Value of EHRs becomes clearer - Encourage consumers to take ownership

“One lesson that healthcare learned from hurricanes Katrina and Rita in 2005 was that paper medical records, and those on disks and servers, are incredibly vulnerable. Now, in light of hurricanes Gustav and Ike, the value of electronic health records (EHRs), accessible from remote locations, has become crystal clear.
In fact, one health system was able to return to practice without missing a beat just one day after Hurricane Gustav, thanks to its EHR. Results like this reinforce the value of EHRs and lessons learned from previous disasters.”
Article
Tracey Walker, Managed Healthcare Executive, 1 November 2008

Data exchange needed for urgent care

“Urgent and emergency care providers in England must share more data electronically if they are to improve services, the Healthcare Commission says today.
Its latest report, Not Just a Matter of Time, shows that important information on patient care is often not shared between different parts of the urgent and emergency care system. It says this leaves it fragmented and patients repeating their story to different services.”
Article
e-Health Insider, 26 September 2008

See also:
Healthcare watchdog calls for new drive to improve the system for delivering urgent and emergency care (Healthcare Commission, UK, 26 September 2008)

Science panel calls for EMRs tailored for disaster response

“A federal panel will soon recommend that field usability be a primary goal for an electronic medical record system now in development for use in federal disaster response efforts.”
Article
Kathryn Foxhall, Government Health IT, 25 September 2008

Journal of Telemedicine and Telecare, TOC, September 2008

Telemedicine can improve the health of youths in detention
“Young people in correctional care facilities often have physical or psychological disorders that contribute to their behavioural problems. In the US, the need for medical services in youth facilities far exceeds current resources, especially for paediatric mental health and specialty services. There is obvious potential for telemedicine to improve access to care and thus the level of health care for juvenile detainees. A few studies have indicated that in specific instances telemedicine has improved access to care, referrals, contact between providers, and has also reduced unnecessary referrals. The question remains, however, whether this improved access and timeliness to care has any effect on the major goals of the incarceration: treatment, education and rehabilitation. Further investigation of this linkage is needed.”
Abstract
Karen C Fox and Anna Lyn Whitt, J Telemed Telecare 2008;14 275-276, doi:10.1258/jtt.2008.008002

Emergency telepsychiatry
“Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or manmade disaster.”
Abstract
Peter Yellowlees, Michelle M Burke, Shayna L Marks, Donald M Hilty, and Jay H Shore, J Telemed Telecare 2008;14 277-281, doi:10.1258/jtt.2008.080419

Hageseth’s principle of extraterritorial jurisdiction and international telemedicine
“At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law.”
Abstract
Thomas R McLean and Alexander B McLean, J Telemed Telecare 2008;14 282-284, doi:10.1258/jtt.2008.080416

The use of information and communications technology for health service delivery in Namibia: perspectives of the health service providers
“We surveyed health service providers in Namibia to find out how they used information and communication technologies (ICTs) to deliver health services to their patients. A structured questionnaire was administered to 21 health service providers in two regions of the country (one urban, one rural). There was overwhelming consensus among the health service providers that ICTs were very important, especially for medical services (100%). Ninety-one percent of health service providers viewed ICT as helping them to interact with other providers in other health institutions. The most commonly used ICT was the telephone, which was used in the admission areas of most health institutions (36%); the next most commonly used ICT was the PC (23%). The most commonly used channels for communication with patients were the telephone followed by TV. Some of the problems common to all health institutions in Namibia were poor budgetary resources and lack of basic infrastructure such as electricity or telephone lines. There is a need to promote ICT use for health service delivery and also to stimulate patients to use ICT to access health services and relevant information.”
Abstract
Meke I Shivute, Blessing M Maumbe, and Vesper T Owei, J Telemed Telecare 2008;14 285-289, doi:10.1258/jtt.2008.071204

Assessment of a remote monitoring system for implantable cardioverter defibrillators
“We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient’s condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users.”
Abstract
Cristina Masella, Paolo Zanaboni, Francesca Di Stasi, Serena Gilardi, Patrizia Ponzi, and Sergio Valsecchi, J Telemed Telecare 2008;14 290-294, doi:10.1258/jtt.2008.080202

Quality of diabetes care among patients managed by teleconsultation
“We studied a new teamwork-based teleconsultation model for treating patients with diabetes, where a specialist in diabetes care, a diabetes nurse and a patient attended by videoconference. The study series consisted of all the patients (n = 101) at three health centres in northern Finland whose care was provided by a single physician at a remote diabetes clinic. A total of 101 patients with diabetes (19 of type 1 and 82 of type 2) were studied at baseline and at 10–14 months after the first consultation. Mean HbA1c was 8.0% at baseline and 7.6% at follow-up (P = 0.007). The proportion of patients with poor glycaemic control decreased from 32% to 13%. Mean LDL cholesterol was 3.3 mmol/L at baseline and 2.7 mmol/L at follow-up (P < 0.001). The percentage of patients with optimum lipid levels increased from 20% to 50%. Mean systolic blood pressure was 146 mmHg at baseline and had decreased by 6 mmHg at follow-up (P = 0.004). The percentage of patients with poor blood pressure control decreased from 19% to 8%. The most common changes in medication were the introduction or modification of insulin treatment and the introduction of statin and antihypertensive drugs and acetylsalicylic acid. Although the study was uncontrolled, there were improvements in glucose and LDL cholesterol levels and blood pressure in patients who were managed by teleconsultation.”
Abstract
Tuula Nikkanen, Markku Timonen, Kirsti Ylitalo, Olavi Timonen, Sirkka Keinänen-Kiukaanniemi, and Ulla Rajala J Telemed Telecare 2008;14 295-299, doi:10.1258/jtt.2008.080313

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
“We studied the effects of home telemonitoring in elderly patients with congestive heart failure (CHF) on mortality and rate of hospitalization, compliance with treatment, quality of life and costs of CHF management, by comparison with a group receiving usual care. Fifty-seven elderly CHF patients were randomized to standard care or to home telemonitoring-based care and followed for 12 months. In the subjects who were monitored, weekly reports on their clinical status were obtained and their management was modified accordingly. Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations (P = 0.006), a better compliance with therapy, more frequent use of beta-blockers and statins, lower total cholesterol level and a better reported health perception score. The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients.”
Abstract
Roberto Antonicelli, Paolo Testarmata, Liana Spazzafumo, Cristina Gagliardi, Grzegorz Bilo, Mariaconsuelo Valentini, Fabiola Olivieri, and Gianfranco Parati, J Telemed Telecare 2008;14 300-305, doi:10.1258/jtt.2008.071213

Acceptability to primary care providers of telemedicine in diabetes case management
“We studied the perceptions of primary care providers (PCPs) about the telemedicine intervention in a trial of telemedicine for management of diabetes in medically under-served areas of New York State. A survey was mailed to 206 rural and 159 urban PCPs. The response rates were 25% and 22%, respectively. Eighty percent of respondents believed that a diabetes telemedicine case management system would help their practice. An overall satisfaction score (possible range 0–80) suggested good acceptability (mean 66, SD 12). In multiple linear regression, the rural location and younger age of the PCPs were independent predictors of higher satisfaction (both P < 0.01). Within-PCP comparisons showed a higher perceived impact on patients, as compared to impact on PCP practices (P < 0.001). However, the findings should be interpreted with caution due to the low response rates."
Abstract
Walter Palmas, Jeanne Teresi, Ruth S Weinstock, and Steven Shea, J Telemed Telecare 2008;14 306-308, doi:10.1258/jtt.2008.080410

The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre
“We evaluated the effect of telemedicine compared with traditional telephone conversations when evaluating patients for aeromedical retrieval. A convenience sample of consecutive patients referred for retrieval from Palm Island over a six-month period was compared retrospectively with patients referred during the previous six months. There was a significant difference (P = 0.014) in the number of patients referred in the telemedicine period (113) compared to the previous six months (78), which may have been a seasonal fluctuation. There was a smaller proportion of aeromedical retrievals in the telemedicine period (78%) compared to the control period (92%), P = 0.009. Other significant differences between the telemedicine and control period included a larger proportion of patients not transferred at all (16% compared to 5%, P = 0.022) and a smaller percentage of rotary flights (52% compared with 73%, P = 0.004). Retrieval coordinators perceived that telemedicine use prevented 10 aeromedical flights and six night flights. The coordinators and referrers felt that telemedicine improved patient care in 75% and 65% of consultations, respectively. The coordinators felt that it improved communication with the referring doctor for 84% of the consultations.”
Abstract
Kate A Mathews, Mark S Elcock, and Jeremy S Furyk, J Telemed Telecare 2008;14 309-314, doi:10.1258/jtt.2008.080417

A pilot study of videotelephone-based support for newly diagnosed paediatric oncology patients and their families
“As part of the preparation for a randomized controlled trial, we conducted a pilot study to investigate the feasibility of providing videotelephone-based support to a sample of families (,em>n = with a child diagnosed with cancer, returning home for the first time after diagnosis and initial treatment. Seven of these families received support via videotelephone over a three-month period. Twenty videotelephone calls were made totalling 400 minutes (median 21 min, IQR 16–24). All videotelephone calls involved the specialist nurse providing support to mothers (85%) or fathers (15%) and involved communicating directly with the patient in most of the calls (55%). Social workers were involved in three calls (15%). All families expressed satisfaction with services delivered in this way. There were few technical problems. The use of a hybrid approach to providing videotelephony, using the family home computer and Internet connection for video and the home telephone line for full-duplex audio, was less costly than the custom-made device used in past studies.”
Abstract
Mark Bensink, Nigel Armfield, Helen Irving, Andrew Hallahan, Deborah Theodoros, Trevor Russell, Adrian Barnett, Paul Scuffham, and Richard Wootton, J Telemed Telecare 2008;14 315-321, doi:10.1258/jtt.2008.080505

Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction
“We examined the use of telemedicine for improving access to care in a work-site clinic. A prospective study of 100 patients was conducted over a four-month period in a work site that housed 700 employees. Sinusitis (10 visits), upper respiratory tract infections (9 visits), otitis media (9 visits), hypertension (9 visits) and back pain (8 visits) were the most common reasons for the visits. In 99 visits, clinicians were of the opinion that the telemedicine visit felt similar to a face-to-face visit. For most of the visits (67), patients strongly agreed or agreed that telemedicine had a positive effect on their relationship with the health-care provider. The otoscope, microscope and stethoscope telemedicine peripherals were important in aiding diagnosis (and ruling out other causes) in about 55% of the visits (upper respiratory tract infection, sinusitis, otitis media, cough, sore throat, nevi, rhinitis and ear wax related concerns). The ability for the patient to watch their ENT examination and see any associated abnormalities was appreciated by many patients. Physicians, nurses and patients were capable of using the technology with little training.”
Abstract
Prathibha Varkey, Kay Schumacher, Claudia Swanton, Barbara Timm, and Philip T Hagen, J Telemed Telecare 2008;14 322-325, doi:10.1258/jtt.2008.080512

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

How PDAs & Smartphones will Change Emergency Medicine

“Interview with John Pringle
Program manager for electronic documentation for the City of San Diego Fire and Rescue department, John Pringle has played an integral role in the development of TapChart, San Diego’s PDA-based information capture system, which has been used by EMS responders in the city for the past decade. John spoke on this topic at TEPR 2008 and will be doing an update at TEPR+ 2009 as well as organizing presentations there on other EMS implementations of electronic patient documentation.”
Article
MRI Newsletter, July 2008

Yuma patients benefitting from telemedicine program

“The telemedicine program came to Yuma Regional as part of the Arizona Department of Health Services Children’s Rehabilitation Services program. The center’s Neonatal Intensive Care Unit is linked to University Medical Center in Tucson for emergency consultations on infants with serious, often life-threatening conditions.”
Article
Tucson Citizen, 7 July 2008

Access To Electronic Medical Records Significantly Increases Efficiency Of Emergency Care

“A new study led by Paul Sierzenski, MD, RDMS, of Christiana Care Health System, Wilmington, DE, discusses the benefits gained from providing health care workers with immediate access to patient medical records during a mass casualty incident.”
Article
ScienceDaily, 31 May 2008

Indiana hospital to provide portable medical records to patients

“Patients at St. Vincent Heart Center of Indiana will now be able to carry their medical records with them in case of emergencies. The hospital is offering patients a small compact disc that contains their updated cardiovascular medical information and history.”
Article
Richard Pizzi, Healthcare IT News, 28 May 2008

Why no e-Prescribing in the ED?

“As previously reported, we have a wonderful system that permits doctors to order prescriptions online, allowing patients to pick them up directly from their preferred pharmacy. Recently a friend of mine went to our BID~Needham Emergency Department, and came home with a script to get her prescription from our pharmacy. So I inquired.”
Article
Paul Levy, The Health Care Blog, 22 May 2008

Erickson, hospitals to create patient information exchange

“In a bid to improve treatment and reduce errors, Erickson Retirement Communities and three Baltimore-area hospital systems said yesterday that they plan to create a pioneering health information exchange that would give emergency room physicians quick access to patients’ medication histories.”
Article
Lorraine Mirabella, Baltimore Sun, 21 May 2008

Telemedicine a Cost-Effective Alternative to ER Visits

“Telemedicine is a cost-effective way to replace more than a quarter of all visits to the pediatric emergency department, according to a community-wide study conducted in New York.”
Article
The Washington Post, 9 May 2008

Medical Advances—Through Your iPhone?

“Bioengineering professor Boris Rubinsky has what he hopes is the perfect antidote to bulky, expensive, hard-to-use medical machines: the mobile phone.
The University of California professor says that by reducing a complex electromagnetic imaging machine to a portable electromagnetic scanner that can work in tandem with a regular cell phone and a computer, he has essentially replicated a $10,000 piece of equipment for just hundreds of dollars. The mobile scanner plugs into the phone, which beams the data to the computer, generating an image that can be transmitted to a doctor or hospital far away.”
Article
Olga Kharif, Business Week, 30 April 2008

Wales extends use of emergency care record

“Informing Healthcare, the Welsh NHS IT agency, has announced that it is to pilot an extension of the emergency care record, officially titled the Individual Health Record (IHR), to include use in a hospital medical admissions units.”
Article
e-Health Insider, 23 April 2008

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

GC Publishers unveils new high-tech wrist band with emergency medical info

“Medical equipment company GC Publishers LLC has developed a new application designed to furnish ready access to a person’s medical information if a person is faced with a medical emergency.
The company has developed the CARE Memory Band, a wrist device the builds upon the concept of an emergency medical bracelet.
Only the CARE Memory Band is based on USB flash memory technology that can be read by emergency medical technicians with a laptop.”
Article
San Antonio Business Journal, 18 January 2008

Robot helps doctors treat patients in rural areas

“Within moments of a request for medical consultation, a doctor seated at a computer control station — at her home or office in Louisville, an airport terminal or anywhere in the world that has a wireless connection — can connect via the Internet to the RP-7 Robot located in the OMHS Emergency Room.”
Article
University of Louisville News, 5 November 2007

HIMSS, COMCARE aim to improve emergency response via IT

“The Health Information and Management Systems Society and the COMCARE Emergency Response Alliance are teaming up to extend electronic medical record technology to emergency response.”
Article
Bernie Monegain, Healthcare IT News, 15 October 2007