“EMR Implementation Guide, The Link to a Better Future” by The Physicians Foundation

I just posted this on ClubPACS.com and thought I’ll do the same here

I chanced upon this interesting resource and thought I’ll put it here as the Electronic Medical Record / Electronic Health Record / Electronic Patient Record (or one of the other version) is pretty ‘hot’ these days.

The 105-page EMR implementation guide contains a (rather) comprehensive coverage on the current HITECH guidelines, information on how to prepare the adoption and selection process, case studies for review and (most importantly), the budgeting, financing, and contracting considerations.

The EMR guide is available for download here

Grassley probes 10 health IT companies about software

Now this is an interesting read (food for thought).

“Ranking member of the Senate Finance Committee Charles E. Grassley, R-Iowa, has sent a letter to 10 health IT companies requesting consumer complaint information about their health IT products.

The Oct. 16 letter was sent to 3M, Allscripts, Cerner, Cognizant Technology Solutions, Computer Sciences, Eclipsys, Epic Systems, McKesson, Perot Systems and Philips Healthcare and asked them for infomation about complaints received from Jan. 1, 2007 to Oct. 16, 2009.

Grassley is seeking information to conduct an oversight investigation of the manufacturers of health IT and computerized provider order entry (CPOE) systems. In the letter, Grassley said he has received complaints from numerous health industry parties “regarding difficulties they have encountered with the health IT and CPOE devices in their medical facilities.” These complaints, he noted, have included “faulty software…that resulted in incorrect medication dosages.”

The senator pointed out that $19 billion have been earmarked for the development and implementation of these systems, and went on to state that he has “a special responsibility to protect the health of Medicare and Medicaid beneficiaries and safeguard taxpayer dollars.”

“It is appropriate,” Grassley said, “that [taxpayers'] monies are appropriately spent on effective and interoperable health IT systems and devices.”

He also is requesting companies’ information on settlements relating to health IT/CPOE devices and products in the last 18 months, and whether or not they offer financial incentives to healthcare providers for purchasing their products is also being requested.

Grassley revealed in the letter that it “has been reported that IT/CPOE contracts with medical facilities may include ‘hold harmless’ provisions that absolve manufactureres…of any liability for errors that are allegedly [health] IT/CPOE system or software failtures.”

“Gag orders” may be included in these contracts, Grassley wrote, which might prohibit healthcare providers from disclosing flaws and defects in the software.

In addition to the earmarked funds and consumer complaints as reasons for the oversight process, Grassley stated that “there is no system in place to track, monitor and report the performance of these systems/devices, which could impact a healthcare provider’s ability to make informed decisions regarding the implementation of an IT/CPOE system.”

Grassley asked for appropriate responses to be submitted no later than Nov. 6.”

Source : www.CMIO.net

Report: Health IT central to healthcare debate

Health IT is taking a central role in the current healthcare debate, according to a report published by the Institute for Health Policy at Massachusetts General Hospital, George Washington University Medical Center and Robert Wood Johnson Foundation (RWJF)

The report, funded by the Princeton, N.J.-based RWJF, is a continuation of reports done in 2006 and 2008, which outlined the challenges to increasing EHR adoption. The current U.S. survey of hospitals was conducted by the HIT Adoption Initiative, in collaboration with the American Hospital Association.

According to the authors, there is broad bipartisan support to speed health IT adoption and the American Recovery and Reinvestment Act of 2009 (ARRA) has made promoting a national interoperable health information system a priority, authorizing significant resources to achieve this goal.

Among the findings were:

• Less than 2 percent of non-federal general acute-care U.S. hospitals have a comprehensive EHR, and 7.6 percent have a basic EHR.
  
• The individual functionalities most commonly reported as implemented across all units of the hospital were electronic viewing of laboratory (77 percent) and radiology reports (78 percent) and radiology images (78 percent). Approximately one in five hospitals reported fully implemented computerized provider order entry and clinical decision support.
  
• Given the focus on financial barriers, additional reimbursement for EHR use and financial incentives for implementation were the policy options most often cited as likely to have a positive impact on adoption.
  
• Between 2005 and 2008,168 pieces of health IT legislation were passed by states.
  
• Two main barriers prohibit large-scale EHR use for collecting and reporting clinical quality measures. First, the current level of EHR adoption is dismally low in virtually all clinical settings. Second, adoption of records and systems with the capability to enhance and accelerate measurement and public reporting is likely even lower still.
  
• Quality measurement and reporting, combined with the potential of meaningfully applied health IT, could prove to be the necessary accelerator for rapid improvements in the quality and efficiency of care Americans receive.

Source : www.CMIO.net

IBM launches health analytics center

IBM has launched a Health Analytics Solution Center, part of a network of global centers addressing the demand for advanced analytics needed to help hospitals and medical staff improve decision making and optimal quality of care.

The company said its center, located in Dallas, will employ more than 100 health analytics experts, technical architects and specialists, with access to hundreds more IBM employees from IBM’s Business Analytics and Optimization consulting organization and IBM Research.

The center will seek to address the need for advanced analytics across the healthcare industry, such as collecting and analyzing data streaming in from sensors, patient monitoring systems, medical instruments and handheld devices, as well as the volumes of data generated by hospitals every hour. Also, IBM said that analytics can be used by pharmaceutical companies, medical device manufacturers and health insurance providers to derive intelligence from their data.

Source :  www.CMIO.net

Ramblings: So I just took the CPHIMS exam

So I just took the CPHIMS exam and I must admit, I did not expect to ‘almost run out of time’.

Only 4 people took the CPHIMS this round (first time it’s offered in Singapore), there’s me, an IT Project Manager and a Medical Doctor involved in health informatics plus a gentleman whom I didn’t manage to speak to.

First thing first, we were given a paper based exam and the time allocated remained the same at 2 hours (a computer based exam is also 2 hours), I personally feel that they should allocated more time for a paper based exam as the ‘workflow’ of a paper-based exam is different from a computer based exam (time is taken when we look at another piece of paper located in a different area, locate the correct area to shade and then back to the question booklet, locate the next question etc).

Another few attributes that irk me (slightly) was poor lighting and that the environment was quite noisy. The examination took place in a classroom (with no sound proofing) of an institute of higher learning for 16-19 year old kids. One of the proctor had to leave the room several times to request the kids next door to keep the noise level down. For me, I sat next to the door and ‘enjoyed’ footsteps and conversations of students walking by – constantly.

One interesting part of the exam is that the questions seems to be geared towards the healthcare context of the US (2 other candidates who took the exam agreed with me) so I hope HIMSS will take that into consideration during grading and also fine-tune future exams for this region (HIMSS, if you are reading this, I can help you guys review the questions, I am designing curriculum for institutes of higher learning on health informatics in Asia).

Having said all these, I think the CPHIMS exam does cover a very interesting scope (see my previous post on the CBOK) and it’s well worth the time to take the preparation course even if one is not interested in taking the exam as it serves as a good recap on the various domain of knowledge one would need to navigate the complicated world of health informatics.

The results of the exam will be made known in about 2 6 weeks time so lets see if I ‘make the grade’.

Till then~

GE forms alliance with UAE’s Etisalat

According to HealthImaging.com,

“Telecommunications provider Etisalat and GE Healthcare have signed a memorandum of understanding to form a strategic healthcare alliance in the United Arab Emirates (UAE).

According to the companies, the UAE-based Etisalat will leverage GE’s solutions to capture patient information. The firms said the alliance will result in the development and offering of medical data management and remote clinical support services through Etisalat’s telecom infrastructure.

One area of cooperation the two companies plan to explore is that of cardiology systems with the introduction of GE’s Muse Cardiology Information system to provide cardiac assessments to hospitals and clinics.”

Now that in my opinion is a smart move. Network bandwidth remains (to date), the most critical (and arguably the most expensive) component in Telemedicine. Although ECGs are relatively small in filesize, the partnership will open doors for GE to digitize the rest of the cardiology images.

Baucus Bill Champions Healthcare Technology

I’d like to share this article from InformationWeek By Alexander Wolfe
(Source : here)

Legislation just sent to the floor by the Senate Finance Committee includes recommendations encouraging rapid adoption and use of health IT systems.

Much of the public discussion surrounding the new healthcare bill has focused on its costs and its insurance provisions — notably, the prohibition against insurance companies denying coverage to people with pre-existing conditions. The legislation was just sent to the Senate floor for a full vote after approval by the Senate Finance Committee

The legislation is being referred to as the Baucus Bill, after Sen. Max Baucus, D-MT, who heads the Senate Finance Committee and championed the bill.

However, the bill also takes a significant stab at setting the technological agenda for the U.S. healthcare system of the future. It includes recommendations encouraging rapid adoption and use of health IT systems.

A summary of the bill (available here [pdf download]) includes more than a dozen references to technology. Much of the verbiage is devoted to advocacy for electronic medical records (EMR). Computerized patient data is seen as a key to making care more efficient.

It’s also envisioned as a feeder into so-called “grouper” technology, where success rates for different treatments can be determined by analyzing large chunks of data.

Notes the summary: “Health IT is needed for quality reporting and improvement and to give providers ready access to better evidence and other clinical decision-support tools. Reinvesting in the training of a twenty-first century health care workforce is necessary for many delivery system reform goals to be realized.”

The most detailed take out on the bill’s healthcare IT intentions are contained in this lengthy passage on pg. 57 of the summary:

“Health Information Technology. Most providers in the health care system collect and transmit information on paper, over the phone, and via fax machines. More advanced health information technology (IT) offers tools to streamline and support the process of collecting and analyzing the data needed to provide the best and most efficient care possible. Clinical IT comprises multiple applications that can support different functions in health care, such as:

• Tracking patient care;
• Allowing physicians to order medications, lab work, and other tests electronically, and then access test results;
• Reporting to chronic disease registries; and
• Providing evidence-based decision support to physicians.

Encouraging more rapid adoption and use of health IT systems will improve health care quality and make our health care system more efficient.64,65 Automating the collection of clinical data will also be a vital component of better quality performance measurement and reporting. Technology can facilitate richer data sets for comparative effectiveness research, and help providers use comparative effectiveness findings in their own clinical practices. The Baucus plan provides Federal-level leadership to spur the modernization necessary to support a truly patient-centered delivery system.

Health IT adoption by providers has been low to date, especially for physicians in small group practices. Providers, particularly physicians, cite as obstacles the cost of purchasing and implementing systems, a fear of investing in systems that may soon be obsolete, as well as a lack of a clear return on investment. Some providers, especially in smaller settings, lack the resources or expertise to navigate the large and complex market of health IT products or to maintain such a system over time. Implementing health IT also requires changes in office organization, processes, and culture that clinicians and office staff may resist. Safeguards must be put in place to ensure that patient privacy is protected. And existing payment incentives discourage health IT adoption. Reductions in office visits, hospital admissions, and other services that could be achieved through the use of health IT would accrue to the benefit of payers and patients but not to providers themselves.

Despite these challenges, there is a growing consensus among patient advocates, providers, and payers that a path forward that drives adoption and protects patient privacy must be found.”

Interesting eh, what would your thoughts be?

The 1st African PACS & RIS Edu-conference

Dear fellow medical imaging informatics professionals, I’d like to share with you details on the 1st African PACS & RIS Edu-conference to be held on the 22 – 24th October, at the Faculty of Health Sciences at the Tygerberg Campus of the University of Stellenbosch, Cape Town, South Africa.

Personally, I am extremely excited because this conference is a ’sign’, a milestone that signifies the importance and reach of medical imaging informatics. Our profession has come a long way indeed and the exciting part is – we are nowhere near stopping.

The goal of this edu-conference is to share experiences and knowledge gained through the implementation of PACS & RIS solutions at various sites throughout Africa. The hope is that participants will be able to take the knowledge gained during the edu-conference and ensure a successful PACS & RIS implementation at your institution and so doing improve patient care.

For the interested, the website is http://www.pacsrisafrica.com

Ramblings: My SIM card went dead (and why it relates to health informatics)

I’d like to share something interesting that happened to me last week – my SIM card went dead all of a sudden (while I was using the phone).

Now my first reaction when that happened was – the phone is faulty and for the record, it’s a brand new phone (My Dopod was functioning fine but the battery is so old that it can no longer last for more than 1/2 a day so I got myself a new phone) and I did what any self-respecting techie will do – try to troubleshoot.

I tested my faulty SIM card with my 2 other mobile phones – didn’t work, I tested my wife’s SIM card with my phone – worked fine. So it was obvious, my SIM card malfunction in the midst of its usage and I had no choice but the wait till the next day to visit the service center to get it replaced.

My visit to the service (for this purpose) was;

1. Time consuming as I had to forgo my lunch, drive to the nearest service centre, queue and wait for quite a fair bit
2. Non-informative as the customer service representative didn’t provide a reason for why the SIM card fail (but he was not even remotely surprised so I suspect this happens quite often)

Now, what does this have to do with health informatics?

Well to reconstruct this scenario in the world of let say, medical imaging informatics;

1. A technical error occurred, the first thing that the end-user will think that the fault lies with the PACS solution, however, it could easily be due to the network, hospital’s HIS, modality, other hardware component failures, anti-virus, firewall  etc. The PACS itself could be functioning properly but it will get the ‘blame’ as it is the main component that the end-user is facing when an error occurs
2. Now it would be unreasonable to expect clinical end-user to perform troubleshooting when an error occurs but simple troubleshooting (e.g. Ping) by supporting staff (maybe the rad-tech) can help quickly narrow the error source
3. Most solution providers / PACS Administrators do not provide the necessary education / information update to the end-user. It is beneficial to have the end-users be informed on what exactly happened, how it was fixed and what could be done to prevent it (e.g. end-user related error) but of course, use non-technical language
4. There is also expectation management, stuff like SIM cards have a lifespan, so does other hardware components like batteries. In the example of medical imaging informatics again, stuff like monitors, keyboard, pointing devices etc have life span too. Things breakdown, set proper expectations to your end-users.
5. Backup Backup Backup. There are some components in your PACS solution that does not have a high availability option. Are you prepared to handle the situation when it fails? Have you done your backup?
   (I can buy spare batteries for my phone, keep a spare phone around, backup my SIM card but if my SIM card fails, I’m kind of stuck with ‘a problem’)

Now its much easier to fix a problem with my mobile phone as the technology is much more consumer friendly but when mobile phones were first release, I’m sure most users had problem and blamed the phone (and the service provider) whenever something went wrong. I’m sure health informatics will evolved to where mobile phones are now – consumer friendly enough for the average joe to perform troubleshooting, till then, let’s do our best to educate and set the right expectation

Its finally here! Today is the International PACS Administrator Appreciation Day!