IT is a significant driver for a safer and more efficient healthcare system in Ireland, funded to the tune of €17bn per year.  In a move to make the system more efficient and to better track patients through the system, the system is beginning to use patient wristbands with barcodes that provide full access to the patients key information (see Taking the pulse, reported on the SiliconRepublic.com).

"In times of financial prudence, the budget for infrastructure such as IT is often cut to the quick in an attempt to rein in costs. Conversely, industry observers say now is the time to spend because IT has been proven to save money and drive efficiencies. Despite past technology projects going very publicly awry, the HSE is proceeding with smaller projects that it hopes will improve patient care and increase efficiencies.

ID technology integrator Zetes is involved in a project for patient wristbands with two-dimensional (data matrix) barcodes. The wristband contains key demographic information that includes the patient’s name, surname, date of birth, sex and hospital number. The information is now electronically transferable for use by a PDA-type device, mobile computer or any electronic interface.

“We did this for a hospital in Roscommon that wanted to improve its phlebotomy practices. It previously had to print labels and it now uses electronic wristbands,” explains Barry Long, sales manager with Zetes. “This has two advantages: electronic transfer of information and the details on the wristband is consistent and the same as on the hospital’s system.” Barcoding is a fundamental building block in the installation of wireless networks in hospitals and many hospitals throughout the country are either putting in or piloting the technology, according to Long."

Read the full article Taking the pulse.

A recent agreement between Canada Health Infoway (Infoway) and the Canadian Institute for Health Information (CIHI) has given the green light to establishing a new Canada-wide coordination body.  Housed by Infoway, the Infoway Standards Collaborative will manage, deliver and maintain health information standards, including those standards related to pan-Canadian electronic health records (EHR).

Currently, Canada’s health information standards are managed by several different organizations and initiatives, including CIHI. Having one body responsible for these standards being upheld ensures that the data collected about Canada’s health system meet quality criteria and can be easily compared.

The Infoway Standards Collaborative will take on several of CIHI’s initiatives already underway that support health information standards, including the Partnership for Health Information Standards, HL7 Canada and liaison activities with Digital Imaging and Communications in Medicine (DICOM). While CIHI will no longer be managing the same slate of standardization activities, it will continue to provide leadership in the development and maintenance of the key content standards (such as ICD-10-CA, CCI, MIS Standards) underpinning its information products and services.

Based on extensive consultations and collaboration, the Blueprint is focused on interoperability – the capability of computer systems to seamlessly communicate with one another. It provides guidance for integrating the approximately 40,000 existing health information systems in use across the country, while remaining flexible to allow for incorporating new and better information systems and capabilities.

This announcement follows on the heels of the release of a revised version of the Electronic Health Record Solution Blueprint developed by Infoway. The revised blueprint provides stakeholders developing Electronic Health Record Solutions with a technology framework for sharing health information securely and appropriately across Canada. It also takes a closer look at privacy and security issues.

For more information on Canada Health Infoway, please go to www.infoway-inforoute.ca .

Portion of this article originally published in CIHI’s Directions newsletter, June 2006 issue.

The American Hospital Association (AHA) claims that advances in technology have transformed patient care, particularly in the shift from inpatient to outpatient settings and in the development of less invasive diagnostic and therapeutic techniques.  Perhaps this explains why annual IT spending in the healthcare industry has jumped $12 billion since 2000.

According to industry analysts Sheldon I Dorenfest & Associates, $31 billion dollars was spent on picture archiving and communications systems, and computerized provider order entry systems, among other IT gadgets and software this year.  And it doesn’t look that this spending splurge will end anytime soon.

This detail clearly challenges the view that healthcare organizations spend much less on IT than other industries. According to reports on spending in 2001, banking and financial services spent about 5% to 6% of revenues on IT, compared with 3% to 4% for healthcare organizations.

Data from a Modern Healthcare/PricewaterhouseCoopers annual survey of hospital executives indicate that the typical healthcare organization allocates 2.5% of the operating budget to IT. Senior hospital executives responding to the Modern Healthcare 2005 survey indicated their primary near-term IT priority to be the electronic health record (EHR).

Implementing a national EHR system would be in the realm of $276 billion to $320 billion over 10 years.  Broken down this translates to an estimated initial cost of $2.7 million for a medium-sized hospital and then $250,000 per year, with an expected annual savings of $1.3 million once the system is fully operational.  If accurate, that could mean a $77.8 billion annual savings nationally.

Originally reported in Canadian Healthcare Technology.

With the help of a $1.8 million investment from Canada Health Infoway’s Innovation and Adoption program, VIHA will implement electronic tools to match clients with mental health and addictions challenges with the most appropriate care in the community.

“Electronic health initiatives are improving and modernizing the delivery of better, faster and safer health care,” said Health Minister George Abbott. “B.C. is leveraging investment and partnership opportunities from Canada Health Infoway to lead the country in developing electronic health information systems and we may see achievements in B.C. replicated in other jurisdictions."

“We are very grateful for Canada Health Infoway’s investment in this innovative project,” Waldner said. “By leveraging VIHA’s electronic health record system and introducing new web-based decision support technology, we can provide our clinicians with comprehensive information at the point of care, allowing them to make the best possible treatment decisions based on their clients’ needs.”

As in many other Canadian jurisdictions, VIHA clinicians do not currently have a standardized method for identifying and recording clients’ needs and risks, nor do they have access to an inventory of services available in the community. With paper-based processes still being used to document clinical information and refer clients to community-based services, transfer of critical health information and treatment can be delayed.

“This is a remarkable example of electronic tools supporting the needs of patients with acute or chronic conditions,” said Richard Alvarez, Infoway’s President and CEO. “This innovative solution will help reduce wait times and lead to more appropriate care and could serve as a model for other jurisdictions across the country,” he added.

With Infoway’s investment, VIHA’s Mental Health and Addictions Services team and Information Management/Information Technology staff will work closely with two of their existing technology providers, Cerner and Strata Health Solutions, to develop standardized electronic assessments forms and decision support tools specific to mental health and addictions needs. Clinicians will document a client’s assessments in Cerner’s PowerChart tool. Using that information, Strata Health’s web-based Strata PathWays’ ™ tool will provide access to a real-time inventory of mental health and addictions services available in the community that meet the needs of the specific client. VIHA expects it will take approximately 24 months to develop, test and implement the new electronic tools and train staff to use the new technology.

Strata PathWays™ is part of the B.C. eHealth initiative to build an integrated, electronic system that improves outcomes for patients by making their specific information available in hospitals, doctor's offices – wherever and whenever they need to seek health care services.

Read more at Canada Health Infoway invests in mental health apps

(Las Vegas – Forum for Healthcare Strategists) Healthcare technology is delivering wins for providers and patients.

Here are just some of the case study success highlights from the Forum for Healthcare Strategists in Las Vegas:

Consumer health & wellness

• 72% of all online adults searched for health information in 2005 (WSJ/Harris Interactive – cited by Greystone.net)³
• Approximately 57% of users indicate they have discussed online health information with their physicians (Manhattan Research – cited by Greystone.net)³
• Health website user priorities according to Harris Interactive (cited by Greystone.net)³
• Ask question that doesn’t require a visit (77%)
• Schedule/ Cancel appointments (71%)
• Refill a prescription (71%)
• Receive test/lab results (70%)

Electronic Health Record (eHR)

Sutter Health has spent millions of dollars on their her system, but the rewards have been high. “We absolutely believe that eHR has more than paid for itself,” says Cecilia Montalvo, a VP with Sutter.

• Mammogram completion rates (Sutter Health patients) more than double with those patients who use electronic health records (eHR); and more than quadruple when the patient receives an e-mail reminder (Sutter Health²)
• Older patients (Sutter Health) are more likely to use eHR with the highest enrolment and use by age skew is 60-69 years old (about 10% of patients that are 80-89, and 90+ years old are using eHR)²
• 96% of patients (Sutter Health) using online messaging with their physicians and e-visits are satisfied or very satisfied with their eHR system²
• 90% of physicians (Sutter Health) are satisfied or very satisfied with their eHR system²

Here’s a telling quote from a Sutter Health patient using their eHR system called PAMFOnline²: “I do not put off appointments or asking my doctor a question.  I can ask a question and find out if I need to come in, have a lab test or that nothing is needed. I feel so secure that I can message Dr. S. – he responds so fast – and with my medical problems fear is one of the worst things I deal with. Know my doctor is an (eHR) message away comforts me. He is the best!”

Return on Investment

• By implementing a ‘targeted knowledge transfer’ (TKT) system, Bon Secours Health System was able to enhance revenue and reduce costs by $54 million¹.
• The Internet as a physician referral marketing channel is second only to Yellow Pages in generating revenue from marketing activities (almost $1.2 million) for UK Healthcare⁴

^-- 

¹ The Marketing Challenge: Technology Trends & Transition, Michele van Zuiden and Stephanie McCutcheon, HealthTech

² A Technology Milestone: Getting Patients Online, Cecilia Montalvo & Bill Black, MD, PhD, Sutter Health 

³ The Broadband Media Strategy, Michael Schneider and Robin Snow, Greystone.net

⁴ Demonstrating Marketing and Communication Accountability, William R. Gombeski Jr., Director, Strategic Marketing, UK HealthCare

(Las Vegas – Forum for Healthcare Strategists) Technology has always driven change in healthcare. However, those running and managing healthcare delivery have never been more aware and supportive of technology driven change.

Driving support and investment in healthcare technology are the CEOs. In a recent survey by HealthTech, CEOs were asked, “In the future, what role would you like technology innovation to play in the development, communication, and implementation of your organization’s strategy?”

100% of the CEOs said that technology would play a greater role than today – 67% said “significantly more” than today with each hoping to be a “technology leader” (source: HealthTech¹).

Other survey findings from HealthTech found…

• Satisfaction is lagging with the technology planning process (about 60% expressed dissatisfaction or only “slight satisfaction” with their planning process
• Top five barriers to technology planning:
• Prioritization with limited resources
• Balancing impact on cost/quality
• Physician bias/enthusiasm
• Time availability
• Physician input/involvement

So while enthusiasm has never run higher, there exists an enormous opportunity for healthcare technologists to help minimize the gap between current and desired end state.

HealthTech is one of those ceasing the opportunity. HealthTech is a non-profit “pooled expert-led research center for delivery systems and health plans” with funding that is “independent” of technology vendors. One of three key organizations along with Kaiser Permanente and VHA Health Foundation, HealthTech and others are driving a an innovation learning network called A-ICU.

A-ICU has the chief objective of reducing the net cost for healthcare for most expensive chronic disease patients by 40%. The network will connect participating health provider organizations with the focus being “accelerated adoption of innovations and emerging technologies.” A-ICU is currently being designed (6 months) and is due to be implemented by October of this year.

¹ The Marketing Challenge: Technology Trends & Transition, Micheele van Zuiden and Stephanie McCutcheon

David J. Brailer, National Coordinator for Health IT, also known as the Health IT Czar, has announced his retirement after two years in the position. Dr. Brailer’s top priority was electronic health records (EHR).

"Everybody's connected but nobody is sharing," Dr. Brailer was quoted on eWeek.com (see Outgoing Health IT Czar Worries About Information Silos). "That's the natural consequence without federal intervention (one of the biggest concerns facing government).

The Secretary of Health however is not worried, but has no replacement as of yet.

“While I will miss him here at HHS, I am pleased that David has agreed to serve as Vice-Chair of the American Health Information Community (The Community), which is charged with making recommendations to the Secretary of HHS to facilitate the development and adoption of standards-based health IT,” said Mike Leavitt, Secretary of Health and Human Services.

“David has helped the Community identify promising breakthroughs for near-term progress while continuing to move us closer to longer-term health IT goals. David will also continue to serve as a consultant to HHS to help lead the President’s health care transparency initiative.”

In two years as Health IT Czar, Brailer has been very vocal about what government should do and not do. Brailer has said the government should not be buying IT for every doctor and not mandate standards across the country but ensure the "full portability of information.”

Brailer is regarded as one of the most powerful and widely respected eHealth champions. Prior to his appointment, Dr. Brailer was a Senior Fellow at the Health Technology Center in San Francisco, CA, a non-profit research and education organization that provides strategic information and resources to health care organizations about the future impact of technology in health care delivery. Dr. Brailer holds doctoral degrees in both medicine and economics.

Dr. Brailer also served for ten years as Chairman and CEO of CareScience, Inc., a leading provider of care management services and Internet-based solutions that help reduce medical errors and improve physician and hospital-based performance. While at CareScience, Dr. Brailer led the company in developing groundbreaking inventions with major research institutions, establishing the nation's first health care Application Service Provider (ASP) and creating a care management business process outsourcing partnership that allowed hospitals to outsource their care management functions on an at-risk basis. Dr. Brailer also designed and oversaw the development of one of the first community-based health information exchanges in Santa Barbara County, California.

Brailer has also been a strong opponent of the new anti-corruption legislation which is seen as limiting health IT progress by, for example, blocking corporations donating equipment to doctors and hospitals.

Read more about Brailer's resignation

An outbreak of mumps in the U.S., particularly through the mid-West, is forcing some healthcare officials to think outside the standard box for monitoring immunization.

“Amid a mumps outbreak, health officials Monday showed off an Internet-based immunization registry to make sure Kansans don't miss vaccinations against such diseases,” reports the Associated Press. (See With mumps outbreak continuing, officials tout shot registry).

The 10-month year-old system allows local health departments to check vaccination records regardless of physician, or even if people change doctors.

So far, 36 of 99 health departments and a few of offices and private clinics are part of the system.

Internet immunization registries appear to be a slam-dunk. But they’re not and they’ve been around for a while. ImmTrac is a Texas state immunization registry database developed jointly between the Texas Department of State Health Services (DSHS) and EDS. ImmTrac was launched in 1994. With the consent of the parent, the ImmTrac database “receives vaccination information for a child from across the state, including input from the Bureau of Vital Statistics, Women, Infant and Children (WIC) clinics, Medicaid, the Integrated Client Encounter System (ICES), and private health care providers. Immunization information is available to schools, childcare centers, health departments and public/private health care providers.”

No doubt the potential for viruses once almost completely held in-check – or new super viruses such as Avian Bird Flu – will have many health authorities, agencies and physicians rethinking how to track and monitor immunization levels.

Original post by Toby Ward on Mon 10 Apr 2006 11:33 AM PDT

A new report form the Annals of Family Medicine finds that the computer, if used well by a skilled physician, can enhance the patient-doctor relationship.

Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis finds that when used,  the electronic health record (EHR -  the medical record, patient education materials, and Internet search capabilities) can add a valued dynamic to the patient relationship and enhance therapeutic relationships.

However, the computer can weaken the patient-doctor relationship if the physician uses it as a substitute for dialogue with the client. Therefore, it depends on ‘how’ the doctor uses the computer.

Whether the computer enhances or weakens the relationship depends both on how easy it is to use and how skilled physicians are in making use of it.

These conclusions were derived from a study of participant observation (80 hours) in 4 primary care offices and individual interviews with 23 physicians, 52 patient and other support works. This was accompanied by 5 focus-groups of participants.

"Physicians were often conflicted between recording data in the EHR and giving patients one-on-one attention," wrote the study's authors, led by William Ventres of Multnomah County Health Department in Portland, Ore.

Ventres (et all) found four key factors in influencing this relationship:

• Spatial Factors - for example, how the physical location of the computer monitor influenced dialogue between the patient and doctor (“Large, fixed monitors located in the corner of the examination room caused consternation among both physicians and patients, whereas flat-screen monitors on mobile arms were universally praised.)

• Relational Factors - how doctors and patients used and perceived the computer. "There are times where it’s obvious you’re going through a structured way of dealing with a presenting problem. It’s click, click, point, and your note is done. Then there are these much more complex, human interactions. It just isn’t appropriate to be sitting there typing at the time,” was a quote offered by one of the study’s participant doctors.

• Educational Factors – how skilled and experienced the doctor in using the computer and EHR.

• Structural Factors - factors such as the cost and funding for EHR, and how the host organization (e.g. clinic or hospital) perceived and influenced (culture) the use of EHR.

RELATED ITEMS:

EHRs Enter Patient-Doctor Relationships