Healthcare IT News

Meaningful use promises to open data up to patients, improve the flow of information and drive efficiencies to maximize the level of care providers can offer. But meeting meaningful use requirements can be a daunting challenge, and as the federally ... Read more

The Indiana Health Information Exchange, looking to generate revenue for continued sustainability, is creating a for-profit subsidiary company that will take advantage of software licensed from the Regenstrief Institute for use outside of the ... Read more

The "next generation" of electronic health record systems need to make more than "incremental" changes and move beyond the concept of serving as computerized paper charts, according to a new study of leaders in the Department of ... Read more

Six Republican senators are asking the healthcare community for input on “recalibrating” health information technology policy, arguing that there are several problems with the current trajectory of the meaningful use program. In a white paper titled “Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT,” the Senators argue that the federal health IT program has been hindered by a lack of progress on interoperability, billing increases sometimes associated with EHR adoption, oversight and patient privacy concerns, and financial sustainability beyond the federal incentive payments for providers buying IT systems. “We hope stakeholders can provide information about the areas of concern we have identified, any additional areas of concern, and potential solutions to improve HITECH implementation,” wrote Senators John Thune of South Dakota, Lamar Alexander of Tennessee, Pat Roberts of Kansas, Richard Burr of North Carolina, Tom Coburn of Oklahoma, and Mike Enzi of Wyoming, in a letter broadly addressed to the American healthcare community. With $35 billion allocated for incentive payments and grants in the American Recovery and Reinvestment Act and about $12.7 billion paid out so far, “Congress has the fiduciary responsibility to ensure that these taxpayer dollars are being used to efficiently accomplish the end goal of reduced healthcare costs through the appropriate sharing and use of health information,” the Senators wrote in the white paper. They cited concern that “CMS does not yet seem to have an adequate plan to achieve secure, meaningful interoperability. ” While lauding the ONC and CMS for delaying Stage 3 meaningful use rule development, the Senators say that the program in Stage 2 “continues to focus less on the ability of disparate software systems to talk to one another and more on providing payments to facilities to purchase new technologies.” The “failure to systematically and clearly address meaningful groundwork for interoperability at the start of the program,” they wrote, “could lead to costly obstacles that are potentially fatal to the success of the program.” Among other concerns, the Senators cited so-called “code creep,” increased billing that some have said actually reflects more accurate accounting of services rendered. The Senators also cited something they and some others consider more problematic: habitual copy-and-pasting patient data, by some clinicians possibly weary or inexperienced with computers, which can lead to potentially serious medical ... Read more

  Physicians at Tufts Medical Center (Boston, Mass.) are enthusiastic about gaining instant access to patient imaging studies via the Web on devices such as the iPad using the CARESTREAM Vue Motion viewer. The universal imaging viewer delivers both time savings and convenience to radiologists on call, clinicians doing hospital rounds or physicians who are conducting follow up patient visits at their offices Carestream's Vue Motion allows physicians to quickly review X-ray images on Web-enabled devices. “As a zero-footprint Web-based viewer, Vue Motion allows physicians to review images quickly and easily on Web-enabled devices like the iPad. It also delivers side-by-side comparisons of current and prior images. It’s an incredible tool for onsite and offsite physicians who are trying to deliver responsive care for their patients,” said Michael Foley, Director of Radiology, Tufts Medical Center. The ability to pull up images while making hospital rounds is also appreciated. “Physicians used to sit at a workstation and open the PACS and EMR applications to view X-ray images prior to seeing patients. Being able to view images on an iPad while clinicians are with patients—and then show these images to patients as they are discussing the next steps in their treatment—is a much better care delivery model for both patients and physicians,” Foley adds. One of the things that impressed radiologists was the ability for Vue Motion to pull a patient’s record based on a single field, such as the name. “You don’t need to know the record number. If you input the name, it conducts a global search, pulls files and you can easily find the correct patient,” said Tom Quaranta, PACS Administrator, Department of Radiology, Tufts Medical Center. “This viewer is also much faster than when I am accessing files through the VPN. An entire CT exam—all 2,000 images—comes up instantly. It just doesn’t get any better than that for a radiologist,” reports Dr. Samson Munn, Vice Chair for Core Operations, Department of Radiology, Tufts Medical Center. Image Viewer Integrated with EMR Tufts Medical Center has integrated Vue Motion with its EMR and Foley explains that the image viewer is an incredible asset from an IT perspective as well. “It allows users to access information and avoids the need to support workstations and other platforms that require software maintenance and upgrades. Using a zero-footprint viewer also reduces overhead on the hospital’s network. Usually tools that improve physician access or help enhance patient care require additional IT support but this tool requires less IT support and infrastructure,” said Foley. About Carestream Health Carestream Health is a worldwide provider of dental and medical imaging systems and healthcare IT solutions; X-ray film and digital X-ray systems for non-destructive testing; and advanced materials for the precision films and electronics ... Read more

Emergency room access to a patient's medical history compiled through health information exchange reduced both readmissions and single-day admissions in a study from Israel. The study tracked whether ED physicians looked at patient medical ... Read more

A new computational model highly predictive of breast cancer survival has been developed by Columbia University engineering researchers. Their work is outlined in a study published this week in Science Translational Medicine. Lead researcher ... Read more

Medical Image of Hand“A complex system that works is invariably found to have evolved from a simple system that worked.John Gall, The Systems Bible Gall’s quote above can be very readily applied to meeting the needs of multi-facility hospitals and health care organizations, particularly, the needs of the medical imaging department. Some of the more common challenges with managing medical imaging across multiple facilities include: Radiologist travel needs Slow report turnaround times Disparate systems containing incomplete patient information And it was this last challenge in particular, coupled with over 1,100 medical imaging system installations, that helped to drive the development of the newest enterprise medical imaging solutions from McKesson. Aligning IT to Support Integrated Delivery System An example of one such installation was that of Bloomington Hospital, headquartered in Bloomington, Indiana.  For more than 100 years, Bloomington Hospital has served the communities of south-central Indiana as a regional referral center with a reputation for clinical excellence, innovation and collaboration. But the hospital’s best-of-breed, department-centric IT structure wasn’t aligned with its patient-centric mission and vision. While its facilities shared the same patients, they didn’t share patient information and images. When Mark McMath became Bloomington Hospital’s chief information officer in 2003, he quickly realized that change was necessary. “Clearly, we needed a different approach,” McMath said. “We had to align IT across the organization to support our vision for an integrated delivery system that would provide the high-quality, safe and affordable healthcare our region needs and deserves.” When selecting a vendor to implement this sweeping, multilayered model, Bloomington Hospital’s physicians, staff and leaders chose McKesson. Early successes with McKesson’s document imaging products helped sway the team; so did a common vision — timeline and can-do attitude. “We needed functionally rich products that would go wide and deep, and McKesson was the only company that could meet our comprehensive requirements,” McMath said. “The company’s performance, strong and rapid implementation methodology and wide-ranging integration capabilities sealed the deal. Newer Innovations Forthcoming Ultimately, while installations like the one above teach us about the challenges being faced by multi-facility health care organizations, they also bring to light new opportunities for the type of imaging innovations that can enhance both workflow and patient care.  And these opportunities are what will continue to drive the innovations we bring to this ... Read more

The care.data programme to extract and link large amounts of primary and secondary data has been approved by an Independent Advisory Group. The British Medical Association is now working on guidance for GPs on how it can be implemented.The General Practice Extraction Service IAG discussed an updated customer requirement for NHS England’s care.data programme at a 27 March meeting and recommended by majority vote that the requirement proceed to extraction. Some clinicians and privacy experts had expressed concern that patients would not be able to opt-out of the new extract.An updated information governance assessment says patients will be able to make a “reasonable objection” to their data being shared.Care.data is designed to capture and link data from primary and secondary care to increase transparency and improve patient outcomes.The monthly extract will be done via GPES and is based on four groups of data; patient demographics, events, referrals and prescriptions.Sensitive data will be excluded.The IAG met to consider the programme on 14 February and approved it with some recommendations. NHS England resubmitted its proposal documents and the programme can now proceed to extraction. One of the recommendations was that the dataset and list of excluded codes should be discussed with relevant clinical informatics expert groups. The new IG assessment says: “In order to only extract relevant (and not excessive) information, considerable effort has been made to identify the clinical codes that are relevant to commissioning, excluding irrelevant codes and those expected to be of poor quality and thus unreliable. “This has involved a detailed analysis of the dataset and codes by the HSCIC, including by the national clinical lead for primary care. In addition, the codes are being considered by a subgroup of the Joint GP IT Committee,” it says. The IAG also said a clearer explanation and justification should be provided for the data required. The customer requirement summary for the programme describes six aims of care.data:to support patient choice; to advance customer services; to promote greater transparency; to improve outcomes; to increase accountability; and to drive economic growth. It adds that the programme will not be requesting any free text or retrospective data prior to 1 April 2013. The IG assessment says GPs must comply with this request, however the GPES IG principles state that practices must give explicit consent for identifiable data to be extracted.“Where practices do not wish to use GPES for the extraction, they can agree an alternative method of providing the required data, but it must be acceptable to the HSCIC,” it says. Primary and secondary care records will be matched using four identifiers; NHS number, date of birth, gender and postcode. Anonymised data will then be made available to commissioners and organisations supporting commissioners via standard aggregate reports or record-level extracts that are pseudonymised. “Other users than commissioners – for example patients and the public, private companies – will only have access to standard anonymised aggregate information which will be published,” the assessment adds. The customer requirement summary says people have a right to make reasonable objections to the disclosure of personal confidential data. To do this, they must be given as much information about how their data will be used outside of direct care as is practicable via websites and other publicity materials. If the objection is upheld and the patient does not want any confidential data flowing to the HSCIC, the practice must not pass it on. If the patient is happy for their personal confidential data to flow to the HSCIC, but does not want their personal data to be disclosed, the provider notes the objection with a ‘flag’ on the patient’s record. A BMA spokesperson said: “We are content that the IAG recommendations from the February meeting – and in particular the agreement that patients can reasonably object to their data being extracted – have been taken on board. “This was a fundamental principal which the BMA negotiated with others including NHS England. “Representatives of the Joint GP IT Committee also reviewed the dataset and were satisfied that it was appropriate for commissioning. We are now working on guidance for GPs on how this can be ... Read more

Three health IT prognosticators, who in 2005 foresaw widespread adoption of electronic health records, recently published their latest predictions for the health IT landscape over the next five years. Their perspective ran in the Journal of the American Medical Informatics Association. Interoperability issues, they predicted, will be worked out when the buyers of EHR systems demand it. Article co-author Donald Simborg told InformationWeek that he believes the problem is not standards. "We've got more standards than we can deal with," Simborg said. "The problem is the buyers of healthcare--the hospitals, the big healthcare organizations, the integrated delivery networks. Once they see it's in their economic interest to demand that the vendors be interoperable, that will change things. But so far, they haven't done that." In response to criticism recently by Rep. Michael Burgess, M.D. (R-Texas), who asked National Coordinator for Health IT Farzad Mostashari why he didn't just "make that [interoperability] happen," Mostashari stressed the importance of the industry working together. "We want to really work with the industry to get consensus and accelerate this," Mostashari said. A recent PricewaterhouseCoopers article called interoperability key to scaling out mobile healthcare solutions--another of the predictions in the JAMIA article. Just 53 percent of doctors in the PwC  survey said that mHealth applications and services they use work with their organization's IT system, and even fewer said they are integrated with other technologies in the health system. Simborg and colleagues said they foresee a blurring of the distinction between EHR and telemedicine. "[M]ore and more medicine will happen through the Internet," Simborg told InformationWeek. "Lots of healthcare will happen without there being a physical encounter, and the EHR will have to cope with patient inputs a lot more. So we won't call it telemedicine anymore." And despite all the hullabaloo about big data, the next five years will bring greater understanding of the possibilities for using data analytics to provide personalized medicine and the limitations of doing so, the authors said. Some health leaders have raised concerns about organizations chasing big data without a specific plan to use it to improve patient ... Read more

Technology projects such as the implementation of an electronic health record system, no doubt, come with their share of headaches. CIOs that think that such work merely consists of installing new software or hardware, however, are in for a rude ... Read more

In the new world of healthcare -- one that is focused on collaboration, accountability, providing better care and cutting costs-Aetna executives view the insurer's newly minted Healthagen division, unveiled last month at HIMSS13, as an indispensable piece of getting things right. They describe Healthagen as a portfolio of innovative and growing businesses that tackle the fundamental needs of greater value, coordination and transparency in healthcare. Healthagen brings together Aetna’s population health management solutions and health information technologies from acquisitions that include Active Health Management, iTriage and Medicity. “We have invested more than $1 billion to acquire and build a comprehensive collection of health management and health IT solutions to empower consumers and enable clinical integration and population health management.” says Joseph M. Zubretsky, senior executive vice president for Aetna’s national businesses. “What this really represents is a recognition by Aetna that people have previously used technology not just as an enabler of a particular capability,” says Charles Kennedy, MD, CEO of Aetna Accountable Care Solutions, “but healthcare is relying on technology as a driver of change. ”As Kennedy sees it, bundling the various technology Aetna has acquired in recent years into a single brand – Healthagen – emphasizes that Aetna is about solutions, and, the solutions are specifically tied to connecting everyone involved to the healthcare of the patient, creating new insights and making sure the insights are actionable. That, he says, is the way to achieve better care. “If you then combine that with our healthcare management program, such as our Medicare provider collaborations that have a track record of reducing costs, improving quality and improving the patient experience with care – the so-called Triple Aim,” Kennedy says. "You can begin to see that scaling those kinds of approaches through Medicity, combined with proven care management programs, really allows Healthagen to service what is required for successful healthcare reform, which is achievement of the Triple Aim. "Like Kennedy, Charles E. Saunders, MD, Healthagen’s CEO, puts a high value on connectedness. “Healthagen businesses and solutions,” he says, “are enabling a new level of healthcare connectedness, insight and action. “We’re pretty excited about it,” says Kennedy.“We think it’s the right way to go. We’re excited about combining these into a coherent whole. If you think about iTriage, here’s a company that built an app that actually influenced how people access the healthcare system. That’s something that health plans have been trying to do for decades, and have had very limited success. ”iTriage lets users check symptoms, find doctors and make appointments. Aetna acquired Healthagen, the developer of iTriage in 2011. It acquired HIE technology company Medicity in 2010, and, in 2005, Active Health Management, a technology-driven health management and healthcare data analytics ... Read more

Despite federal incentives and penalties, as well as payer demands, for health data digitization, some providers continue to resist the trend. One health policy and ethics analyst aims to address why in a recent Hospital & Health Networks article. Emily Friedman, wondering if reluctant providers' concerns should be taken more seriously, says she can understand the resistance. She lists some of the arguments against digitization: primarily, lack of ease of use, citing a 2012 CompTIA survey that found 58 percent of respondents think systems are hard to use. "Requiring busy people who might be technologically challenged to clamber up a steep learning curve is asking a lot, in or out of health care," Friedman writes. Cost is another argument against implementation, she says. Some physicians, according to Friedman, perceive that vendors are selling software that's difficult to use, making Meaningful Use a challenge. Interoperability, she says, is yet another resistance factor--she cites multiple instances of physician practices having trouble agreeing on a system to use and not being able to exchange health information between systems. Privacy--which has proved to be a serious concern--clinical autonomy and risk of erroneous information round out Friedman's list of negatives. Still, Friedman contends, digitization will happen, like it or not. "I think those who continue to whine and jump up and down and scream and refuse to accept that healthcare record-keeping has entered the digital age for good are not doing anyone any favors," she says. "[We] would be served far better if we examined the challenges…and sought to remedy them." Despite the initial cost of going digital, the savings are there, Friedman argues. So is improved quality, patient empowerment and fishing out fraud and rogue prescribers. "I'm still excited about the potential for health IT systems, and I hope that those who are not can get over it and help usher in this new era," Friedman ... Read more

  Providing patients with access to the information in their electronic health records "overwhelmingly" yielded positive benefits, according to a new study in the Journal of Medical Internet Research. While patient review of their health data is an opportunity to engage them in their healthcare, some clinicians have expressed concern about such open access. The researchers, from the Veteran's Administration and elsewhere, sought to determine patients' actual experiences with such open access by studying the My HealtheVet EHR access pilot program.  They used focus group interviews conducted at the Portland Ore.-based VA Medical Center, which had the highest percentage (72 percent) of enrollees in the pilot. The researchers found that patients' access improved communication, coordination of care, and appointment follow-through. It also improved patients' knowledge of their own health, created a greater desire for self care, and increased their participation in their care. However, while patients preferred such access, they also reported some negative aspects that stress, including reading offensive language in patient notes, inconsistencies in content, and some technical problems with the EHRs. "As evidence shows that activated patients achieve higher levels of self-care and satisfaction, sharing all clinical notes with patients and their delegates could serve as a fundamental component for the Meaningful Use of electronic records and health information exchange," the researchers said. Stage 2 of the Meaningful Use incentive program requires increased patient engagement. Consumer groups and others have advocated for even more patient engagement and access to their electronic ... Read more

The shift to mobile health is underway, is global, human and accelerating,a session on tablet computing at ECR 2013 heard. The session at the massive radiology event in Vienna, titled ‘Tablets: friend or foe?’, generated debate around whether the iPad and other tablet computers were a good or bad thing. But left the audience in little doubt that these ubiquitous, portable devices are here to stay. Dr Eric Ranschaert, radiologist at the Jeroen Bosch Hospital in the Netherlands, gave a detailed analysis of trends and evidence surrounding the use of tablets. He concluded that they: - should not be used for routine primary diagnosis, though they are good enough for working on-call, for giving a second opinion and for use at the bedside - need adapted safety policies and an adapted ICT environment - are causing a shift towards greater image sharing and communication. - have led to increasing involvement of clinicians (other than radiologists) in image interpretation. Therefore, he concluded, tablet computers are likely to re-shape radiology. Regarding mobile health generally, he said: "The shift is underway, is global, human and accelerating." Dr Ranschaert pointed out that tablets were well suited to doctors' work, which is generally mobile, generates heavy information needs and is conducted in environments with good wi-fi. Some 80% of physicians in a US study said that they owned and used mobile devices. IPads and other tablets have many advantages over other kinds of device, being versatile, portable, generally low price and good for emergency use. They have a high potential to strengthen communication, improve relationships and facilitate access to images for referring clinicians. They bear the hallmarks of a disruptive technology being, initially, simpler, cheaper and lower end than existing technology. But newer versions of the devices are improving and gradually removing the incumbent technology. However, Dr Ranschaert cautioned that use of the devices required a thoughtful approach and they should not be implemented for the sake of implementation. Following a detailed technical comparison of tablets and traditional workstations, he concluded that the mobile devices could not compete with the screen size and resolution of high-end diagnostic workstations, though they could be cost-effective companions to workstations. A questioner from the audience, however, pointed out that the devices could effectively leave radiologists constantly at work. “I don’t want to work at home and on the train,” she said. The session speakers thought the changes were inevitable and that there were benefits. Osman Ratib, professor and chairman of the department of radiology and head of nuclear medicine at the University Hospital of Geneva, said that he did not know a radiologist who didn’t want the ability to access images via a tablet. Would radiologists on call want to go four times a night to the hospital? “Whether we want it or not, today, the workload is such that unless you spend more hours at work you have to have the flexibility,” he commented. More positively, he added that tablets gave radiologists more mobility within their institutions making it easier to participate in the wards and at conferences. “It’s a plus for our profession to be integrated into the team,” he said. Dr Ranschaert agreed that flexibility was important. Other clinicians could now see images before the radiologists and there was a need to communicate with them – that was where iPads could ... Read more

For providers asked to use new technologies like electronic health records and analytics tools, workflow impact, no doubt, is a top of mind issue. Transitioning away from familiar and comfortable practices and adopting new habits is one of the ... Read more

EMIS and TPP are working on a data-sharing agreement to allow clinicians to see information held in each other’s systems.The GP IT companies plan to deliver one-to-one local health community data-sharing for clinical commissioning group areas using both EMIS and TPP systems. The new agreement, described by the companies as “groundbreaking” and “momentous”, means clinicians using one system will be able to view patient records from the other system.This will be subject to sharing agreements and patient consent at the point of care. EMIS managing director Neil Laycock told EHI the two companies were working together to find pilot sites for the new data-sharing arrangement. Areas with high populations of TPP and EMIS users tended to be in the North East and South East of the country.The functionality would then be rolled out across England. The news follows an announcement in January that TPP had agreed to work with Healthcare Gateway Ltd – a 50:50 joint venture company formed by EMIS and INPS – to share patient data via the Medical Interoperability Gateway. TPP said it would offer SystmOne data accessed through the MIG for free.Laycock said the new agreement was a point-to-point relationship rather than the MIG which allowed data sharing between numerous organisations.He said customers of the two systems had been asking for some time to be able to share information. “The whole industry has been waiting for TPP and us to get together to share, there’s an overall demand from the community to start looking at this data anywhere.”Together, EMIS and TPP hold medical records for 60 million patients. TPP cheif executive Frank Hester described the development as a big step forward in enabling truly integrated care.“It’s fantastic that we can offer this level of integration to the NHS for free. This will transform the delivery of patient care across the NHS,” he ... Read more

With the addition of a new audio-video entertainment system at Geisinger-Gray’s Woods Clinic, patients undergoing MRI scans may feel more at ease, and that could help produce more accurate results. Cinemavision was installed at the Gray’s Woods location about a month ago. It allows patients to view DVD videos and live broadcast television, or listen to music, during a Magnetic Resonance Imaging test. Depending on the complexity of the scan, MRI tests can take anywhere from 45 minutes to three hours. The audio-visual technology has been proven to soothe anxious patients and minimize interruptions caused by claustrophobic patients. That leads to faster scans and reduces the need for re-scans according to a news release by Geisinger. Judy Robinson, radiology team leader at Geisinger-Gray’s Woods, says patients wear goggles to view videos, and through attached headphones, they can listen to music, as well as communicate via microphone with the radiologists. Robinson believes Cinemavision, "Makes the time go faster. ”Patients have the option to watch sitcoms, movies, documentaries or they can just choose music. Patients can  bring their own DVDs to an exam. Robinson says Geisinger Medical Center in Danville was probably the first Geisinger facility to acquire the technology a few years ago. The other Geisinger center that uses Cinemavision is Geisinger Wyoming Valley Medical Center in Wilkes-Barre. “I know that we’re the only one in the area that has this,” Robinson said. “It was definitely an investment for the patients. ”The technology can only be used for patients lying on their backs during an MRI, Robinson ... Read more

Implementing an electronic medical records system in Malawi included the usual challenges, such as having tech staff available, selling clinicians on its value and training them to use it. But there were additional challenges, including power ... Read more

Hospitals that used a computerized system for discharge of heart failure patients found 30-day readmission rates fell 2.5 percent compared with hospitals that did not use the system, according to research from Intermountain Healthcare. The study ... Read more