In my search across the galaxy for the future of health information technology, I came across my son's XBOX 360 and found some relevant video posted on "Placebo Journal", and thank you to blogger kevin.md
Here it is
Part I, A Medical Odyssey
Part II....The Next Day
In this column I often write about promoting health information exchange.
In all cases, however, we must comply with HIPAA and place barriers for confidentiality and privacy to protect patients from unauthorized access to their health records without proper authorization.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) is an expansive set of rules to privacy for patient information. The lesser known aspects of it may be largely unknown by physicians. I came across a survey of dentists which had some interesting information, although not all aspects apply to medical offices. It is available for a full read at:Dental Survey
Several lesser known requirements are:
Inventory and Control of all hardware and software
Security and disposal of all media
Log of maintenace of hardware/software
WRITTEN work station
Further details are in the article itself.
Such questions arise such as:
Should patients have the option to specify that their medical records not be shared on a common HIE?
Should there be an audit trail for 'shared information'?
Although the advent of the RHIO as a business structure for the development of Health Information Exchanges has largely failed to do what it was intended to do, the motivation for HIE will largely be driven by CMS mandates and well as quality and safety concerns.
(HealthDay News) -- "From 2004 through 2006, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the Medicare program $8.8 billion, according to the fifth annual Patient Safety in American Hospitals Study
This analysis of 41 million Medicare patient records, released April 8 by HealthGrades, a health care ratings organization, found that patients treated at top-performing hospitals were, on average, 43 percent less likely to experience one or more medical errors than patients at the poorest-performing hospitals.
This analysis of 41 million Medicare patient records, released April 8 by HealthGrades, a health care ratings organization, found that patients treated at top-performing hospitals were, on average, 43 percent less likely to experience one or more medical errors than patients at the poorest-performing hospitals.
The overall medical error rate was about 3 percent for all Medicare patients, which works out to about 1.1 million patient safety incidents during the three years included in the analysis
"HealthGrades has documented in numerous studies the significant and largely unchanging gap between top-performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost," Collier said. "
The entire article can be found at Washington Post.
Of some interest to me is no mention whether their was a difference in the use of "health information technoloogy" between the "high achievers" and the underperforming" hospitals. Does anyone have statistics on this metric?
The Fifth Annual Health Grades Patient Safety in American Hospitals Study
We as health care providers, hospitals, laboratories, emergency departments and others view health information and data exchange through a narrow prism from our side of the health care system.
Patients (consumers) also have begun to form their own virtual world of support groups and education amongst themselves. For years there have been patient oriented support groups and organizations.
Web 2.0 now has some very innovative offerings for patients.
Healing in Community Online offers a "second life" aspect to these interchanges of support and education. It's construct is much like the real world, with provider offices, laboratories, hospitals, and all the usual everyday accoutrements of healthcare.
Diabetes Mine offers a wealth of patient oriented commentary for diabetics.
Patients Like Me offers links to specific disease entities, which include these "communities:
Quote of the Day:
Light travels faster than sound so some people appear bright until you hear them speak.
--Joe Messmore
Quote of the Day:
If you really want to do something, you will find a way. If you don't, you will find an excuse.
--Anonymous
Clinicians each day face innovation, like it or not. It traverses our day from the hospital to our office and to our business engines.
Continuing medical education, and staff training are a key methodology of "technology transfer" from the boiler-rooms of academia and practice management gurus.
We are all involved in some aspect of the process, the rising impact of consumerism, monitoring of outcomes, performance measures, reimbursement based upon compliance with reporting these metrics, and the influx of information technology.
The past three years as a health informatics researcher, I have devoted much time by interviewing vendors and the different approaches they use for their own business models. Understandably they are in it to make a profit.
Most observers realize that HIT has undergone a rapid evolution with many failures, and some successes.
In past years some vendors would offer "beta" systems to practices for a reduced amount to build their software. There were many problems with this approach. A clinical practice setting operates on a daily basis and does not have the IT resources to support the many software and/or hardware "bugs" that are part and parcel of poorly written or undeveloped software.
In the development of Health Information Exchanges I have seen many different approaches to this new challenge.
An early question from the vendors is "who are your stakeholders"
Sales people like to develop lists of hospitals and clinicians they can approach to display their wares. Some are ethical and truly are dedicated to improve health care by using HIT. As a consultant and physician working with a company the company gains some credibilty by having a fellow physician "vette" their offering. Unfortunately in this process I have investigated multiple companies and have disqualified most. Many are smaller companies who do not have adequate support. Many of their "demos" are fancy power point presentations which do not truly exhibit the flaws in the actual operation of their system.
Many of them are very "defocused" attempting to have a large marketing department and not focus on truly developing a pilot program to demonstrate their offering(s). Some are not focused on health information exchanges and want to use this as a marketing bridge for EMRs, transcription systems. Many are the result of mergers, acquisitons, to expand the functionality of their offerings. In some cases they market systems that are not truly connected. In some cases they will offer a complete solution when they do not have the pieces integrated, other than fancy tricolor glossy marketing pieces. They often speak in terms that are unfamiliar to clinicians, such as "revenue cycle management".
They imply practices can "plug and play" as if it operates like a usb port on a personal computer. This is inherent in their asp online solutions (also known as web 2.0). On the surface this has been offered as a "hosted application" residing elsewhere much like a "mainframe" All the practice needs is a "thin client" (formerly known as a workstation. This is connected via the internet. We have al witnessed significant decline in internet performance which degrades swift data entry and/or retrieval.
Initially it is offered on a reasonable monthly subscription cost, much less than the investment of a inhouse client-server system
As the offer evolves you will find surcharges for training and maintenance charges.
If one truly wishes to research health IT, it is worthwhile to attend one of the annual HIMSS meetings. www.himss.org
The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. more >
Attend in the role of an interested observer, not as a place where you select a vendor.
In my next blog we'll discuss weblog's that are resources for innovative ideas, and most important written by knowledgable experienced thought leaders.
Washington -- The jumble of terms in health information technology soon could be simplified. The National Alliance for Health Information Technology announced March 24 that it finished proposed definitions for five key HIT terms and will seek public comment on them until April 9.
The ONC chose the terms because they are the most often confused. Lawmakers have proposed bills that use the terms in different ways, said Karen M. Bell, MD, director of the ONC's Office of HIT Adoption.
After the definitions are finalized, the ONC will officially adopt them and use them in its contract language, said alliance Vice President and Chief Marketing Officer Jane Horowitz, who leads the project. Organizations and companies should follow and operationalize the definitions throughout health care, she said
One of the most significant developments would be distinguishing EMRs from EHRs. The two are frequently used interchangeably. The alliance proposed identifying an EMR as medical information on an individual patient from a single organization, including affiliated settings. EHRs would be data on a patient aggregated from multiple organizations.
The National Alliance for Health Information Technology has proposed definitions for several common health IT terms:
Electronic medical record: A computer-accessible resource of medical and administrative information available on an individual collected from and accessible by health care professionals involved in the patient's care within a single care setting.
Electronic health record: A computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual. The information, drawn from multiple clinical and administrative resources, is used by a broad spectrum of clinical personnel. This enables them to coordinate the patient's care and promote wellness.
Personal health record: A computer-accessible, interoperable resource of pertinent health information on an individual. Unlike the EHR, however, the PHR is managed by the patient, and the patient determines who has the right to access and use it. The information originates from multiple sources and is used by individuals and their authorized clinical and wellness professionals to help guide and make health decisions.
The terms health information exchange and regional health information organization have overlapped, the alliance said. It based its definitions on their root meanings. HIE reflects the technological aspects of sharing data, while RHIO reflects the drive for better health care quality and efficiency within a region.
So the alliance defined HIE as the electronic movement of health-related data across nonaffiliated organizations in a way that protects privacy and security.
It defined a RHIO as a multi-stakeholder governing entity responsible for electronic information exchange within a geographic area. A RHIO must involve data sharing between separate entities in a defined area whose collaboration crosses organizational boundaries. It also must be focused on the greater good of a defined population area, instead of specific disease communities, such as a network exchanging information only on diabetics.
Sorry for being absent the past several weeks. Recently I had the unexpected opportunity to catch up on technology at the bedside (in the bed) at my local community hospital which I had been on the staff 16 years ago. I had been away in another community and only recently had returned to the area but practice in a more rural community in the same town. Some things change, and others never change. Chest pain is chest pain and shortness of breath are the same complaints. My arm band now had a bar code on it. The nurses all used wireless laptops for charting and reading orders.
The doctors were all still at the nursing stations either dictating or writing their chart notes. The doctors seem to be the last link in the chain of IT. I definitely had the feeling IT was "leaking in".
At my post operative visit in the cardiologist's office he was able to retrieve summaries, op reports and demographics via a portal, although he had not yet implemented EMR in his office.
I am now the beneficiary of a cardiac stent, placed into a ten year old coronary vein graft which had only 1% flow through it. Although ten years had passed without incident the old leg scar is still quite evident, more so than the long chest scar.
At the end of the rather prolonged angioplasty I was given a CD with a DICOM viewer and video for my own personal health record. Pictures are worth a thousand words and in the future if I have to have any other procedures this will be instantly available.
This was a far cry from the CABG (4 vessels) that was performed on me ten years ago. I was given a hand sketch of that procedure, which was lost many years ago and unavailable on short notice.
(not many patients are given advanced notice of acute coronary syndrome).
Just six months ago I had returned to near full time ophthalmology practice......the volume was up from 40 patients a day to over 50 patients a day. The practice had no EMR. Those are the numbers in productivity that are needed in some setting with capitation and/or heavy managed care intrustion, unless one adds cosmetic and/or refractive surgery to the mix. Most doctors want one thing from an EMR....improved efficiency and reduced cost, and not over a pay back of more than one year. ROIs must be short because the only predictability of reimbursement is that it will decrease and bureaucracy will increase. Common sense must intrude into the mix of the business of medicine.
Too many think tanks and doctor wannabees are draining dollars from patient care. Much of medicare's "fraud and abuse" mechanism revolve around inaccurate coding (obsolete ones), and complex schemes that require a graduate level education to understand.
My outlook is rather dismal....I used to be one of those optimistic "the glass is half full", now it is the other way around..."it is half empty". Yes, those who can negotiate the system get excellent care.....there will be more care for fewer patients.
The economic engine for a typical practice bears no relationship to how doctors are trained, nor how they want to practice medicine.....Non practitioners have no idea of the stresses involved and why doctors burn out from a profession that initially was very gratifying and rewarding.
I remain hopeful that IT will assist us all in patient care, and not become another misguided burden in caring for patients.
And, oh, by the way the bar coder broke and the nurse was delayed by over an hour trying to get medication for me. Imagine what it will be like when the server "crashes" (not if)
Happy Passover and Easter to all
The third-party payment system has stripped power from patients, distorted incentives and disrupted markets. It doesn’t trust patients to ch...
