Building a Medical Neighborhood for the Medical Home

“Recent efforts to improve primary care in the United States have focused largely on the development and implementation of practice models and payment reforms intended to create a “medical home” for patients. The notion of a medical home makes intuitive sense and indeed has great promise. But unrealistic expectations about this approach abound, and insufficient attention is being paid to several important barriers to the clinical and financial success of the medical-home model.”
Article
Elliott S. Fisher, NEJM, Volume 359:1202-1205, September 18, 2008, Number 12

Remote Patient Monitoring

“Readers of Telemedicine and e-Health will remember the published summary of an expert panel discussion on remote health services (2007;13(3):341–347). One clear message emerging from the above roundtable was that fully mature technology is now available to host numerous patient care applications. Just a few years ago remote patient monitoring was regarded as still experimental, albeit with great potential to reduce healthcare costs.
Perhaps the Baby Boom generation, with its take-charge attitude toward health, is most responsible for the field’s explosive growth, particularly in the last five years. There are ready-made audiences for such technology. Baby Boomers are worried not only about their own health but also about keeping their elderly parents safe, healthy, and secure. This is particularly attractive when geographic distances prevent frequent family visits.”
Article
Kevin D. Blanchet, Telemedicine and e-Health, March 1, 2008, 14(2): 127-130, doi:10.1089/tmj.2008.9989

Market for patient monitoring devices could reach $8 billion by 2012

“Next-generation patient monitoring systems earned an estimated $3.9 billion dollars for manufacturers in 2007, and this market could more than double in five years, according to a market research study released this week.”
Article
Richard Pizzi, Healthcare IT News, 11 April 2008

California healthcare system to offer EMR system to docs

“The San Mateo Medical Center plans to offer unified electronic medical record and practice management software to more than 160 affiliated providers throughout San Mateo County, Calif.”
Article
Richard Pizzi, Healthcare IT News, 11 February 2008

Telemedicine Efforts Target Uninsured, Rural Hispanics

“Chronic disease care in the U.S. continues to consume the majority of health care expenditures. Diabetes, in particular, cost $174 billion in 2007 — 32% more than in 2002, according to a recent report from the American Diabetes Association. The findings indicate that one out of every five health care dollars in the U.S. is spent caring for someone with diagnosed diabetes.”
Article
Mike Hartnett, iHealthBeat, 1 February 2008

Evidence gap on telehealth needs to be filled

“More work is needed to fill the evidence gap on telehealth if it is to enter the mainstream, according to a Department of Health agency.
The Care Services Improvement Partnership (CSIP) has issued a review of the academic literature on the use of telehealth in the management of patients with long term conditions (LTCs).”
Article
e-Health Insider Primary Care, 29 January 2008

Belfast to get European Centre for Connected Healt

“Belfast, Northern Ireland, is to be the home of a new ‘European Centre for Connected Health’, intended to help test technologies that enable people with chronic conditions live independently at home.
NI Health Minister Michael McGimpsey and Economy Minister Nigel Dodds announced the establishment of the centre at last week’s Connected Health Conference, held in Belfast.”
Article
e-Health Insider Primary Care, 29 January 2008

Blue Cross and Zix Corporation pilot disease management through eRx

“Blue Cross Blue Shield of Massachusetts (BCBSMA) and the Dallas-based Zix Corporation announced Tuesday they will jointly conduct a pilot to enroll eligible patients in chronic care through e-prescribing alerts.
The pilot will use ZixCorp’s PocketScript e-prescribing service to alert physicians at the point of care that a patient may be eligible for enrollment in BCBSMA’s disease management program.”
Article
Diana Manos, Healthcare IT News, 25 January 2008

Visiting Nursing Association cuts back on hospitalization with telemonitoring

“The Visiting Nurses Association of Western New York has announced a plan to use telemonitoring technology to help care for chronically ill patients and prevent re-hospitalizations.
The VNA has selected Cardiocom Multi-Disease Management’s Commander Home Telemonitoring System, an interactive home monitoring device for diseases such as CHF, diabetes, COPD, asthma and hypertension.”
Article
Molly Merrill, Healthcare IT News, 22 January 2008

Patients’ perceptions of a home telecare system

“Materials and methods Ten Focus Group Interviews (FGIs) were conducted with patients suffering from congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or both, from seven different ethnic groups in Sydney. Six key discussion points were used to conduct the FGIs. The participants were shown a video demonstrating the HTMS and its operation, followed by the demonstration of an HTMS prototype. The participants, who had no prior experience with the HTMS, were then asked questions to access their perceptions in potentially real situations. The discussions were audio-taped and content analysis performed.
Conclusion Most participants perceived the system as a useful and convenient mode of health care delivery, expressed positive attitudes toward the HTMS and expressed intent to use the system. However, there were concerns centred on the issues of cost, ease of use, clinical support, low self-efficacy and anxiety related to the use of the HTMS. The findings of this study suggest that HTMS self-efficacy and anxiety are likely to be important constructs in patients’ acceptance of home telecare. Therefore, we propose these two factors be included in future HTMS acceptance models. Also it is suggested that in order to develop training programs for patients to use HTMS, tailored training components should aim to reduce ‘HTMS anxiety’ and improve ‘HTMS self-efficacy’. Participants agreed that the HTMS would save cost and time by reducing hospital admissions, emergency department and medical practitioner visits and associated travel. Participants generally agreed that the HTMS could inform patients of their health conditions, thus promoting active participation in their health management and empowering them to perform better self-care. Also, they agreed that the HTMS could improve their health management by their doctors by providing more accurate and up-to-date information, to help them make better decisions. They suggested that the HTMS could have a preventative role in terms of providing early warning when their health conditions were deteriorating, which could lead to on-time appropriate interventions. The latter may result in reducing the use of emergency services and hospital admissions.”
Abstract
Mohammadreza Rahimpour, Nigel H. Lovell, Branko G. Celler and John McCormick, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 26 November 2007, doi:10.1016/j.ijmedinf.2007.10.006

Web-based Telehealth monitors patients in their homes

“Patients and caregivers know that, especially when the patient is an older person whose health may not be what it used to be but whose mental resolve to remain independent stays strong.
Medical services in the home have long played a role in supporting patients newly discharged from the hospital. Now health-care providers and Medicare patients of the VNA Care Network & Hospice have an updated partner in post-hospital care.”
Article
Elizabeth Cooney, TELEGRAM & GAZETTE, 26 November 2007

Exploring Challenges and Potentials of Personal Health Records in Diabetes Self-Management: Implementation and Initial Assessment

“The University of Pittsburgh Medical Center (UPMC) has implemented a personal health record grounded in the Chronic Care Model, UPMC HealthTrak, to assist patients with diabetes self-management. UPMC HealthTrak is based in the physician office and connects the patient, physician, and electronic medical record (EMR). Its functionalities include secure, electronic communication with the physician’s office, along with preventive healthcare reminders, and disease-specific tools and information. In this paper, we describe challenges to office-based implementation of and initial patient reaction to the technology in the context of diabetes care.”
Abstract
Rachel Hess, Cindy L. Bryce, Suzanne Paone, Gary Fischer, Kathleen M. McTigue, Ellen Olshansky, Susan Zickmund, Katharine Fitzgerald, Linda Siminerio,Telemedicine and e-Health. 2007, 13(5): 509-518.

Brown University to create comprehensive long-term care database

“The National Institute on Aging has awarded Brown University’s Center for Gerontology and Health Care Research a major grant to create the first research database aimed at improving the nation’s long-term care system.”
Article
Richard Pizzi, Healthcare IT News, 19 November 2007

Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007

“This 2007 survey compares adults’ health care experiences in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. In all countries, the study finds that having a “medical home” that is accessible and helps coordinate care is associated with significantly more positive experiences. There were wide country differences in access, after-hours care, and coordination but also areas of shared concern. Patient-reported errors were high for those seeing multiple doctors or having multiple chronic illnesses. The United States stands out for cost-related access barriers and less-efficient care.”
Report
Health Affairs, 26, no. 6 (2007): w717-w734, November 2007

AHIMA Launches PHR Project

“In the wake of Microsoft’s much-publicized launch of its HealthVault health care connectivity platform , the American Health Information Management Association (AHIMA) is embarking on a personal health records (PHR) project of its own, with a decidedly different approach.”
Article
Neil Versel, Digital HealthCare & Productivity, 16 October 2007

E-patients With a Disability or Chronic Disease

“About a fifth of American adults say that a disability, handicap, or chronic disease keeps them from participating fully in work, school, housework, or other activities. Half of those living with a disability or chronic disease go online, compared to 74% of those who report no chronic conditions. Fully 86% of internet users living with disability or chronic illness have looked online for information about at least one of 17 health topics, compared with 79% of internet users with no chronic conditions.”
Report
Susannah Fox, Pew Internet and American Life Project, 8 October 2007

Cross-country Check-up on EMR. Some Provinces Doing Better than Others

“In a very interesting and comprehensive review of the state of EMR adoption across Canada, Technology for Doctors explores the EMR market and progress to date”
Article
Alan Brookstone, Canadian EMR, 8 October 2007

Essential but Not Sufficient: Information Technology in Long-Term Care as an Enabler of Consumer Independence and Quality Improvement.

This report prepared for the National Commission for Quality Long-Term Care examines long-term care within the broader context, addressing the steps that need to be taken so that information technology can help improve quality of life for all.
Report
National Commission for Quality Long-Term Care, September 2007

Report concludes IT would boost long-term care

“A new report released today finds that healthcare information technology improves the quality of long-term care by improving data and networking, but full implementation will impact all healthcare sectors, requiring wide collaboration.”
Article
Molly Merrill, Healthcare  IT News, 4 October 2007

Calling Dr. Cellphone

Health care is harnessing electronic devices to monitor chronic diseases
“Each time Joyce Telford visited the doctor and had her blood pressure measured, it always came back too high, an unsettling pattern that led to the 49-year-old taking more and more hypertension medication. What Ms. Telford’s blood-pressure did in the weeks between those visits, however, was always a bit of a mystery.”
Article
Tom Blackwell, National Post, 2 October 2007

Empowering the Patient with ICT-tools: The Unfulfilled Promise

“The potential which ICT offers patients to help them cope with and manage chronic diseases is only being partly exploited. New ICT tools need to be devised to better empower patients. In addition healthcare providers will need to change their working practices and the conditions under which care is provided.”
Abstract
Wouter Meijer, Peter Ragetlie, JITH, 1 October 2007

AHIMA to launch PHR campaign, Web site

“Health information professionals are hoping their Web site and an awareness campaign will lead individuals to begin maintaining their own personal health record.”
Article
Jean DerGurahian, Modern Healthcare Online, 27 September 2007

Coalition urges IT role in battling chronic disease

“A coalition dedicated to fighting chronic diseases is calling for accelerating the use of information technology throughout the healthcare system.”
Article
Bernie Monegain, Healthcare IT News, 26 September 2007

Personalized Health Care: Opportunities, Pathways, Resources

“Underpinning personalized health care is the confluence of two powerful tools: information technology and knowledge management. These forces will provide individualized health care know-how at an unprecedented level. The full potential of these forces cannot be realized unless electronic systems, clinical databases, and knowledge repositories employ interoperable standards and definitions.
While innovation in technology to collect information is a key step, data collection alone will not support personalized health care. As technological capabilities develop across the health care system, better information based on individual differences will aid in future medical product evaluations and postmarketing assessments of safety and efficacy.”
Report
United States Department of Health and Human Services, September 2007

Group Seeks Interoperable Home Health

“An alliance of technology companies formed in the summer of 2006 to facilitate interoperability among home health devices, consumer health devices and health information systems is getting ready to unveil its initial guidelines.”
Article
Health Data Management, 12 September 2007

Companies Test Mobile Devices for Chronic Condition Management

“A variety of technology companies are developing and testing portable devices that can help monitor chronic conditions such as diabetes, the East Bay Business Times reports.
Article
iHealth Beat, 10 September 2007

Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded Theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness

“Objective: Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records.
Conclusions: For patients with chronic IBD, simply providing access to electronic medical records has little usefulness on its own. Useful technology for patients with IBD is multifaceted, self-care promoting, and integrated into the patient’s already existing health and psychosocial support infrastructure. The four identified themes can serve as focal points for the evaluation of information technology designed for patient use, thus providing a patient-centered framework for developers seeking to adapt existing EMR systems to patient access and use for the purposes of improving health care quality and health outcomes. Further studies in other populations are needed to enhance generalizability of the emergent theory.”

Warren J. Winkelman, Kevin J. Leonard, Peter G. Rossos, JAMIA 2005;12:306-314

Article

The surveillance of the people with chronicle diseases making the personal electronic folder in pharmacies for these patients)

Delia Carmen Mihalache*, Andrei Achimas-Cadariu*, Richard Mihalache**
*Medical Informatics and Biostatistics Dept., University of Medicine and Pharmacy “Iuliu Hatiegan”, Cluj-Napoca, Romania
**Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

Abstract:

AIM: The aim of the project is to create the databases in pharmacies, which will include all the medications and treatment schedules for the patients with chronicle disease.
MATHERIAL AND METHOD: In every pharmacy, each patient will have his own electronic file, where the pharmacists have to mention all the medication delivered. For a good supervision of the patients, these people will be distributed to the specific pharmacy, where they will purchase all the drugs, including the over-the-counter. We will supervise only the chronicle disease (e.g. cardiovascular diseases, asthma, hepatitis, epilepsy, Parkinson disease, ulcer, diabetes etc), because in this cases are huge risks for medical interactions between treatment for acute disease and chronicle disease, who can be omitted by the specialists, pharmacists and patients. Using this system the pharmacists can informed all the time the patients how to incorporate the medication into your daily lifestyle, how to manage side effects, when to seek medical help and how to keep track of important information for the doctor and pharmacist.
Doctors can send prescriptions via Internet or wirelessly to the pharmacy (pharmacy receives it as a fax). Alternately, it can be printed via an infrared printer and given directly to the patient. This system removes the possibility of illegible prescriptions and patient tampering, increases efficiency and optimizes the time of physicians and pharmacists. In the same way, the pharmacists will send the information to the doctors.
RESULTS: The databases can provide detailed data about the prevalence and incidence of diseases, distribution of risk and preventive factors, interaction of the drugs, adverse events and patterns of drug utilization.
DISCUSSION: Information obtained in pharmacies will be send to the general practitioners and specialists for:

• Identify the possible drug interaction of the chronicle diseases therapy with treatment for acute disease;
• Identify the other possible reaction which could appear during the therapy;
• Avoid the self medication, which could harm results of the therapy instituted by the specialists;
• Avoid the overdose and under dose because the patient unawareness;

CONCLUSION: The last decade has seen a surge in the use of computerized health care data to provide better health service for the patients and information for pharmacoepidemiology and pharmacovigilace. Results of this study may be compared with clinical trial data and the limited published data from observational studies. In general practice it is know that unlabelled drug related adverse events are more frequently reported compared to labeled events.

Improving the Quality of Care at the End of Life: An Information Systems Approach

Tamang S., Kopec D., Shagas G., Levy K.
Brooklyn College; Albert Einstein Coll. of Medicine, USA

Abstract:

Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide “error-reducing” reforms for vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in medical informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS). These can be used to transform the delivery of care, streamline processes and improve the efficiency and validate the correctness of treatments. As a result, medical error(s) that occur when patients with severe, chronic illnesses and/or the frail elderly are treated, can be reduced.

The palliative care model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend commonly used conventions, but there is no widely accepted definition. This research will discuss the development life cycle of the CONFER management information systems (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN CBR. CONFER is based on the idea of “eCare”, a process based application for care management. CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark-up to define systems data. The CAREN system is a CBR prototype designed for palliative care patients in the cancer trajectory, which was developed by the first author in her research. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best-known precedent cases. The system uses the opensource CASPIAN shell developed by the University of Aberystwyth, Wales and is available by anonymous FTP. Our preliminary results suggest that these systems can be used to improve the quality of care and disseminate expert level ‘know how’ to palliative care clinicians.

Thrombosis Digital Logbook

Hein Willem de Bruijn
Portavita, (+) 31 20 531 5605, info@portavita.nl

Portavita Mission

Enable chronically ill patients to take more responsibility for their own healthcare management, through the implementation of full service home monitoring concepts, offering training, communication, monitoring and medical support.

The Digital Logbook

Critical in supporting the patient is the need to “bridge the gap between the self monitoring patient and the (distant) doctor”.
Portavita has therefore developed a web-based application through which the patient can submit his monitoring results, dosing schemes and additional questions.

The monitoring results and dosing scheme are automatically benchmarked against the patient individual parameters, as set by his physician.
The patient data is either directly stored in the Logbook (electronic patient record), or if needed presented on the work list of the relevant care professional.

Portavita Anticoagulation Service

Portavita has successfully implemented this service for self-management of oral anticoagulation therapy. Fifteen medical institutes and several thousands of patients are currently using the Portavita service. The patients log-on to the Digital Logbook every ten days to submit their data and are being monitored by their physicians.
This while the need to physically meet or talk over the phone has practically evaporated. This has doubled the capacity of the available care professional at lesser cost, while significantly increasing the perceived quality of life of the patient.

For an demo-version of the Digital Logbook, you can surf to www.digitaallogboek.nl, and log in with the following account:
Gebruikersnaam (name): demo
Wachtwoord (password): welkom