Weekly Overseas Health IT Links - 19 March, 2011.

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 subscription payment.



Blumenthal: Stage 2 meaningful use on track

March 09, 2011 | Patty Enrado, Special Projects Editor

WASHINGTON – As concerns about the preliminary Stage 2 meaningful use criteria mount and the search for his replacement continues, David Blumenthal, MD, remains steadfast in the direction and focus of the Office of the National Coordinator (ONC).

“We’re on track for meaningful use Stage 2,” said the outgoing national coordinator for health IT.

The ONC Health IT Policy Committee’s working groups are actively looking at recommendations for Stage 2. Referring to recent objections by several professional organizations that the preliminary criteria are too aggressive, Blumenthal said, that "having these comments is very helpful and is part of the process; it shows our commitment to continued openness and transparency and making sure that we listen to all points of view.”



Drug-naming standard for EHRs expanded

March 10, 2011 — 11:15am ET | By Janice Simmons - Contributing Editor

The RxNorm standard clinical drug vocabulary produced by the National Library of Medicine (NLM) has added more accurate and complete connections between national drug codes (NDCs)--the product identifiers assigned by American manufacturers and packagers of drugs--and standard nonproprietary names of medications recommended for use in electronic health records (EHRs).

Providing new connections between NDC product codes and RxNorm standard names and identifiers will have many potential uses within an individual patient's EHR, according to the NLM. These include the use of NDCs on medicine bottles to speed up standard data entry or to trigger an alert written in the RxNorm standard to prevent a medication error.

No single source currently contains all the NDCs for all medications marketed nationwide. RxNorm, though, has included NDCs provided by the Food and Drug Administration, the Department of Veterans Affairs, and the Multum and Gold Standard drug information sources for several years.



EHR costs for docs top $46,000: study

By Joseph Conn

Posted: March 11, 2011 - 12:00 pm ET

The total cost of planning, buying, implementing and operating an electronic health record-system for the first year in a five-physician primary-care practice averaged $46,659 per physician, a federally funded team of Texas researchers has concluded.

A write-up of their research, "The Financial and Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices” appears in the March issue of the policy journal Health Affairs.



Norway: Launch Of eHealth Blog

Date: 3 Mar 2011 - 11:41

Source: ePractice EU

A new blog site, Ehelsebloggen, has been created to support debate in Norwegian on the digitisation of healthcare, it was announced on 11 February 2011.

Ehelsebloggen (eHealth blog, in English) will feature different sides of the debates, links to other media and interesting articles, and the opportunity to comment on them.

Nard Schreurs, editor of the IT health magazine which is supporting the project, said: "I think there was a need for another channel of information and a forum for discussion. The blog is intended for anyone interested in health and technology, whether at local, national or international level."



New research finds OSS for health IT may be more secure than other systems

Published on March 8, 2011 at 7:17 AM

Globally the sale of health care information systems is a multibillion dollar industry. The vast costs, frequent failed systems, and inability of systems to talk to each other regularly attract media comment. However policy makers still shy away from a class of software, Open Source, that could address many of these problems, because of worries about the safety and security of Open Source systems. Now new research by the University of Warwick's Institute for Digital Healthcare, and the Centre for Health Informatics and Multiprofessional Education at UCL Medical School, finds that Open Source software may actually be more secure than its often more expensive alternatives.



Could some Meaningful Use objectives be too aggressive?

March 10, 2011 — 1:33pm ET | By Janice Simmons - Contributing Editor

As we examined in last week's commentary, many provider and healthcare industry groups had a lot to say about what they would like to see in Stages 2 and 3 of achieving Meaningful Use for electronic health records (EHRs).

This week, a new perspective is offered by the Certification Commission for Health Information Technology (CCHIT) on what maybe should be held back for the current time. CCHIT, a federally authorized health IT testing and certification body, conducted a survey, which sought to find out current opinions on Meaningful Use objectives and measures--incorporating both clinical workflow perspectives and perceived technological challenges.

According to a post by CCHIT Chair Karen Bell, MD, they received an earful from the survey's 468 responders that included providers (36 percent), electronic health record (EHR) vendors (29 percent), and others (29 percent).

Of the nine proposed Stage 2 Meaningful Use core measures that are enhancements of Stage 1 objectives and measures for successful EHR use, all nine were considered "too aggressive" by at least one-third of the survey participants. Several measures were even considered too aggressive by most of the survey respondents.



Robots handling Rx orders at UCSF

By Rebecca Vesely

Posted: March 10, 2011 - 12:00 pm ET

Robots are filling prescriptions in San Francisco. UCSF Medical Center has opened a $15 million robotic pharmacy.

Located in a secure, sterile environment at the UCSF Mission Bay campus, the automated system prepares oral and injectable drugs for patients throughout the hospital system. The goal is to improve patient safety and cut down on human error. No errors occurred in the 350,000 doses of medications prepared during the pharmacy's phase-in period, according to hospital officials.



Thursday, March 10, 2011

Physician Quality Reporting -- the Hidden Requirements of Meaningful Use

The American Recovery and Reinvestment Act of 2009 includes incentive payments for hospitals and eligible professionals (EPs) who are able to demonstrate meaningful use of certified electronic health record technology.

Many of the Stage 1 meaningful use requirements address data capture. For EPs, the core requirements include not just prescription writing, but also problem lists, allergies, smoking status and vital signs. Quality reporting is another one of the core requirements. EPs must also meet five additional requirements selected from a menu of 10 options.

Most of the Stage 1 quality measures are familiar, having previously been incorporated into the CMS Physician Quality Reporting Initiative. A typical health system or medical group likely will have individual EPs reporting on all of the six possible core measures and many of the selectable measures because of the nature of the practices.



Survey shows how hospitals’ IT uses compare to patients'

March 07, 2011 | Molly Merrill, Associate Editor

ROUND ROCK, TX – Hospital executives and patients agree that healthcare needs a revamp, and they're looking to information technology to make that happen, according to a recent survey. But when it comes to their technology desires and concerns there are some differences.

The survey was conducted by Dell in the fall of 2010, polling 150 hospital executives and 309 hospital patients on issues facing the healthcare industry.



March 8, 2011, 7:00 am

A Team Approach to Patient Care Falters


For many doctors and health care experts, the future of medicine lies in transforming primary care practices into something else entirely: centers where every patient’s care is team-based, preventive and comprehensive.

But a new study published this month found that converting traditional practices into the newer model — patient-centered medical homes — creates a host of challenges. Some are logistical, like putting in place the extensive technology needed to make the centers effective. Other problems are more intangible, like trying to require doctors and other medical staff to give up their old roles of treating individual patients in private, one-on-one encounters and instead working within more collaborative teams.

The new study, published in the current issue of the journal Health Affairs, based its findings on data from the National Demonstration Project, the first large-scale experiment with patient-centered medical homes. As part of the project, 36 family practices across the country were recruited and turned into patient-centered practices.

To do this, the practices installed electronic record-keeping and expanded patient access with longer hours and open scheduling. They also began incorporating preventive care, rather than treating just single episodes of illness, into a broader approach. And patients were no longer treated by just one doctor, but by teams of nurses, doctors and assistants who worked together.



How Mobile Apps Improve Quality of Care

Cheryl Clark, for HealthLeaders Media , March 4, 2011

A subtle but significant sign that mobile apps to improve quality of care have come of age appeared when Apple launched its “iPad is Amazing” TV commercial in the fall of 2010.

For just a second, obstetrics doctors and nurses would recognize the streaming waves undulating across the tablet as those from a fetal heart rate monitor at a patient’s bedside.

With this app, AirStrip Remote Patient Monitoring, providers can view these waves from wherever they happen to be—while treating another patient or attending a soccer game. With mobile access on the iPad or iPhone, or any mobile device, they can see trouble as it starts, both historic and in real time.

The developer, AirStrip Technologies, decided to classify the software as a medical device, similar to a pacemaker, hearing implant, or imaging test. In so doing, it subjected the technology to review for safety and efficacy by the U.S. Food and Drug Administration.The company decided that its software did not just send information from one source to another, like calling up the Stedman’s Medical Dictionary online.



Study: Promise of PHRs Still Elusive

HDM Breaking News, March 7, 2011

A new study of the personal health records software market finds that the promises of the technology remain a long way off, despite some large delivery systems adopting PHRs and the federal government encouraging their use.

"Unfortunately, despite the renewed buzz and some well-publicized initiatives, the reality is that we are still no closer to a true personal health record than we were five or 10 years ago," according to the report from information technology services/advisory firm Computer Sciences Corp., Falls Church, Va. "Fundamental barriers still exist, and without major changes in behavior and dramatic increases in adoption of technology, a true PHR--and the benefits associated with it--will not be possible."



'Physician champions' help other docs with EHR adoption

By Mary Mosquera

Friday, March 04, 2011

The Office of the National Coordinator for Health IT, through its regional extension centers, has started recruiting “physician champions” who are well on their way to becoming meaningful users of electronic health records (EHRs) to help others in their area get over the hurdles of digitizing their medical records.

Meaningful Use Vanguard (MUV) participants work with their area extension center to assist providers who are struggling to deploy EHRs and become meaningful users, so they can qualify for incentive payments from the Centers for Medicare and Medicaid Services.



The Connected Patient: Charting the Vital Signs of Remote Health Monitoring

Jane Sarasohn-Kahn, THINK-Health

The Connected Patient: Charting the Vital Signs of Remote Health Monitoring (1.16Mb)

February 2011

Remote health monitoring technologies — devices that gather a patient’s health data and relay it to a care provider — have been the subject of much study in recent years. Proponents have lauded their potential to reduce health care costs and improve patients’ quality of life, while skeptics pointed to the lack of persuasive clinical evidence supporting such claims. Meanwhile, technology vendors have begun testing the waters, launching both pilot projects and products into what they hope will prove to be a robust market.



Big-Bang EHR: The Right Choice

Becky Quammen

Health Data Management Blogs, March 2, 2011

While conventional wisdom typically says to bet on the tortoise, I’m putting my money on the hare when it comes to electronic health records implementations. Slow and steady simply doesn’t work in this race.

First off, there are those American Recovery and Reinvestment Act deadlines. With the pressure to not only implement but to prove the meaningful use of electronic records technology only months away, there’s simply no time for the long, drawn out, phased-in implementation.

But even without the added meaningful use pressure, I still advocate strongly for big-bang implementations over phased-in approaches. Why? When it comes to information technology in the clinical care setting, I’ve learned that a phased-in approach simply doesn’t work.



Most docs eligible for EHR money: study

By Joseph Conn

Posted: March 8, 2011 - 12:00 pm ET

About 76% of office-based physicians could qualify for federal incentives for purchasing an electronic health-record system under the Medicare provisions of the American Recovery and Reinvestment Act, according to research (subscription required) published in the March issue of the policy journal Health Affairs.

In addition, about 15% of office-based physicians could qualify for potentially higher EHR payments under federally subsidized state Medicaid incentive programs.

Medicare offers physicians as much as $44,000 in EHR incentives over five years.

Medicaid payments max out at $63,750 over six years, although pediatricians who don't have a high enough proportion of Medicaid payments to be able to qualify for top pay may still be able to receive as much as $42,500 in Medicaid incentives over six years.



PR for EHRs: More to the Story Than Data Breaches

Gienna Shaw, for HealthLeaders Media , March 8, 2011

An annual study by the internet security firm White Hat Security found that the average website had 230 "serious vulnerabilities"—those that could lead to breach or data loss—in 2010. The good news is that healthcare websites were among the most secure, with an average of 35 serious vulnerabilities in 2010, edging out even banking and financial services sites.

The bad news? It doesn't matter how many or how few times a healthcare organization's data is breached or even if it is only potentially breached. In the healthcare industry, it takes just one event—a lost laptop, a misfired e-mail, or a website that leaks sensitive, user-specific data—to make headlines.

Healthcare leaders are rightly concerned about it. In the 2011 HealthLeaders Media annual industry survey, we asked technology leaders to rank their top three concerns about electronic medical records and/or patient portals: privacy and security was the number one ranked choice.



HISPs evolve to facilitate Direct messaging with low government interference

March 6, 2011 — 6:17pm ET | By Ken Terry

The advent of the Direct Project protocol for secure clinical messaging already has spawned a new type of connectivity service and a new acronym: HISP, which stands for health information service provider. HISPs are necessary because health information exchanges (HIEs) still are not well-developed, yet physicians must exchange data to show they're meaningful users of EHRs. That need was the catalyst for the Direct Project, although physicians who don't have EHRs also can use the protocol.

At the recent HIMSS conference in Orlando, Fla., potential HISP vendors were much in evidence. They ranged from EHR companies such as Allscripts, which debuted a "referral network" for its users; to e-prescribing vendor Surescripts, which recently launched a new clinical messaging network; to established connectivity vendors such as RelayHealth, Axolotl, Medicity, and Kryptiq (Surescripts' partner). The Office of the National Coordinator of Health IT (ONC) also is working with several HIEs that want to use Direct messaging.


Majority Of Patients Want Online Access To Doctors

Nearly three-quarters of people want to be able to get lab results, request appointments, pay medical bills, and communicate with their doctor's office through secure portals, finds Intuit Health study.

By Nicole Lewis, InformationWeek

March 4, 2011

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=229300352

As a growing number of Americans use the Internet to perform a variety of health-related tasks, a new study shows that nearly three-quarters of those polled say they want the convenience of having an online connection to their doctor's office.

These findings come from Intuit Health's second-annual Health Care Check-Up Survey, which found that 73% of Americans surveyed would use a secure online communication solution to make it easier to get lab results, request appointments, pay medical bills, and communicate with their doctor's office.

Doctors should take note of these trends, particularly since a connected office may determine the number of patients they attend to. The survey also found that almost half of respondents would consider switching doctors to a practice that offered the ability to communicate and complete important healthcare tasks online.

The survey, which was conducted in January by Decipher Research for Intuit Health, polled 1,000 American adults online. The survey confirmed what other studies have shown, that Americans are increasingly turning to the Internet to help them manage various aspects of their healthcare.



Global market for telehealth tech on upswing

March 04, 2011 | Bernie Monegain, Editor

MOUNTAIN VIEW, CA – Remote patient monitoring, or telehealth, has taken huge strides forward, with demand for this technology on the rise – especially among home-care agencies, disease management companies and clinical trial groups, according to a new report from market research firm Frost & Sullivan.

The advent of low-energy Bluetooth, near-field communication (NFC), secure data management and wireless sensor platforms together are driving a change in how healthcare is delivered – from a hospital-centric to a patient-centric approach, the report notes. Participation from market giants, such as GE, Google, HP, IBM, Intel, Microsoft, Philips, Qualcomm, Siemens and Wal-Mart, has enabled development of remote monitoring products that effectively interface IT and life science technologies.

Frost & Sullivan’s analysis, Remote Patient Monitoring Technologies – A Strategic Assessment, finds that with the escalating need to manage chronic diseases such as diabetes, chronic obstructive pulmonary disorder (COPD), asthma, liver diseases and congestive heart failure, especially in the elderly population, the demand for wireless monitoring has increased significantly over the past few years.



3.3.11 | Dr. John D. Halamka

Emerging Health IT trends to watch

I’m keynoting this year’s Intersystems Global Conference on the topic of “Freeing the Data” from the transactional systems we use today such as Enterprise Resource Planning (ERP), Customer Relationship Management (CRM), Electronic Health Records (EHR), etc. As I’ve prepared my speech, I’ve given a lot of thought to the evolving data needs we have in our enterprises.

In healthcare and in many other industries, it’s increasingly common for users to ask IT for tools and resources to look beyond the data we enter during the course of our daily work. For one patient, I know the diagnosis, but what treatments were given to the last 1000 similar patients. I know the sales today, but how do they vary over the week, the month, and the year? Can I predict future resource needs before they happen?

In the past, such analysis typically relied on structured data, exported from transactional systems into data marts using Extract/Transform/Load (ETL) utilities, followed by analysis with Online Analytical Processing (OLAP) or Business Intelligence (BI) tools.

In a world filled with highly scalable web search engines, increasingly capable natural language processing technologies, and practical examples of artificial intelligence/pattern recognition (think of IBM’s Jeopardy-savvy Watson as a sophisticated data mining tool), there are novel approaches to freeing the data that go beyond a single database with pre-defined hypercube rollups. Here are my top 10 trends to watch as we increasingly free data from transactional systems.



Groupon, similar sites target medical services for deals

Technically Speaking. By Pamela Lewis Dolan, amednews staff. Posted March 7, 2011.

Sean Doherty, MD, a plastic surgeon at Boston Plastic Surgery Associates, said his group wanted to attract new patients by introducing them to easy-to-perform procedures and treatments. So it did what a lot of restaurants, shops and vacation destinations have done: It offered a deal through the online site Groupon.

Chicago-based Groupon was the first in a growing number of Internet companies offering daily deals designed to be "too good to pass up" for people looking to try a new product, restaurant, hobby or vacation destination. In recent months, the growing list of services has included medical and health procedures.

Here's the way it works: A company offers a deal -- generally at least 50% off -- on the Groupon site, but only if a predetermined number of people agree to buy the service. Numerous online sites -- Living Social, Daily Dibs and Zulily, among the largest -- offer similar "daily deals" by e-mail or a website link. Many sites offer geographically targeted deals or personalize deals based on a customer's profile.

Buyers of the Boston Plastic Surgery Associates deal could get laser hair removal, skin-rejuvenation treatments or 50 units of Dysport, an injectable wrinkle remover. The best deal was laser hair removal for $129, regularly priced at $800.



Monday, March 07, 2011

Keeping California in Front of the Telehealth Curve

For a couple decades, California has been a leader in exploring ways to use telecommunication technology in health care. In 1996, the California Legislature passed the Telemedicine Development Act to lay policy groundwork for developing technology. The law has been updated a few times in an effort to keep up with new tools and new ways of doing things.

The time has come not only for more updates -- including changing terms like "telemedicine" to the more broadly interpreted "telehealth" -- but also for removing barriers in the health care system so telehealth can flourish, according to a new report from the Center for Connected Health Policy.

The report, titled "Advancing California's Leadership in Telehealth Policy: A Telehealth Model Statute & Other Policy Recommendations," is directed at legislators and policymakers. Although it's aimed at creating a welcoming policy environment for telehealth in California specifically, officials at the Center for Connected Health Policy hope other states follow similar paths.





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