Today’s Abstract

“Today’s medication adherence related abstract, “Supporting the Patient’s Role in Guideline Compliance: A Controlled Study”, comes from The American Journal of Managed Care, and even has a link to the full article.”
Article
Alex Sicre, The Medication Non-Adherence Blog, 11 November 2008

Supporting the Patient’s Role in Guideline Compliance: A Controlled Study

“Objective: Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients.
Study Design: For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging.
Methods: The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used.
Results: Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests.
Conclusion: Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.”
Article
Stephen N. Rosenberg; Tatiana L. Shnaiden; Arnold A. Wegh; Iver A. Juster, Am J Manag Care. 2008;14(11):737-744

Spanish hospital drives efficiency, profit with SMS communication IT

“A recently-built hospital in Valencia, Spain attributes its profit margin and efficient care management to a communications platform its doctors and nurses can access from their mobile phones.
Hospital de Torrevieja uses a remote care managing tool that facilitates SMS-based communication and reporting, allowing doctors and managers to receive updates on patient care and business activity.”
Article
Chip Means, Healthcare IT News.eu, 5 November 2008

The real health care change we need

“Simple stuff like e-mail. Whether from a fear of lawsuits, privacy concerns, or mere Luddism the medical profession’s use of basic technology tools still lags badly.
This is not just an American problem. The King’s Fund, a UK think tank,  is out today with a report saying that country’s National Health Service can dramatically improve service through the use of day-to-day technology.”
Article
Dana Blankenhorn, ZDNet Healthcare, 29 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

Project E-vita links RTX telehealth monitor data with electronic patient record

“Isle of Man-based electronic patient record (EPR) company EvaWare has moved the goalposts for telehealth companies that rely on the manual transfer of telehealth monitoring data into patient records. Its ‘Project E-vita’ takes data from monitors via the RTX hub, and patient’s answers to personally designed questions and instantly updates the patient’s EPR. It then automatically sends the clinician an email or SMS text alert if predetermined clinical thresholds have been breached.”
Article
Telecare Aware, 18 September 2008

Army will test cell phones to prompt trauma victims

“The Army wants to develop a text-messaging system to communicate with service members suffering from traumatic brain injury. The system would help health care providers monitor TBI patients as well as prompt them to take treatment actions.”
Article
Peter Buxbaum, Government Health IT, 17 September 2008

Text Messaging in Healthcare: The Elephant Knocking at the Door

“In discussions of telemedicine modalities, text messaging, also more technically referred to as SMS for Short Message Service, isn’t the elephant in the room, the one everybody’s ignoring and afraid to talk about. Text messaging is the elephant at the door, the one everybody knows is trying to get into the room, but nobody’s quite sure how it’ll fit through the door, how big it is, or what exactly they’re going to do with it once it gets through.
Comparatively, the U.S. is behind the rest of the world in terms of text messaging. Research company SNL Kagan (Charlottesville, VA) released a report in 2007 estimating that 84% of the U.S. population—including consumers, business users and people with multiple units—would have mobile phones by the end of 2007, which would surpass 100% by 2013. Yes, that’s ‘surpass’ 100% due to the number of multiple unit owners. Informa Telecoms and Media (London, UK) reported in 2006 that thirty countries had exceeded 100% cell phone penetration in that year.
It is further estimated that 50% of the global population currently owns a mobile phone and 98% of those phones have text messaging capabilities. Here’s one more statistic to further drive home the growth of text messaging: According to messaging services provider Acision (Nieuwegein, Netherlands), on New Year’s Day, January 1, 2008, 43 billion text messages were sent globally.”
Article
Mark Terry. Telemedicine and e-Health. August 1, 2008, 14(6): 520-524. doi:10.1089/tmj.2008.8495.

Patients’ Engagement With “Sweet Talk” – A Text Messaging Support System for Young People With Diabetes

“Background: Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team. “Sweet Talk” is a novel intervention designed to support patients between clinic visits using text messages sent to a mobile phone. Scheduled messages are tailored to patient profiles and diabetes self-management goals, and generic messages include topical “newsletters” and anonymized tips from other participants. The system also allows patients to submit data and questions to the diabetes care team.
Objectives: The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to understand its utility to this user group.
Methods: Subjects were 64 young people with diabetes who were participating in the intervention arms of a randomized controlled trial. All text messages submitted to Sweet Talk during a 12-month period were recorded. Messaging patterns and content were analyzed using mixed quantitative and qualitative methods.
Results: Patients submitted 1180 messages during the observation period (mean 18.4, median 6). Messaging frequency ranged widely between participants (0-240) with a subset of 5 high users contributing 52% of the total. Patients’ clinical and sociodemographic characteristics were not associated with total messaging frequency, although girls sent significantly more messages unrelated to diabetes than did boys (P = .002). The content of patients’ messages fell into 8 main categories: blood glucose readings, diabetes questions, diabetes information, personal health administration, social messages, technical messages, message errors, and message responses. Unprompted submission of blood glucose values was the most frequent incoming message type (35% of total). Responses to requests for personal experiences and tips generated 40% of all the incoming messages, while topical news items also generated good responses. Patients also used the service to ask questions, submit information about their self-management, and order supplies. No patients nominated supporters to receive text messages about their self-management goals. Another option that was not used was the birthday reminder service.
Conclusions: Automated, scheduled text messaging successfully engaged young people with diabetes. While the system was primarily designed to provide “push” support to patients, submission of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers. Responses to the newsletters and submission of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community. Although participants submitted relatively few messages, positive responses to the system suggest that most derived passive support from reading the messages. The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups, and the results of this study may help to inform the design of future text message support interventions.”
Article
Franklin VL, Greene A, Waller A, Greene SA, Pagliari C, J Med Internet Res 2008;10(2):e20, doi:10.2196/jmir.962

Military mulls using cell phones to spread health info

“The Defense Department’s Military Health System is pondering how to incorporate cell phones into its health promotion activities.
MHS is considering the use of cell phones to disseminate health information and alerts via text messages, facilitate clinical consultations, and track medications and symptoms, said Dr. S. Ward Casscells, assistant Defense secretary of health affairs.”
Article
Government Health IT, 27 June 2008

HealthBridge data exchange gives boost to e-prescribing, diabetes registry

“HealthBridge, a Cincinnati-based community health information exchange, has won a grant to enable e-prescribing and another to develop a disease registry. Both projects - already under way - will leverage HealthBridge’s core messaging system.”
Article
Healthcare IT News, Patty Enrado, 18 March 2008

Characteristics of Effective Electronic Mail Messages Distributed to Healthcare Professionals in a Hospital Setting

“Electronic mailing systems (e-mail) are an important means to disseminate information within electronic networks. However, in large business communities including the hectic environment of hospitals it may be difficult to induce account holders to read the e-mail. In two mailings disseminated in a large university hospital we evaluated the impact of e-mail layout (three e-mail text versions, two e-mails with graphics) on the willingness of its 6500 recipients to seek additional electronic information and open an integrated link. Overall access rates after 90 days were 21.1 and 23.5% with more than 70% of the respondents opening the link within 3 days. Differences between different layouts were large and artwork text, HTML text, animated GIF, and static image prompted 1.2, 1.7, 1.8, and 2.3 times more often access than the courier plain text message (p ? 0.001). This study revealed that layout is a major determinant of the success of an information campaign.”
Abstract
Jens Kaltschmidt, Simon P.W. Schmitt, Markus G. Pruszydlo and Walter E. Haefeli, Journal of the American Medical Informatics Association, Volume 15, Issue 2, March-April 2008, Pages 235-239, doi:10.1197/jamia.M2503

The impact of patient–physician web messaging on healthcare service provision

“Background
Information technology can support the delivery of healthcare. Patients are eager to make use of such tools as web messaging, yet its deployment has been limited to date. A fear still pervades that the cost associated with a possible increase to physician workloads may outweigh any suggested benefits.
Goal
This paper aims to review the body of research completed in the area of patient–physician web messaging. The findings of this review will then be assessed and synthesised, with the intention of creating an overview of both the benefits and costs of patient–physician online messaging. Areas of particular importance to future research may then be identified.
Results
Demand and support for online communication tools amongst patients is strong, and can increase quality of care due to increased patient–physician communication. Although there would seem to be great potential to increase process efficiency, there would not seem to be sufficient evidence as of yet to suggest that this is the case.
Conclusion
Further quantitative research in particular is required to assess the impact of online communication, with special regard to the effect on overall patient demand and on healthcare process efficiency.”
Article
David McGeady, Jaakko Kujala and Karita Ilvonen, International Journal of Medical Informatics
Volume 77, Issue 1, January 2008, Pages 17-23, doi:10.1016/j.ijmedinf.2006.11.004

Behind-the-Scenes of Patient-Centered Care: Content Analysis of Electronic Messaging Among Primary Care Clinic Providers and Staff

“Background: Transitions to patient-centered health care, the increasing complexity of care, and growth in self-management have all increased the frequency and intensity of clinical services provided outside office settings and between visits. Understanding how electronic messaging, which is often used to coordinate care, affects care is crucial. A taxonomy for codifying clinical text messages into standardized categories could facilitate content analysis of work performed or enhanced via electronic messaging.
Results: Messages contained diverse content: communications with patients, families, and other providers (47.2%), diagnoses (25.4%), documentation (33%), logistics and support functions (29.6%), medications (32.9%), and treatments (28.9%). All messages could be classified; 59.5% of messages addressed 2 or more content areas.
Conclusions: Systematic content analysis of provider and staff electronic messages yields specific insight regarding clinical and administrative work carried out via electronic messaging.”
Abstract
Renée A. Stiles; Stephen A. Deppen; M Kathleen Figaro; William M. Gregg; Jim N. Jirjis; Russell L. Rothman; Philip E. Johnston; Randolph A. Miller; Robert S. Dittus; Theodore Speroff, Medical Care. 45(12):1205-1209, December 2007, DOI: 10.1097/MLR.0b013e318148490c

HL7 Conformance: How to do Proper Messaging

Frank Oemig a and Bernd G.M.E. Blobel b
a Agfa HealthCare / GWI Medica GmbH, Bonn, Germany,br /> b eHealth Competence Center, University of Regensburg Medical Center, Germany

Abstract.

Communication and cooperation between different applications is mediated by interfaces following corresponding standards. The interpretation of standards, the understanding of requirements and specification of solutions is very different within the vendor community. In a shared care environment based on extended inter-organizational inter-relationships, this interoperability has to be provided at semantic and service-oriented level. For that purpose, harmonized reference models, agreed terminologies, ontologies and concept representations as well as a unified development and deployment process have to be standardized. The latter also includes testing and certification procedures. The paper shortly introduces in the semantic interoperability approach provided by HL7.