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The human side of developing integrated electronic health records
Bob Brewin July 6, 2012
As the Defense and Veterans Affairs departments work to develop an integrated electronichealth record the concept is simple—streamline the military health care system for active-duty service members, veterans and retirees—but getting there is not. The two departments will not deploy the system until 2017, eight years after President Obama kicked off the project in April 2009.
The interagency program office managing the iEHR wasn’t set up until October 2011, and its director wasn’t appointed until April 2012. That gives VA and the Pentagon five years to develop what Defense Secretary Leon Panetta dubbed the world’s largest electronic health record system, which would serve 9.7 million active-duty and retired military personnel and their families, and 7.8 million veterans.
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Study: Clinical Trial Alerts in EHRs Have Limitations
JUL 6, 2012 12:07pm ET
Physicians using electronic health records that give alerts about appropriate clinical trials experience alert fatigue but rates of response remain relatively high, according to a new study. Still, overall results are mixed.
Researchers for 36 weeks documented the response patterns of 178 physicians receiving alerts for an ongoing clinical trial, collecting data on response rates to the alert and patient referral rates. Response rates declined over time, but even after 36 weeks remained in the 30 to 40 percent range, concludes the study.
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Opt-In Policy Best For HIE Patient Privacy
John Halamka, CIO for Beth Israel Deaconess Medical Center, believes health information exchanges should use an 'opt-in to disclose' policy to safeguard patient data.
By Ken Terry, InformationWeek
July 05, 2012
URL: http://www.informationweek.com//news/healthcare/policy/240003183
July 05, 2012
URL: http://www.informationweek.com//news/healthcare/policy/240003183
Healthcare providers have yet to agree on the best way to protect the privacy of personal health information (PHI) in health information exchanges (HIEs), but John Halamka, MD, has an opinion.
As CIO at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Halamka recently announced in a blog post that BIDMC will have all of its 1,800 affiliated ambulatory care providers ask their patients to "opt in for data sharing among the clinicians coordinating their care." This would allow data exchange, not only within BIDMC, but also with outside clinicians who provide care for those patients. The patients who opt in now will still be able to opt out later. 
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Avoid common pitfalls of healthcare website design
July 6, 2012 | By Dan Bowman
Looking to attract new patients and improve your facility's reputation with a new website or redesign? Be sure to have both a goal and a budget in mind, according to an article published this week in Medscape Business of Medicine.
The article outlines several potential pitfalls of healthcare website design.
Too often, when busy providers create websites they become an afterthought, according to author Morgan Lewis, when a thoughtful approach is more likely to increase business.
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EHR disaster prep should be a priority, not an afterthought
July 3, 2012 | By Marla Durben Hirsch
One of the first announcements our regional power company made after vicious storms swept through the Washington, D.C., region last weekend was that power had been restored to local hospitals. Now, the company said, it could turn to the restoration of electricity to homes and businesses.
Of course the restoration of power to hospitals and other vital entities should be a priority. But hospitals always have an obligation to engage in disaster planning, and that includes protection of their electronic health records and other patient records.
EHRs generally are protected during disasters, as such data is stored both on a hospital's emergency power system and at a backup offsite storage location. But what happens to the data if those options also are knocked out?
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The Promise and Pitfalls of Population Health
JUL 1, 2012
Heath care is personal, but in the eyes of the industry and its federal overseers, the fundamental mission of clinical care needs to broaden its horizons.
The Centers of Medicare and Medicaid Services forecasts that national health expenditures, tagged at $2.6 trillion in 2010, will continue to rise faster than inflation, indeed, from 2010 to 2020 to grow by 5.8 percent annually, outpacing the average annual growth in the overall economy by 1.1 percentage points (4.7 percent). By 2020, national health spending is expected to be $4.6 trillion and comprise 19.8 percent of Gross Domestic Product (from the current 17.6 percent).
That's not encouraging, nor is the frightening spike in chronic diseases. The Centers for Disease Control and Prevention notes that chronic diseases-heart disease, stroke, cancer, diabetes, obesity and arthritis, among others-are among the most costly and maddeningly preventable conditions the health care industry deals with.
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Cerner questions Epic win for Cambridge patient records
Short-listed supplier queries trust over procurement process for multi-million pound software deal
- SA Mathieson
- Guardian Professional, Friday 6 July 2012 17.38 BST
Patient record supplier Cerner has written to Cambridge University Hospitals foundation trust over its recent award of a major software tender to Epic, Government Computing understands.
The letter, understood to be from Cerner's European managing director Alan Fowles to the trust's interim chief executive Dr Karen Castille, questions the scoring of the rival bids; apparent changes to the procurement process while it was running; and the relative prices of the three short-listed bids from Allscripts, Cerner and Epic.
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Cerner challenges Cambridge EPR decision
5 July 2012 Jon Hoeksma
Cambridge University Hospitals NHS Foundation Trust has been challenged by clinical IT vendor Cerner over its recent eHospital electronic patient record procurement, in which Cerner was beaten by US arch rival Epic.
The firm accuses the high-profile trust of failing to conduct a fair and transparent tender process and of picking a winner in advance - which it then rigged the tender process to deliver - ignoring considerations of price and proven product.
Cerner calls for the trust to re-tender, a suggestion that Cambridge has given short-shrift.
Insider view: Jon Hoeksma
Cerner’s decision to challenge the decision by two Cambridge trusts to award an eHospital EPR project to Epic looks like sour grapes; but it may serve the NHS IT market, says EHI editor Jon Hoeksma.
5 July 2012
Cerner’s decision to accuse two Cambridge trusts of rigging their eHospital electronic patient records procurement in favour of Epic is a serious charge.
It will be seen by many as being motivated by a serious case of sour grapes from a supplier smarting after losing out to its arch rival.
The trust flatly denies the accusations and it is to be hoped that the lawyers don’t get involved (although a letter seen by eHealth Insider suggests that they are already on board). So this is a high risk move for Cerner. Why do it?
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EHealth Initiative: ONC approach would hamper info exchange
Posted: July 3, 2012 - 3:15 pm ET
The not-for-profit eHealth Initiative is rejecting what it calls a "heavy regulatory approach" in a proposed federal framework for governing the Nationwide Health Information Network.
The initiative, in an 23-page letter (PDF) dated June 26 but released along with a prepared news statement on Tuesday, took issue with much of the direction of a formal request for information issued May 15 by HHS' Office of the National Coordinator for Health Information Technology.
That request included 66 specific questions that ONC wanted answered about who should participate in the proposed network as well as who would decide who can join and under what rules. The ONC proposed creating a category of nationwide health information network validated entities, or NVEs, for eligible participants, and conditions for trusted exchange, or CTEs, as criteria for eligibility.
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VA wants advanced clinical decision support for iEHR
By Mary Mosquera
The Veterans Affairs Department wants industry help to describe standard technical specifications for services that are needed for clinical decision support that could be incorporated in its integrated electronic health record (iEHR) with the Defense Department.
Clinical decision support (CDS) is currently linked with specific vendor electronic health record software and modules. The Interior Department’s National Business Center, which is working on behalf of the VA, wants to develop CDS functionality as a service.
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Research Highlights Growth in Healthcare Cloud Computing
July 3, 2012
According to new research from MarketsandMarkets, the global healthcare cloud computing will be worth $5.4 billion by 2017. The report which studied the cloud computing market over the five year period from 2012 to 2017, found that in healthcare it will grow at an annual compounded rate of 20.5 percent in that time period.
The global cloud computing market revenue is expected to increase from $1.77 billion in 2011 to $5.4 billion by 2017. The report says that North America will be the largest contributor to this market as a result of various changes such as the conversion from ICD-09 to ICD-10 clinical diagnosis codes and meaningful use rules of American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health Act (HITECH), which mandate the adoption of electronic medical records.
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dm+d made 'fundamental standard' for NHS
3 July 2012 Lyn Whitfield
The Information Standards Board for Health and Social Care has approved the NHS dictionary of medicines and devices as a fundamental standard for the NHS.
The move means that the dictionary - which is better known as the dm+d - should be used across the NHS and by its suppliers when referring to medicines.
In a statement, the ISB said the move would improve the exchange of clinical information and improve the safety of prescribing.
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Cerner at odds with hospital over installation of system
By MARK DAVIS
The Kansas City Star
Cerner Corp. and a small Kansas hospital have become embroiled in a dispute over failed attempts to install an electronic medical records system.
Girard Medical Center, a critical-access hospital northwest of Pittsburg, Kan., had sued the North Kansas City-based supplier of information technology to hospitals, doctors and others in health care.
Their quarrel is now in arbitration under an order issued in U.S. District Court in Kansas City, Kan.
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Patient Engagement Requires Right IT Tools
Federal and private policy makers are insisting that healthcare providers get patients more involved in their own care, but that's not going to happen without a careful analysis of your IT strategy.
By Paul Cerrato, InformationWeek
July 02, 2012
URL: http://www.informationweek.com//news/healthcare/policy/240003073
July 02, 2012
URL: http://www.informationweek.com//news/healthcare/policy/240003073
Health IT managers could learn a lot from my car mechanic. Mike once explained the difference between "parts changers" and real mechanics--those who are skilled diagnosticians. Parts changers will look at your ailing engine, make a snap judgment about what's wrong, replace the part he suspects is at fault, and hope for the best. A good mechanic, on the other hand, works through a diagnostic process, looking for subtle clues, and bringing his in-depth understanding of the internal combustion engine to bear to find the root cause of your problem.
As most healthcare providers know, the federal government is insisting that hospitals and practices improve their e-patient engagement strategy in order to meet Stage 2 Meaningful Use criteria. Private insurers are already going down this same path. When faced with such mandates, health IT executives and clinical leaders can take the parts changer's approach to patient engagement, or do a deeper root-cause analysis to find the best technology to address the issue.
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5 keys to the legal issues of social media in healthcare
By Michelle McNickle, New Media Producer
Created 07/02/2012
Social media is without a doubt playing a major part in patient engagement, marketing efforts, and an overall sense of communication within the industry. Yet with the growth of these tools come other issues to keep in mind — like the legal ramifications of using outlets like Twitter, Facebook, and LinkedIn within a healthcare setting.
"These social media sites have moved beyond the novelty stage and into the mainstream," read a recent whitepaper by Actiance. "They have become so pervasive that they have emerged as effective tools within the corporate setting as well. The line separating the recreational use of these tools from legitimate business purposes has become increasingly blurred."
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After SCOTUS decision, health IT orthodoxy worth rethinking
By John W. Loonsk, MD, CMO CGI Federal
Created 07/03/2012
Now that the Supreme Court has upheld the substance of the Affordable Care Act (ACA), a collective sigh can be heard, of relief by some and frustration by others, but certainly of avoided tumult.
The focus of ACA attention will turn to results or repeal. And while a different decision could have had ACA become a weight on HITECH and health information technology (HIT), the principally bi-partisan nature of the HIT agenda should now refocus attention almost exclusively on results for it.
It is from this latter perspective, though, that there may still be HIT tumult to come. HITECH was constructed from a health IT orthodoxy (set of tightly-held, common beliefs) that has shown a few cracks of late. And some of these cracks have to do directly with the population health IT needs of health reform from a program (HITECH) that is principally built around individual patient transaction technology.
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Report: Digital health firm investments skyrocketing
July 3, 2012 | By Ken Terry
Investments in "digital health" companies--including firms in the health IT and wireless spaces--more than tripled in the first six months of 2012, according to a new report from Burrill & Co., a San Francisco financial services company. Venture-capital investments in the sector soared to $499 million in 46 transactions from $156 million in 19 transactions during the first half of 2011.
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JPMorgan Chase unit to acquire M-Modal in $1.1 billion transaction
July 3, 2012 | By Ken Terry
In what is by far the biggest venture capital deal in health IT this year, One Equity Parters, the equity investment branch of JPMorgan Chase, has agreed to take M-Modal (NASDAQ:MODL) private, buying all of its shares for $1.1 billion in cash.
M-Modal, which offers a cloud-based voice recognition program that uses natural language processing (NLP), recently announced a new product that it said could convert doctors' dictation into discrete data in electronic health records. The "speech-to-text platform," called Fluency, is a refinement of its earlier NLP software.
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FDA Finally Issues Unique Device Identifier Rule
JUL 3, 2012 10:44am ET
The Food and Drug Administration has released a proposed rule to establish a unique medical device identifier, called UDI.
The long-awaited identifier, which Congress authorized in 2007 with renewed pressure from members in recent months to implement, is designed to better enable users to track devices and enable FDA to identify safety or effectiveness concerns quicker and better target recalls.
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INPS and EMIS to supply GP IT in Wales
3 July 2012 Chris Thorne
NHS Wales has agreed a framework agreement with GP practice suppliers EMIS and INPS to provide a managed IT service to the country’s GPs, EHI Primary Care understands.
NHS Wales went out to tender for a new GP IT Clinical System Services Framework Agreement in May 2011.
The tender document says it is looking for a managed service to provide GP clinical system functionality via a central hosting arrangement with the inclusion of support services. The new framework is set to run for four years.
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That was then...
Ten years after the start of the National Programme for IT in the NHS, how do IT directors, suppliers and analysts view it? What is its legacy, and is the NHS in the right place to move forward? Chris Thorne reports.
28 June 2012
The first leader of the National Programme for IT in the NHS was the man who introduced the congestion charge to London, Richard Granger.
The programme’s failings have been well-publicised, and the scheme has often been described as a car-crash. Yet it did have some successes.
PACS was good
Paul Curley, clinical director for IT and a consultant surgeon at Mid Yorkshire Hospitals NHS Trust, believes that while it was “too ambitious” overall, it had considerable success with e-prescribing and picture archiving and communications systems.
“This is an area where NPfIT and NHS Connecting for Health [the agency set up to run the programme] have done some really useful work. This includes reviews of available systems and detailing the pros and cons – the ‘Which’ guide of pharmacy systems,” he says.
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Study: EMRs Improve Physician Compliance for Reviewing Portal Images
July 2, 2012
According to a new study, the use of an EMR for reviewing portal images dramatically improves compliance with timeliness and record keeping. The study, which appears in the July issue of the Journal of the American College of Radiology, found that portal images are used to verify the positioning of patients during daily radiation treatments to improve the accuracy of the radiation field placement, to reduce exposure to normal tissue and to deliver accurate dose to tumor volumes.
"The benefits of the implementation and utilization of an EMR have been well documented. Other studies have shown that the use of EMR's improves the quality of care, saves time and decreases cost," Andre Konski, M.D., co-author of the article, said in a statement. Konski is chief of radiation therapy at the Barbara Ann Karmanos Cancer Center; and professor and chair of the Department of Radiation Oncology at the Wayne State University School of Medicine in Detroit.
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CIOs and CMIOs Speak Their Minds about the Supreme Court Decision
Scott Mace, for HealthLeaders Media , July 3, 2012
This week, some voices of healthcare CIOs and CMIOs, speaking out about last week’s U.S. Supreme Court decision on the Patient Protection and Affordable Care Act:
Marc Probst, Chief Information Officer, Intermountain Healthcare, Salt Lake City, Utah
Bottom line is politically I don't like the ACA and the lack of financial responsibility which our country’s leaders have. In the end, the problem of "going broke" just continues to escalate.
However, that's politics. As for us at Intermountain, the outcome of the Supreme Court ruling doesn't change at all the strategy and efforts we are pursuing. The ability for the government to pay for health care continues to diminish, therefore if we are going to be in a position to provide the high quality of care we believe we should and do it at substantially lower costs, then we need to maintain our focus on our current efficiency and accountability efforts.
As a CIO, there is a huge responsibility to focus on cost saving workflows, better access to data and systems, and of course on using data as a strategic asset for increasing quality and lowering costs. Luckily, that has been a focus at Intermountain for many years. We have a lot to do—but the path we are on is a good one. Regardless of what the politicians do, the problem is economic. We know what it will take to be successful in the future and we know we can succeed.
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ID re-entry helps reduce wrong-patient errors
July 2, 2012 | By Susan D. Hall - Contributing Writer
Requiring providers to re-enter patient ID numbers in computerized physician order entry systems significantly reduced the number of wrong-patient orders in a study published by the Journal of the American Medical Informatics Association.
The New York-based researchers used a retract-and-reorder measurement tool to determine the reasons for wrong-patient orders, then set up a three-pronged study to look at two possible solutions compared with no intervention: a single-click confirmation of patient identity and requiring that the ID number be re-entered.
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Supreme Court decision a huge win for health IT
July 1, 2012 | By Ken Terry
Some observers say that last week's Supreme Court decision upholding most of the healthcare reform law won't really have much of an effect on health IT. The healthcare industry, these pundits point out, was already moving down the tracks to accountable care, patient-centered medical homes, and value-based reimbursement. Moreover, the main financial driver of health IT adoption is the HITECH Act's incentives for Meaningful Use of electronic health records.
This argument is partly true, but it isn't the whole truth. Let's start with Meaningful Use. Although the HITECH Act was passed before the Patient Protection and Affordable Care Act (ACA) as part of the 2009 stimulus law, the framers of the Meaningful Use regulations have made it abundantly clear that they're trying to use the incentives to steer the healthcare industry in the same direction that the ACA wants it to go: toward a high-quality, safe and efficient healthcare system.
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Hospital Association Comments on Health Information Exchanges
June 29, 2012
The American Hospital Association submitted comments in response to HHS' requests for feedback on how to govern and advance health information exchange, according to an AHA News Now report.
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Monday, July 02, 2012
Upping the Health IT Bar During Cost Containment
by Ernie Hood and Daphne Lawrence
More than ever, cutbacks and cost savings are top-of-mind priorities for health care organizations, as hospital revenue and margins continue to decline, Medicare reductions loom, case mix worsens, and increased competition and consolidations become a daily reality. Yet the need for new and often costly IT initiatives such as electronic health record implementations has not abated. The challenge to meet organizational needs for ICD-10, meaningful use, accountable care and clinical integration often is both costly and urgent.
Staying on target without compromising performance requires a careful approach to cost containment that will rely on assessing and refining existing performance measurement tools and, in many cases, initiating new ones.
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Enjoy!
David.