AMIA Presentation on Web 2.0 for Clinical Decision Support

“Of the many presentations at the American Medical Informatics Association, one was about the specific application of Web 2.0 technology to clinical decision support. Three examples were given.”
Article
John Sharp, eHealth, 14 November 2008

Confessions of a Physician EMR Champion

“Starting this month and continuing for the next year or so, I’ll be presenting a standard talk to physician audiences entitled “Confessions of a Physician EMR Champion,” subtitled “A Conversation with American Physicians About How to Save Medicine in the Age of Information.”
Article
David Kibbe, The Health Care Blog, 10 November 2008

The Return on Investment of EHRs

“An experienced clinician recently emailed me, lamenting that Electronic Health Records do not have a return on investment i.e. doctors buy them, lose productivity, and do not get paid incrementally to justify the acquisition and use of EHRs.”
Article
John Halamka, Life as a Healthcare CIO, 27 October 2008

Four Challenges in Personalized Medicine

“Personalized medicine has just begun to alter health care in fundamental and profound ways. Genetic tests have already become mainstream practice for some cancers in identifying treatment strategies. And as an indication of what the future might hold, genetic analyses indicate that asthma, hypertension and Alzheimer’s have many genes in common. But before we can take full advantage of available genetic information, there are four factors we need to address: the electronic health record, reimbursement, privacy practices, and provider and patient education. These are in addition to the progress in medical science needed to understand the specifics of the relationships among our genome, the environment and our health.”
Article
John Glaser, HHNMostWired, 1 October 2008

Impact of a Patient-Centered Technology on Medication Errors During Pediatric Emergency Care

“Objective
The aim of this study was to determine the impact of a patient-centered health information technology (HIT) on the error rate for ordering and prescribing of medications during emergency pediatric care.
Methods
We conducted a quasi-experimental intervention study by using control and intervention periods to evaluate the effect on medication ordering and prescribing from a patient-centered HIT designed to enhance communication between parents and emergency clinicians during emergency care. Parent-child dyads presenting to 2 emergency department (ED) sites with complaints of fever, asthma, head trauma, otalgia, and dysuria were eligible. During intervention periods, parents used the HIT to enter data on symptoms and medication-related history; a printout provided recommendations to clinicians. Data on errors/adverse drug events were collected via record reviews and phone interviews with parents. The primary outcome was the number of medication errors in orders or prescriptions for drugs targeted by the HIT.
Results
Of 2002 parent-child dyads screened, 1810 (90%) were eligible, 1411 of 1810 (78%) were enrolled, and 1410 analyzed; 1097 subjects had a total of 2234 orders or prescriptions written. Of these events, 1289 of 2234 (58%) were associated with at least 1 error. Of the 1755 errors discovered, 232 errors were serious and preventable. Among 654 patients exposed to medications targeted by the HIT, the number of errors per 100 patients during control versus intervention periods was not significantly different (173 vs 134 with both sites combined; P = .35.)
Conclusion
The patient-centered HIT demonstrated minimal impact on medication errors during ED care.”
Abstract
Stephen C. Porter, Rainu Kaushal, Peter W. Forbes, Donald Goldmann and Leslie A. Kalish, Ambulatory Pediatrics, In Press, Corrected Proof, Available online 21 July 2008, doi:10.1016/j.ambp.2008.06.003

A Broad Vision of Health 2.0: Reformulating Data for Transparency, Decision Support, and Revitalized Health Care Markets

“The term Health 2.0 refers to the concept, described by O’Reilly, of Web-based platforms that allow users to reformulate data for their own purposes. The Health 2.0 movement is rapidly gaining steam and traction, propelled by established and startup firms. The efforts displayed at the recent Health 2.0 meeting in San Francisco, convened by Matthew Holt and Indu Sabaiya, were both wide-ranging and narrowly focused. Even so, several end-of-day panelists noted that, at this early stage, Health 2.0’s definitions and translations into practice remain murky and fragmented.”
Article
Brian Klepper, Jane Sarasohn-Kahn, HealthCare & Informatics Review Online, 30 June 2008

German medication specialists back decision support

“Two leading members of the medication commission of the German National Chamber of Doctors have urged German hospitals to implement “intelligent” computerised physician order entry (CPOE) with decision support systems to improve patient safety. They also advocated personal electronic medication lists in chronically ill patients.”
Article
e-Health Europe, 18 June 2008

MADE IN IBM LABS: New Data Sharing Technology Speeds International Collaboration to Identify and Respond to Infectious Diseases

“IBM, in collaboration with the Nuclear Threat Initiative’s (NTI) Global Health and Security Initiative and the Middle East Consortium on Infectious Disease Surveillance (MECIDS), has created a unique technology that standardizes the method of sharing health information and automates the analysis of infectious disease outbreaks, in order to help contain diseases and minimize their impact.”
Article
CNN Money, 2 June 2008

Silverlink, IncentOne aim to make health and wellness an easy choice

“Through its Adaptive HealthComm Science platform, Silverlink combines technology with decision support methodologies to deliver personalized, one-on-one communications to preconfigured populations, such as health plan participants. Silverlink’s customer base includes nine of the nation’s top 10 health plans as well as pharmacy benefit managers, medical supply companies and population health companies.”
Article
Eric Wicklund, Healthcare IT News, 14 May 2008

Beth Israel Deaconess begins EHR/PM roll-out

“Beth Israel Deaconess Medical Center is collaborating with CDW Healthcare to deploy technology that will enable affiliated physician practices to access the hospital’s electronic health record and practice management software. The implementation, which includes a range of standardized hardware products, wireless technology and network solutions, will provide more than 300 physicians in 175 offices with the infrastructure to support pay-for-performance data capture and valuable decision-support tools.”
Article
Molly Merrill, Healthcare IT News, 12 May 2008

“Smart Forms” in an Electronic Medical Record: Documentation-Based Clinical Decision Support to Improve Disease Management

Abstract:
Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due in part because clinicians do not use CDSS fully. Barriers to clinicians’ use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.
Abstract
Jeffrey L. Schnipper, Jeffrey A. Linder, Matvey B. Palchuk, Jonathan S. Einbinder, Qi Li, Anatoly Postilnik, and Blackford Middleton, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2501

Advantages and Disadvantages of Electronic Health Record Systems

“Hospitals across the US are relying less on papers-based documenation of patient records and operation data, thanks to electronic health record systems. Such systems are primarily designed to allow doctors or other health care provider to have direct access to patient data during appointments. Physicians and other health workers will revert to using “sticky notes” if electronic tools are not available.”
Article
Angel , Medicaltalknow, 4 May 2008

Developing informatics tools and strategies for consumer-centered health communication

Abstract:
As the emphasis on individuals’ active partnership in healthcare grows, so does the public’s need for effective, comprehensible consumer health resources. Consumer health informatics has the potential to provide frameworks and strategies for designing effective health communication tools that empower users and improve their health decisions. This white paper presents an overview of the consumer health informatics field, discusses promising approaches to supporting health communication, and identifies challenges plus direction for future research and development. The authors’ recommendations emphasize the need for drawing upon communication and social science theories of information behavior, reaching out to consumers via a range of traditional and novel formats, gaining better understanding of the public’s health information needs and developing informatics solutions for tailoring resources to users’ needs and competencies. This paper was written as a scholarly outreach and leadership project by members of AMIA’s Consumer Health Informatics Working Group.”
Article
Alla Keselman, Robert Logan, Catherine Arnott Smith, Gondy Leroy, and Qing Zeng-Treitler, Journal of the American Medical Informatics Association 2008, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2744

An integrated strategy of knowledge application for optimal e-health implementation: A multi method study protocol

“Background
E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.
Methods
A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.
Conclusions
These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.”
Article
Marie-Pierre Gagnon, France Legare, Jean-Paul Fortin, Lise Lamothe, Michel Labrecque and Julie Duplantie, BMC Medical Informatics and Decision Making 2008, 8:17 doi:10.1186/1472-6947-8-17

Decision Support Service Providers

“I’ve recently written about decision support and speculated on the ways we can transform data to information to knowledge to wisdom.
Over the past few weeks, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support. Application Service Providers offer remotely hosted, high value Software as a Service applications at low cost. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.”
Article
John Halamka, Life as a Healthcare CIO, 30 April 2008

Misys to Embed Content in EHR

“Starting in July, Misys will offer the software for primary care and cardiology practices embedded with reference and drug information, evidence-based guidelines, clinical decision support, and documentation and coding tools specific to those practices. Over time, the vendor will add Wolters Kluwer content for other specialties.”
Article
Health Data Management, 28 April 2008

New FP7 eHealth Project - COMOESTAS

“COMOESTAS aims to develop an innovative ICT system that allows patients with Medication Overuse Headache (MOH), a common condition and a major cause of disability, to receive continuous and personalised treatment. The system will be based on an advanced Alerting and Decision Support System that follows patients from the diagnosis and supports the physician in managing the therapy, controlling relevant events impacting on patient safety.”
Article
eHealthNews.eu, 25  April 2008

Designing the Ideal Electronic Health Record

“Yesterday, I keynoted a Veterans Administration meeting via teleconference (part of my effort to reduce travel, improve my carbon footprint, and be increasingly virtual) on the topic of designing the ideal electronic health record.”
Article
John Halamka, Life as a Healthcare CIO, 23 April 2008

Functional and Technological Description of a Real-Time Data Management System for Telehealthcare

Abstract:
In health systems, there has been an emergence of new types of data and new technologies that allow continuously monitoring the status of the patients and make easy the achievement of real time information. The storage of all the acquired information makes possible to identify trends in medical data by means of new Clinical Decision Support subsystems. Current knowledge management solutions are specific, proprietary and closed and can not perform real-time analysis to improve the patient’s diagnosis or treatment. There are neither solutions that integrate the large amount of heterogeneous information that nowadays are available in health environments. To overcome these objections, this paper proposes a new approach to design a data management system in a telehealthcare system with specific real-time constraints on knowledge acquisition and generation. It is a preliminary study and presents the main features of the system architecture and a preview of the technological solution implemented.

Fabiola FERNÁNDEZ^a, Laura M. ROA^a,b, Manuel PRADO^b,a
a Biomedical Engineering Group, University of Seville, Seville, Spain
^b Network Center of Biomedical Research in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Seville, Spain

To be published in “Medical and Care Compunetics 5″, IOSPress, 2008.
To be presented at the ICMCC Event 2008.

Intelligent information system for treatment response monitoring and prognosis establishment on genital neoplasia patients

Abstract:
Cancer is the second death cause in the majority of countries, including Romania. Nowadays the main cause of this very aggressive disease is still unclear, the study of cancer risk factors being the object of research. This article is presenting an intelligent virtual system, which has as a main purpose the monitoring of treatment response at genital area cancer patients as well as the assessment of their life expectancy and prognosis. The intelligent system is being developed by an undergoing national research project and will be implemented at The Oncology Institute of Bucharest, Romania.

Claudiu PLAISANU^a, Daniel NICULAE^b, Cristina OGESCU^b, Cristina STEFAN^b
a Project coordinator, SC IPA SA, Romania
^b Project developers, SC IPA SA, Romania

To be published in “Medical and Care Compunetics 5″, IOSPress, 2008.
To be presented at the ICMCC Event 2008.

Microsoft’s future vision

“A few years from now, when you drive into a McDonald’s parking lot, your dashboard computer will start beeping.
The computer is synced to your phone, and both devices have geographic location services. They know where you are and, based on your credit-card activity, they guess you’re about to order another burger and supersized fries.”
Article
Brier Dudley, Seattle Times, 17 March 2008

The iPhone’s Possibilities for Healthcare Are Endless

“Apple’s recent announcement that it is allowing third party developers to create applications on the iPhone will have tremendous effects on the healthcare industry. Healthcare technology applications – particularly electronic health records (EHRs) and clinical decision support (CDS) – will be more likely to be adopted by physicians, translating into better healthcare for patients.”
Article
Christine Chang, iPhone Developers Journal, 14 March 2008

Improving Decision Support Tools for the Long Term Care Consumer

“The California HealthCare Foundation (CHCF) launched the CalNHS.org Web site in 2002 to help meet the growing consumer need for information and assistance in long term care decision-making. The site provides comparative data on nursing facilities, home health agencies, and other long term care services in California. Consumers can use the site to assess options and to compare specific facilities and services.
In 2007, CHCF partnered with Howard Degenholtz of the University of Pittsburgh, the HMS Group, and Sam Boonin Consulting to perform an extensive review of CalNHS.org and analogous sites. The purpose of the review was to better understand how consumers, referring professionals, and providers seek information regarding long term care services, and thereby help CHCF and other site producers develop strategies for refining their sites.
This report summarizes the research project’s findings and analysis, extrapolating lessons that can be applied by online tools that seek to guide consumers and professionals regarding long term care information and options.”
Report
Howard Degenholtz, Californian Healthcare Foundation, March 2008

The State of Health Information Technology in California: Consumer Perspective

“Although consumers frequently use and seek out health information online, most are ambivalent about using health information technology (HIT), such as personal health records, due to concerns about privacy and confidentiality.
A recent survey, which is summarized in this snapshot, provides a comprehensive overview of California consumers’ adoption, use, and perception of HIT. The findings reveal that most consumers are not actively using online tools, including electronic health records, email with their health professionals, and online appointment scheduling.”
Report
Californian Healthcare Foundation,

The EMR and the Couch Potato

“We’re comfortable with decision support at home. Why not in health care?”
Article
Michael L. Millenson, HHNMostWired, 5 March 2008

Patientencoaching soll den informierten Patienten unterstützen

Health coach should support informed patient.

Article (German)
Heise Online, 28 February 2008

The Healthcare Challenge

Last week the US National Academy of Engineering (NAE) has declared Health informatics as one of the grand engineering challenges of our time.
They list a number of aspects that are part of that challenge, to start with interoperability and medical records. Their next comment is on the availability of information to professionals: “Doctors suffering from information overload need systematic electronic systems for finding information to treat specific patients and decision support systems to offer “just in time, just for me” advice at the point of care“. This sounds very much like the inventories and knowledge centres ICMCC has been focusing on during the almost 4 years of its existence.”
Article
Lodewijk Bos, ICMCC Blog, 20 February 2008

The Healthcare Challenge

Last week the US National Academy of Engineering (NAE) has declared Health Informatics as one of the grand engineering challenges of our time.
They list a number of aspects that are part of that challenge, to start with interoperability and medical records. Their next comment is on the availability of information to professionals: “Doctors suffering from information overload need systematic electronic systems for finding information to treat specific patients and decision support systems to offer “just in time, just for me” advice at the point of care“. This sounds very much like the inventories and knowledge centres ICMCC has been focusing on during the almost 4 years of its existence.
Monitoring information is mentioned next as one of the tools to improve healthcare. I should have been presenting at the German KIS meeting today, but due to medical problems I was unable to attend. I was supposed to talk about “Mobile devices from a patient viewpoint” and one of the issues I wanted to raise was the fact that these devices should be unobtrusive, easy to handle and if possible self-explanatory. The NAE even completely focuses on micro technology and interoperability once more is a key element: “Seamlessly integrating the input from such devices into a health informatics system raises the networking challenge to a new level“.
In the next part of their declaration the focus changes to public health emergencies, firstly the environmental monitoring to signal possible chemical and biological attacks, followed by a large chapter on disease surveillance to tackle pandemics, one of the other focussing points in the ICMCC history.

Read the rest of this entry »

Advance health informatics

“Stronger health information systems not only improve everyday medical visits, but they are essential to counter pandemics and biological or chemical attacks.”
Article
US National Academy of Engineering, February 2008

FDBE releases SNOMED CT-based condition check

“Clinical decision support specialist, First DataBank Europe (FDBE) has released live condition checking content within its drug knowledge base, the Multilex Drug Data File (Multilex DDF).
The new content supports the SNOMED CT based condition checking functionality, released in July 2006, and means that patient data recorded using SNOMED CT codes can be used within a Multilex DDF condition check.”
Article
eHealth Insider, 1 February 2008