Monday, July 28, 2014

Weekly Australian Health IT Links – 28th July, 2014.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. 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.

General Comment

Some interesting items this week - especially the apparent problems with the South Australian e-Health roll out - that until recently was seen as going pretty well. Given there has not been a change of Government in SA, who have driven the project for a good number of years, it seems there is really a problem. After the problems in Qld, Victoria and WA this is all getting a bit frustrating!
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Minister puts future of $422m SA eHealth system in doubt

EPAS still on hold.

South Australian Health Minister Jack Snelling has refused to commit to the continuation of the state’s $422 million electronic patient administration system (EPAS) rollout, which is currently on hold as the government works through funding and performance issues.
“We are having a look at it at the moment,” Snelling said, when challenged by opposition MP Duncan McFetridge to guarantee the rollout during an estimates hearing late last week.
“We have obviously put a pause on the rollout, which has partly been driven as a result of the federal cuts."
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Andrew Knight: e-Health revolution

Andrew Knight
Monday, 21 July, 2014
THE benefits of having an effective electronic health record seem obvious. Rapid sharing of information, reduction of duplication and greater ownership by patients of their health information offer hope of reduced harm and savings in time and money.
The review of the personally controlled electronic health record (PCEHR) commissioned late last year by the federal government certainly thinks so.
The reviewers point to modelling which suggests that e-health changes could lead to savings of $7 billion a year by 2020. The modelling estimates implementing e-health would avoid 5000 deaths, two million outpatient visits, 390 000 hospital admissions and 10 million laboratory and imaging tests by 2020.
The overwhelming majority of those making submissions to the review were also supportive. According to the review, more than 1.2 million Australians have demonstrated support by registering for an e-health record, exceeding the 2013 target.
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Campaign for single eHealth record, says Young

By Natasha Egan on July 23, 2014 in In-depth, Industry, Technology
AUDIO: Aged Care Industry Information Technology Council representative Rod Young has called on the sector to campaign for a single eHealth and aged care record at the council’s annual technology conference currently underway in Hobart.
Mr Young, Associate Professor Kate Swanton from Feros Care and Dr George Margelis took part in a panel discussion on the government’s eHealth record at the Information Technology in Aged Care (ITAC) conference on Tuesday.
All three speakers agreed that, when it began doing assessments in July 2015, the My Aged Care record would add another unnecessary layer to an already complex system.
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Providers get update on sector’s ‘ICT vision’

By Natasha Egan on July 25, 2014 in Industry, Technology
 AUDIO: Work is underway to achieve aged care’s ICT vision, the ITAC conference heard in Hobart this week, but the sector will remain vigilant on key issues including the client eHealth record.
Aged Care Industry IT Council (ACIITC) chair Suri Ramanathan gave a report on progress since the council, which is a joint initiative of Aged & Community Services Australia (ACSA) and Leading Age Services Australia (LASA), launched the IT roadmap in March.
Mr Ramanathan said fact sheets developed two years ago as part of the Pathfinder project to help providers roll out the eHealth record system would soon be available on ACIITC’s website.
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My eHealth Record

My eHealth Record is a way of securely storing and sharing important healthcare information with your consent, so that it is easily and quickly available when needed for your ongoing care. Click on a category below to find out more...

eHealthNT Happenings 

The new eHealthNT Happenings will be a regular publication, which over time will provide updates on all eHealth initiatives in the Northern Territory. The first issue (to be published soon) will provide information on the project to transition registered consumers and healthcare providers from the My eHealth Record service to the National eHealth Record System (also known as the personally controlled electronic health record or PCEHR system).
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Tasmania – tapping scripts into the PCEHR

Tasmania is set to become the first state to connect and upload information to the National Prescribe and Dispense Repository. The move comes after extensive development work, including the digitisation of discharge prescription summaries, along with outpatient prescribing.
“We’re doing things a little bit backwards,” says Tom Simpson, executive director, statewide hospital pharmacy in Tasmania. “We implemented the last thing first, and we’ll do what would traditionally have been the first thing towards the end.”
The backwards implementation was a positive move for Tasmanian hospitals, because it meant getting the doctors and other clinical staff on board. This might not have happened if the highly complex move to in-patient prescribing had been the first task out of the blocks.
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System issues being fixed (for providers)

This page lists current issues which may impact Healthcare Providers using the PCEHR system.
It includes what is being done to resolve the issue and ways you can work around them in the National Provider Portal and in clinical information systems.
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Need help? Select one of the following options if you have a question or require assistance with any of our products or services.

Help Centre

Any personal information you provide to NEHTA will be used by NEHTA to assist us with responding to your enquiry. If we cannot resolve your enquiry, we may need to pass your information on to the Department of Human Services or Department of Health.  If you do not wish your enquiry to be transferred to another entity, please let us know. 
For more information on the ways NEHTA handle your personal information, how you can access and seek correction of the information, how privacy complaints can be made and how NEHTA deals with such complaints, please see the NEHTA Privacy Policy.
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Technology One Assists Epworth Hospital

Epworth HealthCare has opened two new hospitals in Camberwell and Hawthorn with the help of TechnologyOne’s OneHealth Software.
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Healthdirect Australia looks through the 'software lens'

Summary: Healthdirect Australia has transformed its entire back-end architecture on the basis that software applications will play a crucial role in how it delivers clinical information to the public.
By Aimee Chanthadavong | July 22, 2014 -- 07:32 GMT (17:32 AEST)
Healthdirect Australia started out as an initiative set up by the Council of Australian Governments for procurement in 2006. But five years down the track as the world began to move online for advice, it forced Healthdirect to change its strategy from being a telephony based contact centre to a multichannel information service provider.
Speaking at the Gartner Application Architecture, Development and Integration Summit in Sydney on Tuesday, Bruce Haefele, Healthdirect Australia chief architect, said it was important for the organisation to move into offering digital services across all of its brands, including Pregnancy Birth and Baby, after hours GP helpline, mindhealthconnect, and National Health Services Directory.
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Question: NEHTA CDA & GP referrals

Posted on July 22, 2014 by Grahame Grieve
Question
Is there any example of NEHTA compliant CDA document that I can look at from a perspective of a GP referral form ( http://nhv.org.au/uploads/cms/files/VIC%20-%20GP%20Referral%20(March%202013).rtf )? Is there a tool that can be used to navigate and generate the CDA from a HL7 v2 message?
Answer
There’s been a lot of discussion over the last decade or so about creating a CDA document for these kind of referral forms. I saw a pretty near complete set of functional requirements at one point. But for various reasons, the project to build this has got any funding, either as a NEHTA project, or a standards Australia project (it’s actually been on the IT-14-6-6 project list for a number of years, mostly with my name on it).
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Robots fail to impress in surgery

  • Joseph Walker
  • The Wall Street Journal
  • July 24, 2014 9:49AM
A new study finds treating bladder cancer with a surgical robot made by Intuitive Surgical is no better at reducing procedural complications than performing the procedure with traditional surgery, a result that surprised researchers, who had expected the robotic technology to be superior to human hands alone.
The small study may cast further doubt on the benefits of Intuitive Surgical’s da Vinci robot, which allows surgeons to perform minimally invasive procedures from computer consoles that control the robot’s arms and surgical tools.
A study last year questioned the cost benefit of the da Vinci for hysterectomies, or uterus removal, compared with minimally invasive laparoscopic procedures done by hand.
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Robot enhances human dexterity

24 July, 2014 Rachel Worsley
Researchers have developed a robot that enhances the grasping motion of people with limited dexterity.
The robot, which is worn on the wrist, features two extra fingers worn around the one’s wrist and would that help the user achieve routine tasks that generally require two hands, such as removing a bottle cap or lifting a heavy object.
The Massachusetts Institute of Technology (MIT) researchers hope their work will lead to a model that can be scaled down an integrated with a watch or a bracelet.
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23 July 2014, 11.50pm AEST

Evidence based medicine is broken. Why we need data and technology to fix it

David Glance
A recent paper in the British Medical Journal suggests that evidence based medicine is in crisis. Evidence based medicine is based on the practice of employing treatments that have scientific research that backs up their effectiveness. It is usually set against medical practice that is based on anecdotal experience or simply doing things because that is the way they always have been done.

The ways evidence based medicine is broken

The authors of the paper point out however that there are a number of problems with evidence based medicine that together, significantly compromise its effectiveness. The first problem is that evidence based medicine plays right into the hands of companies and organisations with a vested interest in seeing a treatment recommended. Of particular concern are drugs that are recommended for treating pre-diseases. The classic example of this is the use of [statins]9http://en.wikipedia.org/wiki/Statin) to lower cholesterol in the attempt of reducing cardiovascular disease.
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Easy GPeasy - checks at the touch of a button

Jamie Morton is science reporter at the NZ Herald.
5:00 AM Monday Jul 21, 2014
Digital innovations expected to change face of system in next 20 years.
A future where a health check-up could take just a few taps of your smartphone has moved a step closer.
AUT University has launched its Centre for eHealth, bringing together researchers with health sector partners to share developments in innovation.
The centre will build on work by the Ministry of Health's IT Health Board, which has overseen a project that will give patients of nearly all GP practices access to their records through portals.
Dozens of researchers at AUT, including experts in IT, engineering, business, design and infomatics, will work together on projects using technology to improve the health system.
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General practitioners order more imaging in Australia

July 22, 2014 -- General practitioners (GPs) in Australia are placing more orders for medical imaging exams, with total orders for imaging growing 45% from 2005 to 2012, according to a survey released this week by researchers from the University of Sydney. The numbers also indicate a shift away from general radiography and toward more advanced modalities such as ultrasound, CT, and MRI.
The figures were released on July 22 as part of the Bettering the Evaluation and Care of Health (BEACH) program, a national study of clinical activity by general practitioners in Australia. The report compares imaging use over two time periods: from 2002 to 2005 and from 2009 to 2012. The BEACH data represent physician orders for imaging exams, as opposed to exams that were eventually performed and billed to the federal Medicare system.
In general, the report found that while Australian general practitioners mostly comply with appropriateness guidelines, there is some room for improvement in several areas. The lead author on the study was Helena Britt from the University of Sydney.
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National broadband network: Coalition spends $10m on cost-benefit analyses

THE Abbott Government has spent more than $10 million in taxpayers’ money to work out whether the national broadband network is good value.
As superfast broadband continues to be rolled out across the country, consultants have been the biggest winners, pocketing millions of dollars from numerous reviews and cost-benefit analyses.
A Question on Notice tabled in Federal Parliament revealed the external consulting cost for the NBN was $10.1 million. The cost of implementing the recommendations was not included.
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Six Clicks: The best Linux desktop environments

Summary: Unlike Windows or Mac OS X, Linux offers a wide variety of desktop environments. Here are my picks of the most important of these PC interfaces.
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Enjoy!
David.

Sunday, July 27, 2014

I Wonder Why It Is People Keep Pretending ‘eHealth’ Is An Unalloyed Good And The PCEHR Is Largely OK?

This appeared last week.

Andrew Knight: e-Health revolution

Andrew Knight
Monday, 21 July, 2014
THE benefits of having an effective electronic health record seem obvious. Rapid sharing of information, reduction of duplication and greater ownership by patients of their health information offer hope of reduced harm and savings in time and money.
The review of the personally controlled electronic health record (PCEHR) commissioned late last year by the federal government certainly thinks so.
The reviewers point to modelling which suggests that e-health changes could lead to savings of $7 billion a year by 2020. The modelling estimates implementing e-health would avoid 5000 deaths, two million outpatient visits, 390 000 hospital admissions and 10 million laboratory and imaging tests by 2020.
  
The overwhelming majority of those making submissions to the review were also supportive. According to the review, more than 1.2 million Australians have demonstrated support by registering for an e-health record, exceeding the 2013 target.
The new federal government has affirmed its commitment to e-health and continued funding to implement the recommendations of the review. One of the reviewers, GP and former AMA president Dr Steve Hambleton, has been appointed the new chair of the National E-Heath Transition Authority (NEHTA).
Those of us at the coalface of general practice know that the reality of implementation to date has had problems. Uptake by health professionals is well below targets and has plateaued.
The review points to “classic issues of change management” such as lack of strategic direction and clear policies, poor understanding of potential benefits, unengaged or unwilling stakeholders, and poor execution of e-health initiatives.
To be useful, My eHealth Record (as the PCEHR has been renamed) needs high-quality information from GP record systems. This means that investment in engaging, training and supporting general practice is crucial if we are to achieve the e-health dream.
How to achieve successful implementation and use was explored by the Improvement Foundation and 54 general practices through a NEHTA-commissioned Quality Improvement Collaborative. Small practice teams attended workshops separated by supported action periods.
More here:
Here is the abstract of the paper referred to:

The eCollaborative: using a quality improvement collaborative to implement the National eHealth Record System in Australian primary care practices

  1. Andrew W. Knight1,2,
  2. Craig Szucs3,
  3. Mia Dhillon2,
  4. Tony Lembke2 and
  5. Chris Mitchell3
  • Accepted April 8, 2014.

 Abstract

Quality problem The new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success.
Initial assessment New work was required in general practices participating in the national electronic health record. National implementers needed to engage with small private general practices to test the changes before general introduction.
Choice of solution The National E-health Transition Authority contracted the Improvement Foundation Australia to conduct a quality improvement collaborative based on 9 years of experience with the Australian Primary Care Collaborative Program.
Implementation Aims, measures and change ideas were addressed in a collaborative programme of workshops and supported activity periods. Data quality measures and numbers of health summaries uploaded were collected monthly. Challenges such as the delay in implementation of the electronic health summary were met.
Evaluation Fifty-six practices participated. Nine hundred and twenty-nine patients registered to participate, and 650 shared health summaries were uploaded. Five hundred and nineteen patient views occurred. Four hundred and twenty-one plan/do/study/act cycles were submitted by participating practices.
Lessons learned The collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.
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There are two key comments I want to make on all this.
First the first three or four paragraphs keep suggesting how wonderful ‘ehealth’ is and how it is obviously great but then we read:
 “Those of us at the coalface of general practice know that the reality of implementation to date has had problems. Uptake by health professionals is well below targets and has plateaued.
The review points to “classic issues of change management” such as lack of strategic direction and clear policies, poor understanding of potential benefits, unengaged or unwilling stakeholders, and poor execution of e-health initiatives.”
Hardly a ringing endorsement of how the PCEHR Program has been conducted!
Second, then we go to the details of the paper where there were 56 practices being supported to get the PCEHR working well and widely. Assuming each practice has a few thousand patients on their books we are talking about 650 shared summaries being uploaded from 1000 registered patients out of a pool of patients that certainly exceeded 100,000 over a six month operational period. In the last month amazingly only 20 records look to have been uploaded in the last month of the trial and the rate of usage was flattening on the graph.
Overall this all looks like a total flop!
Would have been good to have a little update on where things were just before the paper was published rather than reporting now on what was happening almost two years ago!
However, with all that said I do agree with the sentiments in the last two paragraphs in the article:
“History has taught us that important enablers include adequate financial support, local training and practice support and systems that have been properly designed and tested in the real world to be fit for purpose.
Failure to invest effectively in general practice will seriously delay e-health. We need an effective implementation plan which will properly resource and support general practice for success if Australians are to receive the benefits of the e-health revolution.”
Pity fixing the system fundamentally was not also mentioned!
David.

AusHealthIT Poll Number 228 – Results – 27th July, 2014.

Here are the results of the poll.

Do You Think Continuing Work On The PCEHR Can Lead To A System That Will Improve The Quality, Safety and Efficiency Of Healthcare? I.E. Is The PCEHR Fixable?

For Sure 20% (14)

Maybe 16% (11)

Neutral 6% (4)

Probably Not 17% (12)

No Way 40% (28)

I Have No Idea 1% (1)

Total votes: 70

A very good response and the view 57% to 36% that the PCEHR is not really fixable with very few undecided.

Time will tell who is right!

Again, many thanks to all those that voted!

David.

Saturday, July 26, 2014

Weekly Overseas Health IT Links - 26th July, 2014.

Note: Each link is followed by a title and few paragraphs. 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.
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Medical Errors Third Leading Cause of Death, Senators Told

Cheryl Clark, for HealthLeaders Media , July 18, 2014

At a Senate subcommittee hearing, hospital quality experts urge lawmakers to establish measures to halt preventable medical errors in hospitals, which kill as many as 400,000 people each year.

The Centers for Disease Control and Prevention's role in quality of care should be greatly expanded to reduce many more types of patient harm, several leading healthcare quality leaders told members of the Senate Subcommittee on Primary Health and Aging Thursday.
"There's no reason to think what [the CDC] has been able to do around [healthcare-associated infections] they can't do in other areas like venous thromboembolism and medication errors, and they can partner with the U.S. Food and Drug Administration," said Ashish Jha, MD, founder of the Initiative on Global Health quality at the Harvard School of Public Health.
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EHR Systems Falling Short in Improving Patient Safety

Greg Slabodkin
JUL 18, 2014 9:21am ET
Health information technology, such as electronic health records, has the potential to dramatically improve patient safety. Nevertheless, a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks.
“Most hospitals, even those with EHR systems, do not know their own rates of adverse events,” testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, on July 17 before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. “They don’t know how often they harm patients. However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
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How robots are creating a patient-centered healthcare environment

July 18, 2014 | By Kent Bottles
In a famous 1927 essay titled "The Care of the Patient," Francis Peabody states that the personal bond between the doctor and the patient is the source of the "greatest satisfaction of the practice of medicine." Many providers who balk at the rapid transformation of the American healthcare delivery system complain that electronic medical records and other interventions interfere with this central relationship. It is always assumed the interaction between two living human beings is central to the care of patients.
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Survey: EHRs' Positive, Negative Effects on Physician Practices

Written by Akanksha Jayanthi (Twitter | Google+)  | July 17, 2014
Physicians offer split opinions on the benefits and shortcomings of implementing electronic health records in their practice. Nearly the same percentage of physicians reported EHRs improve clinical operations as the percentage who said they worsen clinical operations, according to a recent survey from Medscape.
The survey gathered responses from 18,575 physicians across 25 specialties.
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Healthcare IT Cloud Safety: 5 Basics

7/17/2014 07:06 AM
Healthcare is warming up to cloud services, and that means extra vigilance. Here's what you should be doing at a minimum to keep data safe.
As more healthcare organizations become comfortable with using cloud services, there's a risk this familiarity could lead to complacency -- and that endangers patient data, networks, and the organization's very reputation.
Cloud services continue to gain traction across verticals, including other highly regulated industries such as finance, and healthcare organizations can tap existing tools, governance policies, and procedures to preserve integrity and security. To do so, IT must be vigilant and proactive, experts say, and CIOs must work closely with their business counterparts to ensure the cloud is both the best technological and organizational solution to the problem.
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Transition point

Trusts have a long list of innovations that they would like to see in mental health systems. But will the widespread end of National Programme for IT contracts over the next two years see them delivered? Or are there too many obstacles ahead? Fiona Barr reports.
Stimulating the mental health systems market is one of four, key priorities named by the Mental Health Informatics Network for the coming year.
For those at the sharp end, it is a priority that cannot be acted on soon enough.  Dr Hashim Reza, clinical director of informatics at Oxleas NHS Foundation Trust in Sidcup, says he was surprised when he began to look at systems recently.
Nearly ten years after the first electronic patient record was installed at his trust in 2005, “it was extremely disappointing that the systems had not actually moved on in a huge way,” he says.
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VC investments, mergers for healthcare IT skyrocket

July 17, 2014 | By Katie Dvorak
Venture capital funding and mergers and acquisitions activity in the healthcare IT sector both saw record numbers in the second quarter of 2014, according to a new report from Mercom Capital Group.
VC funding saw $1.8 billion raised with 161 deals, more than double the $861 million raised in the first quarter of the year--a 104 percent increase, according to the report.
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Health data aggregation poses privacy concerns

July 17, 2014 | By Susan D. Hall
Aggregation of consumer health data holds the potential to improve healthcare, but raises worrying issues about patient privacy, according to a report from the California HealthCare Foundation.
"[M]ost people are not aware of the amount of information they are leaving behind that is not covered by HIPAA or any privacy rules. Without such protection, different kinds of data are being combined and used by third parties in ways that consumers might not anticipate, and some would not want," it states.
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Patients' Preferred Healthcare Communication Reminders

Written by Akanksha Jayanthi (Twitter | Google+)  | July 16, 2014
Patients often receive reminders for various elements of their healthcare, such as reminders to take their medicines and confirming upcoming appointments. Interestingly, patients prefer different modes of communication for different reminder types, according to a survey administered by FICO, an analytics software company.
Here are the top three preferred communication methods for different types of healthcare reminders.
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Telemedicine Providers Welcome AMA Guidelines

Jacqueline Fellows, for HealthLeaders Media , July 17, 2014

In its recommendations, the AMA cements what providers have been hearing for years: Telemedicine needs more regulation and reimbursement.

In what is seen as its biggest step forward in acknowledging the value of telemedicine, the American Medical Association issued, in early June, a list of eight policy recommendations for providers who provide telemedicine services to follow.
The AMA's suggestions include establishing a "valid patient-physician relationship" before telemedicine services are provided; requiring physicians to be licensed in the state where the patient who is receiving telemedicine services resides; transparency in services and cost, as well as encouraging more reimbursement, research, and support for telemedicine pilot projects.
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Watson + Siri: new mHealth power couple?

Posted on Jul 16, 2014
By Tom Sullivan, Editor, Government Health IT
It's one of those thoughts many mHealth insiders and observers have at some point had: What if one could put the power of Watson analytics into a smartphone and interact with it like Apple's Siri at the point of care?
Well, that specific dream moved closer to reality on Tuesday when Apple and IBM joined forces to create a mobile platform christened IBM Mobile First for iOS.
"For the first time ever we're putting IBM's renowned big data analytics at iOS users' fingertips," Apple CEO Tim Cook said in a prepared statement. "This is a radical step for enterprise and something that only Apple and IBM can deliver."
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Study: Age, sex, socioeconomic status major factors in eHealth use

July 16, 2014 | By Katie Dvorak
Socioeconomic status, age and sex are some of the biggest predictors when it comes to U.S. residents' use of the Internet for healthcare. For instance, adults who are of lower socioeconomic status, older and male are some of the least likely people to engage in their healthcare activities online, according to a study published in the Journal of Medical Internet Research.
The study's researchers used data from the National Cancer Institute's 2012 Health Information National Trends Survey. With that information, they then used variable logistic regression to model the odds that education and income, race/ethnicity, age and sex predicted eHealth usage among adults.
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Patient-generated data in comparative effective research will enhance quality of care

Laura Pedulli
Jul 14, 2014
Patient-generated data and comparative effectiveness research hold the key to greatly improving both individual and population health, according to a study published in Health Affairs .
Researchers from Duke University analyzed the strengths and weaknesses of patient-generated data, or patient-reported outcomes, for use in research to make evidence-based decisions about the most appropriate therapies.
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EHRs Not Enabling Systemic Fraud, Say Researchers

Greg Goth
JUL 14, 2014 8:03am ET
Concerns that nationwide electronic health record adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan School of Information and the Harvard School of Public Health.
The study, by Julia Adler-Milstein, assistant professor of information at Michigan, and Ashish K. Jha, Harvard professor of public health, is published in the July issue of Health Affairs.
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Study: E-Prescriptions May Produce More Labeling Errors Than Paper Prescriptions

Written by Akanksha Jayanthi (Twitter | Google+)  | July 15, 2014
When comparing types and prevalence of dispensing errors for electronically transmitted prescriptions versus paper prescriptions, e-prescriptions did not necessarily result in fewer prescription errors, according to a study in BMJ Quality & Safety.
Researchers examined the prevalence of labeling errors, content errors and pharmacist label enhancements on prescriptions sent to 15 community pharmacies in England.
They found electronically transmitted prescriptions had labeling errors for 7.4 percent of items, while paper prescriptions had labeling errors for 4.8 percent of items.
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Recap of Q2 2014 Federal Health IT Activity

by Helen R. Pfister, Susan R. Ingargiola and Dori Glanz, Manatt Health Solutions Wednesday, July 16, 2014
The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the second quarter of 2014. Below is a summary of key developments and milestones achieved between April 1 and June 30.
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Progress Slow for FDA Surveillance System

The Food and Drug Administration’s active surveillance system designed to search health data to uncover adverse safety events for newly approved drugs is coming under fire from critics who say that progress is coming too slowly.
Aaron Kesselheim, M.D., a health policy researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham & Women’s Hospital in Boston and an Assistant Professor of Medicine at Harvard Medical School, believes the FDA’s Sentinel system is promising, but says the jury is still out on whether the regulatory agency will in fact succeed in achieving its goal.
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The Internet of Things for seniors

By Anthony Brino, Associate Editor
For many of the nation’s 45 million (and growing) senior citizens, aging in place is alternatively a much sought-after way to live out the golden years or the default option for those with modest incomes. To make aging in place work, especially for baby boomers, advocates and the government may need to help nurture new technologies that address major problems for seniors. 
As the population of Americans 65 and older starts off an expected doubling, to more than 80 million, by 2050, the number of households headed by someone 70 or older is set to soar 42 percent, to 28 million, by just 2025, according to research by the the Joint Center for Housing Studies of Harvard University. 
Almost 90 percent of American seniors, including those older than 70, want to age in place at least for the next five to ten years of their lives, according to a survey by the American Association of Retired Persons. 
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Social media nightmare for health IT

Posted on Jul 15, 2014
By Evan Schuman, Contributing Writer
Few healthcare IT policies these days are as delicate, sensitive and potentially emotionally explosive as efforts to restrict or regulate employee social media activity. And yet hospital hierarchies are routinely stepping on these political minefields as providers try to protect their reputations.
Consider a recent incident at the 2,478-bed New York Presbyterian Hospital.
An ER nurse posted a photograph of a trauma room – no staff or patients were in the picture – after caring for a man who had been hit by a subway train. The caption: "Man vs. 6 train." The image simply showed a room that had seen a lot of action moments before. The veteran nurse was fired after the incident, according to an ABC News report, not because she had breached hospital policy or violated HIPAA, but, as she put it: "I was told I was being fired for being insensitive."
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Joe’s view of 40m SCRs

Joe McDonald is angry about the death of a charming junkie, who played the health service for drugs. He argues that the medication information in the NHS Summary Care Record might have stopped the death; and that now that 40m SCRs exist, it could soon be seen as negligent for doctors not to check for one.
15 July 2014
Johnny was a charmer but a self confessed junkie. He was 19 when he died.
The council had reduced the bin collection to fortnightly just the year before and fly-tipping was rife.
The cold snap meant no one noticed the smell until the council workers arrived to clear the fly-tipping site where Johnny’s body had lain among the bin bags and builders’ rubbish for a week at least.
Ironic that the council JCB driver should see him flop lifelessly from his machine’s huge scoop into the dustcart; Johnny had spent most of his childhood in the care of the council.
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Scottish board builds shared care record

14 July 2014   Lis Evenstad
NHS Dumfries and Galloway is creating an electronic shared care record to integrate primary and secondary care data.
The Scottish health board is using the CareCentric software from Graphnet to build the integrated care record, which will be an extension of its already existing care record.
It has also integrated GP data from Emis Web into the Graphnet software to allow sharing of information between primary and secondary care data.
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3 lessons for big data success in healthcare

July 15, 2014 | By Susan D. Hall
Too often organizations rush into big data projects without keeping an eye on the big picture, Booz Allen Hamilton's Steven Escaravage and Joachim Roski write in a Health Affairs Blog post.
They propose some best practices that, along with disciplined project management, can eliminate pitfalls they've encountered in such projects with government agencies including the National Institutes of Health (NIH), Centers for Disease Control (CDC) and the Department of Veterans Affairs (VA).
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Standardize EMRs, For Security & Safety's Sake

7/14/2014 09:06 AM
Alison Diana
Commentary
Electronic medical records help healthcare organizations improve patient care, but lack of standardization could cause safety and security problems.
The foundation hospitals built when they overwhelmingly adopted electronic medical records is trembling under the weight of concerns over security and lack of standardization.
Healthcare organizations already see plenty of benefits from EMRs. The Internet is full of success stories detailing how hospitals save and improve lives, reduce costs, and enhance research capabilities through new access to real-time data. Many EMR applications are high-quality tools that take users' needs and wishes into account and evolve to meet mandates and clinicians' changing requirements.
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Personalized Medicine Meets EHR Integration at Mt. Sinai

Scott Mace, for HealthLeaders Media , July 15, 2014

At Mt. Sinai Health System in New York, a combination of personalized medicine, natural language processing, and clever integration with electronic health record software is allowing clinicians to adjust medication selection and dosages based on patients' genomic differences.

Personalized medicine is one of those technology topics that perpetually comes up in conversations about The Next Big Thing.
Think combining genomics data with population health, throw in some predictive analytics, and you've got the basic idea.
As a direct-to-consumer play, personalized medicine has run into some roadblocks, and at least one big setback. See the FDA's takedown of 23andMe's service that tested consumers' genomes and suggested correlations to particular predicted conditions or diagnoses.
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Mercy Health Finds Value in Patient Portal

JUL 14, 2014 7:34am ET
Mercy Health System in Portland, Maine, has been working to make its patient portal as user-friendly as possible, along with new features, as the organization prepares for a Stage 2 meaningful use reporting period in October.
Giving real value to patients through the portal is necessary to meet the Stage 2 threshold of getting more than 5 percent of patients to access online their health information. Christopher Hall, M.D., CMIO at Mercy--part of Eastern Maine Healthcare System--used the portal himself recently to make appointment requests for his children, and was impressed. He made the requests in the evening and got appointments for the next morning. “The portal defeats a phone call because you can get right in,” he says. “It is faster than a call as you won’t get put in a queue.”
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Stage 2: Rubber meets the road

Posted on Jul 14, 2014
By Bernie Monegain, Editor
As David Blumenthal, MD, sees it, Stage 2 is where the rubber meets the road for the Meaningful Use EHR Incentive Program – the government’s grand scheme o drag the American healthcare system, kicking and screaming, into the 21st Century.
The program’s promise and appeal from the start was that it would move healthcare from an industry stuck in antiquated ways and mired in paper, into a smooth, sleek, efficient digital system, more akin to what consumers experience when banking, or buying a book or refrigerator on Amazon.
Blumenthal, who served as the third national coordinator for health information technology – is often credited as the architect of the meaningful use program.
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St. Luke's Boise eICU monitors patients around the state

by Jamie Grey
KTVB.COM
Updated Thursday, Jul 10 at 11:50 AM
BOISE -- St. Luke's Health System uses a unique patient monitoring system for its intensive care patients by adding a team of doctors and nurses monitoring patient rooms remotely.
The program, known as an eICU for Electronic Intensive Care Unit, works almost like a control room for intensive care. St. Luke's was the first in the state to have this type of program and remains the largest eICU in the mountain west region.
Doctors say this type of telemedicine is linked to increased patient safety and fewer deaths in hospital ICUs. The program does not completely replace traditional bedside doctors and nurses, but adds remote staff to help quickly monitor vital signs and even quickly check in with patients via a video feed.
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Better Use of EHRs Makes Clinical Trials Less Expensive

July 11, 2014
Following participation in the study, most general practitioners expressed support for the use of patients’ electronic records to support clinical trial
Using electronic health records to understand the best available treatment for patients, from a range of possible options, is more efficient and less costly than the existing clinical trial process, a new study from the UK shows.
The researchers looked at the use of statins in 300 people with high risk of cardiovascular disease by tracking their electronic medical records (EHRs). The study was published in the journal Health Technology Assessment.
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Big data's burgeoning healthcare role causes increased legal, ethical concerns

July 14, 2014 | By Katie Dvorak
From Facebook to the doctor's office, our information is continually being collected and analyzed. Now the question lies in what data should be accessible, and by whom.
When it comes to doctors, people are sharing their information with the view that they are looking out for your best interests, unlike a company such as Facebook, Glenn Cohen, a professor of health law and ethics at Harvard Law School, says in an interview with Vox.com.
"[Doctors are] paid, but we have a whole bunch of regulations in place to make sure that healthcare professionals don't act out of their own interests. ... It seems to me that Facebook is not the same kind of relationship, and we've never pretended otherwise," Cohen tells Vox.
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Federal incentives help eRx rate to skyrocket

July 14, 2014 | By Dan Bowman
The rate of physicians who prescribe electronically has skyrocketed thanks to a pair of federal incentive programs, according to new statistics unveiled by the Office of the National Coordinator for Health IT.
As of this past April, e-prescribing rates via an electronic health record are up to 70 percent of all U.S. doctors since the passage of the Medicare Improvements for Patients and Providers Act (MIPPA) in December 2008 and the start of the Medicare and Medicaid EHR Incentive Programs in 2011. Prior to MIPPA's passage, only 7 percent of U.S. providers used e-prescribing.
MIPPA, also known as the "eRx incentive program," provided financial incentives for doctors to use electronic prescribing tools, while the EHR incentive programs required participants to use their EHRs to e-prescribe to meet Meaningful Use standards.
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July 11, 2014 4:31 pm

The computer will see you now

Doctors are going to have to learn to live with Google
“Whatever you do,” said the doctor, “please don’t google this.” Her tone was almost pleading. We would find all kinds of horror stories; we would not know which information could be trusted. Of course, we assured her, we would act responsibly.
An hour later we were googling like crazy and had every horror story at our disposal. Headaches, vomiting, loss of appetite and a range of other possible side effects were listed. This was no surprise, because they seem to be the side effects listed with pretty much any medication. In general, however, the horror stories were not too terrible. None of the patients had, for example, joined Ukip or taken up fretwork.
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Enjoy!
David.