Reader mail: Pitfalls of EMR implementation

“This recent comment about information technology implementation by a reader named Rob was so excellent it deserved re-running.
I’m a technologist. I’ve been implementing information technology professionally for 25 years. I’ve been doing EMRs for the last five. There are lots of ways this can go wrong, large or small.”
Article
The Health Care Blog, 5 October 2008

EHR Face-Off: What’s Easy, Hard

“Four years after work began, Kaiser Permanente announced in May the completion of a national rollout of electronic health records systems across ambulatory facilities.
The milestone is part of Kaiser’s initiative to adopt a wide range of information technology applications across its provider network. Its Kensington (Md.) Center of more than 40 physicians was one of the earlier sites, going live about three years ago.”
Article
Joseph Goedert, Health Data Management, 1 October 2008

Information technology critical to nationwide redesign of HAI prevention

“A nationwide redesign to reduce healthcare-associated infections is in the works, using information technology to build a national definition of prevention.”
Article
Chelsey Ledue, Healthcare IT News, 25 September 2008

Family physicians move beyond adoption of IT to best use

“As the 2008 Scientific Assembly of the American Academy of Family Physicians got under way Wednesday, a healthcare IT expert with the organization said there was a “renewed focus” on IT in the family practice setting.
Jason Mitchell, MD, assistant director of the AAFP’s Center for Health Information Technology, said AAFP-affiliated family practice physicians are beginning to “move beyond” discussions about IT adoption and implementation, and are instead talking about how best to utilize healthcare IT tools.”
Article
Richard Pizzi, Healthcare IT News, 18 September 2008

EMR initiative to link independent physicians at El Camino

“An electronic medical records initiative will link more than 100 independent physicians affiliated with Mountain View, Calif.-based El Camino Hospital.
New Jersey-based ITelagen will provide El Camino with information technology and EMR support and services as the non-profit hospital implements EMR systems and solutions that are designed for smaller medical practices.”
Article
Molly Merrill, Healthcare IT News, 11 September 2008

“Think Green” with IT infrastructure optimization

“As someone who has straddled the roles of physician, hospital vice president, CIO and CMIO, I know all too well the scenarios that play out every year at budget time in the hospital board room. Radiologists want the latest scanners. Surgeons are demanding new anesthesia machines.  Nurses are requesting next generation infusion pumps for the ICU. Oh, and you Mr. CIO, you’d like to buy new servers, upgrade the network, deploy wireless, and institute a data recovery center. Guess who usually wins this boardroom grab for the gold? Not you Mr. CIO.  You are usually last on the list.”
Article
Bill Crounse, Healthblog, 8 September 2008

Can IT Help Hospitals Improve Their Relationships With Community Physicians?

“In boardrooms across the country, health system chief executives are searching for any tactic that might better align hospital and physician interests. Downward pressure on physician incomes has placed unprecedented strain on hospital-physician relations. At a minimum, doctors are increasing their productivity by reducing the time they spend on hospital initiatives. On the other of end of the spectrum, some physicians are competing directly with local hospitals through physician-owned outpatient centers.”
Article
Matt Cinque, iHealthBeat, 2 September 2008

Organizational effects of information and communication technology (ICT) in elderly homecare: a case study

“The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users’ involvement and commitment, stimulating them to test and improve the prototype until the final version.”
Abstract
Vivian Vimarlund, Nils-Göran Olve, Isabella Scandurra, Sabine Koch, Health Informatics Journal, Vol. 14, No. 3, 195-210 (2008), DOI: 10.1177/1081180X08092830

Connecting with Physicians and Vendors for IT Adoption

“The road to connected health care is paved with complex conversations. Hospital leaders strategize with the board, bargain with vendors and negotiate with physicians, all with the goal of using information technology to improve the quality, safety and efficiency of care. To introduce an ambulatory electronic medical record, hospitals and physicians often need to talk their way from conflicting agendas to common ground. And when working with a vendor, honest communication about expectations and deliverables is needed to lay the foundation for a fruitful partnership.”
Article
Jane Jeffries, HHNMostWired, 20 August 2008

Health Information Technology: A Few Years Of Magical Thinking?

“One of the biggest obstacles to expanding the use of information technology (IT) in health care may be the current narrow focus on how to stimulate its adoption. The challenge of thinking of IT as a tool to improve quality requires serious attention to transforming the U.S. health care system as a whole, rather than simply computerizing the current setup. Proponents of health IT must resist “magical thinking,” such as the notion that technology will transform our broken system, absent integrated work on policy or incentives. The alternative route to transforming the system sets all of its sights on the destination.”
Article
Carol C. Diamond and Clay Shirky, Health Affairs, 19 August 2008

Infrastructure strategy for NHS Wales

“Informing Healthcare has published its infrastructure strategy for NHS Wales. The first edition covers networking, user access devices, servers and storage, messaging and collaboration, directory and voice services.”
Article
e-Health Insider, 12 August 2008

U.S. Health System Is A ‘National Tragedy’

“In his LinuxWorld keynote, McKesson’s CIO said the lack of modern technology in doctors’ offices, hospitals, and research centers is costing Americans their lives.”
Article
Antone Gonsalves, InformationWeek, 5 August 2008

Survey: ‘Wired Hospitals’ lead to increase in key quality measures

“According to the 10th annual Most Wired Survey and Benchmarking Study, hospitals that embrace information technology demonstrate better patient satisfaction outcomes, risk-adjusted mortality rates and other key quality measures.”
Article
Molly Merrill, Healthcare IT News, 16 July 2008

A Benefits-Driven Approach to IT Implementation, Part Two

“When Texas Health Resources, a 13-hospital system in Arlington, decided to adopt an electronic health record, its leaders realized that obtaining benefits from the investment would not be automatic. So they adopted a benefits-driven approach to the EHR implementation, which they called the “Value Model” program.”
Article
Douglas Thompson, Patricia Johnston, HHNMostWired, 9 July 2008

Las nuevas tecnologías de la información en Medicina revolucionarán la formación

“Los profesionales de la Medicina aún no están explotando el potencial que ofrecen las nuevas tecnologías de la información y la comunicación (TIC) tanto en la práctica clínica como en el campo de la formación, según José Luis Fresquet, profesor de historia de la ciencia de la Universidad de Valencia.”
Article (Spanish)
Karla Islas Pieck, Diario Médico, 3 July 2008

Profesionales: la tecnología no sólo beneficia a los pacientes siete uci digitales

“Menos burocracia, más tiempo, más comodidad y un sistema que se adapte a sus necesidades específicas: eso es lo que los profesionales sanitarios le piden a un proceso de informatización de un servicio o un centro, y muchas veces conseguirlo está en su mano.”
Article (Spanish)
Rosalía Sierra, Diario Médico, 3 July 2008

A Benefits-Driven Approach to IT Implementation, Part One

“Typical hospital information system implementation processes are designed to meet technical and project management goals, such as on-time delivery, high reliability and adherence to technical specifications or the project budget. However, most health care executives do not buy systems for technical reasons, but to increase their strategic competitive advantage by improving patient safety and clinical quality, increasing efficiency and reducing costs, and meeting local competitive demands.”
Article
Douglas Thompson, Patricia Johnston, HHNMostWired, 2 July 2008

El paso del papel al sistema digital tiene que hacerse en seco, en un día

“Apenas el 3 por ciento de las unidades de críticos de los más de 800 hospitales españoles están informatizadas, lo que resulta contradictorio siendo áreas tan sensibles donde tan importantes son la seguridad y la precisión. De todos modos, no hay que relajarse: la digitalización también genera algunos problemas, como la falta de comunicación entre médicos.”
Article
Rosalía Sierra, Diario Médico, 2 July 2008

Using virtual reasoning to redefine health care

“The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.”
Article
Marlene Beggelman, Health 2.0, 1 July 2008

Building an inter-organizational communication network and challenges for preserving interoperability

“Abstract
Background: The ideal scenario for information technology to bridge information gaps between primary and secondary healthcare and to improve the quality of healthcare in the medication process is to build an interoperable communication network. This type of undertaking requires diverse information systems to be integrated, and central to this are the preservation of data integrity and the integration of different pieces of patient data.
Objectives and methodology: In this study, we focused on sources of challenges to the integration process and to the building of an interoperable communication network. Interviews, document analysis, and observations were conducted to evaluate the integration process in a project that involved medication data communication between primary healthcare providers (i.e., general practitioners and community pharmacists) and secondary healthcare providers (i.e., hospital pharmacists and specialist physicians).
Results: The project encountered numerous integration problems, many of which persisted even after extensive technical intervention. An analysis of the problems revealed that they were mostly rooted either in problematic integration of work processes or in the way the system was used. Despite the project’s ideal technical condition, the integration could be accomplished only by applying human interfaces.
Conclusion: The main challenge to building interoperable communication network does not lie in technical integration. The real problem occurs when the technical linkage is implemented without the work processes being aligned and integrated.”
Abstract
H. Pirnejad, R. Bal and M. Berg, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 25 June 2008, doi:10.1016/j.ijmedinf.2008.05.001

New Healthcare IT survey pinpoints professional needs

“Medical technology and IT professionals are hungry for information on emerging technologies and guidance on the integration of IT systems in the healthcare environment, according to the results of a major new industry survey.”
Article
HealthTech Wire, 24 June 2008

Steve Case: Long I.T. Journey Ahead

“Shifting health care to a consumer-centric model by making greater use of information technology could be a 10- to 20-year journey, said Steve Case, chairman and CEO of Revolution Health Group, Washington. Case was the June 24 keynoter at the Healthcare Financial Management Association’s Annual National Institute in Las Vegas.”
Article
Health Data Management, 24 June 2008

NHS leaders see IT as promising NHS opportunity

“Over 90% of NHS leaders see IT as a promising opportunity for the NHS over the next ten years, a poll for the NHS Confederation has found.”
Article
e-Health Insider Primary Care, 24 June 2008

Supporting Quality with Information Technology

“Next week, I’m meeting with the BIDMC Board’s Patient Care Assessment and Quality Committee (PCAC) to discuss the 2009 tactics for improving quality with information technology. The overall presentation includes 2008 accomplishments, 2009 goals, the national context, and our general approach. I’ve chosen to communicate the specifics in the context of the Joint Commission’s 2008 Patient Safety Goals.”
Article
John Halamka, Life as a Healthcare CIO, 18 June 2008

Canada must apply healthcare IT to home care setting, report says

“Canadian provincial and local governments need to focus on opportunities for information technology applications in the home, the place where Canadians experience the majority of their healthcare, according to a new report.
The Canadian Home Care Association wrote the report - entitled Integration through Information Communication Technology for Home Care in Canada - to gain a better understanding of the potential and readiness for information communication technology in home care in Canada.”
Article
Richard Pizzi, 13 June 2008

Pharma to see growth in drug safety monitoring IT

“Pharmaceutical companies are increasingly relying on signal detection technologies to aid in identifying and managing adverse drug events, says a new report.
According to analysts at the British market research firm Datamonitor, the pharmaceutical industry will see accelerated growth in the uptake of drug safety monitoring technology.
Article
Richard Pizzi, Healthcare IT News, 6 June 2008

Empowering Mr Green with ICT tools

Mr Green is a diabetic who is also wheelchair bound. For many years his diabetes has been hard to control, resulting in peripheral vascular disease and, being sedentary, this has resulted in frequent pressure sores and leg ulcers. At Chorleywood Health Centre, we have introduced a wide range of ICT tools to support the diagnosis and management of patients. Using remote patient monitoring we have established automatic daily monitoring of his blood sugar levels so that the clinical team have been able to respond to his needs. By observing the effect of the changes made to his medication, we have been able to intervene repeatedly and timely until his diabetes is properly under control. We have discovered that such data empowers the patient to receive the correct management. His vascular disease is followed using images and data, such as ABPI, recorded in the home. Electronic referral of the problem to the hospital consultant results in a teleclinic appointment, Mr Green attends at the local health centre with the home nurse present to provide clinical input, reassurance and advice. A care plan is agreed between all three parties, all without Mr Green needing to move more than 1km from his home.

Malcolm Clarke(1), Russell Jones(2), Linda Hands(3)
1. Brunel University, Uxbridge, UK
2. Chorleywood Health Centre, UK
3. John Radcliffe Hospital, Oxford, UK

To be presented at the ICMCC Event

Trial of Computerized Screening for Adolescent Behavioral Concerns

“Objective. Injury risk, depressive symptoms, and substance use are the leading causes of adolescent morbidity and death. The goal of this randomized, controlled trial was to determine whether computerized screening with real-time printing of results for pediatricians increased the identification of these adolescent behavioral concerns.
Methods. A total of 878 primary care patients 11 to 20 years of age participated in computerized behavioral screening (the Health eTouch system) in waiting rooms of 9 urban clinics. These clinics all served predominantly low-income patients. The clinics were randomly assigned to have pediatricians receive screening results either just before face-to-face encounters with patients (immediate-results condition) or 2 to 3 business days later (delayed-results condition).
Results. Fifty-nine percent of Health eTouch respondents had positive results for 1 of the following behavioral concerns: injury risk behaviors, significant depressive symptoms, or substance use. Sixty-eight percent of youths in the immediate-results condition who screened positive were identified as having a problem by their pediatrician. This was significantly higher than the recognition rate of 52% for youths in the delayed-results condition.
Conclusion. Immediate provision of an adolescent’s self-report of behavioral concerns to a pediatrician increased recognition of those problems, compared with the delayed provision of results.”
Abstract
Jack Stevens, Kelly J. Kelleher, William Gardner, Deena Chisolm, Jennifer McGeehan, Kathleen Pajer, and Lindsay Buchanan, Pediatrics Vol. 121 No. 6 June 2008, pp. 1099-1105 (doi:10.1542/peds.2007-1878)

The power of e-patients

“There is a whole blogosphere around the idea of transforming medicine into e-health. There are plenty of bloggers who often write about the IT opportunities of medicine and healthcare. But! What about patients? The consumers? Even if we have a Jay Parkinson, what can he do without patients who are ready to use his service?”
Article
Bertalan Meskó, ScienceRoll, 1 June 2008

AHIP: I.T. Key for Reducing Costs

“America’s Heath Insurance Plans highlights the role of information technology in its new plan that it estimates could reduce U.S. health care costs by $145 billion by 2015.
The board of directors for the Washington-based trade organization developed a series of cost containment and public policy principles and related proposals in the plan. The initiative is part of an 18-month effort by the organization to present a roadmap for payers and other industry stakeholders that offers solutions designed to help make health care more affordable.”
Article
Health Data Management, 30 May 2008