E-Health Designs, LLC

The Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER) and Why They Are Important to the Department of Defense (DOD)

http://www.health.mil/MHSBlog/Article.aspx?ID=764

LCDR Steve Steffensen, MC, USN, Chief Medical Information Officer for the U.S. Army Telemedicine and Advanced Technology Research Center, Fort Detrick, MD, and the Military Health System’s Coordinator for the Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER), discusses both projects.

Healthwise, Inc. CEO Comments on HL-7 InfoButton Standard

January 28, 2010

The Info-Button Standard: Bringing Meaningful Use to the Patient

By DON KEMPER, CEO HEALTHWISE

“Regardless of the U.S. administration’s “meaningful use” requirements, if health information technology (HIT) is to become meaningful for patients, it must include the prescription of information and tools to help each patient better manage his or her own care.

Ask patients what they want from HIT systems, and they will tell you three things:

- “Tell me my diagnosis, what will happen, and what I can do myself to better manage the problem.”

- “Tell me my medical tests results and what they mean to me.”

- “Tell me my treatment options, and help me participate in the treatment decisions.”

The soon-to-be-finalized HL7 International Context-Aware Information Retrieval standard (nicknamed the HL7 “Infobutton” standard) makes it far easier for providers of electronic health records (EHRs) and personal health records (PHRs) to deliver just what the patient wants. And that is what will put the meaning into meaningful.

Using the HL7 Infobutton Standard for Information Prescriptions

The HL7 Infobutton standard has been widely adopted since 2007. It facilitates the delivery of a set of standardized information about the patient, the provider, and the activity of a specific care encounter or moment in care. An Infobutton manager (or equivalent) accessed by an EHR application can then pull from that set the information it needs for any relevant use case. In most cases the Infobutton has been used to bring up decision support information for the clinician.

This same HL7 standard can also be used to trigger relevant, helpful patient education orders or “information prescriptions”—for the patient. While the knowledge request can be triggered by the click of a button, the button click is not always necessary. The information prescriptions can be automatically generated, based on the context of the patient’s particular moment in care, for presentation in a handout or secure message, or on the personal health record (PHR).

In an EHR, a clinician triggers a knowledge request to a content provider. (A knowledge request differs from a query, because it returns tailored, targeted, and relevant information instead of the overabundance of documents with varying degrees of relevance that a standard query might deliver.) The content provider responds with a list of patient information prescriptions appropriate for that patient and that specific care encounter.

In the PHR, the request can be launched by the patient or automatically triggered by a scheduled appointment, a preventive service that is due, a medical test report, or any other clinical event. The content provider responds with relevant Web-based consumer health content.

By having both synchronous and asynchronous triggers, systems can generate relevant, helpful information at every point in the health care continuum. In all cases, the knowledge request and response protocols are defined by the HL7 Infobutton standard. This minimizes development effort and provides a single consumer content integration solution for both HIT developers and content providers.

Download the full white paper: “Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information Prescriptions (PDF)”

As chairman and CEO of Healthwise Mr. Kemper is a passionate advocate for raising the quality of patient engagement in health care. By prescribing prevention, self-management, and decision-support tools relevant to each patient’s needs, clinicians can engage and motivate their patients to become active partners in their health and wellness.

Mr. Kemper co-authored Information Therapy: Prescribed Information as a Reimbursable Medical Service with Molly Mettler. The Ix book lays out both the concept and the practical details of how
information prescriptions will become a core and expected part of health care.

More information about Healthwise can be found at http://www.healthwise.org/”

Biomedical Informatics Handbook, WikiPedia

From one of my LinkedIn groups:

“New Free Handbook on Biomedical Informatics has 250+ articles

In another striking innovation in the world of electronic publications and Web 2.0, the online encyclopedia Wikipedia, in its English version, has published today a new online Wikibook entitled “Handbook of Biomedical Informatics “, version 1.0, after more than 5 months of organization work. The book is based on articles published on the subject by Wikipedia.

Access to and the download of the book are totally free, with no need for registration of the user at the address:

http://en.wikipedia.org/wiki/Book:Biomedicalnformatics

The book has 276 pages in its PDF version, and gathers, organizes and classifies all the knowledge amassed by the Wikipedia articles on topics in health informatics, telehealth, standards and classifications in health informatics, and related topics, organized into 21 sections and more than 250 entries. Thus, it is considered one of the most comprehensive and complete books in the area.

Users can generate in real-time and download their own copy in PDF, or request a printed copy to a print shop operated by the Wikipedia Foundation. The final file is 4.7 MB.

The most interesting aspect of this new form of publication created by Wikipedia is that, due to the dynamic nature of Wikipedia articles, the book will remain in permanent updating process, i.e, the book will literally change daily.

The organizer of the book is Prof.Dr. Renato ME Sabbatini, former president and current director of Education and Professional Training of the Brazilian Society of Health Informatics, president of the Edumed for Education in Medicine and Health, Campinas, SP, Brazil, and retired adjunct professor of the Faculty of Medical Sciences UNICAMP, where he was also the founder and director of the Center for Biomedical Informatics for 20 years.

The Board of Professional Education and Training of the Brazilian Society of Health Informatics officially adopted the “Handbook of Biomedical Informatics” as a reference source and textbook for its educational programs, as well as the basic study material to obtain the official title of specialist in Health Informatics, to be launched in 2010. “

Government Releases First EHR “Meaningful Use” Criteria

As reported in Healthcare IT News, “The government delivered on Wednesday the long-awaited definition of meaningful use of electronic health record technology, and it came wrapped in about 700 pages of proposed regulation.

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20]  Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.

Healthcare Reform Proposals as of 30 Nov 2009

Synopsis_health_reform_side_by_side_Nov_30_20091 (2)

John Glaser’s Recent Comments on Need for Healthcare IT Interdisciplinary Approach

From CHIME website:

“Improving health care through the use of information technology is inherently a multidisciplinary undertaking. Computer science. Health informatics. Management. Clinical domain knowledge. Finance. Social sciences. Many bases of knowledge, experience and perspective must all come together to effectively leverage electronic health records. Those who lead technology-enabled changes in care practice must appreciate the need to assemble and apply this diversity of know-how and individuals. No one leader can possibly be deeply conversant across this range, but they can develop an appreciation of the interdisciplinary nature of the undertaking. And they can use their leadership skill to bring together the disciplines and harness their collective contributions. Being a leader in health care information technology is difficult and complicated. Perhaps the greatest leadership challenge is leading multidisciplinary teams. But well-led teams also are the most potent contributor to our efforts to improve care. ”

–John Glaser, Ph.D., vice president and CIO at Partners HealthCare System, is serving as chairman of the CIO SmartBrief Advisory Board. His commentary on selected articles will appear each Friday in the CIO SmartBrief

Interesting New Web Site on Mobile Healthcare Applications

Mike Auricchio, a student in The George Washington University graduate program in healthcare administration (my alma mater), has created an interesting blog discussing Mobile Healthcare Applications.

Check it out at:  http://www.healthcareapplication.com

HHS Releases Healthcare IT Training Funds to Community Colleges

http://www.healthcareitnews.com/news/hhs-releases-80-million-train-hit-workforce

The Department of Health and Human Services will release $80 million in grants to help develop and strengthen the health information technology workforce through community college training programs

Healthcare IT Savings Wishful Thinking?

http://www.healthcareitnews.com/news/health-it-savings-estimates-are-wishful-thinking-say-harvard-researchers

New Harvard study questions whether investment in healthcare IT actually improves hospital efficiency, cost-savings, and quality.

My take is that it is too early to get a definitive answer.  We are in the infancy stages and won’t be able to measure any significant ROI until we have critical mass of physicians and hospitals adopting robust electronic health records and engaging in electronic healthcare information exchange.

VHA, Kaiser, DoD Health Information Exchange Using NHIN

As announced in Healthcare IT News, VHA, DOD, and Kaiser will exchange health information using the NHIN Connect solution. VHA and Kaiser will be first out of the gate, with DOD expected to join in early calendar year 2010. Initial exchange will focus on a HITSP compliant c.32 document.

http://www.healthcareitnews.com/news/va-kaiser-plan-link-electronic-medical-records