The California Department of Insurance on Tuesday debuted an online preferred provider organization report card to allow consumers to compare PPO ratings.
Researchers at Children's Hospital Boston and Harvard Medical School have developed a prototype that uses information culled from electronic health records, or EHRs, to paint a picture of a patient's medical history. Its first application has been toward predicting domestic abuse cases, but lead researcher, Ben Reis, said the goal is to expand the use for other conditions.
October 2009 is National Cyber Security Awareness Month (NSCAM), which the FBI endorses and participates. The NSCAM event has been held every October since 2001, as a national awareness campaign to encourage everyone to protect their computers and our nation's critical cyber infrastructure.
Cyber security requires vigilance 365 days per year. However, the Department of Homeland Security, the FBI, the National Cyber Security Alliance, and the Multi-State Information Sharing and Analysis Center, coordinate to shed a brighter light in October on what home users, schools, businesses and governments need to do in order to protect their computers, children, and data.
Ultimately, our cyber infrastructure is only as strong as the weakest link. No individuals, business, or government entity is solely responsible for cyber security. Everyone has a role and everyone needs to share the responsibility to secure their part of cyber space and the networks they use. The steps we take may differ based on what we do online and our responsibilities. However, everyone needs to understand how their individual actions have a collective impact on cyber security.
Please read the Awareness Month Fact Sheet, Awareness Month What Home Users Can Do Tip Sheet, and the Awareness Month CSAVE Fact Sheet.
You can read more by visiting STAYSAFEONLINE.ORG.
While having physicians employed by vendors is a nice start, experience shows us that is certainly not enough. Rather, vendors need to start spending a lot more time with their actual users—physicians and other clinicians in the trenches. They should make their programmers go out and observe physicians using the systems they are creating, as well as use formal usability techniques to better understand how to improve their systems—the synergies and learning will be critical all the way around.
Kaiser Permanente researchers conducting a clinical trial on the impact of e-mailed reminders on diet and physical activity found gentle electronic nagging actually worked: People who received regular messages suggesting modest lifestyle improvements increased their activity level and made healthier food choices.
Since the beginning of the information silo era, clinical lab systems, ambulatory and inpatient electronic health records, and more recently, personal health records and health information exchange platforms have displayed cumulative test results for viewing and sharing as fragmented, incomplete data using variable formats.
The poor quality of the existing test results interface is responsible for the mismanagement of billions of diagnostic tests and contributes to estimated duplicate annual testing rates in the 15% to 20% range.
[F]ull interoperability will require a standardized reporting format and comprehensive, clinically integrated data that presents a unified and common view to EHR, PHR and HIE users. Converting fragmented data into meaningful information will provide a workflow tool that has been shown to facilitate results viewing and sharing by producing a media reduction of up to 80% and greatly improved readability.
Significantly improving the viewing and sharing of test results information among collaborating physicians as well as between physicians and patients is just one example of how computer-savvy clinicians, imaginative software developers and experts in human-machine interface design can collaboratively create the next generations of EHR, PHR and HIE systems that will be easy and intuitive for both physicians and patients to use.
[emphasis added]
Today's clinical IT systems “provide little support for the cognitive tasks of clinicians or the workflow of the people who must actually use the system(s).” ... The “overarching, grand research challenge” of the computer science research community is developing “patient-centered cognitive support.” Computer systems need to build virtual models of a patient’s status, models that “depict and simulate a theory about interactions going on in the patient” similar to those models going on in the head of a physician working unaided by a computer.
The primary focus of virtually every computerized medical record system is documentation, meeting Joint Commission on the Accreditation of Healthcare Organizations, Health Insurance Portability and Accountability Act, third-party payer, medico-legal and regulatory stipulations. Only the most cursory and sophomoric thought is given to information and how to organize and present it to the clinician in a manner so that they can leverage that information to improve patient care. The inability to look simultaneously at multivariate, multimodal data in multiple windows to correlate and integrate information reveals an utter lack of understanding as to what physicians actually do when confronted with a clinical problem.... Until imaginative software developers work in tandem with computer-savvy clinicians and experts in human-machine interface design I fear the situation will get rapidly worse.
Like any information systems, the ambulatory electronic health-record systems being sold to small practices are a point in an evolution. Prior systems designed to enhance revenue through improved accuracy of insurance claims are giving way to systems designed to eliminate medical errors and improve continuity of care. No one should think this is the final, ultimate objective -- evolution will continue. Also, new standards will emerge, network and interoperability issues will change, vendors will merge and fail and new ones will emerge. Practitioners should understand that a few years after investing in an EHR system they will be facing a conversion or at least an upgrade.
I could go on and on about scenarios that I have either witnessed or participated in. With an average car ride of 10 minutes, and an average meal at 1 hour, how much opportunity are we wasting in the 18 or so years that the kids are at home. Given that the average family eats out 2 times a week, and drives together roughly 6 times a week for 10 minutes, parents are missing out on over 3700 hours of interaction. These numbers of course are on the light side.
What can a parent do in this extra time? They can let their children know that they matter. They can talk about school, their interests, what is the meaning of life. It simply doesn’t matter. The child will see the connection and the care and know that they matter in the lives of the parent.
With all this connectivity, when we are at work we are thinking about being home. When we are at home we are thinking about work. A study by Nielsen shows that Americans have 34 more unscheduled hours of leisure than they did in the past. The remarkable thing is that more Americans feel that their lives are crammed full and have no time to breathe. My take is that we fill our lives with insignificant things to feel significant. Live a life connected to the present and will bring about the significance you are looking for.
So, remember, if you don’t disconnect the electronic handcuffs, you will be disconnected from those who are important.
So what are some practical applications:
Hopefully you have found this information useful. It is important that we pass along our values to the next generation. I pray that our values are not ones of disconnectedness and apathy. These simple ideas may not work for your household. Find a happy median that works and sustains your family.
The high EHR failure rate is largely attributable to the fact that either they are just too hard to use for many physicians, or slow them down too much.... While the hard-dollar cost of an EHR is certainly a concern to many physicians and practices, that problem would not even be solved by providing these traditional EHR products free of initial costs to each of them. "Usability" is an essential missing ingredient in the CCHIT formula.
Traditional EHRs -- and there are a bewildering array of them in the market -- come with a host of other issues that have created resistance and inertia during the past 10 years or so of deployment: failed installations, long learning curves, high cost of training, lost productivity because of seeing fewer patients, anathema toward using electronic charting in the presence of the patient, difficulty in doing any "new" tasks with the system, poor integration with other essential systems, nonintuitive user interfaces with nested menus, pull-downs and pick lists. These are a few EHR problems the market has struggled mightily with. Adding financial incentives does little to solve these at all.
The process of “certifying” EHR products can help greatly in lifting these nonfinancial obstacles, but only if “usability” becomes an essential element of the certification process. The de facto certification criteria are presumed to be CCHIT’s list of 480 functions, regardless of how they are accomplished....
With CCHIT's 480 functional requirements in place, and more coming in 2009, EHRs are being driven to largely identical functionality. The only way to differentiate between the vast array of EHR products is to have a "usability" standard defined for performing key functions....
[emphasis added]
"Doctors should hate the current raft of electronic medical records. They are generally unhelpful and do not provide the benefit they should. The basis of the problem is that the information technology vendors all have their own ideas that fit within their technology limitations and can’t see beyond this. Pair this with the failure of interoperability and you get something that is not workable in reality. Without the complete information from all medical sources, how can a physician review priority variables?
Omissions because of lack of interoperability are key. Because the practice of medicine is an idiosyncratic art form, the "perfect" disease without co-morbidities is a fallacy, and yet most EMRs are based on the concept of the perfect example, in isolation. And information is stored variably, from tabular numeric pathology results to staging protocols to text notes. How do we bring together the essential information, in its necessary format to enable a pre-encounter review, understand status and the nature of the problems—not necessarily the diagnosis—and what we are doing to treat them is vital.
Because the vendors have not cracked this nut and because they are too busy trying to sell what they have instead of solving the problem, we have products that are clumsy, require too much time and effort, and don’t deliver on results.
There are answers. The technology exists, but we need someone to bring it together and make it professionally useful. And, yes, doctors are smart people. That’s why they don’t want to use something that doesn’t deliver the outcome.
Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is “in pain,” and to restrain my potty mouth when the computer malfunctions or the screen locks up. I advise teenagers to limit computer time as I sit before one myself for hours each day until my own eyes twitch and my neck starts to spasm.
In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care.
An Introduction to Information Therapy
Information Therapy (Ix®) is the timely prescription and availability of evidence-based health information to meet individuals' specific needs and support sound decision making. Ix prescriptions are specifically targeted to an individual's needs at a particular moment in care and are delivered as part of the process of care.
Mission: To advance the practice and science of prescribing and using information to improve people's health.
Vision: A future in which every health decision is informed
"If you can login to your banking website and be confident that your money is safe, why can't your login to the intranet from outside the firewall (i.e., via extranet) and be confident that the data is safe?"
Based on all of the identity theft and credit card fraud, it's hard to believe that anyone actually thinks their data is safe... If someone gets your banking or credit card information, how much do you lose? Maybe several thousand dollars? In medical ID thefts, the costs are usually tens to hundreds of times greater. People whose medical information was compromised have received bills in excess of $100K for operations and hospital stays that they did not actually receive.... The information that we are talking about here is much more valuable and more sensitive than financial data.
All that being said, we really need to provide a much better Web presence and the ability for patients to access their information and set up their own appointments.
My bank uses a mix of AIX and Solaris to run their webservers and databases. They have partitioned databases. Web application servers do not directly access back end databases. The web applications themselves are written in Java. Finally, they have dedicated security staff that runs regular audits & code reviews and monitors web traffic & application performance.
All of that and I still don't actually trust that the site is truly secure, but they warrant that I will not be financially liable for online fraud. What will we be able to refund or un-release if PHI is stolen?
Kaiser Permanente lets you see your Electronic Medical Record on their Website. Are they not as serious about protecting PHI as we are?
Kaiser fined $200,000 for release of PHI
Kaiser worker data breached, identity fraud reported
We engage our customers and colleagues as we channel innovation and harness technology to create a postive customer experience.
An IS team employs kinesthetic techniques to help solidify their vision.
"This is enormous; possibly the biggest virus we have ever seen," said software security specialist David Perry of Trend Micro.
