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."

Wednesday, November 19, 2014

Position Paper - Clinical Results In The PCEHR. A Good Idea Or Not? - Draft For Comments.

This paper considers the place of holding diagnostic investigation information in the PCEHR. Before reviewing the proposition there are some assumptions which may or may not be true and need to be surfaced.
These include:
1. That there is a demonstrable benefit of holding diagnostic results in the PCEHR to be accessed by providers and consumers.
2. That diagnostic results can be safely and accurately displayed to relevant users.
3. That navigation and search for results, as well as trend information presentation, is much improved.
4. That overall the ease of use of the PCEHR is improved and that there is a commitment to ongoing support for continuing improvement of all aspects of the system.
5.  That all operational, security, information integrity and privacy issues can be resolved.
I will leave it to the reader to decide the their position on the truth of these claims.
Issues To Be Addressed.
Once and if it is decided it is reasonable, sensible, justifiable and beneficial to load results into the PCEHR the next issue to be considered is what is required of the process.
On the face of it the following are important:
1. The timing of result transmission to the PCEHR.
2. The mode of storage of the information.
3. The mode of presentation of the information is suitable for both professional and consumer use.
4. That there be at least some level of consumer decision to assist understanding (maybe a help line etc.)
5. Avoidance of consumer anxiety while making it easy for the sophisticated / experienced user to benefit from results.
I think it is arguable these issues can be addressed by adopting the following approach.
How Should It All Work?
On the assumption that it is generally agreed results information in the PCEHR is a good and worthy idea, and assuming that the contents of one’s PCEHR should be controlled by the individual, as the name of the PCEHR implies then it seems this has to be the way things happen.
1. Treating clinician decides on need for investigation.
2. Investigation ordered and patient asked if they want results uploaded to PCEHR when finalised, at this point the clinician can discuss with patient what they are looking for and what potential results might mean. (This can be a simple tick box, to approve upload, on the request form which the information provider then actions when results are finalised)
3. Patient says fine and results are uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
4. Patient says no and results are not uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
Why can’t it all be just this simple?
A poll finalised today made it clear readers also believe consent to upload of results should be obtained before it happens.
See here:
Of course there are some other approaches available - especially if the PCEHR is taken out of the equation or treated as the secondary system it is. Ideas like having the information provider provide access directly on authorised patient request or having a tick box which results in the results being sent to the patient on request might be considered.
There are all sorts of more radical things which might be possible, for example, the patient being given a digital key when the test is done and then being e-mailed an encrypted result when it is available.
Overall I believe that placing test results in the PCEHR is being pushed because the PCEHR exists and is looking for a reason for existence rather than because use of the PCEHR is the best way to provide patients with access to their results. Maybe some thinking outside the square might be useful.
David.

Tuesday, November 18, 2014

This Really Sounds Like, While They Are Not Saying It Yet, The Opt-Out PCEHR Is Coming.

This appeared today.

PCEHR pulls off a billion-dollar comeback

David Ramli
It has taken four years and over $1 billion but one of Australia’s biggest taxpayer-funded failures has almost been cured, according to the senior doctor leading the project.
The Personally Controlled Electronic Health Record (PCEHR) initiative is designed to be the foundation on which Australia’s future healthcare system will be built.
At its most basic it is designed to provide every Australian who wants it with a centralised medical record that can be accessed by doctors and hospitals across the nation, from general practitioners to emergency rooms.
National e-health transition authority (NEHTA) chairman and former president of the Australian Medical Association, Steve Hambleton, told The Australian Financial Review the project had been treading water for several months while the government considered its response to a review of the troubled project that was commissioned in November 2013.
But he also insisted the ­much-criticised project, which has burned through more than $1 billion since it was announced in 2010, has bounced back and is ready pending the belated government go-ahead.
The spokesman for Health Minister Peter Dutton said previous implementations were rushed and chaotic and that it was determined to take its time and not make the same mistakes.
Lots more here:
The article seems, from the headline, to be saying that ‘all is fixed’ but what we read is:
1. We are waiting for the Government to agree to  ‘opt-out’ i.e. everyone having a PCEHR record created unless they specifically tell the Government to go away.
2. The system is hardly being used (10,000 accesses a week from a 2 million person user base).
3. The doctors are not at all interested (if they have even heard of it) and we will need more marketing for docs and patients needed (Aspen Medical will love that!).
4. It is going to cost ‘a lot’ to implement.
5. There will be a fair few Liberal voters not at all happy with this sort of arrangement (Note: I am pretty sure some legislation will be needed)
On the same track I was asked today, from another source,  the following:
“I've been told that, in preparation for the "opt out" version  of the PCEHR/MYHR, all public health records are being batch downloaded by the DoH to the PCEHR that will become operational in 2015, without anyone's consent or knowledge.”
As the old saying goes there is seldom any smoke without a fire somewhere!
In parallel we have seen a push to upload non-consented diagnostic test results.
Additionally we have this:

Coming Soon: Invitation to Apply – Private Hospital PCEHR Rapid Implementation Programme

Created on Tuesday, 18 November 2014
With more than 260 public hospitals and health centres now connected to the personally controlled electronic health record (PCEHR) system, NEHTA will shortly be inviting private hospital organisations to apply for a funding contribution to support their integration to the system.
The Private Hospital PCEHR Rapid Integration Programme will assist successful applicants to deploy PCEHR viewing and/or clinical document upload capability. Look out for information soon on the Tender and Offers page of the NEHTA website.
The source is here:

So it seems NEHTA has some money to splash about on something that will not come to fruition if NEHTA and / or the PCEHR are to be gone.
 
If this is not all a concerted push by NEHTA and its new chair to both survive and thrive I will be very surprised.
Stand by to see the Abbott government add mightily to the Debt and Deficit Disaster on the basis of precisely zero evidence or evaluation.
 What do others think or know? It is hard to believe seeing all this at once is not suggesting that a major announcement is imminent.
David.

Monday, November 17, 2014

Weekly Australian Health IT Links – 17th November, 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

A very interesting week, but, as ever with very little out from the Government still on what is happening with the PCEHR and so on.
I am not sure there is a trend here but there does seem to be a lot more private sector e-Health activity than we have seen for a while.
Of course lobbing a probe on a comet is really just amazing as well. I do hope some sun shines on the probe soon so more work can happen at some point.
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eHealth and the missing links

10 November, 2014 Associate Professor Ivor Katz*
Telehealth is one of the great promises of the internet age. A system that allows patients throughout remote and rural Australia to attend virtual specialist appointments without leaving town.
All the essentials are there, including government cash and commitment, an expanding national broadband network and simple and affordable video-enabled devices.
So, by 2014 telehealth should be gaining traction. There should be a growing number of rural GPs and patients telling positive stories about their positive experience. It should be closing the geographical health gap. Telehealth should be saving lives, health dollars and time.
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Researchers, medical workers seek tech answers to Ebola outbreak

Sharon Gaudin (Computerworld (US)) on 08 November, 2014 06:40
WORCESTER, Mass. -- Researchers in robotics will meet with health care and aid workers around the country Friday to get ideas on how technology could help fight the deadly Ebola outbreak, as well as the spread of other dangerous viruses.
"When someone says robots, I'm old enough that this is what I see," said Catherine Brown, a veterinarian with the Massachusetts Bureau of Infectious Disease, looking at an image of R2-D2 and C-3PO from Star Wars during a session this morning at Worcester Polytechnic Institute. "I know this is not what robotics is really like, but I'm not sure what that is... You're always chasing the last outbreak. That's really unfair and it's a huge, huge problem for the countries involved. We're going to be talking about opportunities for the robotics community to engage with the public health and the medical community."
Led by WPI and Texas A&M University, the workshops are aimed at providing a forum for health care workers to discuss with technologists what they need to better care for Ebola patients, to help stop the spread of the virus and to protect care givers from contracting the disease.
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Telstra makes new e-health push

Telstra has forged deeper into the burgeoning e-health sector, snapping up a strategic stake in New Zealand’s Orion Health, which is scheduled to list on the Australian and NZ stock exchanges later this month.
The telco’s move into the Auckland-based company, which provides software to hospitals and clinics in more than 30 countries, reflects its strategy to become a leading player in the business as the medical industry gravitates from inefficient paper-based ­administration processes to an electronic patient records system.
Telstra declined to comment on the acquisition, however, it is understood an announcement on the move is imminent.
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Protecting the community through real-time prescription monitoring

Friday, 14 November 2014
A re-elected Coalition Government will develop a real-time prescription monitoring system to protect Victorian patients and their families, friends and loved ones from the tragic and often fatal consequences of prescription drug misuse.
  • $6.98 million investment over five years to link prescription records
  • Protecting the community from the impact of pharmaceutical abuse
  • Napthine Government building a healthier Victoria 
Minister for Health David Davis said the commitment reflected the Coalition Government’s concern about the number of deaths in Victoria resulting from pharmaceutical abuse.
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Victorian real-time monitoring commitment

14 November, 2014 Chris Brooker
The Victorian government has committed to introduce real-time prescription monitoring if it is re-elected at the upcoming state election.
The promise follows a call by state coroner Ian Gray for urgent action after real-time prescription monitoring recommended eight inquest findings since February 2012.
Health Minister David Davis says the government will invest $7 million over five years to institute real-time monitoring.
The move has been welcomed by Victorian pharmacists.
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Doctors ‘paternalistic’: CHF

10th Nov 2014
THE claim by a consumer group that electronic health records are under attack by “self-interested doctors” has been roundly dismissed by experts.
The row stems from the looming integration of pathology and diagnostic results into the personally controlled electronic health record (PCEHR) system, slated to begin 30 November, which could involve test results being automatically sent to patients.
In a statement last week, the Consumers Health Forum said the “full potential” of the PCEHR was being threatened by “self-interested doctors who wrongly claim they are putting patients’ interests first”.
GPs have warned of potentially dangerous consequences arising from the misinterpretation of results, a view CHF CEO Adam Stankevicius told MO was “paternalistic rubbish”.
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Ultranet's costly failure an education in politics and procurement

Date November 15, 2014 - 9:51AM

Richard Baker, Nick McKenzie and Ben Preiss

On Friday August 27, 2010, Victoria's then education minister Bronwyn Pike joined students at Hume Central Secondary College as they logged on to computers to chat live to 20 of their contemporaries 8000 kilometres away.
Days earlier, students from Glen Waverley and Balwyn secondary schools touched down in buzzing Shanghai with education department deputy secretary Darrell Fraser and a multimillion-dollar, life-sized classroom to show the world Victoria's "classroom of the future".
Thankfully for Pike and Fraser, the video link to China worked. Just two weeks earlier, the pair had been embarrassed by the shambolic debut of Labor's high-tech online schools learning system dubbed the Ultranet.
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America's Youngest Female Billionaire Explains How She's Transforming Medicine

Kevin Loria Nov 13, 2014, 10:17 AM
If you were to visit your doctor today, that doctor might send you to a lab to get a blood test. Then you’d go for a follow up exam, but if that blood test raised other questions, you might have to go get another vial drawn from your arm. Finally you’d return for a third doctor’s visit.
Three doctors visits and two trips to get blood drawn in a lab. That’s expensive and inefficient. Between 40 and 60% of people don’t even end up getting the lab tests their doctors ask them to, due to the cost, time involved, and perhaps a fear of needles, according to Elizabeth Holmes, who spoke at TEDMED in Sept.
Holmes wants to change that.
She is a Stanford dropout who founded a company called Theranos that’s trying to revolutionise the blood test. Instead of having to go to a lab to get blood drawn and then having the results interpreted by a doctor, Theranos has set up a system where people can walk into a Walgreens for an apparently painless fingerprick that draws a tiny drop of blood.
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2012 funds finally make it to Victorian hospitals

By admin Finance Nov 12, 2014
The Victorian Government has finally released the funds established in a $100 million e-health pool that was established in 2012, distributing it to hospitals and health services. Victorian Health Minister David Davis announced Monash Health as the big winner, with $40 million allocated for the institution to kick start its electronic records and electronic medication management system. For more on this system, see the latest edition of Transforming the Nation’s Healthcare.
Monash Health emerged as a big winner in the funding round, being given $40 million to start its implementation of integrated electronic medical records and an electronic medications management system.
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Online assistance to help mentally ill

By NATALIE KOTSIOS

Nov. 14, 2014, midnight
THE internet could be used more widely in treating rural people with mental health concerns, helping patients finally beat the tyranny of distance.
The prospect of e-health services was just one of many topics covered at the annual Rural and Remote Mental Health Symposium, held at the Commercial Club in Albury yesterday, and touched upon by guest speaker Senator Fiona Nash.
The Nationals senator for NSW and Assistant Health Minister said while physical, face-to-face services were sought as much as possible, online services could be a way for those with limited access to still get the help needed.
“I think people in rural areas realise there isn’t a heart surgeon on every corner, for example, but they do want and expect a reasonable level of access,” she said.
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Updated: Use Cases and Conformance Requirements for Healthcare Identifiers

Created on Monday, 10 November 2014
NEHTA has released an updated version of the use cases and conformance requirements for healthcare identifiers, to allow healthcare providers to request a verified Individual Healthcare Identifier (IHI) for a newborn child.
When a child is born in a hospital setting or other organisation that offers maternity services (e.g. Indigenous Health Services) a patient record is created for the child in the local clinical information system. The clinical information system can now access the Healthcare Identifiers (HI) Service to request a verified IHI to be created for the newborn child.
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Coleman: Health Informatics NZ Conference, Auckland

Tuesday, 11 November 2014, 4:56 pm
Hon Dr Jonathan Coleman
Minister of Health
11 November 2014
Speech to Health Informatics NZ Conference, Auckland
Thank you to Liz Schoff, HiNZ Board Chair, for the invitation to speak to you all today.
This conference has had a 30 percent increase in attendance since last year, which highlights the increasing importance of health informatics and the broader topic of eHealth.
It’s pleasing to see that Clinicians Challenge has attracted a record 79 entries. This shows clinicians recognise the importance of using technology to improve clinical practice and lift outcomes for patients.
As a doctor, I know the value of clinicians stepping into leadership roles to drive progress in our health system, with the patient at the centre of everything we do.
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Innovative eHealth idea wins $10,000

Wednesday, 12 November 2014, 9:35 am
Health Minister Jonathan Coleman has congratulated the winner of a challenge to find innovative IT ideas to improve health services.
“The Clinicians’ Challenge encourages health professionals to find ways technology can solve problems they face in their day-to-day practice and make a difference to the health of New Zealanders,” says Dr Coleman.
This year’s Clinicians’ Challenge has been won by Dr Tom Morton, an emergency physician at Nelson Marlborough DHB, who presented ‘Emergency Department at a Glance’, an information system that displays data for managing patients’ journey through an emergency department.
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Visage 7 Elevates Enterprise Imaging

November 11, 2014 15:08 ET| Source: Pro Medicus Ltd.
SAN DIEGO, Calif., Nov. 11, 2014 (GLOBE NEWSWIRE) -- via PRWEB - Visage Imaging Inc. ("Visage"), a wholly owned subsidiary of Pro Medicus Ltd. (ASX: PME), announced today that the latest release of the industry-leading Visage® 7 Enterprise Imaging Platform will be demonstrated at the 2014 Radiological Society of North America (RSNA) conference, November 30 - December 4, in Chicago, Illinois, at Visage Imaging Booth #4365, McCormick Place-South Building. Integration to Visage 7 will also be demonstrated at prominent vendor exhibits across the RSNA show floor reinforcing Visage's leadership role in best-of-breed, Deconstructed PACS SM. Visage has also announced the release of Visage Ease Pro for mobile diagnostic image and results access, available for users in Canada, Australia and the European Union (EU). Visage 7 enables enterprise imaging with amazingly fast, thin-client, server-side processing technology.
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Global Health MD Mathew Cherian discusses recurring revenue at Investor Forum

Friday, November 14, 2014 by Proactive Investors
Global Health's (ASX:GLH) managing director outlined to investors in Melbourne this week the company's revenue generating e-health software applications.
Currently 95% of GLH's revenue comes from healthcare clients, with software licences and recurring subscriptions between 70% to 80% of total revenue.
GLH's business model is to connect clinicians and consumers, through a combination of on-premises and cloud applications across healthcare segments.
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ResMed unveils the invisible sleep monitor

14/11/2014
By Jamie Hinks, CONTRIBUTOR
Sleep monitoring usually conjures up images of sensors placed all over the room or even in the bed making you think so much about the devices that you struggle to get off to sleep.
ResMed thinks it has the solution with its S+ system that it brags is the world’s first non-contact sleep system to come onto the market by using a wealth of data to give tips on how to sleep better.
S+ uses bio-motion sensors to measure the stages of sleep through breathing patterns and body movement, light, noise and temperature levels from within a room.
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Aconex, provider of a leading cloud collaboration platform for the global construction industry, has deployed its new Dynamic Manuals product for mobile asset information management at The Royal Melbourne Hospital (RMH), one of the world’s leading clinical hospitals. The hospital’s operations team uses the tablet-based, Windows 8-compatible solution to access and update its digital operation and maintenance (O&M) manuals on site.
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NBN Co takes a stand for common sense

NBN Co’s statement of the principles that will underlie its multi-technology rollout are statements of common sense in an area of policy blighted by absurdities.
There is nothing radical or surprising within the principles, given that they are directed by Turnbull’s desire (and that of NBN Co’s relatively new board and management) to deliver the NBN as quickly as practicable at the lowest cost to taxpayers.
They do, however, provide clarity as to what broadband technology consumers might expect to be connected to.
There are three key differences between the national fibre-to-the-premises network originally announced by Labor’s Stephen Conroy and Kevin Rudd.
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Fibre to the node becomes default NBN deployment

Summary: NBN Co has formally ended the plans to roll out fibre to the premises to 93 percent of Australian premises, mandating that fibre to the node should be the default technology choice.
By Josh Taylor | November 13, 2014 -- 04:37 GMT (15:37 AEST)
Australian homes and businesses not on the schedule to get fibre to the premises on the National Broadband Network (NBN) today will likely not get fibre to the premises (FttP) under the new plan from NBN Co.
Since the change of government in September 2013, NBN Co has moved from a 93 percent fibre-to-the-premises rollout, to be "agnostic" in its technology choice for the NBN, opting for a "multi-technology mix" where the most cost-effective technology for each area is determined when the company moved into that area and assessed the quality of the copper network to meet the government's minimum 25 megabits-per-second download speed guarantee. 
NBN Co CEO Bill Morrow had said that NBN Co would like to roll out more fibre to the premises than fibre to the node if cost savings could be found.
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Unions key to payroll success, says NSW Health

CLOSE collaboration with key union groups was one of the driving forces behind the success of an ambitious payroll systems upgrade for 40,000 employees at NSW Health.
NSW Health is in the final stages of a multi-year project to upgrade to a new version of Oracle’s payroll platform.
It has 3000 awards and 27 different types of customers -- making for a very complex environment, said NSW Health corporate IT director, e-health, Farhoud Salimi.
The payroll upgrade, part of Oracle’s e-business suite 12, has been implemented across core local health districts and health agencies to replace legacy systems.
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Microsoft Band review: Unlike any other wearable and uniquely yours

Summary: The Microsoft Band is a data collection machine and with the ability to select your tile interface, it can do as much or as little as you want it to.
By Matthew Miller for The Mobile Gadgeteer | November 13, 2014 -- 15:00 GMT (02:00 AEST)
Daily activity tracker, multi-platform smartwatch, GPS sport watch, heart rate monitor, and fitness coach. The Microsoft Band can be whatever you want and that is the real power of the Band.
I've now spent nearly two weeks with the Microsoft Band — read my first impressions — and it has secured a place on my wrist for the foreseeable future.
As a guy who covers the mobile space, I use smartphones running every mobile operating system; the Microsoft Band is currently the only wearable to work across Windows Phone, iOS, and Android. Come to think of it, I will have to test it with my BlackBerry Passport and the Android Microsoft Health app since my Pebble works through this approach.
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The 5 SMART stats that actually predict hard drive failure

Backblaze released data showing SMART stats are inconsistent from manufacturer to manufacturer and don't always indicate a failure.
Lucas Mearian (Computerworld (US)) on 13 November, 2014 05:29
Hard drive firmware that IT administrators use to monitor hard drive health is highly inconsistent from drive to drive and manufacturer to manufacturer, according to figures collected from nearly 40,000 spindles.
The data, released today from cloud service provider Backblaze, also indicated which five of the 70 metrics that SMART stats cover are likely to predict a hard drive failure.
SMART, or Self-Monitoring, Analysis, and Reporting Technology, is nearly ubiquitous firmware that vendors embed as tools to alert IT admins to impending problems.
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Probe lands on comet in historic first

  • AP
  • November 13, 2014 5:53AM

Rosetta spacecraft makes first-ever landing on comet

HUNDREDS of millions of kilometres from Earth, a European spacecraft has made history with a successful landing on the icy, dusty surface of a speeding comet — an audacious first designed to answer big questions about the universe.
Scientists at the European Space Agency control room in Darmstadt, Germany, cheered and applauded when the probe began sending signals from the comet after a walking pace descent of 20km through space.
The landing of the Philae probe on comet 67P/Churyumov-Gerasimenko required immense precision, as even the slightest error could have thrown the spacecraft far off course and imperilled the mission. In the end, the touchdown of the Philae lander appeared to be almost perfectly on target, said Paolo Ferri, head of mission operations for the European Space Agency.
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Enjoy!
David.

Sunday, November 16, 2014

Emerging Issues And Complexities Regarding The Commonwealth’s PCEHR System.

Prompted by the recent discussions in some quarters regarding the holding of laboratory and radiology results in the Federal PCEHR I thought it might be worthwhile to go back to basics and ask a basic elementary question.
The really key and crucial question might be “What was the PCEHR intended to do and achieve?”
This might be best answered by referring to the 2009 report developed by the National Health and Hospital Reform Commission and finalised in April 2009.
The document was entitled:
Person-controlled Electronic Health Records
The key messages were:
1. Health care is knowledge intensive. The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care.
2. Current health information systems are disjointed, which often results in health care professionals operating with incomplete or incorrect patient information. It is estimated that up to 18 per cent of medical errors are a result of inadequate availability of patient information.
3. As technology, work practices and medical knowledge continue to evolve in the coming years, the complexity of health care interactions will become greater, which means the need to document and readily access a patient’s health profile will become more critical.
4. A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.
5. Investment in health IT lags well behind that of other information-centric consumer industries such as the financial and telecommunication industries, which have invested heavily over the last 20-30 years to achieve global connectivity.
6. According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record (EHR).
7. The implementation and widespread use of information technology in the health sector (e-health) is one of the most important enablers of personal health management and quality health care.
8. The overall economic benefit from increased productivity and reduced adverse events that would be achieved with a national individual electronic health record in Australia has been estimated to be between $6.7 billion and $7.9 billion in 2008-09 dollars over 10 years.
9. The protection of privacy and confidentiality is a key factor in winning widespread community acceptance and uptake of electronic health records.
10. Health providers and the IT industry must work together to develop open, nationally-agreed standards for the secure electronic capture and storage of personal health information.
11. The essential role of governments in a new e-health environment is to protect the public’s interest through legislative reform and ensuring people retain control over who has access to their personal health information.
----- End Extract.
Viewed from the vantage point of some five and a half years later it seems what was being proposed in the other 18 pages of the document were a mixture of over-ambition, misunderstanding and naiveté regarding the complexity of the health sector and health information technology.
What strikes one most forcefully in all this is the apparent lack of impact of the PCEHR System and a seemingly wilful lack of keenness to make assessments of the system success, despite the fact such evaluation was planned. While there is information on numbers enrolled and records automatically updated there are no actual usage statistics by consumers or clinicians in terms of clinical records actually access etc.
One question that comes up out of this, as mentioned above,  is around just what the PCEHR was intended to do? On the basis of the extract above what was originally hoped for was:
1. Improved patient engagement in their healthcare.
2. Improved speed and accuracy of the communication of health information.
3. Improved quality and safety of care.
4. Improved co-ordination of care delivery.
5. Savings for the Health Budget.
After 5.5 years, and a $1.0 Billion expenditure, if these were the objectives it would seem the evidence for success, so far, is pretty limited.
Can we form a view yet or is it too early to tell? If the claim is that it is too early to tell then surely there should be clear performance hurdles, and a defined budget, before more is spent? Otherwise we just have a very dark black hole in front of us!
Additionally we need to be clear that the stated objective of a personally controlled record has rather drifted with such a deluge of largely useless information being fed  into the record (MBS of tests and bills etc.) not under any apparent sort of consumer control! Once you have a record all this just seems to arrive. (I wonder did I consent to all this when the PCEHR stated 2.5 years ago - don't remember) Interestingly the PCEHR does not appear to have changed much in the roughly 12 months since I last logged in. The user interface is just as awful as ever.
Was a dog an age ago and still looks to be.
David.

AusHealthIT Poll Number 244 – Results – 16th November, 2014.

Here are the results of the poll.

Should Patients Be Asked To Consent To The Uploading Of Their Investigative Results To The PCEHR Before It Happens?

For Sure 73% (145)

Probably 16% (31)

Neutral 2% (3)

Probably Not 4% (8)

No Way 5% (10)

I Have No Idea 1% (1)

Total votes: 198

A very clear response with a big majority seeing consent as crucial before results are sent to a PCEHR.

Good to see such a clear outcome and lots of votes.

Again, many, many thanks to all those that voted!

David.

Saturday, November 15, 2014

Weekly Overseas Health IT Links - 15th November, 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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Commentary: Will GOP Change Health IT Policy?

NOV 5, 2014 2:57pm ET
With Republicans in charge of both houses of Congress in January, some health information technology legislation that has languished might get resurrected in 2015, and efforts to challenge the statutory authority of federal agencies to regulate HIT also may be renewed.
The U.S. House in particular has seen several bills introduced in the past two years, generally led by a Republican member but some also co-sponsored by a Democrat. None of the bills could likely move on their own, but could get attached to legislation going through both chambers. Example: A new ICD-10 compliance date and delayed enforcement of the Medicare two-midnight payment policy were part of the “Doc-Fix” legislation enacted last spring to stave off a huge cut in Medicare reimbursement rates for physicians.
The proposed HIT legislation, which dies at the end of this year if not enacted, can be reintroduced in the new two-year congressional session that starts in January. Major legislation moving through Congress, such as an emergency appropriations bill or another Doc-Fix bill early in the year, could include HIT provisions. HIT bills introduced in the current congressional session that could be brought back next year include:
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Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Authors: Greenhalgh T, Swinglehurst D, Stones R.
Journal: Health Services and Delivery Research Volume: 2 Issue: 39
Publication date: November 2014 - DOI: 10.3310/hsdr02390
Citation:  Greenhalgh T, Swinglehurst D, Stones R. Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies. Health Serv Deliv Res 2014;2(39)

Abstract

Background

Nationally mandated information and communication technology (ICT) systems are often locally resented and little used. This problem is sometimes framed in behaviourist terms, depicting the intended user of technology as a rational actor whose resistance stems from Luddism and/or ignorance, and viewing solutions in terms of training, incentives and sanctions. The implication is that if we get the ‘rewards’ and ‘punishments’ right, people will use technologies. Previous research in the social sciences, notably sociotechnical systems theory, actor–network theory and normalisation process theory, have considered the human, social and organisational context of technology use (and non-use). However, these have all had limitations in explaining the particular phenomenon of resistance to nationally mandated ICT systems.
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CDC Ebola Safety Videos Available Online

NOV 6, 2014 11:00am ET
The Ebola virus disease training modules for healthcare workers developed in collaboration between experts at Johns Hopkins Medicine and the Centers for Disease Control and Prevention are now available online.
The interactive, web-based learning program, called Ebola Preparedness: PPE Guidelines, is available for free through the CDC’s website. The program trains healthcare providers in three critical areas: proper donning of personal protective equipment (PPE), the safe removal of gear, and active monitoring skills.
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Allscripts posts $25.8M loss in Q3

Posted on Nov 07, 2014
By Mike Miliard, Managing Editor
Allscripts stock tumbled late Thursday as the company announced a $25.8 million net loss for the third quarter, but CEO Paul M. Black insisted the electronic health record developer "continued to show progress," citing new clients here and abroad.
Moreover, that net loss was much preferable to the $48.9 million loss posted for the same quarter in 2013.
Allscripts' bookings were $223 million in Q3, compared with $236 million in the third quarter of 2013 and $234 million in the second quarter of 2014.
Still, Allscripts made the case that it's continuing to rebound from its annus horribilis of 2012. For the first nine months of 2014, bookings totaled $680 million – an increase of approximately 8 percent over the first nine months of 2013.
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New CIO to lead eHealth Strategy

November 7, 2014 by Gary Culliton
Richard Corbridge, who was named one of the top 20 Chief Information Officers (CIOs) in the UK and has been nominated for a number of awards for delivery of business intelligence systems in healthcare, is to be the first health service CIO for Ireland.
The appointment is timed to coincide with new moves to develop Community Healthcare Organisations and hospital Groups. The Government’s eHealth Strategy recommended the establishment of eHealth Ireland under the leadership of a CIO for the Health Service. Arising from this, the Office of the CIO, incorporating eHealth Ireland, is being established. The CIO will lead the transformation of health information technology (ICT) and also develop “eHealth ecosystems” —partnerships between health service providers, academia, industry and patients.
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EHR-generated clinical quality information can be made more reliable

November 4, 2014 | By Marla Durben Hirsch
Providers can come together to standardize the data extracted from electronic health records in order to increase the reliability of quality measure reports, support quality improvement and align with national clinical reporting requirements, according to the results of a new case study published in eGEMs (Generating Evidence and Methods to Improve Patient Outcomes).
The lack of standardization in data capture and reporting within EHRs drives distrust in the EHR data. The case study, conducted by the researchers from the Louisiana Public Health Institute, focused on an initiative by the Crescent City Beacon Community in New Orleans, creating a five-step process implemented in 13 safety net clinics over nine months using diabetes and cardiovascular disease data.
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CIOs: EHR usability for record retrieval 'poor'

November 3, 2014 | By Marla Durben Hirsch
Electronic health records are falling down on the job when it comes to finding the information that they hold, according to a new survey from Frost and Sullivan.
The study, "EHR Usability-CIOs Weigh in on What's Needed to Improve Information Retrieval," which was conducted in conjunction with the College of Health Information Management Executives (CHIME), surveyed about 60 CIOs, primarily from mid to large community hospitals. The respondents reported that while the EHR market was mature, the technology itself was immature, and was too slow and lacked precision when it came to information retrieval. These problems, as well as the difficulty in finding and reviewing the data, created "significant" productivity losses and increased potential risks to patient safety.
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At Cerner, interoperability is personal

Posted on Nov 06, 2014
By Bernie Monegain, Editor
Cerner CEO Neal Patterson put EHR interoperability front and center during the Cerner Health Conference – a client gathering that drew as many as 11,000 participants to the Kansas City Convention Center this week.
Kansas City is headquarters for the healthcare IT giant.
On Tuesday Patterson delivered a keynote talk that made the quest for interoperability personal by invoking the travails of his wife Jeanne as she carried bags of healthcare documents from one location to another around the country during her battles with cancer.
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Epic ups and downs at Cambridge

6 November 2014   Claire Read
A week and a half after its launch, Epic is “starting to deliver some real benefits” to Cambridge University Hospitals - although the trust’s eHospital programme director admitted that the implementation has not been without its teething problems.
Speaking at a well attended session at the Health CIO Network conference, held alongside EHI Live 2014 in Birmingham, Carrie Armitage said that there had been more than 2,000 support calls from staff on the first Monday after go live.
“An awful lot were ‘I can’t remember my password’ – very basic problems. But over the first week, the number of tickets has fallen off considerably, and over two thirds of outstanding issues have now been resolved.”
Other challenges had been around “the little, tricksy things that trip you up,” she reported.
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Partners' Cara Babachicos: The people part of IT is really complicated

November 6, 2014 | By Dan Bowman
While health IT education is a passion for Cara Babachicos, the corporate director of information systems and CIO of community hospitals and non-acute entities at Boston-based Partners HealthCare, also has a bevy of day-to-day responsibilities to ensure that the 10 sites she oversees run smoothly. From a personnel standpoint, alone, the task is not an easy one.
"There are a lot of differences in all the sites and people that report to me," she said at the College of Healthcare Information Management Executives' annual fall forum in San Antonio last week. "Some CIOs who report to me might be more influential when it comes to their hospital's executive team, while others are reporting to their facility's chief financial officer and struggling to get a seat at the decision-making table."
In part II of FierceHealthIT's exclusive interview with Babachicos, she talks about the state of Partners' move from a homegrown electronic health record system to a vendor product, as well as ongoing security efforts.
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Many May Have Undiagnosed Diabetes

Diabetes may be undiagnosed in many, but electronic record searches may identify these patients

November 4, 2014 / Author:  Don Rauf / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh
 (dailyRx News) Left untreated, diabetes can lead to a host of health problems, such as heart attack, stroke and kidney disease. The condition, however, may go undetected in many patients.
If a person’s blood sugar stays at a high level because of untreated diabetes, it can damage the heart, eyes, kidneys, nerves and other parts of the body over time. Medication and lifestyle changes like diet and exercise can keep the complications at bay.
But a new study found that many patients may not even know they have the condition. A simple electronic search of medical records, however, may easily pinpoint those who have the condition, the study authors noted.
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Calif., N.Y. Efforts Highlight How HIE Activity Is Shifting Away From Fed Gov't

By William S. Bernstein and Susan R. Ingargiola, Manatt Health Solutions Thursday, November 6, 2014
A major source of funding for electronic health information exchange has historically been federal grants, such as those provided by the HITECH Act, which included, among other things, grants for the development of statewide HIE infrastructure. With this funding largely gone, the locus of electronic HIE activity has been shifting from the federal government to public -- and, increasingly, private -- health care stakeholders at the state and local level.
In the absence of federal funding, health care providers, health plans, consumer advocates and state policymakers are all testing new strategies to increase interoperability and to shore up the financial sustainability of their HIE efforts. Not surprisingly, their strategies are diverse and include regional HIE initiatives (e.g., the Santa Cruz HIE and various other regional HIEs operating throughout California) and private proprietary HIE initiatives operated by hospitals that use Epic Care or other health IT tools to connect with health care providers in the community, among others.
Two unique efforts are occurring in California and New York. Both serve as viable options for a large-scale exchange; they also provide a glimpse into how a nationwide health information network might evolve in the post-HITECH world (i.e., in a world without federal grants to fund electronic HIE).
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Poor MU showing renews calls for change

Posted on Nov 05, 2014
By Mike Miliard, Managing Editor
A fresh batch of disheartening Stage 2 attestation numbers has prompted several industry groups to once again implore the Centers for Medicare & Medicaid Services to shorten the meaningful use reporting period in 2015.
Officials from the AMA, CHIME, HIMSS and MGMA said in a joint press release that the numbers are "disappointing, yet predictable," and reiterated their calls for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.
CMS numbers released Nov. 4 show that fewer than 17 percent of U.S. hospitals have demonstrated Stage 2 capabilities. Even worse, fewer than 38 percent of eligible hospitals and critical access hospitals have met either stage of meaningful use in 2014. The data suggest inherent difficulty in the program, and suggest that these travails will only continue in 2015, according to industry groups.
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Trust issues over health privacy persist

Posted on Nov 05, 2014
By Erin McCann, Associate Editor
Healthcare industry, listen up: You've got a consumer distrust issue on your hands. The majority of American consumers continue to have serious doubts over the privacy and security of their medical records – so much so that a sizable number of them actually withheld information from care providers over those concerns. 
This according to a new Centers for Medicare & Medicaid Services survey, which took a pulse of consumer perceptions toward healthcare privacy and security. The numbers are telling.
After surveying more than 2,000 consumers, CMS officials found that about three-quarters of them were either very or somewhat concerned over the privacy and security of their medical records. What's more, 10 percent of respondents withheld information from their healthcare provider who used an electronic health record. (This compared to the 6 percent who withheld data from providers who used paper medical records.) The differences between the two were not statistically different, CMS pointed out. 
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Geisinger's Glenn Steele: OpenNotes changing care at a fundamental level

November 5, 2014 | By Dan Bowman
Through initiatives like the OpenNotes project, Danville, Pennsylvania-based Geisinger Health System is aiming to change patient care at a fundamental level, CEO Glenn Steele said during a keynote speech at last week's College of Healthcare Information Management Executives annual fall forum in San Antonio, Texas.
Steele called the current healthcare environment "schizophrenic," saying that despite a push toward care accountability on the part of providers and payers, fee-for-service still reigns.
"We're moving away from a fragmented system," Steele said. "We're moving away from a doctor-centric and hospital-centric approach."
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November 3, 2014, 1:49 PM

Google revamps Flu Trends after it overestimated illness

Google says it is revamping its online flu tracking system after it vastly overestimated the number of U.S. flu cases in recent seasons.
Google Flu Trends launched in the U.S. in 2008, aiming to document and predict the spread of the flu based on how many people were searching for flu-related terms online. "We do hope it can help alert health professionals to outbreaks early, and in areas without traditional monitoring, and give us all better odds against the flu," the company said in a blog post.
At first, Google said its results seemed to be remarkably accurate when compared with official data released by the Centers for Disease Control and Prevention.
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Less than 17% of Hospitals Demonstrate MU Stage 2 Capabilities, CMS Says

John Commins, for HealthLeaders Media , November 5, 2014

Key stakeholders say the results of a federal report are "disappointing, yet predictable" and call once again for the Centers for Medicare & Medicaid Services to shorten the 2015 reporting period.

News Tuesday from the federal government that less than 17% of the nation's hospitals have reached Stage 2 capabilities under Meaningful Use requirements was met with consternation but not surprise from a coalition of provider associations.
The news came Tuesday during a briefing by the Department of Health and Human Services' HIT Policy Committee, which also reported that less than 38% of eligible hospitals and critical access hospitals have met either stage of Meaningful Use so far in 2014.
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Want to reduce security risks? Assess near misses

By Rick Kam, President and co-founder, ID Experts and Mahmood Sher-Jan, Vice president of product management at ID Experts
Life is full of “near misses”: the rear-end collision that didn’t happen, the chest pain that wasn’t a heart attack, the time your child stumbled but didn’t fall. Healthcare organizations also experience their own near misses; that is, they have hundreds, even thousands, of privacy or security incidents involving PHI/PII that never become data breaches.
But there are lessons to be learned from these near misses — they are a treasure trove of information that most CISOs or privacy officers may not be mining to identify their future security vulnerabilities.
In an article in CIO Insight, “Security strategies must be integrated,” the author notes that one of “security’s primary aims is to prevent negative incidents” since it is “almost impossible for organizations to avoid such events.” He says that without a proper analysis of negative incidents — these near misses — that an organization may “not spend money where it’s most needed to reduce the odds of a major data breach or other security incident.” In other words, to reduce data breach risks, an organization needs to look at the incidents that might have been data breaches.
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Hospitals are finding ROI from RFID

Posted on Nov 04, 2014
By Anthony Vecchione, Contributing Writer
Just a few years ago, discussion of the use of radio-frequency identification in healthcare was usually limited to drug manufacturers and wholesalers, who use RFID as a way to track drug products through the supply chain or to combat counterfeit drugs.
Nowadays, RFID technology is being used by more and more hospitals to improve safety and efficiency.
At University of Michigan Hospitals and Health Centers in Ann Arbor, hospital pharmacists are using RFID to help them manage drug kits through the use of an automated pharmacy stocking system.
By utilizing cloud-based software and an RFID scanning station from Washington, DC-based Kit Check, pharmacy technicians inventory dozens of medications in seconds that are in pharmacy kits including crash carts and anesthesia trays. Previously technicians and pharmacists would inspect each kit vial individually, a process that can take up to ten times longer.
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How ACOs are harnessing IT to transform care coordination

November 4, 2014 | By Susan D. Hall
The Office of the National Coordinator for Health Information Technology (ONC), in a new report, highlights success stories from accountable care organizations that are harnessing technology in the transition to value-based payments.
While adoption of electronic health records helps individual providers access patient information and evidence-based guidelines for care, population health management and registry tools help them see larger trends among groups of patients. At the same time, infrastructure that ties together collaborating organizations and communities are necessary to fully deliver coordinated care, write the authors of a post at Health IT Buzz.
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EHRs can improve clinical note quality

Beth Walsh
Nov 03, 2014
Physicians' clinical notes improved in quality after EHR implementation, according to an article published in the Journal of the American Medical Informatics Association (JAMIA).
Researchers from the Uniformed Services University of the Health Sciences in Maryland conducted a five-year multicenter study of the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with Type 2 diabetes. The notes were evaluated six months before EHR implementation, six months after implementation and five years after implementation, using an instrument called QNOTE.
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The Impact of the ICD-10 Delays

Scott Mace, for HealthLeaders Media , November 4, 2014

Despite a Congress-mandated fourth delay of the implementation deadline, ICD-10 preparations continue, though the effect on organizations varies.

This article appears in the October 2014 issue of HealthLeaders magazine.
Although Congressional action has postponed the ICD-10 coding mandate until at least October 1, 2015, preparations to adopt it continue at a slower pace, even though physician opposition to the mandate remains steadfast.
"We were prepared to be ready October 1 of 2014," says Randy McCleese, vice president of information systems and CIO at St. Claire Regional Medical Center in Morehead, Kentucky, which has 110 staffed beds and 2013 revenue of about $126 million.
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Why technology won't replace human interaction in healthcare

November 3, 2014 | By Katie Dvorak
Technology may take the place of human interaction in some aspects of healthcare, but that doesn't make in-person contact any less important, according to two industry professionals. 
Humans and computers are very good at different things, Sam Altman, president of Silicon Valley-based tech incubator Y Combinator, told the Wall Street Journal in an interview.
"A computer doctor will do a better job than a human on looking at a massive amount of data ... but on cases that require judgment or creativity or empathy, we are nowhere near any computer system that is any good at this," he said.
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EHR Clinical Decision Support Produces Better Patient Care

Author Jennifer Bresnick | Date October 31, 2014

EHRs equipped with clinical decision support tools are associated with higher quality of care in a new study.

Providers who use electronic health records equipped with clinical decision support (CDS) technologies are able to produce better blood pressure control and more comprehensive cancer screenings for patients than providers who had disabled or didn’t use CDS features, says a study in the American Journal of Managed Care.  The study suggests that the basic level of clinical analytics encouraged by the EHR Incentive Programs may be having a measurable impact on quality and outcomes.
“Although the meaningful use requirements have already been established, the evidence is inconsistent regarding improvement in healthcare processes or patient outcomes as a result of the implementation of general and individual EHR components,” writes the team of researchers from Brigham and Women’s Hospital, Harvard Medical School, and the Harvard School of Public Health.
“Prior studies have shown that EHR-based CDS is associated with improved prescribing safety, preventive care measures, and diabetes testing and control. CDS has also been associated with some improvements in quality indicators, but results have been variable.  Despite having EHRs, many physicians report being unable to complete basic panel management activities, which affects their ability to deliver high-quality care for patients with chronic conditions.”
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Doctors Using EHRs Spend More Time on Administrative Work, Study Finds

October 31, 2014
Doctors who use electronic health records (EHRs) are more likely to spend time on administrative work than those who do not.
That was one of the key findings of a study from researchers at the City University of New York and Harvard Medical School. The study was published this week in the peer-reviewed International Journal of Health Services.
The researchers, Steffie Woolhandler, M.D. and David Himmelstein, M.D., looked at the 2008 Health Tracking Physician Survey, which used a sample of 4,720 physicians who practiced at least 20 hours per week. The average doctor spends 8.7 hours per week, or 16.6 percent of their working time, on administration. Doctors with an EHR spend 17.2 percent of their time on administrative tasks while it’s 18 percent for those who use both electronic and paper. Those who only use paper records spend 15.5 percent of their time on administration.
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Conference Highlights Progress on Different Fronts in Connected Health Technology

by Andy Oram Monday, November 3, 2014
Technology is not the focus of the Connected Health Symposium, but technical advances play a major role there because of the potential for digital technology to help health care meet its broad goals of listening to patients and coordinating care among these patients, their family members and the professional team.
In some ways, the technology is far more advanced than the health care providers who could benefit from it, and it is up to those health care institutions to evolve organizationally and culturally. But on the other hand, much technology looks good only on the surface and quickly comes to shame when connected to real-life workflows and patient needs.

Devices: Bold Without Being Big

For people used to traditional blood pressure cuffs, infusion pumps and other conveyers of individual health, the modern landscape for devices will surprise you.
For instance, the Muse and BioBeats Pulse headbands provide biofeedback about brain activity. These have been used by many people to reduce stress and learn how to focus better on what they want to achieve.
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Hospital Records Are Adapting to Flag Ebola

A New Application Matches Patient’s Travel and Family History With Medical Symptoms

Dr. Garry Choy, who helped design Mass General’s QPID system. Dominick Reuter
By Melinda Beck
Nov. 2, 2014 8:20 p.m. ET
A month ago, Massachusetts General Hospital in Boston had no way to flag in its electronic medical records if an incoming patient had been to West Africa and had symptoms suggesting Ebola.
Now it does. Five days after the first U.S. case was confirmed in Texas, the hospital deployed a new Ebola application made by QPID Health Inc. that automatically matches a patient’s travel and family history with medical symptoms. If Ebola is suspected, the application flashes a blinking “Q” to alert hospital personnel.
Medical experts say concern over Ebola cases entering the U.S. has become a “teachable moment” for electronic medical records systems, or EMRs.
EMR vendors have scrambled to add new screening questions and alerts to their systems in the wake of the missteps with the Ebola patient at Texas Health Presbyterian Dallas Hospital. That patient, Thomas Eric Duncan, who had recently come to the U.S. from Liberia, was initially misdiagnosed as having “sinusitis” and sent home, only to return three days later, gravely ill.
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What Technology Can Do for Health

Sue Desmond-Hellmann and Sam Altman on Tackling the Big Problems

Sue Desmond-Hellmann Gary Fong/Dow Jones
Nov. 2, 2014 4:35 p.m. ET
Sue Desmond-Hellmann runs the $40 billion Bill and Melinda Gates Foundation, which is probably best known for investing in the development of drugs and vaccines to fight widespread diseases such as AIDS and malaria. Sam Altman is the president of Y Combinator, one of the best-known technology incubators in Silicon Valley.
Together, they sat down with Dennis Berman, The Wall Street Journal’s business editor, to discuss how technology is being used to solve the world’s problems. Here are edited excerpts.
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Enjoy!
David.