ExpressScripts faces sum of personal health record fears

“Executives at ExpressScripts woke last month to a nightmare.
The electronic health records company received a note from a blackmailer, threatening to release the Personal Health Records they had on patients to the whole world unless they were paid off.”
Article
Dana Blankenhorn, ZDNet Healthcare, 10 November 2008

Patient safety through e?prescribing

“The focus of the first joint E?Health Insider/British Computer Society Health Informatics Forum (HIF) round table was how to use  electronic prescribing to improve patient safety. The event sought to examine what lessons the primary care experience of e?prescribing could offer secondary care professionals working to develop acute  sector e?prescribing.
The participants in the day?long event were a high-level panel of  experts from academia, pharmacy, and GP and pharmacy system  suppliers. IT professionals with experience of prescribing implementations took part, as did representatives of NHS Connecting for Health and the Scottish national e?health  programme.
Chaired by Dr Glyn Hayes, the ex?chair of the BCS HIF, the panel examined what the acute sector could learn from primary care, which, since the 1980s, has steadily introduced computer systems and moved towards e?prescribing. Two years ago, 95% of all  prescriptions in primary care were being electronically generated. The improved legibility of printed prescriptions has been the key patient safety benefit achieved.”
Report
E?Health Insider and British Computer Society Health Informatics Forum, September 2008

Patient Online Access in the Safety Net: Ted’s Slides

“I am attaching the opening remarks that I made, alongside Veenu Aulakh, at the Patient Online Access in the Safety Net discussion, hosted by the California Healthcare Foundation. It describes the “why?” in the context of my journey of discovery. Click on any image to see full size, and comments are welcome.”
Article
Ted Eytan, 21 August 2008

Speaking For Consumers On Health IT

“Achieving comprehensive national uptake of health information technology (IT) is a monumental issue for the United States, in terms of improving patient safety, lowering taxpayer costs, and making health care portable in our increasingly portable society. By incorporating advanced IT into our health care delivery system, we will be able to transform our current system into one that better meets patients’ needs consistently through timely, affordable, transparent, interoperable processes that assure instant access to complete medical information — anytime, anywhere — that is transmitted seamlessly and securely from provider to provider.”
Article
Nancy Davenport-Ennis, Health Affairs, 20 August 2008

Act paves way for National Information Governance Board

“The National Information Governance Board is to become a statutory body, replacing the Patient Information Advisory Group, following Royal Assent for the Health and Social Care Act 2008.”
Article
e-Health Insider, 23 July 2008

Google Health

“Google Health announces that it is “safe, secure, and free.” It will not only store your private medical information from multiple facilities but will also let you control access to the information while acting as a medical resource of sorts. They claim they will never sell your data and “you choose what you want to share and what you want to keep private” and for further concerns to take a gander at their privacy policy. I’ve read that policy along with the 6 other pages the policy links to, more on that later.”
Article
John D., Infinity and Beyond, 18 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

GPs vote to halt Care Record Service development

“GP representatives overwhelmingly backed a motion to call a halt to development of the NHS Care Records Service at the BMA’s annual Local Medical Committees conference on Friday.
LMC representatives backed a motion expressing no confidence in the government’s ability to store electronic patient records safely.”
Article
e-Health Insider Primary Care, 16 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

Using Hospitalists to Maximize Inpatient Information Technology, Part 2

“This is the second installment in two-part series on the symbiotic relationship between hospitalists and health information technology. Last week, the author explained how hospitalists can help an organization derive full value from its IT investments. This week, he describes how a mobile application assists hospitalists in collecting valuable data about their patients.”
Article
Brian Levy, HHNMostWired, 14 May 2008

Keeping Medical Records Safe - BIDMC’s Approach

“Last week, I wrote a post addressing the risks of digital medical records and referenced the EMR platform that was developed by John Halamka and his team over at Beth Israel Deaconess Medical Center (BIDMC) here in Boston. In that post I stated that I was dismayed that when Halamka talked about this new EMR they are rolling out, and in some detail, nowhere did he make reference to the security features that would be built into the system to prevent, or at least minimize the kinds of breaches we’ve seen recently at any number of institutions. (I’ve written plenty on this in the past, do a search on the site to find more references.)”
Article
John Moore, Chilmark Research, 8 May 2008

Kaiser completes outpatient EHR rollout

“Kaiser Permanente has completed the rollout of its outpatient electronic health record system in nine states and the District of Columbia. Kaiser’s 13,000 physicians in 421 offices now have electronic access to their patients’ medical records.”
Article
Bernie Monegain, Healthcare IT News, 5 May 2008

EHR Safety: The Way Forward to Safe and Effective Systems

Abstract:
Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.
Abstract
James M. Walker, Pascale Carayon, Nancy Leveson, Ronald A. Paulus, John Tooker, Homer Chin, Albert Bothe, Jr., and Walter F. Stewart, J Am Med Inform Assoc. 2008;15:272-277. DOI 10.1197/jamia.M2618

Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety

Abstract:
We develop a typology of clinicians’ workarounds when using barcoded medication administration (BCMA) systems. We then identify the causes and possible consequences of each workaround. BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication administration records. Ideally, BCMAs help confirm the “five-rights of medication administration:” right patient, drug, dose, route, and time. BCMAs are reported to reduce medication administration errors-the least likely medication error to be intercepted–although these claims have not been clearly demonstrated. We studied BCMA use at five hospitals by: 1-observing and shadowing nurses using BCMAs at two hospitals; 2-interviewing staff and hospital leaders at five hospitals; 3-participating in BCMA staff meetings; 4-participating in one hospital’s failure-mode-and-effects analyses; 5-analyzing BCMA override log data. We identified 15 types of workarounds, including, for example, affixing patient-ID-barcodes to computer carts, scanners, doorjambs, or nurses’ belt-rings; carrying several patients’ pre-scanned medications on carts. We identified 31 types of causes of workarounds, such as, unreadable medication-barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-barcoded-medications; failing batteries; uncertain wireless connectivity; emergencies. We found nurses overrode BCMA-alerts for 4.2% of patients charted and for 10.3% of medications charted. Consequences of the workarounds include administration of wrong medications, doses, times, and formulations. Shortcomings in BCMAs’ design, implementation and workflow integration encourage workarounds. Integrating BCMAs within real-world clinical workflows requires attention to use in situ to ensure safety features correct use.
Article
Ross Koppel, Tosha Wetterneck, Joel Leon Telles, and Ben-Tzion Karsh, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2616

A risk analysis method to evaluate the impact of a Computerized Provider Order Entry system on patient safety

Objectives Quantitative evaluation of safety after the implementation of a computerized provider order entry (CPOE) system, stratification of residual risks to drive future developments.
Design Comparative risk analysis of the drug prescription process before and after the implementation of CPOE system, according to the Failure Modes, Effects and Criticality Analysis (FMECA) method.
Measurements The failure modes were defined and their criticality indexes calculated on the basis of the likelihood of occurrence, potential severity for patients, and detection probability. Criticality indexes of handwritten and electronic prescriptions were compared, the acceptability of residual risks was discussed. Further developments were proposed and their potential impact on the safety was estimated.
Results The sum of criticality indexes of 27 identified failure modes was 3813 for the handwritten prescription, 2930 (-23%) for CPOE system, and 1658 (-57%) with 14 enhancements. The major safety improvements were observed for errors due to ambiguous, incomplete or illegible orders (-245 points), wrong dose determination (-217) and interactions (-196). Implementation of targeted pop-ups to remind treatment adaptation (-189), vital signs (-140), and automatic edition of documents needed for the dispensation (-126) were the most promising proposed improvements.
Conclusion The impact of a CPOE system on patient safety strongly depends on the implemented functions and their ergonomics. The use of risk analysis helps to quantitatively evaluate the relationship between a system and patient safety and to build a strategy for continuous quality improvement, by selecting the most appropriate improvements to the system.
Abstract
Pascal Bonnabry, Christelle Despont-Gros, Damien Grauser, Magali Despond, Deborah Pugin, Claire Rivara-Mangeat, Magali Koch, Martine Vial, Anne Iten, and Christian Lovis, Journal of American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2677

Informatics Opportunities: The Intersection of Patient Safety and Clinical Informatics

Abstract:
Healthcare providers have a basic responsibility to protect patients from accidental harm. At the institutional level, creating safe healthcare organizations necessitates a ystematic approach. Effective use of informatics to enhance safety requires the establishment and use of standards for concept definitions and for data exchange, development of acceptable models for knowledge representation, incentives for adoption of electronic health records, support for adverse event detection and reporting, and greater investment in research at the intersection of informatics and patient safety. Leading organizations have demonstrated that healthcare informatics approaches can improve safety. Nevertheless, significant obstacles today limit optimal application of health informatics to safety within most provider environments. The authors offer a series of recommendations for addressing these challenges. This position paper focuses on next steps in using health informatics to improve patient safety. The paper does not attempt to provide a comprehensive review of patient safety-related technical accomplishments, because recent Institute of Medicine reports have done so. This paper focuses instead on current pressing issues and opportunities for addressing them in the short-term future. The intended audience includes provider organizations responsible for the safe delivery of health care; policy makers responsible for funding and regulatory decisions that influence healthcare safety; and the health informatics developers community (including vendors), who build the computer systems that support patient care.
Article
Peter M. Kilbridge and David C. Classen, Journal of American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2735

Letter Pushes Medicare E-Scripts

“Forty-four businesses and organizations have signed a letter to Congress asking that legislation to mandate electronic prescribing for the Medicare program be approved.
The letter was sent May 1 to leaders of the Senate Finance Committee and the House Ways & Means and Energy & Commerce committees. “We urge you to actively support passage of the Medicare Electronic Medication and Safety Protection Act of 2007 (S. 2408 & H.R. 4296) this year to reduce deadly and costly prescription medication errors,” the letter states. “We, the undersigned, represent more than 210 million Americans through consumer and labor groups, employers, public purchasers, physician groups, pharmacy benefit managers, insurers, and other prescription drug stakeholders.”
Article
Health Data Management, 1 May 2008

UK hospitals adopt US records system

“The University of Pittsburgh Medical Center (UPMC) and Newcastle-upon-Tyne Hospitals, a NHS Foundation Trust in the UK, today announced an innovative partnership to deploy electronic health record (EHR) technology.”
Article
HospitalHealthcare.com, 28 April 2008

Gov. Tim Pawlenty: Health-care records lag technology

“Technologically, health care is at least a generation behind. Instead of using e-health records, roughly two-thirds of hospitals and nine out of 10 doctors rely on paper record-keeping. In today’s society, it’s akin to commuting by stagecoach.”
Article
Newt Gingrich and Tim Pawlenty, Star Tribune, 27 April 2008

Scottish government funds telecare and IT research

“University of Edinburgh is to receive a share of £4m funding from the Scottish government to research telemetric supported self-monitoring of long-term conditions.
The project is one of four to have received government funding for research programmes over the next five years, aiming to help improve healthcare for patients in Scotland.”
Article
e-Health Insider Primary Care, 21 April 2008

Creating EHR Networks in the Safety Net

“Most community clinics and health centers have yet to make the transition to electronic health records (EHRs), despite mounting evidence that they can help raise the quality of medical care, increase patient safety, improve efficiency, and produce significant cost savings.
While studies have found that the primary barrier to EHR adoption is cost, research also shows that successful implementation requires investments beyond the price of the software, including significant amounts of planning and preparation, optimizing the system after installation, and training for key personnel. Small, independent health care providers often lack either the financial or staffing resources to fund and sustain such efforts.
One solution is the EHR network — an information technology partnership focused on community clinics and health centers that provides services to support the adoption of EHRs and other applications. This issue brief explores the network approach to EHRs and its potential to increase adoption rates among these crucial providers of safety-net medical services.
In developing the brief, Manatt Health Solutions employed a variety of primary and secondary research techniques, including interviews with clinic members of EHR networks and conversations with industry and academic experts. The authors conclude that a network approach can provide California’s community clinics and health centers with the infrastructure and support necessary to efficiently implement EHR systems.”
Report
Manatt Health Solutions, for Californian Health Foundation, April 2008

The Security of Patient Data

“HIMSS Analytics, the research arm of the powerful, thoughtful and highly regarded Health Information Management Systems Society, has published a sobering study, Security of Patient Data - see here - that highlights the gap between hospital patient data security practices and the reality of impacts if a breach occurs. The report, commissioned by Kroll Fraud Solutions, should be a splash of cold water to health care executives in all settings with responsibility for patient data. A link to the Executive Summary has been placed at the bottom of this post.”
Article
Brian Klepper, The Health Care Blog, 8 April 2008

HIMMS Report

Digital Files Put Medical Records at Doctors’ Fingertips

“New technologies now allow doctors and hospitals to keep electronic health records, but the U.S. has been slow to switch formats. Susan Dentzer reports on the advantages and difficulties that some hospitals are facing in their efforts to digitize medical records.”
Transcript
Susan Dentzer, Online NewsHour, 25 March 2008

FDA, AMA, Others Back New Healthcare Notification Network

“A coalition of medical societies, malpractice insurers, pharmaceutical and medical device manufacturers, health plans, and government agencies is trying to end the era of paper patient-safety alerts with the launch of an electronic network to disseminate wide-scale drug and device recalls and warnings.”
Article
Neil Versel, Digital Healthcare & Productivity, 25 March 2008

Allscripts joins Google, Cleveland Clinic’s eHealth partnership

“Allscripts, a clinical software provider, has formed a collaboration between the National ePrescribing Patient Safety Initiative (NEPSI) and Google Health to provide physicians with a new means of sharing health information over the internet with their patients, which was announced today at the 2008 HIMSS conference after Google CEO Eric Schmidt made his keynote address.”
Article
Health Imaging News, 28 February 2008

Exchange of Computable Patient Data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): Terminology Mediation Strategy

“Complete patient health information that is available where and when it is needed is essential to providers and patients and improves healthcare quality and patient safety. VA and DoD have built on their previous experience in patient data exchange to establish data standards and terminology services to enable real-time bi-directional computable (i.e., encoded) data exchange and achieve semantic interoperability in compliance with recommended national standards and the eGov initiative. The project uses RxNorm, UMLS, and SNOMED CT terminology standards to mediate codified pharmacy and allergy data with greater than 92 and 60 percent success rates respectively. Implementation of the project has been well received by users and is being expanded to multiple joint care sites. Stable and mature standards, mediation strategies, and a close relationship between healthcare institutions and Standards Development Organizations are recommended to achieve and maintain semantic interoperability in a clinical setting.”
Abstract
Omar Bouhaddou, Pradnya Warnekar, Fola Parrish, Nhan Do, Jack Mandel, John Kilbourne and Michael J. Lincoln, Journal of the American Medical Informatics Association, Volume 15, Issue 2, March-April 2008, Pages 174-183, doi:10.1197/jamia.M2498

Doctors like online option

“An online drug prescription program touted as a time-saver and error-eliminating tool was given the thumbs-up by Metro Detroit physicians using it, according to a survey released today for the Southeastern Michigan ePrescribing Initiative.”
Article
Jennifer Youssef, The Detroit News, 27 February 2008

Consent Forms That Patients Can Understand

“Informed consent may be the biggest misnomer in medicine: Studies show that most patients don’t read the forms they sign before undergoing surgery or medical treatment. More than half of those who do read the forms don’t understand them, and only a quarter of forms include all of the data patients need to make an informed decision.”
Article
Laura Landro, The Wall Street Journal, 6 February 2008

Call for Papers ICMCC 2008

The call for papers is closed.

For its fifth annual event, ICMCC will focus on the power of information. Information is both the result of data put to use and, once combined with experience, the basis of knowledge. If used properly it can empower patients, both actively and passively.
Information is one of the primordial aspects of medical and care compunetics, the field of social, societal and ethical aspects of computing and networking.
Therefore information related aspects will be at the core of the 2008 event program and this call for papers.

The main themes of the conference are:

• Electronic Health Record (EHR) Approaches
• Patient Record Access
• Compunetics (Social, societal and ethical issues of ICT)
• Data- , Information-, Knowledge Management

Authors are encouraged to focus their contributions from a patient’s perspective.

Accepted papers will be published in “Medical and Care Compunetics 5″ (IOS Press - “Studies in Health Technology and Informatics”) available at the conference.

Click here for author guidelines.

Papers can be sent as mail attachments to 2008 [at] icmcc [dot] org mentioning “Event paper” in the subject line before February 18, 2008.

The following is a non-restrictive list:

Electronic Health Record (EHR) Approaches

• EHR solutions and their comparison
• National and regional EHR strategies
• EHR data quality criteria, quality evaluation schemes and consequences of an insufficient data (and information) quality management
• Personalization of EHR
• EHR vs. PHR - should there be a split up?
• Urban and rural aspects of EHR and access to such EHR
• Security, safety and privacy aspects for access control systems (authentication, authorisation, authenticity, integrity, confidentiality, accountability)
• Record summaries (subset, extract) vs. comprehensive record structures
• Linking to additional (health-related) information (lifestyle, wellness; linkage tokens and mechanisms
• Storage and storage system access (central, de-central, local, distributed, private)
• Long-term archives and self-management of stored information including data management
• Existing and emerging standards for EHR architectures
• Aspects of ownership of EHRs and EHR systems
• Empowerment of health professionals towards extended ICT use

Patient Record Access

• Active patients accessing generic record structures
• Access rights handling (read, write, create, update, lock, delete; clinicians, nurses, patients)
• Access systems (kiosks, internet, cards, sticks, devices)
• Benefits of permanent record access (for patients and clinicians, economic aspects, cost-benefit-relationship, impact on health, impact on treatment, impact on recovery, health outcome)
• Legal and ethical aspects of accessing records (e.g. 3rd party information, parental access)
• Social aspects of accessing records (especially access by (mentally-)incapacitated and (physically-)disabled persons and 3rd party access)
• Training / further education and eLearning aspects for useful and usable record access (health professionals, patients, relatives)
• Relevant standards inside and outside the healthcare and welfare domain
• Record Access policy and use (national, EU, USA, WHO)
• Critical issues and issue resolution
  • Errors (e.g. patient and clinician agree the data is wrong)
  • Conflicts (one of the patient or clinician feel the data is wrong)
  • Disclosure (The patient and clinician disagrees with the level of disclosure or sharing)

Compunetics

• Role of compunetics in treatment and after-care
• Role of compunetics in information gathering and dissemination
• Role of compunetics in quality management
• Community and individual engagement through health IT
• Use of ICT to make protocols more adaptable, more patient-specific and more safe
• Modeling concepts
• Patient behavioral aspects

Data- , Information-, Knowledge Management

• The links and dependencies between data, information, knowledgement
• Use of secondary data for different purposes (incl. scientific studies)
• Orphan diseases
• Disease surveillance and surveillance systems
• Management of (anonymous) EHR data to provide information to the patient
• Anonymization and pseudonymization as challenge to information systems
• Storage of Patient data:
  • where
  • How long
  • Costs
  • Use and sharing policies and who maintains those

Patient Empowerment - The Power of Information

I would like to bring to your attention the ICMCC Event 2008 and it’s call for papers.

The 2008 Event will focus on the power of information.

How important information is, is shown by two recent publication that I would like to mention here:

• Information Behaviour of the Researcher of the Future
• Insta-Americans: The Empowered (and Imperiled) Health Care Consumer in the Age of Internet Medicine

Lodewijk Bos