Weekly Overseas Health IT Links - 21st September, 2013.

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Managing prescription drugs

The quarter-of-a-trillion-dollar question

Sep 12th 2013, 8:40 by G.F. | SEATTLE
IN JULY Babbage, a 40-odd male, got a drug-coated stent in his left anterior descending artery. He unexpectedly found himself in need of the procedure, probably owing to radiation therapy to his chest 15 years ago. It had been administered as a prophylactic against the recurrence of Hodgkin's lymphoma (itself treated with chemotherapy) but a growing body of research suggests that can lead to early-onset coronary ailments. At a recent cardiac rehabilitation session he sat patiently and took notes as a nurse described the purpose and benefits of five major categories of medicine prescribed to patients with heart disease after an intervention. 
Your correspondent needed one of each: an angiotension-converting enzyme (ACE) inhibitor that widens blood vessels and thus lowers blood pressure; a beta blocker to regulate the heart's action and let it work at a lighter pace; aspirin, to thin blood and reduce the potential re-occurrence of clots; a platelet inhibitor to prevent the stent from being coated with sticky cells; and an increased dose of an anti-statin drug he already takes, used to reduce cholesterol level and thus mitigate formation of arterial plaque. He also takes three other medications routinely for more minor conditions. (Babbage has also modified his diet and now eats plenty of kale too.)

How big data is changing the role of HIM professionals

September 13, 2013 | By Ashley Gold
The challenge of big data is to harness it, understand it and use it to cut costs, create more predictive healthcare and improve outcomes. To that end, providers are realizing the need for more sophisticated IT systems that allow healthcare information management professionals to meet the challenge in various new roles, according to an article published this month in the American Health Information Management Association's Journal of AHIMA. 
For example, according to the article, Rayan McMackin, a senior data analyst for New Ulm (Minn.) Medical Center, part of Allina Health, has worn many different hats in her time with her company--and she wouldn't have it any other way.
McMackin moved roles as the need for data analysis grew. Starting as a file clerk, and then a coder, her current role calls for writing structured query language (SQL) queries, running scheduled and ad hoc reports, explaining the data and making suggestions for process improvement.

Inappropriate use of EHR default values harms patients

September 11, 2013 | By Marla Durben Hirsch
Using default values in electronic health records can boost efficiencies and standardization, but can cause adverse patient safety events when used improperly, according to a new advisory issued by the Pennsylvania Patient Safety Authority.
The Patient Safety Authority analyzed 324 adverse patient events related to the use of default values in EHRs and computerized physician order entry (CPOE). While 97 percent were events that caused no harm, four resulted in a harmful event, two of which required hospitalization. The most frequently reported event type was medication errors, including wrong time, extra dose, dose omission and wrong dose/overdose.

VA researching natural language processing in EHRs to prevent suicide

September 12, 2013 | By Ashley Gold
The U.S. Department of Veterans affairs is researching the use of natural language processing within its electronic health records system to automate suicide risk alerts.
According to an announcement from the VA, natural language processing is "part of the technology that makes Google work," and ongoing research at the VA Puget Sound Health System and the University of Washington is seeking to learn how the VA can use it.
VA research has found that past suicide attempts are the most compelling sign of future risk--even stronger than major depression; their studies show that a past suicide attempt raises the odds of going through with suicide by 40 times.

Medical identity theft hits growth phase

Posted on Sep 12, 2013
By Erin McCann, Associate Editor
Medical identity theft is on the rise and hasn’t shown signs of slowing down anytime soon, according to a new report released Thursday.
Conducted by privacy and security research firm Ponemon Institute, the report underscores the serious nature of medical identity theft, which has seen a nearly 20 percent uptick in the number of victims just from last year alone.
Some 1.84 million people in the U.S. are currently affected by medical identity theft, with these victims handing over more than $12 billion in out-of-pocket costs and paying, on average, $18,660 per individual, according to survey findings.

There's a healthcare piece to new iPhone

Posted on Sep 12, 2013
By Eric Wicklund, Editor, mHealthNews
Lost in all the ho-hum reviews of the new iPhone 5S this week is an addition that could boost its value as an mHealth device.
The new version of the iPhone includes a M7 "motion coprocessor," a second processor that gathers data from the phone's sensors. Drawing data from the compass, GPS, gyroscope and accelerometer, the phone works with a new 64-bit A7 CPU to track a user's movements and activity, determining when a user is walking, running, stationary or driving, even when the phone's not in use.

Healthcare cloud changing 'with a vengeance'

By Tom Sullivan, Editor
Even though healthcare is often perceived as being behind other major industries in cloud computing, that is changing and doing so perhaps even faster than previously thought.
“We were really surprised with these research results showing that 60 percent of the C-suite rates the need for cloud computing on a 4 or a 5 of a five-point scale,” said John Haughton, MD, CMIO of Covisint, a vendor that provides what it calls a cloud engagement platform. “It’s no longer, ‘Do I have to go to the cloud?’ Now we’re at a majority saying, ‘I really need to engage.’ And we didn’t expect that to happen so quickly.”
The research Haughton referenced is a study shared exclusively with Government Health IT prior to its publication that Covisint sponsored and Porter Research conducted.
The report, "Healthcare Industry Reaches Tipping Point: CIOs Now Demand the Cloud for Shared Savings and Interoperability," found that one-third of EHRs lack critical population health management functionality including reporting capabilities, despite the demand for integrated workflow isolated processes are rampant and shared savings programs, ACOs included, are all driving healthcare organizations to consider cloud-based solutions across the spectrum of technologies.

Getting More Health Out of Health IT

by Jane Sarasohn-Kahn Thursday, September 12, 2013
How can we get more health out of health IT? Getting more patients involved in their own health will help maximize providers' investments in health IT. Let's call this ROH (return on health).
Notwithstanding roughly 100,000 mobile health applications available in mobile phone stores, several dozen activity-tracking devices unveiled at the 2013 Consumer Electronics Show and the availability of patient portals built into the top-selling electronic health record systems in the nation, it's hard to find the health return on investment in health IT in America.

Decision Tool Cuts ED Pneumonia Deaths

Published: Sep 11, 2013 | Updated: Sep 12, 2013
By Ed Susman , Contributing Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
BARCELONA -- Use of an electronic decision tool that suggests treatment algorithms improved emergency department triage and significantly reduced in-patient pneumonia mortality, researchers said here.
In-patient mortality decreased from 5.7% in 2010 -- before use of the electronic tool -- to 3.5% in 2012, a relative reduction in mortality of 25% (P=0.02) after adjusting the data to account for severity of illness, reported Barbara Jones, MD, a fellow in pulmonary and critical care medicine at the University of Utah, Salt Lake City.

EHR software recalled after big glitch

Posted on Sep 11, 2013
By Erin McCann, Associate Editor
UnitedHealth Group has voluntarily recalled its OptumInsight emergency department electronic health record software after a glitch resulted in physician notes failing to appear in the records.   
Customers of OptumInsight’s Picis ED PulseCheck were notified of the issue, which is associated with prescription notes not showing up on the prescription or patient chart, back in June. The recall is affecting providers across 22 states.
Wakefield, Mass.-based Picis Inc., which was acquired by UnitedHealth Group in 2010, has already reported six EHR software related recalls since 2009, according to a Bloomberg report

ONC tackles patient matching problem

Posted on Sep 11, 2013
By Mike Miliard, Managing Editor
In a bid to smooth data exchange between disparate technology systems, the Office of the National Coordinator for Health IT has launched a collaborative project to seek out common denominators and best practices being used for patient matching by private healthcare systems and other federal agencies.
By identifying and recommending standardization of the attributes most commonly used for matching, the project aims to improve patient safety, care coordination and efficiency, wrote Lee Stevens, policy director for ONC's State HIE Program.
Stevens said the initiative will focus on two objectives related to patient matching.
First, it seeks to define common attributes that achieve high positive match rates across disparate systems. "These attributes may include common fields such as name, date of birth, address, sex, cell phone number and new criteria such as emergency contact and insurer," he wrote.

HIE shares lessons on Direct communication efforts

September 11, 2013 | By Susan D. Hall
Much work remains to be done by states in using Direct technology for interstate health information exchange, but a pilot between California and Oregon healthcare providers shows that it can be done.
That's part of the takeaway in a report from the Western States Consortium (WSC) project, 13 states that collaborated on ways to break down technical and policy barriers to interstate exchange.
California and Oregon are exchanging data following the pilot, which focused on two scenarios, according to a Health IT Buzz post.

WebMD launches new iPhone app for personalized health information

PBR Staff Writer Published 10 September 2013
US-based pharmaceutical and healthcare firm WebMD Health has introduced a new version of its iPhone application, which offers a personalized and an engaging multimedia lifestyle content.
The new app offers health information ranging from recipes and dieting tips to advice on sex and relationships, delivered in 'snackable' quantities, in addition to physician-reviewed health content and interactive tools.

Phys. Referrals Leading Patients to Search for Health Information Online

September 10, 2013
Patients are educating themselves online, spending 52 hours annually looking for health information on the web and some of this comes from physician influence, reveals a recent survey.
The results of the survey, conducted by New York-based companies, Makovsky Health and Kelton, found that 51 percent Americans are likely to visit a pharma-sponsored website after receiving a diagnosis from their physician. Forty-two percent of the approximately 1,000 people surveyed said they had gone to a pharma website after being referred by a physician. Overall, the survey looked at how U.S. consumers are using the web to research health information.
Other findings from the survey were that WebMD was the most frequented online source for healthcare information (53 percent), nearly one-fourth of consumers use social media to seek healthcare information, and most Americans use a personal computer for health searches – not a tablet or smartphone.

Electronic health records linked to improved care for patients with diabetes

The use of electronic health records in clinical settings was associated with a decrease in emergency room visits and hospitalizations for patients with diabetes, according to a study published today in the Journal of the American Medical Association.
Researchers examined the medical records of 169,711 diabetic patients over 1 year of age in the Kaiser Permanente diabetes clinical registry before and after the implementation of Kaiser Permanente HealthConnect, the organization's comprehensive EHR system. They found that patients visited the emergency room 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after the implementation.
"Using the electronic health record in the outpatient setting improved the quality of care in ways that cumulatively resulted in fewer negative events," said Mary Reed, DrPH, staff scientist with the Kaiser Permanente Division of Research in Oakland, Calif., and the study's lead author. "A reduction in the number of emergency department visits represents not just improvements in diabetes care, but the cumulative effect of the EHR across many different care pathways and conditions."

IT, other doc expenses jump

Posted on Sep 10, 2013
By Bernie Monegain, Editor
Medical practices' annual expenditures per full-time-equivalent physician for information technology costs have climbed 27.8 percent, from a median of $15,211 in 2008 to a reported $19,439 in 2012, according to the MGMA Cost Survey Report: 2013 Report Based on 2012 Data.
"Implementing and optimizing information technology is a significant investment for physician practices," said Derek Kosiorek, principal, MGMA Health Care Consulting Group, in a news release. "Although an electronic health record can be costly, it’s admirable that physician practices are leveraging sophisticated tools that produce higher efficiencies and impact patient care."

What to do (and what not to do) when your $1B system-wide EHR fails

Posted on Sep 10, 2013
By Erin McCann, Associate Editor
The 24-hospital Sutter Health system in Northern California was the talk of the town late August after a software glitch rendered its $1 billion Epic electronic health record system inaccessible to nurses and clinical staff throughout all Sutter locations. 
On Aug. 26 at approximately 8 a.m., nurses, physicians and hospital staff had no access to patient information, including patient medications and all vital patient history data, according to reports from the California Nurses Association, part of National Nurses United, the largest nurses' union in the U.S. 
"Many of the families became concerned because they noticed the patients were not getting their medications throughout the day,” explained Mike Hill, RN at Sutter’s Alta Bates Summit Medical Center and CNA representative for the hospital. "Meds were not given for the entire day for many of the patients."

Big data plus mapping equals opportunities to improve care, cut costs

September 10, 2013 | By Susan D. Hall
Technology that not only aggregates a person's health data, but adds in publicly available information about where patients live, can help healthcare organizations achieve the Triple Aim of improving the care experience, improving care and cutting costs, according to an article at Health Affairs.
The Health Affairs article describes the geographic health information system used at the Duke University Health System, which combines not only 16 years' worth of health data on patients--it's the predominant provider in its county--but birth and death records, U.S. census demographic data, county tax-parcel data, crime and housing statistics, environmental data and more.

Mayo Clinic's Remote Monitoring System Targets Critically Ill Patients

September 9, 2013
A new 24/7 remote monitoring system from the Mayo Clinic will improve care and shorten hospital stays for critically ill patients, according to Mayo officials in a recent announcement. The Enhanced Critical Care program will offer monitoring of the sickest patients at six Mayo Clinic Health System hospitals.
Patients will continue to receive care from the local care team, but physicians and nurses in an operations center in Rochester, Minn. will monitor patients' vital signs and other health data on a computerized system able to detect subtle changes in a patient's condition. High definition video cameras and computer screens will allow operations center staff to communicate with patients, their families, and the care team.

ONC's goals for MU stage 3 in 6 charts

By Anthony Brino, Associate Editor
The Office of the National Coordinator is already starting to design the third phase of meaningful use — with a dual focus on functionality and healthcare outcomes.
At ONC’s Health IT Policy Committee meeting this month — the last for outgoing national coordinator Farzad Mostashari, MD — the Meaningful Use Workgroup, chaired by the Palo Alto Medical Foundation’s Paul Tang, MD, presented a few priorities that have emerged from recent discussions.
The intent the workgroup set is “translating desired health outcomes into meaningful use functionality,” or connecting through goals.

Medicare Fraud is Ripe for a Tech Solution, But It's Complicated

Scott Mace, for HealthLeaders Media , September 10, 2013

If CMS could be sued for HIPAA violations, it would be. But behind tales of government inefficiency and inertia is a tremendous debate. Summed up, the very technology that could solve our identity and fraud problems could open up tremendous privacy concerns.

Depending on who you talk to, Medicare fraud is estimated to be a $48- to $120-billion-a-year problem in the United States. Yet, for all the technology this country cranks out, surprisingly little so far has been applied to combating this problem. Could it take another act of Congress?
On August 15, Rep. Jim Gerlach, a Republican from Pennsylvania, introduced H.R. 3024, the Medicare Common Access Card Act of 2013.
Under the proposal, within 18 months of passage, the HHS secretary would conduct a pilot program utilizing smart card technology for Medicare beneficiaries.

Will Regulation Lead the Way to Safer Health Care?

SEP 1, 2013
For Richard Cook, M.D., the question of whether the U.S. Food and Drug Administration should regulate health information technology systems is a no-brainer.
Cook served as a member of the Institute of Medicine committee that issued a report on HIT safety in November 2011. The report was reluctant to embrace FDA regulation, but Cook issued a blistering dissent on that position.
HIT systems are clearly medical devices, asserted Cook, who at the time was director of the Cognitive Technologies Laboratory at the University of Chicago and is now a professor of health care system safety at the Royal Institute of Technology in Sweden. "Electronic medical records, digital imaging, provider order entry and test results delivery do not 'have an effect' on core medical functions, they are core medical functions," he wrote. These components, he added, "participate directly in diagnosis, cure, mitigation, treatment and prevention of specified individual human beings. Health I.T. is a medical device and FDA is or should be its regulatory body."

RIS replacements: hard to do, easy to get wrong

Some trusts that have chosen to implement new radiology information systems on exiting their National PACS Programme contracts have reported problems. Imaging informatics editor Kim Thomas asks why implementing a RIS is so challenging.
27 August 2013
Earlier this summer, reports that patients in Kent and Medway were experiencing delays in getting scan appointments and results hit the headlines.
The delays were blamed by hospital trusts on a new radiology information system from GE Healthcare, implemented in June.
Annette Schreiner, the medical director of Dartford and Gravesham NHS Trust, which was one of four in a consortium formed to buy a new picture archiving and communication system and RIS ahead of the end of their National PACS Programme contract, told EHI the RIS element had not gone well.
“A planned downtime of three days extended to 17 days. During that time, the department had to resort to paper-based systems” she said, adding that it had proved difficult to catch up because the system was slow.

National PACS Programme broke even

4 September 2013   Kim Thomas, editor EHI Imaging Informatics
The programme to deliver picture and archiving communications systems to hospitals in England has saved almost as much money as it cost, according to figures released by the National Audit Office under the Freedom of Information Act.
By the end of March 2011, eight years after the National Programme for IT began rolling out PACS systems in England, the programme had cost £855.2m in 2004-5 prices.
The benefits over the same period amounted to £711.4m – £144m less than the costs. Using real prices, rather than 2004-5 prices, the total benefits came to £814.8m.
The programme’s biggest cost was its local service provider contracts, amounting to £674.8m.

Helping Patients Stay Engaged in their Own Care

Will electronic record keeping make patients more willing to take part in keeping themselves healthy?

September 6, 2013
Will health care workers be able to persuade patients to log in and check their own medical records?
Doctors for years have struggled to get people to change unhealthy behaviors and to care about their own health. Yet people continue to smoke, eat poorly, neglect to fill prescriptions and avoid preventive care.
Various health care reform initiatives, including the imperative for accountable care under the Patient Protection and Affordable Care Act – commonly known as Obamacare – as well as the shift from paper to electronic record-keeping, might not get people to ditch their bad habits, but these changes are forcing providers to get creative, lest they get hit where it hurts the most: in the pocketbook.
Notably, the $27 billion federal incentive program for "meaningful use" of electronic health records (EHRs) moves into its second of three phases as soon as Oct. 1 for some hospitals.

Massive breach spawns class-action lawsuit against Advocate Medical Group

September 9, 2013 | By Susan D. Hall
On top of federal and state investigations into its data breach, Advocate Medical Group in Downers Grove, Ill, faces a class-action lawsuit from affected patients.
The lawsuit claims the Chicago area's largest physician group violated privacy regulations by failing to use encryption and other security practices, according to the Chicago Tribune.
Personal information for more than 4 million patients was compromised in the July theft of four computers. It's the second-largest loss of unsecured health information reported to the Department of Health and Human Services since the agency made notification mandatory in 2009.

FDA Reaches Into Smartphone Market With App Regulations: Health

September 06, 2013
It sounded like a good idea at the time: A smartphone application that tapped into a growing consumer desire to self-diagnose health ailments at home.
Biosense Technologies Private Ltd. made a splash in February when it unveiled a kit that lets people use their phone cameras to read subtle color differences on test strips designed to show unhealthy levels of proteins and other substances in their urine. What the creators didn’t anticipate was the need for U.S. government approval.
Now Biosense is adjusting to a new reality. After receiving a letter from the Food and Drug Administration questioning the company’s lack of regulatory clearance, Biosense has stopped selling its kit in the U.S. and now plans to seek approval. The letter offered a glimpse into a new push by the FDA to set boundaries in how apps are used for medical care.

Global mobile health market set to hit $20.7 billion by 2018, report finds

Free apps currently represent 90% of download total
September 5, 2013 | By Alaric DeArment
DALLAS — The global market for mobile health apps and other products is expected to reach a value of nearly $21 billion in five years, according to a new report.
Market research firm MarketsandMarkets announced Thursday the release of the report, which analyzed the market for mobile health through 2018 in North America, Europe, Asia and elsewhere, forecasting that it would be worth about $20.7 billion by then. The market is currently valued at about $6.3 billion.
Currently, connected devices dominate the market, contributing about 85% of total revenue, with cardiac monitoring and fitness tracking ranked as the most prominent uses of mobile-enabled connected devices.

Physicians Divided on Cloud-Based EHRs

by Ken Terry, iHealthBeat Contributing Reporter
Monday, September 9, 2013
The use of cloud-based electronic health records is spreading, especially among small physician practices, observers say. But the strength of this trend varies by region, and many doctors' distrust of cloud services still impedes their use of this technology.
In New Jersey, for example, most regional extension center members in practices of three or fewer doctors -- who form about 60% of the REC's nearly 8,000 enrollees -- have chosen cloud-based EHRs. But in Kentucky, only 17% of the physicians enrolled in the state's REC who have gone live on EHRs are using cloud-based solutions or traditional EHRs hosted remotely by hospitals.
Ninety percent of Kentucky REC members have access to high-speed Internet, according to Carol Steltenkamp, the organization's director. So, while some areas of the state remain off the grid, that's not what deters most physicians from going to the cloud.

This Doctor Will Save You Money

Eric Topol is on a mission to get health care out of the mess it’s in.
I visited cardiologist Eric Topol at the Scripps Green Hospital in La Jolla, California, one day this summer. He’d had a busy morning seeing patients and, by about noon, was claiming to have already saved the medical system thousands of dollars using his iPhone and a pocket-sized ultrasound machine. Then he pointed to the stethoscope in his pocket and said he hasn’t used it in three years. “I should just throw it out,” he said. “This is basically a worthless icon of medicine.”
Topol is perhaps the most prominent advocate in the U.S. of how digital technology can lead to less expensive health care, and he invited me to see the savings in action. As we lope toward the exam room, Topol, slightly hunched and repeatedly turning to deal with questions flying at him from his staff, seems a little rattled by the commotion and barrage of demands, but a calm sets in the moment he enters the exam room. He folds his arms across his chest as a young colleague updates him on the patient’s history. Topol introduces himself to the 85-year-old man, who has been tiring easily as of late, and then the doctor immediately pulls out his iPhone.

How UPMC Plays To Win In Healthcare IT

UPMC, the No. 1 company in the IW 500 ranking, expects tech to improve patient heath, cut operating costs and also be a revenue source.
Information technology has two broad roles at UPMC. First, it must improve the operations of the company's hospitals and health insurance plan, improve the care of patients, and drive down the company's costs. Second, technology should make money for UPMC -- it's not just a cost center.
At most companies, that second goal is a nice-to-have if things work out that way. But under the leadership of CIO Dan Drawbaugh, UPMC is explicit that its IT organization will develop unique technologies that it can sell to other healthcare providers and insurers.
A clear example of the two roles coming together occurred in March, when electronic health records vendor Allscripts acquired dbMotion, which makes software that helps healthcare providers share medical information across software platforms. UPMC was the largest shareholder in dbMotion; it bought a stake in the company in 2006 and then helped develop the software for its own and others' use. UPMC's take from the Allscripts acquisition: $67.8 million, on an original investment of $30.5 million.



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