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."

Saturday, November 03, 2012

Weekly Overseas Health IT Links - 03rd November, 2012.

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.
-----

Mind Over Machine: Use Your Brain Waves to Control Your Computer

By Stacey Higginbotham on October 23, 2012
When it comes to controlling our computers, the last five years has seen incredible improvements in user interfaces including amazing touchscreens and much more natural vocal recognition. Now a Toronto company wants to take the UI to the next level—by going directly to the brain. You think it, and the Muse headband will make it happen under very limited circumstances.
InteraXon, the maker of the Muse headband, has listed its device on Indiegogo in hopes of raising $150,000 for building a mass-produced headband that translates your mental commands into a computer action. The example it shows on the site is playing a game using an iPad, where the rotation of a wooden block occurs when the user focuses on it. The user tilts the iPad to change the angle of the rotation.
-----

Health plans embracing ACOs, boosting IT, study shows

By Diana Manos, Senior Editor
Created 10/26/2012
WAYNE, PA – Health plans are heading toward 100 percent participation in accountable care organizations (ACOs), according to a new study, with 78 percent of respondents already part of one, and 22 percent planning to participate in one. This is all leading to a scramble for health IT.
"While health plans have been preparing for a changing marketplace for a few years, the pace and clarity of their plans are ramping, and their technology needs are expanding," said Ellen Donahue-Dalton, executive vice president and chief marketing officer of Medecision, a Wayne, Penn.-based, care management solutions firm.
-----

Nursing informatics programs gaining ground

By Anthony Brino, Contributing Editor
Created 10/26/2012
Hoping to fill a projected gap of some 50,000 healthcare IT professionals in the next several years, the Office of the National Coordinator’s Health IT Workforce Development Program is funding community college programs that can train IT professionals in healthcare and train healthcare professionals, like nurses, in IT.
The Bureau of Labor Statistics is also projecting a 20 percent increase in demand for registered nurses during the next decade, and amid increased enrollment in nursing schools, nursing informatics is growing as part of the curriculum.
-----

Weill-Cornell to launch health informatics master's program

Posted: October 25, 2012 - 3:00 pm ET
The Weill Cornell Graduate School of Medical Sciences in New York will launch a program next year for a master of science degree in health informatics.
The graduate school's Center for Healthcare Informatics and Policy, also called CHiP, is accepting applications for the January program, according to a news release. Students can use the degree to pursue careers in health information technology, analytics, management, research and policy.
-----

Web-based Prostate Cancer Database Portal Launched for Patients

October 25, 2012
The National Proactive Surveillance Network, the Ceders-Sinai Samuel Oschin Comprehensive Cancer Institute, the Prostate Cancer Foundation, and Johns Hopkins are jointly launching what they are calling the world's first online medical database designed to help men track the progression of their prostate cancer while avoiding complications from overtreatment. According to the group, the database portal will allow men with slow-growing forms of the disease to track it in a secure, interactive environment.
"Recently, new research has estimated that as many as 50 percent of newly diagnosed prostate cancer patients have a form of the disease that is so slow-growing that it often does not pose a threat to the life or long term health of the patient," said Stuart Holden, M.D., director of Cedars-Sinai’s Louis Warschaw Prostate Cancer Center and medical director for the Prostate Cancer Foundation, said in a statement. “As a result, a growing number of prostate cancer patients are deciding that the best course of action for them may be to defer initial treatment until it can be determined whether they, in fact, have the more aggressive or less aggressive form of the disease.”
-----
  • October 22, 2012, 7:20 p.m. ET

Physician, Steel Thyself for Electronic Records

Who's got time to listen to patients when the government demands 'meaningful' data entry?

By ANNE MARIE VALINOTI

There is a new television show on Fox this fall called "The Mob Doctor." Its heroine, Dr. Grace Devlin, is a surgeon who, in order to help settle her brother's gambling debt, agrees to serve as a one-woman HMO for Chicago's underworld. This would include everything from tending to the wounds of the nearly-whacked to treating the strep throats of gangsters' children.
While this professional track would have its unique occupational hazards, one appealing advantage makes up for the downsides: You can bet that no one is making Dr. Devlin use an electronic medical-record system.
The electronic medical record, or EMR, is a computerized system that allows physicians to record patient information electronically instead of using paper records. Test results can be reviewed through the system, and prescriptions can be emailed straight to the pharmacy. You can order medical tests and medications worth thousands of dollars with just a few mouse clicks.
-----

Why Can’t We Solve Big Problems?

On July 21, 1969, Buzz Aldrin climbed gingerly out of Eagle, Apollo 11's lunar module, and joined Neil Armstrong on the Sea of Tranquility. Looking up, he said, "Beautiful, beautiful, magnificent desolation." They were alone; but their presence on the moon's silent, gray surface was the culmination of a convulsive collective effort.
Eight years before, President John F. Kennedy had asked the United States Congress to "commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth." His challenge disturbed the National Aeronautics and Space Administration's original plan for a stepped, multi-generational strategy: Wernher von Braun, NASA's chief of rocketry, had thought the agency would first send men into Earth's orbit, then build a space station, then fly to the moon, then build a lunar colony. A century hence, perhaps, humans would travel to Mars. Kennedy's goal was also absurdly ambitious. A few weeks before his speech, NASA had strapped an astronaut into a tiny capsule atop a converted military rocket and shot him into space on a ballistic trajectory, as if he were a circus clown; but no American had orbited the planet. The agency didn't really know if what the president asked could be done in the time he allowed, but it accepted the call. 
-----

Electronic standing orders in EHRs improve preventive care

October 23, 2012 | By Marla Durben Hirsch
Utilizing electronic standing orders in electronic health records improves patient treatment, according to a new study published in the Journal of the American Board of Family Medicine.  
Standing orders are useful since they enable nurses and other ancillary staff to carry out medical orders without a physician's examination. The 21-month pilot demonstration study, conducted by researchers from the Medical University of South Carolina in Charleston, studied eight primary care physician practices in eight states. The practices ranged from two to 25 clinicians per practice. The standing orders were applied to 15 measures involving screenings, immunizations and diabetes care, such as flu shots, cholesterol checks and bone mineral density.  
-----

Hospital execs slow to measure technology ROI

By Mike Miliard, Managing Editor
Created 10/25/2012
WEYMOUTH, MA – Most healthcare C-suite members are dissatisfied with their organizations' efforts to measure return-on-investment from clinical IT systems, according to a new report from Beacon Partners.
The survey, "Finding the ROI in Clinical IT Systems," polled more than 300 healthcare executives, including CEOs, CIOs, CMIOs and CFOs. Beacon Partners, a healthcare management consulting firm, sought to analyze how hospitals and care delivery organizations use clinical system performance measures as a way to calculate the ROI of electronic medical record (EMR) systems.
-----

Docs: CPOE doesn't improve care or increase productivity

October 25, 2012 | By Julie Bird
While computerized physician order entry remains largely unpopular with doctors and nurses, a new study finds, over time nurses become more accepting of CPOE.
In a study published online today by the Journal of the American Medical Informatics Association, researchers from the University of Wisconsin-Madison reported that users were "moderately satisfied" with CPOE. That level of satisfaction didn't change over time for "ordering providers," or doctors, but improved significantly for nurses.
Nurses started out less happy with CPOE than doctors, the research found, but after a year their level of satisfaction matched that of doctors.
-----

Death by defibrillator: FDA called to address hacking risk

By Brian Alexander, NBC News Contributor
It sounds like a scenario out of a James Bond movie: a villain spots his quarry and uses a small device to hack into the official’s heart defibrillator, sending a signal for mayhem. There’s chest grabbing, and a collapse, and alarms, but the bad guy walks free because there’s no gun, knife, poison dart -- no evidence at all a murder has been committed.
According to a recent report by the Government Accountability Office (GAO), a non-partisan agency that works for Congress, not only is such a scenario possible, there’s a growing danger that grandpa’s heart rhythm device, or, say, a child’s insulin pump – any implantable device that can be accessed remotely --  could be susceptible to hacking.
-----

The Kiss of Death for Meaningful Use Efforts

OCT 24, 2012 11:54am ET
The kiss of death to an electronic health records meaningful use effort is boiling down the criteria to a checklist of to-do items for physicians. That’s the word from Jeff Loughlin, project manager at the Massachusetts eHealth Collaborative and executive director of the Regional Extension Center of New Hampshire.
“Physicians hate lists and once you think of meaningful use as a list, you are doomed to failure,” Loughlin said at the MGMA Conference in San Antonio. The program does provide qualification criteria in list format, he acknowledged, but the way to streamline adoption of meaningful use is to describe the criteria not as discrete tasks, but rather as steps that are part of any practice’s given workflow.
-----

CMS Staffer Says Stage 2 Patient Engagement Criteria Not Set in Stone

OCT 24, 2012 11:56am ET
Stage 2 electronic health record meaningful use requirements that at least five percent of patients conduct secure messaging with physicians, and view, download, or transmit their ambulatory and inpatient data came at the insistence of HHS Secretary Kathleen Sebelius. And those requirements might not be set in stone.
That’s the word from Travis Broome, a health insurance specialist at the Centers for Medicare and Medicaid Services, during a presentation of the Stage 2 rules at the MGMA Conference in San Antonio.  He devoted most of the presentation to rehashing the rules, but the tedium quickly dissipated during the question and answer period. It was dominated by concerns around requirements for patient access to a portal, government auditing of incentive payments, and the program’s longevity in face of recent Republican questions about its effectiveness.
-----

What Scares Healthcare CIOs

Scott Mace, for HealthLeaders Media , October 23, 2012

We now know the extent of the HHS Office of Inspector General (OIG)'s fraud and abuse fishing expedition regarding electronic health records, which came to light in the CHIME Fall CIO Forum in Palm Springs, CA, last week.
According to the American Hospital Association, the OIG letter went to all hospitals that received an incentive payment between Jan. 1, 2011 and March 31, 2012, directed specifically to the CEO's or administrator's office. The letter requests that responses be submitted by this Friday—one week from issuance.
The AHA says OIG will use the information from the survey as part of a report expected out next year. OIG staff informed the AHA that hospitals may take additional time to respond to the survey if needed. In addition, OIG will allow a health system to file a single response for all facilities, where the survey responses would be the same for each entity in the system.
-----

Blogging helps chronic pain patients feel less isolated

October 24, 2012 | By Dan Bowman
For patients suffering from chronic pain or illness, blogging about their condition can help to decrease feelings of isolation and increase their sense of usefulness, according to a study published this week in the Journal of Medical Internet Research.
Of of the 230 respondents, most (88 percent) had blogs that were public and searchable online, and 64 percent used their own names on their posts.
-----

Recent OIG report reignites call for CMS to drop SSNs from Medicare IDs

October 24, 2012 | By Julie Bird
Citing a report issued earlier this month by the U.S. Department of Health & Human Services' Office of Inspector General, Republican leaders of two key subcommittees of the House Ways and Means Committee are urging the Centers for Medicare & Medicaid Services to stop using Social Security numbers in identifying Medicare patients.
U.S. Reps. Sam Johnson (Texas), chairman of the Social Security subcommittee, and Wally Herger (California), chairman of the health subcommittee, made the argument in a letter dated Oct. 22.
-----

Healthcare system hackers usually after financial info

October 24, 2012 | By Susan D. Hall
Despite reports of efforts to blackmail patients and the possibility of hacking pacemakers, healthcare data breaches in the end are similar to other cyber crimes, according to a new report from Verizon. In an examination of approximately 60 confirmed data breaches over the past two years, the report concludes that those who attack healthcare systems primarily look for information from which they can make a profit.
"POS [point-of-sale] systems and desktops were at the forefront of breaches in the healthcare sector," according to the report's authors. "At first glance, this may seem counterintuitive, since electronic health records would almost certainly be stored in a file or database server, and surely this is what the criminals are after. But this likely represents an incorrect assumption; most cybercriminals are more interested in accessing your bank account and applying for loans in your name than they are the details of your last medical exam."
-----

Open source GP project takes off

18 October 2012   Rebecca Todd
A locum GP is co-directing a project to develop an open source GP clinical system to allow "true interoperability" with other healthcare systems.
Dr Marcus Baw told EHI Primary Care the idea of an open source primary care system has been “knocking around for years” amongst GPs that code.
“The open source model fits in very neatly with the NHS model because it’s about the sharing of ideas and the ideology of the NHS is essentially about sharing the risk of illness.”
Dr Baw introduced the idea at an NHS Hack Day held in September where he got an enthusiastic response.
-----

Health 2.0 Showcases More Clinician-Friendly Apps

Software developers show products that are more useful and relevant than ever at this year's Health 2.0 Conference.
Most of the breakout sessions at last week's annual Health 2.0 Conference event in San Francisco featured rapid-fire product demonstrations, and venture capitalists were out in force to view the latest fads. Attendees saw that mobile apps and other health tools are moving past the novelty stage and beyond the limited consumer realm in healthcare to become increasingly useful in clinical settings. Some developers are even taking steps to integrate their apps into clinician workflow.
Ringful Health, a small company based in Austin, Texas, delivers interactive clinical content to patients on mobile devices to help improve outcomes and reduce hospital readmissions. It demonstrated a tablet-based clinical decision support tool for nurses that also can be used for patient engagement. The idea is to reduce risk for major in-hospital adverse events, while fitting the nursing workflow, CEO Michael Yuan said. AdTech Ad
-----
Tuesday, October 23, 2012

Q3 2012 Saw Surge of Federal Health IT Activity

by Helen R. Pfister, Susan R. Ingargiola and Christine D. Chang, Manatt Health Solutions
The federal government continued to implement the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA), during the third quarter of 2012.  Below is a summary of key developments and milestones achieved between July 1 and Sept. 30.
-----

Medication barcoding reduces errors, ushers big savings

By Erin McCann, Associate Editor
Created 10/22/2012
TROY, MI – A newly implemented medication barcoding system at the Michigan-based Beaumont Health System helped the organization prevent some 23,500 possible drug errors within a six-month time period, officials announced Friday.
With an estimated 400,000 preventable drug-related injuries in hospitals resulting in $3.5 billion in unnecessary medical costs each year, Beaumont officials wanted to make medication error prevention a strategic imperative for improving patient safety, quality and cost across its three hospitals.
-----

Study Pegs Cost of Medical Errors Near $1 Trillion Annually

OCT 19, 2012 5:24pm ET
A study in the Journal of Health Care Finance from Wolters Kluwer finds medical errors in the U.S. may cost up to $1 trillion per year.
That figure includes measuring the cost of lost human potential and contributions, making the overall cost from errors considerably higher than shown in previous research. Study authors used Quality-Adjusted Life Years (QALY) to get a more  complete accounting of the economic affect when a person dies from a preventable medical error. They took calculations on measures from multiple previous reports, including the 1998 benchmark figure from the Institute of Medicine of 98,000 deaths caused annually from medical errors.
-----

WHO, ITU Launch mHealth Initiative

October 19, 2012
The World Health Organization (WHO) and International Telecommunication Union (ITU) are launching a global mobile health (mHealth) initiative, aimed at using text messaging and apps to combat noncommunicable diseases (NCDs) such as diabetes, cancer, cardiovascular diseases and chronic respiratory diseases.
With the initiative, ITU and WHO promise to provide evidence-based and operational guidance for various worldwide entities, especially governments, to implement mHealth interventions to prevent NCDs. According to WHO, NCDs contribute to an estimated 36 million deaths every year, including 14 million people dying between the ages of 30 and 70. WHO predicts mHealth can save lives, reduce illness and disability, and reduce healthcare costs significantly.
-----

Bioinformatics called critical to next-generation DNA sequencing

October 22, 2012 | By Julie Bird
Laboratories that want to run next-generation sequencing (NGS) of DNA will need extraordinarily robust bioinformatics infrastructure to fully leverage research and diagnostic opportunities, the Association for Molecular Pathology reports in the November issue of the Journal of Molecular Diagnostics.
"The power of NGS to generate hundreds of millions to multigigabase levels of sequence in a single instrument run, while having opened a diversity of research and diagnostic avenues, is concomitantly stretching our ability to process data," according to the report, "Opportunities and Challenges Associated with Clinical Diagnostic Genome Sequencing."
-----

Database finds docs actively use Twitter

October 22, 2012 | By Susan D. Hall
A new database of physician tweets aims to gain insight into how doctors use Twitter.
San Francisco-based WCG, an independent strategic communications firm, created a database of nearly 1,400 U.S. doctors on Twitter and linked them to their National Provider Identifier, the 10-digit identification number issued by the Centers for Medicare & Medicaid Services.
-----

Study: High-risk teens open to online health records

October 22, 2012 | By Susan D. Hall
High-risk teens could benefit from online records and the ability to share their health information, according to a study published at Pediatrics.
Teens in a California juvenile detention center were overwhelmingly interested in being able to access their health records online, according to research that surprised Stanford researchers.
The teens tended to engage in high-risk behaviors, and the researchers assumed they would pay little heed to their health. The subjects often had no adult keeping a record of immunizations and other medical conditions, including sexually transmitted infections, mental illnesses and substance abuse. This could pose problems for them, even into adulthood, according to senior author Arash Anoshiravani, who pointed out that such teens generally are not considered in the discussion of how to better engage patients in their health.
-----

Enjoy!
David.

Friday, November 02, 2012

A Little Follow Up From A Post Two Weeks Ago. Not Really Good Enough.

Dr Hannan passed on an update from our frustrated physician and would be PCEHR User.

Hi Terry,

I thought I should let you know that I still have not been able to put my Advance Medical Directive, or my own medical history summary into this medical record. I have phoned up the contact number twice, the first time got the message they were having trouble and call back please. The next time the contact person seemed to have little insight and was not used to handling people, and if I had not been persistent would have been put off.

It seems, at least according to her, that there is no capacity to put in one's advance medical directive or personal medical history, that must be put in by ones doctor.

If that is the case, then it is really useless and this is not what all the promotional material says.

Indeed, in attempting to even find where to log in or searching for PCEHR on the internet one is bombarded about just how good it is and how one can input personal data.

When pressing the contact individual about how important it was to get one's advance medical directive in, they were confused, and directed me to the field for entering the custodian's details who may hold my medical record.

That is useless in the real world as they may not be home or be able to find it.

One still cannot put in personal documents.

I seems to me that if it were modelled on Facebook (plus securities) the system may work.

Best wishes,

John

Maybe we could sit down together over a computer one day and go through this together so you will know what I mean

Dr.J.M.Sands

Email: doxanz at nixanz.com

Pretty sad I reckon.

David.

Thursday, November 01, 2012

This Is Really A Totally Astonishing Figure. Could It Be True?

The following appeared a few days ago:

Study Pegs Cost of Medical Errors Near $1 Trillion Annually

OCT 19, 2012 5:24pm ET
A study in the Journal of Health Care Finance from Wolters Kluwer finds medical errors in the U.S. may cost up to $1 trillion per year.
That figure includes measuring the cost of lost human potential and contributions, making the overall cost from errors considerably higher than shown in previous research. Study authors used Quality-Adjusted Life Years (QALY) to get a more  complete accounting of the economic affect when a person dies from a preventable medical error. They took calculations on measures from multiple previous reports, including the 1998 benchmark figure from the Institute of Medicine of 98,000 deaths caused annually from medical errors.
More here:
Here is the abstract of the paper (free full text available from same link)

The Economics of Health Care Quality and Medical Errors

Article from Journal of Health Care Finance, Vol. 39, No. 1, Fall 2012, published by Wolters Kluwer Law & Business

Charles Andel, Stephen L. Davidow, Mark Hollander, and David A. Moreno


Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine’s (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths―conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct―preventable death being ten times the IOM estimate―the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout US hospitals. Whatever the measure, poor quality is costing payers and society a great deal. However, health care leaders and professionals are focusing on quality and patient safety in ways they never have before because the economics of quality have changed substantially.
Key words: medical errors, quality, patient safety, quality-adjusted life year, QALY, Joint Commission, Institute of Medicine, Society of Actuaries, Milliman, efficiency, Medicare, accountable care organizations (ACOs), facility-acquired condition, cost savings.
Full text link here:
The conclusion sentence or two of the paper says it all

Conclusion

“Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured.”
What is interesting is the implications for Australia.
On a population basis 22/315 Million = about 7% = $70 Billion ($US)
On a GDP basis it is 1.4/15 (Trillion $) = about 9.5% = $95 Billion ($US)
Now while all this cannot be got rid of - even small percentage improvements can thus make a huge difference.
Properly implemented e-Health can be part of this story. Seems like there is an opportunity here!
Pity that isn’t the focus of present e-Health rather than the unproven PCEHR.
David.

Compulsory Retrenchments At NEHTA Are Rumoured - Anyone Have Some Facts?

All sorts of people are telling me there has been a rather messy 'staff detachment process' occur in the last few days at NEHTA (No executives, just staff) and that is has been rather less than well handled.

Does anyone have a fact or two to put on the table about numbers, potential impact on workplans, worker impact etc?

David.