health records, providing better analytics, and driving greater efficiency as the country builds a more comprehensive framework that strengthens the public health infrastructure. Additionally, new systems can create cost savings.
"If used in innovative ways, the estimated savings from HIT expansion could reach $261 billion over 10 years," the report said.
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http://www.ehealtheurope.net/news/5897/mckesson_wins_%E2%82%AC40m_irish_pacs_deal
McKesson wins €40m Irish PACS deal
12 May 2010
Ireland’s Health Service Executive has confirmed that it has signed a €40m deal with US healthcare IT company, McKesson, to implement a National Integrated Medical Imaging system to digitise Ireland’s radiological services.
The three year deal will see Ireland’s hospitals digitise and store its full range of diagnostic images including ultrasound, x-rays, CT and MRI scans.
According to the HSE, all of the patient’s previous information and current images will be held electronically in the radiology department, outpatient clinics and hospital wards and will be able to be sent to GPs.
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http://www.chcf.org/publications/2010/04/clinical-documentation-ehr-deployment-techniques
Clinical Documentation: EHR Deployment Techniques
SA Kushinka of Full Circle Projects
April 2010
This issue brief on clinical documentation techniques is the second in a series of tactically oriented publications based on lessons learned through the California Networks for Electronic Health Record Adoption (CNEA) initiative. With electronic health records (EHRs), chart information can be accurately shared among multiple users, including specialists, behavioral care providers, labs and pharmacies, insurers, public health entities, and research organizations.
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Document Downloads
Clinical Documentation: EHR Deployment Techniques (147k)
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Duke-Durham Partnership Uses Informatics to Redesign Health System
Cynthia Johnson, May 5, 2010
When Durham-based Duke University and the Durham, NC, community launched Durham Health Innovations (DHI) in April 2009, they knew they were embarking on a groundbreaking project that would use medical informatics to identify chronic disease interventions and improve the health of patients. But at some point during the recently completed planning stages of the project, team members realized that they had stopped talking about patients—and started talking about communities.
"We realized that we were doing a whole lot of work on individuals," says Lloyd Michener, MD, chair of the Department of Community and Family Medicine at Duke. "Until this project, we hadn't clearly seen how individuals were part of the same networks, the same communities, and the same neighborhoods. In many cases, it makes sense to do things at the community and neighborhood level rather than one at a time at an expensive doctor's office."
The project uses data from Duke's electronic medical records (EMR) system. The university runs customized software that assigns geographic locations to the data, also known as geocoding. This HIPAA-compliant process lets team members look at areas of disease clustering.
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Five Tips to Guide Your Hospital's Social Media Policy
Gienna Shaw, for HealthLeaders Media, May 11, 2010
Hospitals are increasingly pulling their heads out of the sand when it comes to the social media activity of their employees, recognizing that they're active on sites such as Facebook, Twitter, and YouTube regardless of whether the IT department blocks access to them from work computers. Time to face facts: Employees post online comments from their computers at home and use their smart phones to update their Facebook status while at work. And yes, they're talking about your hospital online.
In last week's column, I offered up four steps to take when crafting a social media policy, including borrowing ideas from hospitals that have already begun the process. This week I'll show you some examples of policies with language worth borrowing.
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http://www.fiercehealthit.com/story/saving-healthcare-clinical-narrative/2010-05-09
Saving healthcare with the clinical narrative
May 9, 2010 — 4:18pm ET | By Dr. Nick van Terheyden
A recent exposé on the dangers of electronic health records and in particular "copy-and-paste" functionality accentuates the battle between innovative technology and the essential inclusion of the nuanced clinician narrative. As one specialist put it, limiting a patient's medical record to a point-and-click template decreases the ongoing value of that record and weakens its contribution to clinical decision making. In fact, the value of the narrative is even evident from medical records dating back to 1547; consider the medical history of Henry VIII that even today continues to provide new insights into his clinical conditions and cause of death.
While templates help drive standardization and can ease data analysis, without the narrative we risk losing important clinical data that is buried, as shown in an example found on the Medical Transcription Industry Association website. The same note captured using a typical EHR system balloons to five pages, burgeoned with excess and difficult-to-read content, but from the narrative shrinks to two concise, readily digestible pages. The challenge is how to integrate the narrative into the EHR so as to benefit from the numerous EHR advantages of digitization and rapid sharing of information.
Speech remains the preeminent means of knowledge capture in healthcare. According to the Centers for Disease Control and Prevention, approximately 1.2 billion clinical documents are produced in the U.S. each year, of which 60 percent come from dictation and transcription, the MTIA says. A solution that thousands of clinicians are already using to preserve their often preferred dictation method, while still being able to capture the narrative as part of the EHR, is to apply speech recognition technology to the EHR process.
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http://www.healthdatamanagement.com/news/va-vista-open-source-recommendation-40241-1.html
VA Advisors: Go Open Source on VistA
HDM Breaking News, May 6, 2010
The Veterans Administration should commit to move to an open source, open standards model for the next generation of its VistA information system, according to a report from an advisory group the VA asked to submit recommendations.
The Industry Advisory Council on May 6 released a 100-page report. The council, providing a forum for government agencies and industry to collaborate, works under the umbrella of the American Council for Technology, a Fairfax, Va.-based not-for-profit educational organization created by government executives.
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http://www.ncbi.nlm.nih.gov/pubmed/20386011?dopt=Abstract
Arch Intern Med. 2010 Apr 12;170(7):648-53.
Association of health information technology and teleintensivist coverage with decreased mortality and ventilator use in critically ill patients.
McCambridge M, Jones K, Paxton H, Baker K, Sussman EJ, Etchason J.
Division of Critical Care Medicine, Lehigh Valley Health Network, Allentown, PA 18105-7017, USA.
Abstract
BACKGROUND: Little evidence exists to support implementing various health information technologies, such as telemedicine, in intensive care units. METHODS: A coordinated health information technology bundle (HITB) was implemented along with remote intensivist coverage (RIC) at a 727-bed academic community hospital. Critical care specialists provided bedside coverage during the day and RIC at night to achieve intensivist coverage 24 hours per day, 7 days per week. We evaluated the effect of HITB-RIC on mortality, ventilator and vasopressor use, and the intervention length of stay. We compared our results with those achieved at baseline. RESULTS: A total of 954 control patients who received care for 16 months before the implementation of HITB-RIC and 959 study patients who received care for 10 months after the implementation were included in the analysis. Mortality for the control and intervention groups were 21.4% and 14.7%, respectively. In addition, the observed mortality for the intervention group was 75.8% (P < .001) of that predicted by the Acute Physiology and Chronic Health Evaluation IV hospital mortality equations, which was 29.5% lower relative to the control group. Regression results confirm that the hospital mortality of the intensive care unit patients was significantly lower after implementation of the intervention, controlling for predicted risk of mortality and do-not-resuscitate status. Overall, intervention patients also had significantly less (P = .001) use of mechanical ventilation, controlling for body-system diagnosis category and severity of illness. CONCLUSION: The use of HITB-RIC was associated with significantly lower mortality and less ventilator use in critically ill patients.
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http://www.kaiserhealthnews.org/Daily-Reports/2010/May/10/Health-IT.aspx
Companies Await Health IT Windfall
The Washington Post: A Virginia firm, Vangent, is positioning "itself for a surge of federal spending on health information technology" by setting up a health IT strategy group. "Vangent is likely to face stiff competition for those dollars, but company officials say they expect the firm's reputation as a health-related services provider to serve it well as it bids on contracts." The firm is also involved in civil, defense and national security work, but health services are its largest business. It runs Medicare's "information and assistance program" (Censer, 5/10).
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FairWarning Foils EMR Privacy Breaches
Data definition guides help hospitals and healthcare offices detect, notify, and prevent privacy violations in electronic medical records.
By Nicole Lewis, InformationWeek
May 7, 2010
URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=224701076
FairWarning has developed data definition guides that the company says will help detect and prevent breaches of patient information in healthcare settings, a growing concern as the adoption of electronic medical records accelerates.
The St. Petersburg, Fla. firm supplies cross-platform healthcare privacy auditing for EMRs, and said it has deployed privacy, auditing, and monitoring solutions in more than 300 hospitals and 1,200 clinics across the United States, Canada, and Europe.
The FairWarning Patient Privacy Framework is a series of three documents that help hospital CIOs, IT managers, and other employees implement wide-scale patient privacy auditing, breach detection, remediation, and breach prevention, the company said.
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http://www.modernhealthcare.com/article/20100510/NEWS/100519998
Design with IT in mind
By Andis Robeznieks / HITS staff writer
Posted: May 10, 2010 - 11:45 am ET
The influx of information technology in healthcare means today's hospital architects and designers have to accommodate more wire, more conduit, more plugs and more closets holding more racks of flashing lights than ever before. But they also have a little more room to do so because of smaller—or even nonexistent—central nurse stations, fewer IT-dedicated employees on-site and disappearing file rooms.
If they do it right, experts say, no one really notices. “It just feels substantially different,” said David Sides, vice president of Cerner Worldwide Consulting, a division of the Kansas City, Mo.-based electronic health-record system vendor. “But the good ones do it so it's unobtrusive.”
Von Lambert, a technology solutions manager at HDR, an Omaha, Neb.-based architectural and engineering firm, agrees.
“To the standard observer, you wouldn't notice this,” Lambert said of the flood of IT devices being used by doctors, nurses, patients and their families and the electronic infrastructure that's needed to keep them running. “It's behind a door, so people don't notice, but it does take up space, and it's getting larger and larger.”
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Enjoy!
David.
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