Weekly Australian Health IT Links – 18th March, 2013.

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

Other that the revelations from the Qld Health Payroll enquiry it has again been a reasonably quiet week on the surface - other than the Judith Sloan attack on DoHA! (see blog yesterday)
Following Eric Browne’s and other comments last week it seems that there is something going on with the NPDR (National Prescribing and Dispensing Repository) which may have all sorts of implications for the NEHRS as well as for standards setting. One gets the feeling the unified and rational architecture - such as it was with the NEHRS - is unravelling.
This will be an area to keep a close eye on.
My weekly visit to my NEHRS record was relatively fuss free - but the system is, as always, awfully slow.

Guild supports decision to cancel e-dispensing alerts

The Pharmacy Guild of Australia has backed a decision to switch off computer alerts telling doctors when patients have had prescriptions dispensed, if it encourages GPs to embrace e-health.
The alerts, which were a feature of both eRx Script Exchange and MediSecure, have been stopped after concerns were raised that the alerts would impose a duty on GPs to chase up patients who had not had the prescriptions dispensed, by indemnity insurers and the Royal Australian College of General Practice (RACGP). 
Dr Nathan Pinskier, an RACGP spokesperson, said the College feared the existence of the notifications extended doctors' duty of care to ensure patients were following their advice. 

Plug pulled on e-dispensing alerts

12 March, 2013 Paul Smith
Computer alerts telling doctors when patients' medication has been dispensed have been switched off amid fears they impose a duty on GPs to chase up patients they believe are at risk.
The concerns — raised by indemnity insurers and the RACGP — centre on the two electronic prescribing systems, MediSecure and eRx, which are currently used by thousands of doctors.
When pharmacies signed up to the systems dispense a script, a notification is issued and sent electronically to the prescribing GP.

Queensland Health payroll inquiry begins

Witnesses have begun giving evidence to the Queensland Health Payroll System Commission of Inquiry
  • AAP (CIO)
  • 11 March, 2013 14:14
An inquiry into Queensland Health's $1.2 billion payroll fiasco will examine whether there was a need to "cut corners" in the initial tendering process.
Witnesses began giving evidence to the Queensland Health Payroll System Commission of Inquiry in Brisbane on Monday.
Thousands of public servants were underpaid, overpaid or unpaid after a flawed IBM computer system was introduced in March 2010 by the former government.

Queensland Health payroll inquiry begins

Date  March 11, 2013

Nathan Paull

An inquiry into Queensland Health's $1.2 billion payroll fiasco will look into whether IBM had an unfair advantage in bidding to supply a computer system that caused havoc in the state's healthcare system.
Former Accenture partner Marcos Salouk, whose company was initially the preferred vendor but lost out to IBM, told the inquiry he was "devastated" when his company lost the bid.
He said he was surprised to hear IBM had won with a bid rumoured to be about $100 million below Accenture's and within the government's tight budget.

Queensland Health payroll system 'high risk'

More than 50,000 staff are believed to have been overpaid more than $90 million in the Queensland Health payroll bungle
  • AAP (CIO)
  • 12 March, 2013 14:14
Queensland Health's failed $1.2 billion payroll system was so disastrous because of the complexity of what was required in such a short amount of time, an inquiry has heard.
Former Logica general manager Michael Duke told an inquiry in Brisbane the company only submitted a partial bid during the tendering process in 2007 and was unsuccessful.
Duke said Logica, which had already been operating financial systems for the government, only put in a partial bid because it saw the payroll system as a "large chunk of work" that was complex and "high risk".
He said the company wouldn't have been able to deliver government's plan to roll financial systems into its shared services program along with rostering and payroll, which were all to be implemented and maintained by one prime contractor.

IBM not first choice: payroll inquiry

Date March 12, 2013 - 5:35PM

Nathan Paull

A private contractor led the process that gave global technology giant IBM the job of replacing Queensland Health’s payroll system, an inquiry has heard.
Darrin Bond, a former project director in the government’s IT arm CorpTech, says he was against using a prime contractor for the payroll system and eventually changed departments because of it.
Mr Bond told the Queensland Health Payroll System Commission of Inquiry in Brisbane on Tuesday that it was a private contractor, Terry Burns, employed by CorpTech, who advocated giving a prime contractor control over the system’s finance, HR and payroll components.

Contract signed before payroll system proven to work

Date March 14, 2013 - 7:56AM

Nathan Paull

Senior bureaucrats didn't check whether a proposed system would actually work before signing off on a contract to replace Queensland Health's payroll system, an inquiry has heard.
Darrin Bond, a former project director in the government's IT arm CorpTech, says a push for technology giant IBM to sign the contract meant the Queensland government didn't have time to properly assess the proposal.
IBM's tender bid to run Queensland Health's complicated payroll system was about $100 million cheaper than its nearest rival.

Queensland Health inquiry: Hood admits outside contractor a bad idea

Private contractor and former IBM boss Terry Burns' hand in IBM being selected to implement and maintain the system has been repeatedly called into question during an inquiry to determine what went wrong
  • AAP (AAP)
  • 14 March, 2013 10:09
A senior public servant in charge of Queensland Health's failed payroll system has conceded an outside contractor shouldn't have led the tendering process.
Private contractor and former IBM boss Terry Burns' hand in IBM being selected to implement and maintain the system has been repeatedly called into question during an inquiry to determine what went wrong.
Thousands of public servants were underpaid, overpaid or unpaid after IBM's flawed computer system was introduced in March 2010 by the former Labor government in a fiasco estimated to have cost taxpayers about $1.2 billion.

Scientists used iPhone to diagnose intestinal worms

  • From: AFP
  • March 13, 2013 6:58AM
SCIENTISTS used an iPhone and a camera lens to diagnose intestinal worms in rural Tanzania, a breakthrough that could help doctors treat patients infected with the parasites, a study said on Tuesday.
Research published by the American Journal of Tropical Medicine and Hygiene showed that it is possible to fashion a low-cost field microscope using an iPhone, double-sided tape, a flashlight, ordinary laboratory slides and an $8 cameral lens.
The researchers used their cobbled-together microscope to successfully determine the presence of eggs from hookworm and other parasites in the stool of infected children.

Government IT projects 'not well understood'

Date March 12, 2013

Trevor Clarke

Australia's new CIO Glenn Archer is proud of quiet achievers in IT departments.
The Australian government's new chief information officer says government IT projects are ''not well understood'' by the wider community and their implementers deserve recognition.
Notwithstanding several documented IT stuff-ups in various government agencies over the past decade, including Victoria's CenITex and Queensland's payroll debacle, Australia's recently installed CIO, Glenn Archer, said ''IT departments or sections within departments'' were the quiet achievers in delivering services in a sector that spends over $6 billion a year in technology.
''There is a great deal of interest in those IT projects that don't go quite according to plan but those that quietly function and deliver major business benefit often never get much mention,'' Mr Archer said, while acknowledging there were problem projects.

Delving into the Quantified Self

Health informatics expert Professor Fernando Martin-Sanchez says that the future of health care will involve shared decision-making between patents and clinicians and will often rely on a range of personal health data patients will collect about themselves.
Martin-Sanchez is Professor and Chair of Health Informatics at the University of Melbourne Medical School and Head of Health and Biomedical Informatics Research Laboratory of IBES (Institute for a Broadband-Enabled Society) and will be speaking about his research at next week’s Health-e-nation conference in Melbourne.

Protecting Patient Privacy and Data Security

Julie K. Taitsman, M.D., J.D., Christi Macrina Grimm, M.P.A., and Shantanu Agrawal, M.D.
N Engl J Med 2013; 368:977-979
DOI: 10.1056/NEJMp1215258
On December 4, 2012, two Australian radio DJs called London's King Edward VII's Hospital, identified themselves, in fake British accents, as Queen Elizabeth and Prince Charles, and asked about a celebrity patient who had been admitted for pregnancy complications. A nurse, filling in at the reception desk in the early morning hours, answered the phone and, without attempting to verify the callers' identities, transferred them to the duty nurse caring for the Duchess of Cambridge. The duty nurse then provided them with confidential patient information.1 The Australian DJs broadcast the phone call, considering it a humorous prank, but as the world knows, it had disastrous consequences.

AMA rejects physicians’ plea for PIP payments

11th Mar 2013
A CALL by physicians to have the same access to e-health PIP payments and incentives as GPs has been rejected by the AMA.
Royal Australian College of Physicians (RACP) president Associate Professor Leslie Bolitho said last week e-health could not be successful unless all medical practitioners in Australia, including both GPs and specialist physicians, adopted e-health technologies.
This would result in better patient outcomes, particularly for complex chronic patients who saw a multitude of healthcare providers, she said.

Specialists want cut of e-health cash

12 March, 2013 Paul Smith
Specialist physicians are warning key clinical information will be missing from the government's e-health records system unless they get a cut of the Practice Incentive Program funds.
There have been long-running concerns over whether private specialists will use the personally controlled e-health record system, given the low levels of computerisation in their practices.
Although GPs and practice managers have battled to meet the latest ePIP requirements, the Royal Australasian College of Physicians said it wanted the system extended.

Question: FHIR and un-semantic interoperability

Posted on March 12, 2013 by Grahame Grieve
 I did not understand the blog post about un-semantic interoperability.  Can you elaborate?  Will FHIR provide any of this un-semantic interoperability?
Well, the original post on unsemantic interoperability is just pointing out that many people mis-understand the nature of what semantic interoperability is trying to achieve:
We’ve had semantic interoperability in healthcare since we started having healthcare. Since the beginning of healthcare (by whatever definition you can use), healthcare practitioners have exchanged data using spoken and written words, and the semantic meaning has been clear (well, as clear as it can be given that human knowledge is limited).
So whatever it is that we are doing, it’s not introducing semantic interoperability. In fact, what we are doing is introducing a new player into the mix: computers. And not, in actual fact, computers, but the notion that there is something to be gained by processing healthcare information by persons or devices who don’t properly understand it. So, in fact, what we are actually doing is seeking for unsemantic interoperability.

A few seconds can save patients' lives

Date March 11, 2013

Benjamin Preiss

Researchers at Victoria University are working on a new computer program they hope will save patients' lives by predicting their vital signs during surgery.
The researchers say the software could be installed in hospital operating theatres and intensive care units.
The PhysAnalyser program will give a 20-second prediction on patients' physiological signs such as heart and respiratory rates and blood pressure.
Professor Yanchun Zhang said the program conducted ''deep analysis'' on patient data. This would be used to predict risks for patients and ''visualise the future anomalies''.

Guy Sebastian caught out by stalled patent probe

SINGER Guy Sebastian has weighed in on allegations of patent infringement by the Gillard government's National E-Health Transition Authority.
MMRGlobal, the US firm investigating NEHTA for alleged patent infringements, was in talks with Sebastian's management team to fund his planned charitable foundation.
However, discussions have hit a roadblock pending the outcome of the probe, which has been delayed by NEHTA's silence.

Decision Support may be the new e-Medication Management Frontier

Electronic medication management has been adopted at health sites around Australia, but there’s still low clinician adoption of one of the system’s great advantages - decision support protocols.
“It can be hard to change the mindset of prescribers who are used to the old, linear way of writing scripts,” says Professor Ric Day, head of clinical pharmacology at the University of NSW and a key player in the adoption of electronic medication management at St Vincent’s Hospital in Sydney.
Some systems have excellent shortcuts, such as ‘therapy bundles’ where a commonly-grouped medication list can be prescribed in one mouse-click.

Royal Adelaide Hospital puts X-rays in focus

THE Royal Adelaide Hospital has taken steps to quickly identify radiation levels in an X-ray environment - an issue not easily tackled in the past - thanks to new technical smarts.
With the hi-tech equipment, the X-ray radiation dose required for interventional X-ray procedures can be reduced by more than 70 per cent.
Philips' AlluraClarity intervention suite was the hospital's choice when it had to upgrade from its old system, according to intervention neuro-radiologist Dr Rebecca Scroop and campus clinical head of radiology Dr Mary Moss.

Healthy diagnosis for Terry White Chemists

RETAIL pharmacy franchise Terry White Chemists was halfway through a long-term enterprise resource planning (ERP) implementation project when it diagnosed a problem.
To support the launch of its new website, the company required a quick and easy stock master data management solution.
Terry White Chemists, which was established in 1959, is one of Australia's top 20 retailers and claims a 9 per cent share of the pharmacy market, with more than 160 franchises nationwide.

AMA calls for review of Medicare Locals

12th Mar 2013
THE AMA has given its strongest endorsement of Medicare Locals (MLs), calling on both political parties to commit to a pre-election review to ensure the new primary healthcare bodies have “substance, purpose, meaning and direction”.
With the Coalition seen as a strong chance to win the 14 September federal election, MLs are anxious about their future, following shadow health minister Peter Dutton’s labelling of the 61 bodies as wasteful bureaucracies.
In an opinion piece in MO this week, AMA president Dr Steve Hambleton wrote while his organisation had initially opposed MLs, “trying to undo all the contracts and leases and management structures would be quite complex and expensive to accomplish in the first year of a Coalition government”.

Coalition 'will abolish' all Medicare Locals

A COALITION government would run the ruler over primary healthcare, abolishing Medicare Locals in favour of new links between GPs and public hospitals as part of efforts to redirect hundreds of millions of dollars each year.
Federal Health Minister Tanya Plibersek warned the opposition not to try to replicate the slash-and-burn approach of conservative state governments, saying the Medical Local structure, introduced by Labor less than 12 months ago, was starting to show positive results for patients.
Opposition health spokesman Peter Dutton said yesterday Medicare Locals had created about 3000 extra taxpayer-funded positions across Australia and "the guiding principle of the Coalition will be to take money away from bureaucratic wages and put it into frontline services".

The hackers have come, the hackers have come

Alan Kohler 11/03/2013
This morning’s revelations in the Financial Review that the Reserve Bank of Australia has been repeatedly hacked means we can almost certainly now add Australia to the list of 141 countries that have been hacked by China’s Unit 61398.
The AFR has reported that multiple computers within the RBA’s network have been compromised and that it had been infiltrated by a Chinese-developed malicious software, or ‘malware’ spy program, that was seeking intelligence on sensitive G20 negotiations.
Officials from the Reserve Bank’s risk management unit are quoted as saying in a previously unreported Freedom of Information document: “Bank assets could have been potentially compromised, leading to . . . information loss and reputation [damage].”

Fake fingers fool the boss in hospital scam

Date March 14, 2013
Five doctors at a Brazilian hospital have been suspended for allegedly covering for absentee colleagues by using fake silicone fingers to fool biometric machines.
Thaune Nunes Ferreira was arrested on Sunday for signing in six co-workers to the biometric employee attendance device at a hospital in Ferraz de Vasconcelos, Sao Paulo.

Rover shows Mars could have supported life

Date March 13, 2013 - 10:36AM

Alicia Chang

NASA's Curiosity rover has answered a key question about Mars: the red planet previously had some of the right ingredients needed to support primitive life.
The evidence comes from a chemical analysis by Curiosity, which last month flexed its robotic arm to drill into a fine-grained rock and then test the powder.
If this water was around and you had been on the planet, you would have been able to drink it. 
John Grotzinger, California Institute of Technology
Curiosity is the first spacecraft sent to Mars that could collect a sample from deep inside a rock, and scientist said they hit pay dirt with that first rock.
"We have found a habitable environment that is so benign and supportive of life that probably if this water was around and you had been on the planet, you would have been able to drink it," said chief scientist John Grotzinger of the California Institute of Technology.

'God particle' found: physicists say they have discovered a Higgs boson

Date March 15, 2013 - 5:44AM

John Heilprin

The search is all but over for the so-called God particle that is a crucial building block of the universe.
Physicists said on Thursday they believe they have discovered the sub-atomic particle predicted nearly half a century ago, which will go a long way toward explaining what gives electrons and all matter in the universe size and shape.
The elusive particle, called a Higgs boson, was predicted in 1964 to help fill in our understanding of the creation of the universe, which many theorise occurred in a massive explosion known as the Big Bang.
The particle was named for Peter Higgs, one of the physicists who proposed its existence, but it later became popularly known as the God particle.

I Would Not Want To Be A Senior Officer In DoHA If Mr Abbott Wins The Election! Dead Ducks.

This article simply could not wait for the usual cycle of daily blogs.

Nothing healthy about department of stuff-ups

HEALTH is an area the Labor Party thinks it owns. According to the polls, Labor has generally been judged the better manager of health (and education) than the Coalition.
One of the worrying recent trends for Labor is that this ascendancy has been significantly whittled away. Labor now holds only a slim lead - down to four points -- as the better manager of health. (The gap for education is five points.) One of the more interesting aspects of government involvement in, and funding of, health is that monumental stuff-ups often go under the radar. There are programs that cost hundreds of millions, even billions, but which never generate the anticipated benefits. In some cases, they never generate any benefits. And then there are the forecasting errors of the Department of Health and Ageing that have led to extreme shortages of doctors followed by extreme surpluses.
More generally, we have a federal department - the largest "policy" department with 5500 workers - the head of which seems unable to really explain what her staff do or account for the results of their busyness.
Take the example of electronic health, one of the centrepieces of the health and hospital reforms, as a classic example of a stuff-up. Through the years, hundreds of millions have been poured into various e-health initiatives, with virtually nothing to show for the spending. The most recent program is the Personally Controlled e-Health Records system, which went live in July last year. At this stage, nearly nine months on, only 56,000 individuals have registered to obtain a record. And fewer than 1 per cent of doctors have signed up. The whole scheme, with a budget of more than $1 billion, looks like being a complete operational and financial fiasco.
We should not be entirely surprised. Having spent billions trying to digitise the National Health System records in Britain, the government essentially gave up several years ago. While relatively simple features of patient records - X-ray and pathology results, medications - can be recorded relatively easily electronically, there are other aspects of patient case notes that are not so amenable. Moreover, issues of confidentiality and access are critical in terms of ensuring patient safety and engendering confidence. Were an unauthorised person given access to records, changes could be made that could prove detrimental, if not fatal, to patients. In other words, the goal of achieving universal and comprehensive electronic medical records is unrealistic at this stage. But this has not prevented the federal government wasting billions of dollars finding this out.
….. (Workforce stuff ups omitted)
While e-health and medical workforce planning are examples of specific stuff-ups, at a broader level the whole Department of Health and Ageing is really a massive catastrophe, engaged in multiple, pointless and unaccountable activities while not running one hospital or other health service.
Take this explanation from the department secretary: "We have a budget structure and this includes the definition of subprogram. Then we have another level under this - several other levels. These groupings of things which kind of make logical sense, but are not reconcilable with the budget documents. So there are particular initiatives, some of which do line up, but mostly they do not." Are you following?
She continued: "So this is the workings and this is down to in some cases projects and in some cases thematic elements but is not consistent with universally, and in fact very often, the budget structure which is what we have in IT systems which enable us to produce information." As Manuel from Fawlty Towers would have said: Que?
On the face of it, it would appear that even the head of the department finds it hard to explain what activities are undertaken in her department, why they are undertaken and how they line up with each other. But, never fear, if only they had a better computer system.
"Let me tell you, the Department of Finance said recently that they wanted us to account down to these levels of detail, and our chief financial officer had a great deal of fun explaining to them that, actually, if they wanted that they were going to have to build us a new computer system - which we would quite like, can I say."
Fun? When you are dealing with taxpayer monies that run into the billions? I can think of other nouns, such as disgrace and waste.
Much much more here:
This really is an astonishing blast at DoHA. I wonder what part the shadow Ministers played?
Clearly it is going to be on for one and all as we get closer to the election.

Looks Like MMRGlobal Is Not Being Taken Very Seriously By Many In The US - Including The Government.

I saw an e-mail that was sent out by the Office Of the (US) National Co-Ordinator for Health IT a day or so ago.
Here is a link where you can subscribe to the weekly e-mail. (at the top of the menu)
In that e-mail - at the bottom there was a discussion of the PHRs that are available.

Maintain Your Medical Record

How can eHealth tools help me manage my personal medical and health records?

Keeping track of medical records can difficult if your health information is in multiple places or in a format (such as paper) that is difficult to use. This challenge gets harder when working with several doctors to address several health concerns. Your doctor and other health care providers maintain their own medical records about you. But many patients see advantages in also maintaining their own personal health records to record past appointments, test results, prescriptions, and more. Today, many apps and online services exist to make the job of organizing this information easier. And in some cases, these tools also help patients and family caregivers share information among doctors and other family members so everyone is on the same page.
A personal health record (PHR) is similar to the electronic health record (EHR) that your doctor might keep, except that you to store your most important health information and control who has access to it. Most PHRs require you to add your own information by scanning documents or typing in information. Many PHRs give you the option of adding information you think is relevant but that your doctor may not have, like information about your over-the-counter medications, exercise habits or sleep schedule. For the most part, these PHRs don’t connect to an employer, health system, or insurer. These systems are typically web based, and available for free or for a small subscription fee.
Lots more here:
Key to me was the section at the bottom of the page:
Personal Health Records and eHealth Hubs
A free PHR system that integrates with multiple web sites and personal health devices.
A free standalone PHR system with some options for sharing information with doctors and others.
A free standalone PHR system with some options for sharing information with doctors and others.
eHealth Hubs
Unlike full-fledged PHRs, these sites are focused more on health tracking tools, but include some PHR features such as record upload and sharing tools.
A personal health hub including multiple health trackers and some app/device integration. Includes some medication management and other PHR functions.
A personal health hub with multiple health trackers, a strong focus on medication management, and some capacity to record medical history.
PHR and Medical Record Information for Consumers
Consumer Guides to PHRs
A site specifically about PHRs, including an extensive guide to the systems available today. Sponsored by the American Health Information Management Association.
----- End Extract.
The bottom line of all this to me is to make it clear that whatever MMRGlobal might claim to own in the way of patents there is not a great deal of evidence that the US Government, Microsoft and so on have either heard of or care at all regarding such claims.
It seems highly unlikely the MS, Google (previously) and the others listed did not firstly check and secondly noticed and decided they were free to proceed.
I think all this has been an amusing distraction and that the best thing DoHA / NEHTA can do is advise MMRGlobal that they believe their claims are simply nonsense and are unenforceable given the number of years PHRs have been around and in use.
Wikipedia makes the age of the concept and implementations clear!
“The term “personal health record” is not new. The earliest mention of the term was in an article indexed by PubMed dated June 1978,[2] and even earlier in 1956 reference is made to a personal health log.[3] However, most scientific articles written about PHRs have been published since 2000.
The term "PHR" has been applied to both paper-based and computerized systems; current usage usually implies an electronic application used to collect and store health data. In recent years, several formal definitions of the term have been proposed by various organizations.[4][5][6]
  • "Recordkeeping systems: personal health records". J Am Med Rec Assoc. 55 (12): 42. Dec 1984. PMID 10310901.
  •  "Concepts of the Health Vault". 1999 Paper by Tom Munnecke describing an architecture for the Personal Health Record
  • "[Personal medical records and identification card, synchronized information systems] [Personal medical records and identification card, synchronized information systems]" (in French). Rev Infirm. (106): 45–6. Dec 2004. PMID 15672518.
  • Swain, M; Lawn, B (Apr 2005). "Information prescriptions (Ix): bringing internet-based health content into the treatment process; patients to your site". Internet Healthc Strateg. 7 (4): 4–8. doi:10.1016/0148-9062(76)91830-1. PMID 15929640.
  • "Report on attitudes about personal health records". Internet Healthc Strateg. 6 (9): 10–1. Sep 2004. PMID 15526437.
Full article here:
Back to sleep now!

Weekly Overseas Health IT Links - 16th March, 2013.

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.

President Clinton at HIMSS13: Fundamental Health Reform Must Continue

MAR 7, 2013 1:22pm ET
The jokes were sparse as a somber former President Bill Clinton took on the ills of the health care system during his HIMSS13 keynote speech, and urged his information technology audience to accelerate their work to support improvements.
The politics and social impact of the health reform law have yet to be fully determined, Clinton noted, because that depends on how fully the law is implemented and many contentious issues have not yet been resolved. The politics of reform continue to resonate deep, he reminded. Health care reform politically killed supporting congressional candidates in 2010, then the politics changed and reform politically killed candidates opposed to the law in 2012.

ONC Sets Early Summer for Release of HIT Safety Plan

MAR 6, 2013 1:59pm ET
The Office of the National Coordinator for Health Information Technology anticipates releasing a final health information technology safety plan by early summer, officials announced on March 5 at HIMSS13 in New Orleans.
ONC released a draft plan in December and accepted public comment until February 4. The draft followed an Institute of Medicine report that ONC commissioned that highlighted the need for better understanding of the HIT impacts on safety, as well as shared responsibilities among all stakeholders to improve safety, Jodi Daniel, director of the ONC office of policy and planning, said during an educational session.

Mostashari: 'We are committed to IT'

By Bernie Monegain, Editor
Created 03/07/2013
The day after President Bill Clinton told the HIMSS13 audience that the healthcare system was broken, but could be fixed, ONC chief Farzad Mostashari, MD, offered a personal example of that broken system: his Mom. Mostashari launched his own keynote on Thursday morning by describing what his mother endured when she was admitted to the hospital for routine knee surgery.
"Healthcare is broken not just when it comes to costs of healthcare," he said. "Healthcare is broken as a system, as a lack of systems."

HL7 Announces Plans for Freely Available IP and Future Membership Model

March 7, 2013
Health IT Standards Leader Reveals Details of Move ?to Make Standards and Other Selected IP Freely Available
Health Level Seven International (HL7), announced a plan to make much of its intellectual property (IP) freely available under licensing terms, which it says will ensure that all stakeholders have equal access to its HIT standards. The policy is effective as of April 1, 2013 and includes all currently published standards, implementation guides and other select IP as determined on a case-by-case basis.
“By making our standards freely available, we hope to accelerate the evolution of healthcare information exchange at the very basic levels, and ultimately to impact wellness and healthcare delivery on a global scale” said Charles Jaffe, M.D., Ph.D. and CEO of HL7. 
Friday, March 08, 2013

HIMSS13: Mostashari Says Data & Incentives Matter

NEW ORLEANS -- National Coordinator for Health IT Farzad Mostashari may have had one of the busiest schedules at the Healthcare Information and Management Systems Society's annual conference this year. It's not unusual for federal health officials to stop by HIMSS and other big conferences for just mere hours on the day of their big speech, but Mostashari made a week of it.
He helped kick off the conference on Monday with an Office of the National Coordinator for Health IT Town Hall, sat in the front row for acting CMS Administrator Marilyn Tavenner's speech, held a press conference with reporters and was seen roaming the mile-long exhibit hall and observing the Interoperability Showcase in action, not to mention stopping by HIStalkaplooza at Rock 'n' Bowl.
On Thursday -- the final day of HIMSS13 -- Mostashari took the stage to deliver his keynote, and he had a lot to say after spending nearly a week at the Earnest N. Morial Convention Center in New Orleans.

Big Data Helps Kaiser Close Healthcare Gaps

Analytics from massive clinical data repository are central to closing gaps in care, HIMSS attendees told.
One benefit of Kaiser Permanente spending an estimated $6 billion for an integrated electronic health records (EHR) system to serve 9 million people across eight regions from coast to coast is it that has amassed a vast repository of clinical data. That storehouse also contains information from a patient portal, ancillary systems, smart medical devices and even home-based patient monitoring systems.
All those terabytes of electronic data now are helping to fuel a massive analytics operation, part of an overall organizational goal of improving care and reining in costs. "It's all about the data and information, not the electronic health record," Carol Cain, senior director of clinical information services for the Kaiser Permanente Care Management Institute, said this week at the Healthcare Information and Management Systems Society (HIMSS) annual conference in New Orleans. AdTech Ad

The Robot Will See You Now

IBM's Watson—the same machine that beat Ken Jennings at Jeopardy—is now churning through case histories at Memorial Sloan-Kettering, learning to make diagnoses and treatment recommendations. This is one in a series of developments suggesting that technology may be about to disrupt health care in the same way it has disrupted so many other industries. Are doctors necessary? Just how far might the automation of medicine go?
By Jonathan Cohn
Harley lukov didn’t need a miracle. He just needed the right diagnosis. Lukov, a 62-year-old from central New Jersey, had stopped smoking 10 years earlier—fulfilling a promise he’d made to his daughter, after she gave birth to his first grandchild. But decades of cigarettes had taken their toll. Lukov had adenocarcinoma, a common cancer of the lung, and it had spread to his liver. The oncologist ordered a biopsy, testing a surgically removed sample of the tumor to search for particular “driver” mutations. A driver mutation is a specific genetic defect that causes cells to reproduce uncontrollably, interfering with bodily functions and devouring organs. Think of an on/off switch stuck in the “on” direction. With lung cancer, doctors typically test for mutations called EGFR and ALK, in part because those two respond well to specially targeted treatments. But the tests are a long shot: although EGFR and ALK are the two driver mutations doctors typically see with lung cancer, even they are relatively uncommon. When Lukov’s cancer tested negative for both, the oncologist prepared to start a standard chemotherapy regimen—even though it meant the side effects would be worse and the prospects of success slimmer than might be expected using a targeted agent.

Home BP monitoring leads to better patient outcomes

March 7, 2013 | By Ashley Gold
Home monitoring can help lower blood pressure, according to a study by researchers from Kaiser Permanente Colorado in Denver published online this week in Circulation: Cardiovascular Quality and Outcomes.
The home monitoring, which was pharmacist-led and enabled by Heart360, the American Heart Association's web-based tool for tracking heart health, was tested in 10 Kaiser clinics. Nearly 350 patients with blood pressure above the recommended levels participated, and although there were no "statistically significant differences in baseline characteristics" between the tested groups, the home monitoring group, at six months, was significantly closer to reaching their BP goal than a usual care group.

HHS Wants Input on Speeding Health Information Exchange Adoption

MAR 6, 2013 2:05pm ET
The Department of Health and Human Services has issued a request for information as it considers policy moves to further accelerate interoperability and health information exchange beyond initiatives previously launched under the Office of the National Coordinator for Health Information Technology.
Comments due by April 21. Adoption of basic electronic health records systems has steadily risen under the meaningful use program. An estimated 40 percent of physicians were using the software in 2012, and HHS expects that to top 50 percent during 2013. Now, the goal is to accelerate health information exchange.

44% of Hospitals Had EHRs in 2012

Written by Bob Herman | March 06, 2013
Adoption of basic electronic health record systems in acute-care hospitals has more than tripled since 2009, as roughly 44.4 percent of hospitals had a basic EHR system in 2012 compared with 12.2 percent in 2009, according to new reports from the federal government.
The Office of the National Coordinator for Health Information Technology released two briefs on the status of EHRs among acute-care hospitals in the United States. The first brief (pdf) covered overall hospital adoption of EHR systems, while the second brief (pdf) covered how hospitals were meeting meaningful use objectives.

Unreported Side Effects of Drugs Are Found Using Internet Search Data, Study Finds

Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.
Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.
The study, which was reported in the Journal of the American Medical Informatics Association on Wednesday, is based on data-mining techniques similar to those employed by services like Google Flu Trends, which has been used to give early warning of the prevalence of the sickness to the public.
Thursday, March 07, 2013

HIMSS13: Federal Officials Stress Commitment to Health IT

NEW ORLEANS -- The heavy hitters in the federal health care world were out in full force at the Healthcare Information and Management Systems Society's annual conference on Wednesday. Despite this week's news about federal budget cuts under the sequester, federal officials made it clear that their support for health IT is unwavering. In fact, they're ready to step it up a notch.
During a speech at HIMSS13, acting CMS Administrator Marilynn Tavenner said, "I am truly committed to health IT as a platform and strategy" to transform health care delivery.
She added that the health care system cannot lower costs and improve quality "if we don't have an electronic ability to understand what's going on."

How Tablets are Influencing Healthcare

Scott Mace, for HealthLeaders Media , March 6, 2013

This article appears in the January/February 2013 issue of HealthLeaders magazine.
Like a surging tide, the next wave of technology has landed in hospitals, changing the nature of healthcare delivery. Tablet computers are overturning concepts of how clinicians will use technology, raising work-life balance issues, and having a beneficial impact on hospital IT budgets.
Tablet computers have gone from relative obscurity to something approximating the appearance of stethoscopes: Nearly every doctor has one. What's different with this generation of technology is that demand is coming from clinicians rather than being rolled out by IT departments.
"Certainly the iOS devices from Apple are very popular among physicians," says Ferdinand Velasco, MD, chief health information officer at Texas Health Resources, an Arlington-based system that includes 25 hospitals, more than 21,100 employees, 5,500 physicians with staff privileges, and 3,800 licensed hospital beds.

CMS launches eHealth website

Site will offer central repository for information on health IT programs
Posted: March 5, 2013 - 12:45 pm ET
The CMS launched the eHealth initiative this week as a central repository for information on the federal government's digital record-keeping and electronic prescribing initiatives.
The page provides a central location to search the CMS site for details of the major digital health initiatives, including the $22 billion electronic health-record incentive program, the hospital inpatient quality reporting system and the e-prescription incentive program.
“CMS is committed to helping healthcare providers deliver better patient care by simplifying the use of electronic standards and encouraging the adoption of health information technology,” Robert Tagalicod, director of the Office of E-Health Standards and Services at CMS, wrote on the eHealth blog.

Mostashari: Sequestration will be difficult for Meaningful Use program

March 6, 2013 | By Dan Bowman
Sequestration, set to begin April 1, will prove to be a painful blow to the Meaningful Use Medicare incentive program, National Coordinator for Health IT Farzad Mostashari said Wednesday, speaking to members of the press at the Healthcare Information and Management Systems Society's annual meeting in New Orleans. Medicare reimbursements are set to be reduced by 2 percent, a total that, according to Mostashari, will take roughly $3 million away from ONC's budget.

Pros and cons of the app economy

By Tom Sullivan, Editor
Privacy and security realities hit David Collins hard. 
Looking forward to cracking 1,000 Twitter followers at HIMSS13, the senior director of mHIMSS had 967 – until, that is, his account was compromised.
“I got hacked and I can’t get back in,” Collins said during the Preparing for an OCR Audit session here at HIMSS13. “I have to open a new account so I’m starting to take this personally.”
Collins’ own experience highlighted the lack of privacy and security policies and technologies in the new world of applications, healthcare and otherwise. An even bigger barrier, and one particular to health apps, Collins added, is a general lack of funding for investing in mHealth technologies.

CCHIT Readying Health Information Exchange Certification

MAR 4, 2013 7:01pm ET
The Certification Commission for Health Information Technology will pilot test a certification program for health information exchanges.
CCHIT is a veteran certifier of electronic health records software that meet certain best practice measures; it also is one of a handful of federally-deemed companies that certify EHRs for supporting meaningful use criteria.

Poll: Patients should be allowed to make EHR updates, but not have full access

March 5, 2013 | By Susan D. Hall
Most U.S. doctors believe patients should be able to update their electronic health records, but only 31 percent say patients should have access to their full health record, according to a new poll by Accenture.
While the survey results were largely consistent across 3,700 doctors surveyed by Accenture in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the United States--U.S. physicians were the most open to patients updating their own records.
The U.S. physicians said patients should be able to add into their records demographic information (95 percent), family medical history (88 percent), medications (86 percent) and allergies (85 percent). And 81 percent said patients should be able to add some clinical updates, such as new symptoms and self-measured metrics, including blood pressure and glucose levels. Forty-seven percent, however, believe patients should not be able to update their lab test results.
Tuesday, March 05, 2013

HIMSS13: Other Industries' IT Use Offers Lessons for Health Care

NEW ORLEANS -- The Healthcare Information and Management Systems Society's annual conference kicked off in New Orleans on Monday with a bang, as a high-school marching band treated attendees to some early-morning music.
Soon after the impromptu concert, New Orleans Mayor Mitch Landrieu (D) took the stage to welcome HIMSS13 attendees back to New Orleans; the city served as host to the 2007 HIMSS conference, just 20 months after Hurricane Katrina had a devastating effect on the city.
Landrieu highlighted the progress and recovery New Orleans has made over the last few years, but he also acknowledged that New Orleans and other cities across the U.S. face challenges related to health care. He urged conference attendees to "find a way through technology to bend the cost curve" in health care.

87% of Physicians Say Quantity of EHR Alerts 'Excessive'

Chelsea Rice, for HealthLeaders Media , March 5, 2013

Electronic health records systems are the latest source of information overload.
Nearly one-third of physicians miss electronic notifications of test results in electronic health record systems, according to a research letter published this week in JAMA.
Of the 2,590 primary care providers surveyed in the Department of Veterans Affairs by the researchers, 86.9% perceived the quantity of EHR alerts to be excessive, and 69.6% said they received more alerts than they could effectively manage. More than half (55%) of surveyed physicians said current EHR systems made it possible to miss the alerts.
"What stood out was information overload and the easier the systems were to use, you tended to miss [fewer] test results." said Hardeep Singh, MD, MPH, the study's lead author, from the Houston VA Health Services Research and Development Center of Excellence.

An Automated Intervention With Stepped Increases in Support to Increase Uptake of Colorectal Cancer Screening: A Randomized Trial

Beverly B. Green, MD, MPH; Ching-Yun Wang, PhD; Melissa L. Anderson, MS; Jessica Chubak, PhD, MBHL; Richard T. Meenan, PhD; Sally W. Vernon, PhD; and Sharon Fuller, BA
Ann Intern Med. 5 March 2013;158(5_Part_1):301-311

If Practices Don't Change, EHRs Lose Money

By David Pittman, Washington Correspondent, MedPage Today
Published: March 04, 2013
The average physician lost nearly $44,000 over 5 years implementing an electronic health record system, a large pilot study found, but the technology itself was just part of the reason.
Just 27% of practices achieved a positive 5-year return on investment -- a number that would rise to 41% with the addition of federal incentives to use EHRs, the study in the March issue of Health Affairs stated.
But the vast majority of practices lost money because they failed to make operational changes to realize the benefits of EHRs such as ditching paper medical records after adoption, Julia Adler-Milstein, PhD, of the University of Michigan in Ann Arbor, and colleagues wrote.

EHR a Money-Loser for Most Physicians

John Commins, for HealthLeaders Media , March 5, 2013

Adopting electronic health records appears to be a money-losing proposition for most physicians, especially specialists and those in smaller physician groups.
The average physician would lose $43,743 over five years after adopting EHRs and only 27% of physicians would profit through the transition away from paper records without federal financial aid. And even when the $44,000 in meaningful use incentives are added to the pot, only 41% of physicians would be in the black, according to the study published this month in Health Affairs.
The study examined data gleaned from 49 community practices of varying sizes and specialties that were part of the Massachusetts eHealth Collaborative, an EHR pilot project. Meaningful use incentives were not in place for the period examined by the study. However, the study authors added the value of the meaningful use incentives on top of their initial projections.

Six HIT heavy-hitters announce interoperability organization

By Mike Miliard, Managing Editor
Created 03/04/2013
Big news was made at HIMSS13 on Monday when, in an unprecedented collaboration, some health IT heavy-hitters joined forces in an effort to push the needle on interoperability. 
In announcing the launch of the CommonWell Health Alliance, executives from Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth touted what they say is a first-of-its-kind organization: a collaboration of rival vendors, uniting to enable care integration and data liquidity. 
At a press conference Monday morning, McKesson chairman and CEO John Hammergren said the independent, not-for-profit organization represents an "industry-led approach" to one of the thorniest problems in health IT. 

When it comes to EHRs, 'Installation does not equal implementation'

By Diana Manos, Senior Editor
Created 03/03/2013
When it comes to your organization successfully adopting electronic health records, it's not just a matter of "going live" with the technology, says Don Harrison, co-leader of the Sunday workshop titled "Solving the Healthcare IT Adoption Dilemma," at the 2013 HIMSS Annual Conference & Exhibition.
"Installation does not equal implementation," says Harrison, founder and CEO of Implementation Management Associates, Inc. Many organizations want to purchase the best technology, but fail to take into account the most important factor for success–human behavior. 
If an organization wants to get an exponential return on investment, at the fastest speed possible, they need to shift their thinking from focusing only on time and budget to focusing on human behavior and how to reinforce it, Harrison says. This will involve breaking away from annual, semi-annual or even quarterly reviews linked to financial rewards. Behavioral standards need to be set up, measured, and managers need to reinforce the desired behavior regularly.

Kaiser EHR Success Tip: Listen to Nurses

MAR 3, 2013 6:47pm ET
With its 36 hospitals all at top-rung Stage 7 on the HIMSS EHR adoption scale, Kaiser Permanente knows a thing or two about electronic records. And while having visionaries at the top who champion I.T. is an important part of the program, listening to clinicians in the trenches—particularly nurses—is critical to growth and user acceptance, said Ann O’Brien, R.N., national director clinical informatics, at Kaiser. Speaking before several hundred nurses at the HIMSS Nursing I.T. Symposium in New Orleans on Sunday, March 3, O’Brien noted how in the day to day operation of a hospital, nurses function as a type of “information integrator,” meaning they must pull information from a variety of sources, some digital, some human, in the formulation and delivery of the care plan.
Aside from having nurses in high-level I.T. management roles, Kaiser has taken steps to assure nurse feedback about the way its EHR functions. Nurses were surveyed about their most pressing needs, and the majority said they wanted to quickly access Kaiser’s EHR as they made their rounds. “Nurses would log on 80 to 100 times a day,” O’Brien says.

Low-Income Patients Often Have Trouble Reaching Doctor Via Email

Health clinics in poorer communities less likely to offer services such as electronic communication

March 1, 2013
FRIDAY, March 1 (HealthDay News) -- Many low-income patients want to communicate electronically with their doctors but can't because the clinics they use generally do not offer such services, a new study finds.
An increasing number of health care systems provide online services to patients in order to manage care outside of office visits, and this includes enabling patients to communicate electronically with health care providers.
But this is not available to many poorer patients, according to the study from researchers at the University of California, San Francisco.

Following Government OK, E-Prescribing of Controlled Substances Surges

MAR 3, 2013 7:02pm ET
Electronic prescribing software vendor DrFirst, which integrates with many inpatient and ambulatory clinical information systems, reports strong growth in e-prescribing of controlled substances during 2012 after the federal government approved the practice.

The Delayed Promise of Health-Care IT

February 26, 2013
Because information technology (IT) has so quickly transformed people's daily lives, we tend to forget how much things have changed from the not-so-distant past. Today, millions of people around the world regularly shop online; download entire movies, books, and other media onto wireless devices; bank at ATMs wherever they choose; and self-book entire trips and check themselves in at airports electronically.
But there is one sector of our lives where adoption of information technology has lagged conspicuously: health care.
Some parts of the world are doing better than others in this respect. Researchers from the Commonwealth Fund recently reported that some high-income countries, including the United Kingdom, Australia, and New Zealand, have made great strides in encouraging the use of electronic medical records (EMR) among primary-care physicians. Indeed, in those countries, the practice is now nearly universal. Yet some other high-income countries, such as the United States and Canada, are not keeping up. EMR usage in America, the home of Apple and Google, stands at only 69%.