Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, February 05, 2010

Weekly Overseas Health IT Links 03-02-2010.

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.

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http://content.nejm.org/cgi/content/full/362/3/192

Accelerating the Use of Electronic Health Records in Physician Practices

Steven Shea, M.D., and George Hripcsak, M.D.

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care.1 This payment would apparently come on top of the $44,000 incentive that the American Recovery and Reinvestment Act of 2009 (ARRA) has authorized Medicare to pay each eligible health care professional who uses certified EHRs in a meaningful manner. "Meaningful use" is still being defined, but the overarching goal is to improve the population's health through a transformed health care delivery system with the use of EHRs to improve local processes, foster quality measurement, and increase communication. North Shore's announcement is a sign of the continuing acceleration of EHR adoption by physicians' offices2 and hospitals.3 Support for information systems is exempted from the Stark amendment to the Omnibus Budget Reconciliation Act of 1989, which prohibits hospitals from offering physicians incentives for providing referrals or admissions. The exemption for information technology acknowledges that the likelihood of additional referrals may be part of the motivation for hospitals to form closer links with community physicians through EHRs. Another benefit to hospitals from supporting the use of EHRs by physicians who are linked to them by geography, academic appointment, or practice pattern is the enhanced ability to manage the quality and outcomes of care. For example, if financial penalties and incentives are to be imposed on the basis of rates of readmission, then the more closely aligned a hospital is with the physicians who provide its patients' postdischarge care, the greater the benefits it will reap.

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http://www.healthleadersmedia.com/print/TEC-245673/Will-the-iPad-Revolutionize-Healthcare

Will the iPad Revolutionize Healthcare?

Cheryl Clark, for HealthLeaders Media, January 29, 2010

Apple's announcement of the iPad has been big news this week. The new technology has had health officials wondering: How will the iPad be used in a physician's practice, clinic or acute care setting? Could it really revolutionize care? Will it allow patients to communicate better with their providers through user-friendly pictures easily visible on the screen?

We asked health leaders to weigh in on the iPad, based on the rumor and the hype, and what is known about the device so far. Their consensus? Many things are possible, but maybe not just yet.

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http://www.healthdatamanagement.com/news/registry_als_cdc_research_gehrig-39715-1.html?ET=healthdatamanagement:e1149:100325a:&st=email

CDC Readies ALS Registry

HDM Breaking News, January 28, 2010

The Centers for Disease Control and Prevention has published a notice outlining steps to register individuals for listing in the new Amyotrophic Lateral Sclerosis Registry, authorized under legislation signed in 2008. The motor neuron disorder also is known as ALS and Lou Gehrig's Disease.

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http://govhealthit.com/newsitem.aspx?nid=73061

HHS takes Hippocratic oath on health IT stimulus

By Mary Mosquera

Thursday, January 28, 2010

The Health & Human Services Department will set up a panel of experts to identify and fix any “potentially harmful unintended consequences” of its push to get physicians and hospitals equipped with electronic health records over the next several years.

In announcing a contract to set up the group, HHS acknowledged the plan to offer providers financial incentives to adopt health IT was meant to “enormously improve the quality and efficiency of health.”

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Most Hospitals Increasing IT Spending

Government regulatory issues and financial incentives were named as the top drivers in a survey of hospital IT executives.

By Marianne Kolbasuk McGee, InformationWeek

Jan. 27, 2010

URL: http://www.informationweek.com/story/showArticle.jhtml?articleID=222500180

Three quarters of small to mid-sized hospitals in the U.S. plan to increase their IT budgets this year, with clinical point-of-care systems being the top IT priority, says a new survey.

The U.S. government's health IT stimulus programs are apparently driving many of these hospitals' IT plans.

Government regulatory matters, followed by financial incentives, were named as the top issues driving healthcare over the next two years, said the respondents to a survey conducted by the Healthcare Information and Management Systems Society (HIMSS) last October and released Wednesday.

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http://www.healthcareitnews.com/news/state-union-speech-omits-mention-healthcare-it

State of the Union speech omits mention of healthcare IT

January 28, 2010 | Diana Manos, Senior Editor

WASHINGTON – Healthcare IT has been highlighted over the past four years in State of the Union speeches, though President Barack Obama made no mention of it in his Wednesday night speech. Some stakeholders defend the Administration's support of health IT, while others question it.

Bruce Merlin Fried, a partner at Sonnenschein, Nath and Rosenthal, LLP in Washington, DC, said while there was no mention of healthcare IT, it remains the one fundamental structure for healthcare reform that has been passed and been funded.

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http://www.e-health-insider.com/news/5594/king%27s_showcases_e-prescribing_roll-out

King's showcases e-prescribing roll-out

28 Jan 2010

King’s College Hospital NHS Foundation Trust has started rolling out its iSoft e-prescribing system trust-wide.

The system enables prescribers to order their patient’s medication electronically and view scheduled and administered medications on an electronic drug chart via the iSoft Clinical Manager electronic patient record system.

The trust is one of the first to use the functionality, which is also in use in Salford and was piloted at Epsom and St Helier.

Ben Fidler, senior clinical analyst at King’s, told E-Health Insider: “Orders are placed in the same way as a diagnostic test in the native functionality of iCM, so it has been fairly straightforward for staff to pick up.

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http://ehealtheurope.net/news/5599/first_european_deal_for_healthvault

First European deal for HealthVault

28 Jan 2010

Microsoft and Siemens have signed an agreement to licence Microsoft’s personal health record platform, HealthVault, in Germany.

Siemens will host all the stored health data in what the two companies describe as “security enhanced” data centres in Germany. Data will be transmitted over an encrypted connection over the Internet.

Microsoft launched HealthVault in the US in October 2007. It has promoted HealthVault as an online platform that will allow individuals to store their personal health data, import information from various medical devices, and decide who to share it with.

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http://www.healthdatamanagement.com/news/standards_onc_stimulus_hitsp-39683-1.html?ET=healthdatamanagement:e1146:100325a:&st=email

Halamka: HITSP Still in Business

HDM Breaking News, January 26, 2010

The Healthcare Information Technology Standards Panel will not disband at the end of this week when its current federal government contract expires, contrary to at least two published reports on Jan. 26.

That's the word from John Halamka, M.D., chair of HITSP and CIO at Beth Israel Deaconess Medical Center and Harvard Medical School.

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http://www.e-health-insider.com/news/5583/pennine_care_delays_lorenzo_r1.9

Pennine Care delays Lorenzo R1.9

27 Jan 2010

Pennine Care NHS Foundation Trust has delayed its implementation of Lorenzo Regional Care Release 1.9 until the summer, E-Health Insider has learned.

Last May, NHS Bury’s informatics plan revealed that both the primary care trust and the mental health services trust would be working to implement Lorenzo R 1.9 in 2009, under the National Programme for IT in the NHS.

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http://www.isria.com/pages/27_January_2010_67.php

Slovenia - Minister Pavlinič Krebs: “e-Health Project provides answers to contemporary health challenges"

"The e-Health Project is one of the priority development programmes and among the largest national IT projects. Partly co-financed by the European Social Fund, substantial funds have been earmarked for its implementation." The Minister of Public Administration, Irma Pavlinič-Krebs, addressed these words to participants in her opening remarks to the introductory part of the international e-Health seminar held at Center Evropa in Ljubljana.

http://www.forbes.com/2010/01/25/digital-privacy-ponemon-technology-cio-network-healthcare.html?boxes=Homepagechannels

E-Health

The Next Health Care Debate: Digital Privacy

Andy Greenberg, 01.25.10, 6:05 PM ET

As President Obama has learned over the last year, Americans tend to get angry when you try to fix the country’s dysfunctional health care system. But even as the national debate over universal coverage drags on, there's another sticky issue ahead for health reform: digital privacy.

In a study released Monday by the privacy-focused Ponemon Institute, Americans registered a deep distrust of anyone in either the federal government or private industry who might store digital health records like those that the Obama administration has encouraged hospitals to create. Of the 868 Americans surveyed about their views on digitizing and storing health records, only 27% said they would trust a federal agency to store or access the data--the same percentage as those who would trust a technology firm like Google, Microsoft or General Electric.

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http://www.ethiopianreview.com/health/28673

Spain will promote the new Transplant Directive and “e-Health”

ethiopianreview.com | January 27th, 2010 at 3:43 am |

The new European Directive on organ donation and transplants and the promotion of “e-Health” will be two of the strategic topics of the Spanish Presidency of the EU, according to the presentation by the Minister of Health and Social Policy, Trinidad Jiménez, before the Health Commission of the European Parliament.

Trinidad Jiménez also stated that the Spanish Presidency of the EU will try to drive forward a “very ambitious” proposal on cross-border medical care that “respects the basic principles of patient safety and quality”, given that health is “a public good, not just another market commodity”.

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http://www.ehiprimarycare.com/news/5568/first_welsh_practice_live_with_ihr

First Welsh practice live with IHR

21 Jan 2010

The first GP practice and out-of-hours service in Wales has gone live with Informing Healthcare’s new Individual Health Record solution.

The biggest GP practice in Wales, the Argyle Medical Group in Pembroke Dock, which has 27,000 patients, has become the first practice to use the IHR solution from GP system supplier INPS.

The pilot will link the practice with the Pembrokeshire and Ceredigion out-of-hours service.

Informing Healthcare announced last September that it was changing its approach to the deliver of the IHR in Wales, by signing agreements with GP system suppliers to deliver proprietary versions.

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http://www.govhealthit.com/GuestColumnist.aspx?id=73002

Plain speaking on health data access

By Denny Porter

Wednesday, January 20, 2010

For years a crisis has been brewing for many people who have become tangled up in a cyber-age web where healthcare records are being generated and maintained across an ever-broadening spectrum of healthcare delivery systems.

Two particular categories of patient are at the forefront of this crisis: those that have been diagnosed and told they have a terminal disease; and our country's severely wounded military service members who are forced to transition from the Department of Defense to the Department of Veterans Affairs and out into the civilian healthcare system.

Both sets of patients face a similar, urgent and daunting task. They are literally fighting for their lives while being forced to get their hands on every shred and electron of their medical histories. By searching the Internet you can see that all across the country, patients and families are caught up in this crisis. By the time these patients are at this stage of treatment, every minute, hour and day counts.

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http://www.govhealthit.com/newsitem.aspx?nid=73030

Connect upgrades patient search, authentication

By Mary Mosquera

Friday, January 22, 2010

The Health & Human Services Department has updated the government’s Connect software to incorporate the ability to query for a patient and to assure the identity of sender and recipient in the exchange of health data.

Connect is the federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that comprise the nationwide health information network (NHIN).

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http://www.govhealthit.com/newsitem.aspx?nid=73003

Military Health System lays out five-year IT plan

By Peter Buxbaum

Wednesday, January 20, 2010

For the first time in over a decade, the Military Health System last week finalized a strategic plan for information management and technology.

The five-year plan emphasizes collaboration among the armed services, Tricare the services’ health plan organization, the Joint Chiefs of Staff, the MHS chief information officer, and other Department of Defense health-related offices.

It is MHS's first formally adopted IM/IT plan since 1999, according to MHS CIO Chuck Campbell.

The plan places heavy emphasis on two goals: redesigning the MHS IT architecture and delivering a robust electronic health record.

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http://www.healthleadersmedia.com/content/TEC-245517/Health-IT-Panel-Use-Technology-Now-to-Help-Transform-Healthcare.html

Health IT Panel: Use Technology Now to Help Transform Healthcare

Carrie Vaughan, for HealthLeaders Media, January 26, 2010

Healthcare transformation is long overdue—especially as it relates to technology, according to a panel of technology executives who spoke at a Nashville Health Care Council luncheon last week about the future and current state of healthcare information technology.

Panelists included Steve Ballmer, Microsoft's CEO; Harry Greenspun, MD, chief medical officer of Plano, TX-based Dell Perot Systems; George Lazenby, CEO of Nashville, TN-based Emdeon; and Glen Tullman, CEO of Chicago-based Allscripts Healthcare Solutions Inc.

Greenspun says healthcare IT is about a decade behind other industries, and he is amazed that healthcare consumers have tolerated it given the fact that you can make dinner reservations online but not necessarily doctor appointments. "On my iPhone I can get a custom-made burrito at the nearest Chipotle," he says. "But if I get hit by a truck, I can't find, with that same iPhone, a qualified orthopedic surgeon who takes my insurance."

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http://www.ihealthbeat.org/perspectives/2010/political-earthquakes-health-care-reform-and-health-it.aspx

Tuesday, January 26, 2010

Political Earthquakes, Health Care Reform and Health IT

by Bruce Merlin Fried, Esq.

Sitting in my K Street office in Washington, D.C., I can see the dust settling after the political earthquake that followed the election of Republican Scott Brown to the Senate from Massachusetts. "Turmoil" would be a fair way to describe the behavior of policymakers, stakeholders and journalists in the wake of this electoral seismic event.

Let me hasten to say that I am not analogizing the political turn of events in Washington, D.C., to the profound tragedy that has befallen Haiti and its people. The two are incomparable. But in a real sense, Brown's election has disrupted the order of things in Washington in ways that were unpredicted (or at least unexpected) and with lingering consequences that may not be felt for some time.

What we all know is that the Democratic majority in the Senate has been reduced to 59. With that, the ability of the majority party to overcome minority party filibusters has been lost (unless, of course, a Republican senator can be coaxed to the other side). And with that loss, the prospects for enactment of comprehensive health care reform, such as the bills passed by the House and Senate, are enormously diminished, if not extinguished.

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http://www.e-health-insider.com/news/5578/scottish_pms_deal_may_go_national

Scottish PMS deal may go national

26 Jan 2010

NHS National Services Scotland is to make a decision on whether the recently announced Patient Management System contract should be widened to become a national system to cover all NHS boards in Scotland.

NHS NSS, which procures IT software on behalf on Scotland’s 14 health boards and eight special health boards, selected InterSystems as its preferred bidder in November 2009.

The decision means that InterSystems will provide its TrakCare product to five health boards including NHS Greater Glasgow and Clyde, NHS Ayrshire and Arran, NHS Lanarkshire, NHS Borders and NHS Grampian.

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http://www.kansascity.com/105/story/1707370.html

Race to share your medical info is on

By DIANE STAFFORD

The Kansas City Star

No matter what happens with health care reform, an electronic network to share your medical records is being stitched together.

Health practitioners, information tech experts, lawyers, ethicists and government officials are racing to implement a national system by 2014.

“We don’t want to just have the equipment in place. We want to have a meaningful use of electronic health records that will help consumers and health care providers,” said Helen Connors, director of the University of Kansas Center for Health Informatics.

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http://www.govhealthit.com/newsitem.aspx?nid=73038

HITSP to expire as standards group; successor sought

By Mary Mosquera

Monday, January 25, 2010

HITSP, an organization that did much to sort through and harmonize health IT standards and whose work provided an early foundation for “meaningful use,” will cease to exist in its current form after this week.

Dr. John Halamka, the face of the technical body since its inception in 2005, said the Health IT Standards Panel would disband on Jan. 31, when its contract expired.

HITSP was set up in 2005 as a partnership among public and private sector organizations to help pursue President Bush’s vision of establishing a nationwide system of electronic health record sharing by 2014.

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http://www.who.int/goe/ehir/2010/26_january_2010/en/index.html

26 January 2010

eHealth Worldwide

:: Canada: E-health Leads Nova Scotia's Healthcare Transformation (December 2009 - Healthcare Quarterly)

Nova Scotia's healthcare policy direction seems well-defined and well-established for the foreseeable future. This is the case, despite the recent electoral transition from a Progressive Conservative to a New Democratic Party government for the first time in the province's history; and despite the threat of the province's net direct debt increasing through 2012, after eight years of declining net direct debt as a percentage of the province's gross domestic product. As well, little public consideration is being given to disrupting the current regional healthcare organizational structure by further consolidating the province's nine district health authorities (DHA), as occurred last year in Alberta and New Brunswick. Moreover, the Health Information Technology Services Program of Nova Scotia (HITS-NS), the province's shared IT services or provincial service delivery organization, is steadily expanding the inventory of clinical, financial, and administrative software applications hosted for eight DHAs on a common Meditech Client-Server platform, as well as some applications for Capital Health DHA 9 (CDHA) and IWK Health Centre (IWK), the province's consolidated women's and children's hospital located in Halifax.

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http://www.modernhealthcare.com/article/20100125/NEWS/301259967

Leavitt: CCHIT has proven it can meet federal laws

By Joseph Conn / HITS staff writer

Posted: January 25, 2010 - 7:30 am ET

Part two of a two-part series (Access part one):

The Certification Commission for Health Information Technology announced last week it was taking applications beginning Feb. 12 from vendors for its new, upgraded electronic health-record testing and certification program. The new CCHIT testing criteria have been tailored to conform with new federal rules on certification and meaningful use.

At present, CCHIT has not be "recognized" as an EHR testing and certification body by the Office of the National Coordinator for Health Information Technology at HHS, and therefore, EHRs against the new CCHIT criteria won't qualify, at least for now, as being "certified" and eligible for use by providers seeking federal EHR subsidies under the American Recovery and Reinvestment Act of 2009, also known as the stimulus act.

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http://www.modernhealthcare.com/article/20100125/MODERNPHYSICIAN/301259995

Med students not ready to use EHRs: study

By Linda Wilson

Posted: January 25, 2010 - 7:00 am ET

Does the medical-school curriculum adequately prepare students to diagnose and treat patients using an electronic health record?

That's the question educators at the University of Illinois at Chicago College of Medicine set out to answer this year. The preliminary conclusion: probably not. As a result, the school may add course work to teach students how to incorporate the EHR into an encounter with a patient.

To test the EHR-savvy of nearly 190 fourth-year medical students who haven't participated in a formal class, the school set up a mock patient encounter in the summer and fall of 2009.

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http://www.healthdatamanagement.com/news/ehr_hospitals_himss_analytics_stage_7-39673-1.html?ET=healthdatamanagement:e1144:100325a:&st=email

Three More Hospitals Reach Stage 7

HDM Breaking News, January 25, 2010

HIMSS Analytics, the Chicago-based research and consulting unit of the Healthcare Information and Management Systems Society, has announced three additional hospitals have reached Stage 7 of its 0-7 scale for adoption of electronic health records. That brings the total number of Stage 7 hospitals to 38.

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http://www.healthcareitnews.com/news/healthpartners-use-emr-highlight-cancer-concerns

HealthPartners to use EMR to highlight cancer concerns

January 22, 2010 | Kyle Hardy, Community Editor

MINNEAPOLIS – The HealthPartners Medical Group is using an electronic medical record and race information to raise awareness of colorectal cancer among African American patients.

The Minneapolis-based medical group launched the program in an attempt to save lives by providing more timely colorectal cancer screening for African American patients. Organizations such as the American College of Gastroenterology recommend that regular colorectal cancer screening for African Americans should begin at age 45, compared to age 50 for other races.

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http://www.healthcareitnews.com/news/interoperability-king-ihe-connectathon

Interoperability is king at IHE Connectathon

January 22, 2010 | Bernie Monegain, Editor

CHICAGO – Healthcare data is rendered meaningless unless it can be shared, industry experts say. The Integrating the Healthcare Enterprise (IHE) North America Connectathon, now in its 11th year, recently showed how to get interoperability done right.

Focused on electronic health record system connectivity and interoperable exchange of patient health data with standards-based systems, the IHE 2010 North America Connectathon, held Jan. 11-15 in Chicago, brought together 498 system engineers, who were testing more than 150 health IT systems from 104 participating companies and organizations.

IHE is a global initiative that creates the framework for passing vital health information seamlessly – from application to application, system to system and setting to setting – across multiple healthcare enterprises.

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http://www.healthcareitnews.com/news/healthcare-investment-outpaces-it-investment-first-time%E2%80%A8

Healthcare investment outpaces IT investment for the first time

January 22, 2010 | Mike Miliard, Managing Editor

NEW YORK – Venture capital investment in healthcare has exceeded that for information technology for the first time, according to new statistics released Friday.

Dow Jones VentureSource reported that the healthcare industry in 2009 was the beneficiary of more VC cash than the IT sector, raking in $7.7 billion. While that represents a 14 percent decrease from the previous year, it’s far less than the 35 percent decline in IT investment, which totaled just $6.1 billion in 2009 – the lowest showing in 13 years, and the first year on record that IT was not the venture industry’s most favored sector.

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http://www.fiercehealthit.com/story/healthcare-may-help-it-industry-reverse-job-losses/2010-01-25?utm_medium=nl&utm_source=internal

Healthcare may help IT industry reverse job losses

January 25, 2010 — 1:10pm ET | By Neil Versel

The IT industry has been reeling, having cut a net 175,000 jobs in 2009, or about 13.2 percent of all announced U.S. job cuts across all industries last year. The decline is more than 12 percent greater than the 155,000 tech jobs shed in 2008. But there are some bright spots. Forrester Research recently forecast that U.S. IT spending would grow by 6.6 percent in 2010, reversing an 8.2 percent reduction last year. And then there is the health IT sector.

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http://www.ama-assn.org/amednews/2010/01/25/bil20125.htm

Phishing schemes are becoming sneakier in targeting doctors

A new round of e-mail scams looks like legitimate messages from trusted sources. How can physicians avoid becoming victims?

By Pamela Lewis Dolan, amednews staff. Posted Jan. 25, 2010.

A faculty physician at the University of California, San Francisco, Medical Center received an e-mail last fall appearing to be from the hospital's information technology staff. The e-mail requested the doctor's login information in order to perform routine security upgrades to the system. Because it seemed like an ordinary request, the physician sent the information.

But that e-mail wasn't from his hospital's IT administrators. It was from a scammer, and by responding, the physician had unwittingly exposed the personal information of more than 600 of his patients.

This type of scam has become so common it's earned its own nickname: "spearphishing." Like phishing, this scam is carried out via a fictitious e-mail that looks legitimate. But unlike phishing, in which missives are sent to as many e-mail accounts as possible, spearphishing targets a specific population by posing as someone with whom the e-mail recipient routinely conducts business and exchanges information.

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http://www.auntminnie.com/index.asp?Sec=sup&Sub=ris&Pag=dis&ItemId=89206&wf=3548

Structured reporting is coming; the devil's in the details

By Cynthia E. Keen

AuntMinnie.com staff writer

How much structure is enough for structured radiology reports? That was the question asked at an RSNA meeting session, where a panel of technology evangelists and session attendees agreed that while more user-friendly structured reporting software would stimulate adoption, the technology behind it doesn't exist yet.

However, the question of whether structured reporting will be adopted by radiologists is a question of "when," not "if." Just as the use of speech recognition technology has been replacing medical transcriptionists over the past decade in many private practices and radiology departments, reports prepared in a consistent format amenable to data mining and using some form of standardized terminology will displace the preparation of entirely free-text reports.

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http://www.auntminnie.com/index.asp?Sec=sup&Sub=ris&Pag=dis&ItemId=89021&wf=3548

Healthcare IT pays off, but don't hold your breath

By Cynthia E. Keen

AuntMinnie.com staff writer

January 7, 2010

Investing in healthcare IT projects such as electronic health records (EHR) and e-prescription systems produces significant socioeconomic benefits, but it can take nearly 10 years to see the first positive returns, according to a new study from Europe.

The EHR IMPACT study, the final report of a multiyear study initiated by the European Commission to evaluate the economic impact of utilizing healthcare IT in Europe, concluded that healthcare IT can produce annual socioeconomic returns of up to 400%.

However, it takes at least four -- and more typically nine -- years before EHR and e-prescription initiatives produce their first positive annual socioeconomic return, and it takes between six and 11 years to achieve a cumulative net financial benefit, according to the EHR IMPACT study.

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http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/Karachi/24-Jan-2010/Intl-moot-on-ehealth-begins

Int'l moot on e-health begins

Published: January 24, 2010

KARACHI - E-health is still an elusive concept in Pakistan, but it surely has a deeper concern and relevance to our local environment. Interestingly, very few healthcare professionals are now involved in promoting e-health in our country.

he first e-health conference began at AKUH, on Saturday morning, with the titled ‘Better Health for all through E-Health’.

Shariq Khoja, general secretary E-Health Association of Pakistan and representing AKUH at the platform, said, “No doubt that e-health was first developed in the western countries, focusing on the needs and standards that were supposed to be met according to their lifestyle, but e-health is need of the hour as far as Pakistan is concerned.

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Enjoy!

David.

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