Health care record needs cited at an IBM conference
31426
Computerization of health care record keeping remains both a need and a challenge, said IT and health care dignitaries at an IBM-sponsored conference in San Jose, Calif. on Monday.
547380
(InfoWorld) - As U.S. hospital emergency departments struggle under the weight of overcrowding, lack of staff and ever-increasing government health-care regulations, many are finding relief through IT systems. After The Mount Sinai Hospital in New York implemented an emergency department information system, it went from 5,000 lost or illegible charts in 2003 to none in 2005, a year after it moved from paper to electronic charts. Across the country at the Daughters of Charity Health System in California, revenue rose $40 million across six emergency departments because of better billing processes after an electronic system was put in place. Such impressive returns on investment can be found at hospitals nationwide at the same time that the federal government is pushing health-care providers to move to electronic records and various agencies and industry groups release report after report about emergency department overcrowding and other issues. The U.S. has almost 4,000 hospital emergency departments, or EDs, and many of those are at "critical capacity" with patient visits overall in excess of 107 million per year, according to the American College of Emergency Physicians. Add to that the emphasis on disaster response by emergency departments and the need to track biohazards and threats from epidemics and automation becomes all the more imperative. "By automating processes, the time a physician spends looking for charts, tracking down laboratory results, mobilizing staff, and repeatedly recording information that someone else already recorded can be dramatically reduced," ACEP says on its Web site. "Information technology is changing the way today's emergency departments operate by speeding the flow of patients through bottlenecks, eliminating redundant patient records, sharing complete medical records, and allowing laboratory tests and films to be viewed instantly and simultaneously at multiple sites." Computerizing an emergency department can further decrease costs while increasing revenue and improving care and efficiency, ACEP says. Legal liability can be decreased, labor costs might drop and far fewer patients might give up and leave without being seen because wait times are too long or because they simply get lost in the paper trail. "I think that our patients get better care," says Dr. Kevin Baumlin, the director of informatics for the department of emergency medicine at Mount Sinai. "That's the real point of all of this. It's about taking care of patients, not about making money." The Mount Sinai ED sees anywhere from 180 to 320 patients on any given day. Initially, getting the funding for an automated emergency department system was a challenge, Baumlin says. The hospital spent $150,000 on workstations and spends $28,000 per year on maintenance. A little less than $300,000 a year goes for application lease payments support and actual upkeep. The hospital went with a software system from Picis Inc., based in Wakefield, Massachusetts. It signed its contract for that system in August 2003 and then went live with triage tracking and discharge instructions components of the software system in November of that year. A measured rollout of other software tools followed until the last phase for scanning and an interface to the billing application went live in June 2004. Getting the staff to accept the new system was a hard sell, but Baumlin set about doing that in a "fairly methodical way," with all 28 ED doctors and 80 nurses invited to participate in evaluating vendors. He found the "rule of thirds" was in force, with one-third liking the idea of a thorough IT system, one-third ambivalent to it and one-third not keen on it. One goal Baumlin set, and achieved, was making sure there were enough computers to go around so that even at peak times staff who need a workstation have access to one. The ED has 143 computers, amounting to one for each doctor, nurse, support staffer, and consultant -- plus 10. "I did not want any provider who needed a workstation waiting for a workstation. In my world if you have to wait more than three seconds you're done, you're on to another task," he says. During peak times, the emergency department will triage up to 20 patients an hour. Another benefit has been the ability to work with other sites using Picis software to share data sets and study information on crowding, how rapidly patients who say they are in pain are cared for when they arrive at an ED during a crowded time, as well as to design and share research. "It's a wonderful research tool," Baumlin says. He can also better respond to the needs of regulators and federal mandates that require chart analyses and metric tracking. Without the electronic system, "you'd have to actually hire FTEs [full-time equivalent employees] to do chart reviews and pull them out in real time. That's just nuts. ... I can sit here and pull up the number of pneumonia diagnoses we had last month. In two minutes." Besides working with the software, he continues to evaluate hardware, asking if laptops or handhelds will work better, for instance. Laptops don't work so well in small spaces and handhelds have small screens. And patients, particularly those in emergency care, "want to talk to us -- they don't want to talk to the computer in between us. ... The patients really want that three-minute encounter to just be you and them. As a physician, I'd rather just go touch the patient, hold their hand, say hello, find out what it is I need to do and then do the documentation later." Doctors at Daughters of Charity's five hospitals and one skilled nursing facility are engaged in the same balancing act. At the health-care system's St. Francis Medical Center in Lynwood, California, 70 percent to 80 percent of the ED staff document patient care on laptops that they roll on carts or carry to bedsides, says Dr. Mike Stephen, the medical director of emergency services. He does about half of his documentation at the bedside and the other half after he has finished talking to the patient. The 14 ED doctors and other staff at St. Francis needed about six to eight months to get comfortable with the new system, also from Picis, with deployment beginning in January 2004. "From the corporate perspective, we were looking at really improving patient satisfaction and being able to document and show improved patient care," says Richard Hutsell, vice president and chief information officer of the health system, based in Los Altos Hills. "The vast majority of our hospitals are located in some of the more economically challenged areas" of the state. The decision was made to implement the automated system first in the emergency departments and then roll it out through the rest of the hospitals. "My view is that the ED is the window to the community and I wanted to make that as efficient as possible," he says. The system also lets staff track bed capacity, so they know when they're full up and also allows for keeping tabs on peak times, which helps EDs to make better decisions about when to have more staff on hand. The total cost to implement the system to date has been about $4 million for all facilities, but that has already been recouped because of the improved billing process. An average hospital will find the implementation of such a system pays off in five to eight months after installation because of such revenue increases, said Todd Cozzens, CEO, president and vice chairman of Picis. He turns around the question of the expense of implementing an automated system of software tools and applications to ask, "What's it cost to not do something?"
249724
IBM is releasing software that can predict the spread of infectious diseases among countries.
18910
The U.S. Congress needs to pass healthcare IT legislation before private companies develop multiple systems that don&#39;t talk to each other, two advocacy groups said Tuesday.Members of the Health IT Now Coalition and the Information Technology Industry Council (ITI) urged Congress to move ahead with health IT legislation such as the Promoting Health Information Technology Act. The bill would establish a public/private group to recommend health IT standards and certification and would budget $163 million a year for health-care providers to adopt health IT products, such as electronic health records.Health technologies can help improve healthcare quality, reduce costs and encourage changes in treatment, said former U.S. Representative Nancy Johnson, co-chairwoman of the Health IT Now Coalition.Health IT is &quot;going to produce radical change,&quot; Johnson said at a news conference. &quot;It&#39;s going to radically improve the quality of health care that Americans receive.&quot;With health-care costs continuing to climb, moving to an electronic system that reduces paper and medical errors is the best hope to extend health care to U.S. residents who are uninsured, she added. &quot;It is the only way that we guarantee to Americans of every age that our health-care system will continue to deliver the state-of-the-art medicine for which it has been known worldwide,&quot; Johnson said.The Promoting Health Information Technology Act has stalled in the House of Representatives and a similar piece of legislation, the Wired for Health Care Quality Act, has stalled in the Senate.Some groups, including Patient Privacy Rights, have raised concerns that the legislation doesn&#39;t adequately address patient privacy issues. &quot;The Senate Wired Act has no privacy protections or language ensuring patient control of health records,&quot; the group said on its Web site. &quot;It must not pass unless patients have the right to keep their health records private.&quot;Privacy and security must be major components of a health IT bill, Johnson said at the news conference. But she and Rhett Dawson, ITI&#39;s president and CEO, said Congress should pass a health IT bill before vendors develop multiple systems that don&#39;t interoperate. &quot;The public interest is in interoperability,&quot; Johnson said.A health IT bill would be a major accomplishment that lawmakers could show to voters before the November elections, Dawson said. &quot;We believe the time to act is now,&quot; he added.In addition to the news conference, a group of IT vendors, including Lexmark, NetApp and NCR, demonstrated health technologies at a congressional office building on Tuesday.EMC&#39;s RSA division demonstrated secure Web sign-on technologies that patients and health-care providers can use. RSA&#39;s Secure Web Access for Patient and Provider Portals allows administrators to set access rights based on who&#39;s signing in, said Seth Geftic, RSA product marketing manger. For example, a doctor could have access to more patient records than a nurse or an insurance provider, he said.In addition, RSA provides authentication technologies that can be used to recognize users when they first sign in. For example, the RSA Adaptive Authentication can use publicly available information, such as height, car loans and old addresses, to authenticate a user entering a health IT Web site for the first time, Geftic said.&quot;You don&#39;t even have to enter the last four digits of your Social Security number,&quot; added Shannon Kellogg, director of information security policy in EMC&#39;s office of government relations.
67773
Wellpoint Inc. , a managed care firm, has begun notifying 75,000 members of its Empire Blue Cross and Blue Shield unit in New York that a compact disc holding their vital medical and other personal information had disappeared, The New York Times reported.
615402
Intel's co-founder says health care and energy require "disruptive" solutions
454628
Privacy advocates are concerned that an implantable microchip designed to help doctors tap into a patient's medical records could undermine confidentiality or could even be used to track the patient's movements.
1162
BALTIMORE - Health care organizations not considering offshore outsourcing are missing out on significant cost savings, but administrators need to be aware of potential risks, including lax handling of data security by some vendors and the effect on employee morale, a health care IT analyst said Tuesday.
419603
IBM IBM.N, the world's largest  computer company, is putting a human face on the services it  offers in a new U.S. brand campaign illustrating how technology  can help doctors, lawmakers and young schoolgirls alike.
379668
Wellpoint Inc. , a managed care  firm, has begun notifying 75,000 members of its Empire Blue  Cross and Blue Shield unit in New York that a compact disc  holding their vital medical and other personal information had  disappeared, The New York Times reported.
757382
(InfoWorld) - When youâre as big a services company as IBM ($12 billion in third quarter 2006 alone), doing work for as many customers as Big Blue does, you start to notice some patterns in the work you do. Take insurance. IBM counts many insurance companies as customers, and their needs are unique. But they also tend to share some of the same business processes, such as RQI (rate quote issuance), the process for developing a rate quote for home or automobile policies. [Read about Webify, the company that provides the basis for IBMâs SOA platform.] Rather than just consulting a table, insurance companies doing RQI need to hook into information about where the customer lives, their credit history, driving record, as well as the history of the car or property that the customer is trying to insure, says Brett MacIntyre, IBMâs vice president for Composite Services Development. âIf you look at the business decomposition of a business solution, there are component services that are common across each of them,â MacIntyre says. Rather than code and re-code slightly different flavors of the same component for each client, IBM plans to build the RQI process into a reusable asset that reflects the best practice in the insurance industry, he adds. RQI is just one of a hundred such reusable SOA (service oriented architecture) components that IBM has built and that are now being used to build new solutions from the ground up for each client. The components are part of a larger effort at IBM to leverage the companyâs deep application development and IT services expertise to create a storehouse of reusable assets that can be used with customers of all stripes. Now IBM is taking the promise of SOA reusability a step further: setting up SOA Solutions Centers at Pune, India, and Beijing. Their charter: to identify and create composite business services that can be reused by other customers in the same industry. âWhat we are really doing by building reusable assets is allowing customers to build their solutions that much quicker and become very flexible,â MacIntyre says. âCustomers are going to be able to reconstitute to be able to meet a new business dynamic,â MacIntyre says.                                                     The SOA Centers are among the first of their kind, although other IT services vendors are moving quickly to duplicate IBMâs model. As IBM moves deeper into the development of reusable assets, however, some wonder where the line is drawn between reusable application components and full-blown applications. Different customers, similar needs As he looked across the breadth of consulting operations at IBMâs Global Business Solutions Center (GBSC) in Bangalore, India, Jeby Cherian, who heads the center, had no doubt that the creation of reusable SOA services would cut down on time to implementation and reduce the risk of delivery for clients. The GBSC was set up in March to be the companyâs global hub for the management and creation of reusable software components, including SOA services. With around 500 employees, it has in the last six months created about 100 software assets that IBMâs global delivery centers are using for their customers. A key promise of SOA is that services can be built once and used often, thus cutting down on cost and time for completing a new project. âReusability is a big benefit that SOA will be able to deliver. That and interoperability is the whole point about SOA,â says Marianne Hedin, an analyst at the research firm IDC. The model is a âwin-winâ for both the vendor and customers, Hedin says. It is a win for IBM, as it will speed up application development, and itâs a win for the client, as it will be less expensive to license a preconfigured solution. Building reusable assets Given a complex development and integration project, which services should get tapped for reusable components? IBMâs strategy so far has been to select reusable services based on their potential to be applied to other customer solutions. Once reusable assets are identified, IBM abstracts the process logic from the IT implementation, making it easy to customize or modify the process, while minimizing change to the IT implementation, says Sudhir Sastry, leader of IBMâs SOA Solutions Center in Pune, India. If the process was directly coded into the IT implementation before, IBM now uses process-modeling tools to develop a workflow for the process, and then applies business objects and the interfaces for the specific IT implementation, Sastry adds. For example, the company was recently tapped to develop an order-entry system for a U.S.-based telecommunications service provider. The solution needed to allow the service provider to provision voice, video, and data and other services on a single order entry system, bundle services for a customer and provide cross-service discounts, says Jasabanta Choudhury, telecom practice leader at the GBSC. Looking at the requirements, IBM decided that the order-entry process would be relevant to other telecommunications companies that are trying to shore up flagging margins. âUntil now the information that was available to service providers about customers was in silos, so they could not have a complete view of the customer and all the services [available to] him,â Choudhury says. Making the order reusable beyond IBMâs specific consulting engagement posed a number of problems, however. For example, the entry system would have to be usable by customers across multiple geographies. To accomplish that, the GBSC tapped internal documentation of telecommunications processes and adopted standards developed by the TeleManagement Forum, a telecommunications industry association, Choudhury says. Having satisfied its U.S. customer, IBM has now deployed the same order entry asset for a customer in Europe. And more orders are in the pipeline, Choudhury adds. SOA components have helped IBM along the way, as it moves from a labor-based application development model to an asset-based deployment approach, according to Cherian. âIf we create an asset and go to a customer, it is 70 to 80 percent made, and then we will use the clientâs unique processes to make it unique for the client,â Cherian adds. Application-like â but not actually applications The strategy to get into reusable assets took about three years to evolve within IBM. Because reusable software assets are similar to products, IBMâs consulting business needed to build skills along the way in areas like version management and maintenance of the asset, which it had to learn from the software group, according to Cherian. But at what point do âreusable assetsâ simply become a euphemism for standardized âsoftware applications?â IBM insists that its strategy to create reusable SOA components isnât about getting back into application development. The creation of reusable components is not the same as building applications, according to MacIntyre. Instead, IBM is building âpiece parts:â the pieces of business process that augment and complement large business applications, MacIntyre says. Whatâs the difference? For one thing, composite business services have to be highly customizable: hooked into existing data flows, presentation layers, and the overall business process that companies have, MacIntyre says. âIf you look at an entire solution, not all of that may be in the form of composite business services or modules,â MacIntyre says. In other words, thereâs still a lot of customization based on the core solution. âWe are not at the stage of the Ford assembly line where you pick your parts and put them all together.â On the other hand, IBMâs not necessarily at the at the pre-assembly line days where each car was handcrafted, MacIntyre adds. Unlike the software application business, the business context in which the reusable asset is deployed is also likely to be quite different from customer to customer, according to analysts. âThere are common business processes across many businesses from many different industries,â says IDCâs Hedin. âBut there are also business processes that are unique, and as you start going into the subprocesses, you may find more uniqueness.â In addition to IBM, a number of vendors including Accenture, Capgemini, and Hewlett-Packard are working on preconfigured SOA services in their labs. The consensus among all these companies is that some level of customization of the components will always be required, Hedin adds. And thereâs still a fair amount of hand holding to get clients to accept a changed process and new way of doing things, Cherian says. Every reusable asset contains a prescription, a leading-edge practice about how a process should be done. Often, delays in implementation reflect the difficulties of change management involved in getting the entire organization to accept the changed process, not technology-related issues, Cherian says. The SOA ecosystem To make sure that the assets it invests in are relevant to as many customers as possible, IBM is backing its reusable components with a larger governance model. The company, for example, has industry solutions boards, each addressing a specific industry segment, which are made up of representatives from IBMâs consulting, research, software and systems groups, and covering all the geographies. âThey are the ones who decide whether an asset is worth building, so it is a kind of check and balance that we are not building an asset for a market of one,â Cherian says. For now, the companyâs strategy to create reusable assets is based at the GBSC in Bangalore and the SOA Solutions Centers in Pune and Beijing. While 500 staff at the SOA Solutions Center in Pune will focus on the insurance and health care industries, its counterpart in Beijing, also with 500 staff, will develop SOA services for the banking industry and government. Locating the SOA Solutions Centers in India and China was no accident. First and foremost, IBM has a presence in both countries and is familiar with their cultures, and hence can take advantage of the engineering skills and relatively low cost of labor available in these countries, says IDCâs Hedin. But there are also deeper reasons. IBM is using technology from its acquisition of SOA software and services vendor Webify Solutions as the foundation for building composite business services. Webify, which was headquartered in Austin, Texas, already had a development center in Mumbai, near Pune. IBM also has considerable software development capability in India through its India Software Lab in Bangalore. âWhat we are doing in composite business services is essentially software development, so we could take advantage of the skills there,â MacIntyre says. The same can be said of the second SOA Solutions Center, set up in China, where IBM operated a software lab with an SOA design center, bringing a combination of software and SOA skills, MacIntyre says. The software produced in the two SOA Solutions Centers will get incorporated into the bigger solutions that IBMâs network of global delivery centers, located in 21 countries, are putting together for customers, MacIntyre says. IBMâs global delivery centers, particularly the ones in India and China, also play a key role in helping the company identify business processes that could be potentially made into reusable components. There will be synergy between the global delivery centers and the SOA Solutions Centers in both countries, and the delivery centers can bring ideas for reusable assets back from the customer, Hedin said. The Indian global delivery center, for example, supports eight of the largest telecommunications companies, five of the largest insurance companies, and three of the largest health care companies, and it has built strong industry expertise and process knowledge in the industries it serves. The delivery centers in China work for large banking and telecommunications companies. âAs these centers build solutions for customers, there are all sorts of things we could learn, and we would harvest that, and bring that into the SOA Solutions Centers,â MacIntyre says. âIt has happened often that the people at the delivery center doing the âsolutioningâ for a customer come back to us and say that they have found a particular requirement from, say, 10 customers, and ask us why donât we develop a reusable asset for it,â Cherian adds.
53102
The Centers for Medicare and Medicaid Services has requested information on how to integrate business rules engines and business process management software to modernize Medicareâs fee-for-service claims processing system.
474078
(InfoWorld) - Doctors would get $3 for every patient signed up to use an electronic health record under terms of a bill introduced Thursday by U.S. Representative Patrick Kennedy, a Rhode Island Democrat. The Personalized Health Information Act would require that the U.S. secretary of Health and Human Services create a personal health record incentive program to help speed U.S. adoption of e-health records. E-health records can cut health-care costs by consolidating patient information and eliminating medical errors, such as prescription interactions, proponents say. U.S. President George Bush has called on the U.S. government and private health-care providers to work together to provide e-health records to all residents by 2014. Using e-health records would allow patients to avoid filling out forms found in nearly every doctor's office, Kennedy said. The records would allow health-care providers to send messages to patients, such as reminders that a child is due for a vaccine. Some e-health records allow patients to send e-mail to their doctors, schedule appointments online, or view test results. But e-health records have been slow to catch on, partly because doctors haven't embraced them. Kennedy's bill would give U.S. doctors $3 for each patient converted to an e-health record over three years. A spokeswoman for Kennedy didn't immediately have an estimate of how much the program would cost. E-health records "are a critical piece of the puzzle as we move forward in an effort to improve the quality and cost efficiency of the health-care system in this country," Kennedy said. The bill would empower patients to be better informed and would also improve communication between them and their health-care providers, he said. Several companies and organizations, including Microsoft, e-health record vendor Allscripts, and the American Heart Association, endorsed the bill. Patients' ability to access personal health records "is a critical starting point to improved health care," Peter Neupert, Microsoft's corporate vice president for health strategy, said in a statement.
501104
The U.S. government needs to step up its push for electronic health records because they are not being adopted quickly enough, a group of health advocates said Friday.
441813
Electronic health records -- touted by policymakers as a way to improve the quality of health care -- failed to boost care delivered in routine doctor visits, U.S. researchers said on Monday.
558221
IBM and the plaintiffs in the case of Cooper et al v. the IBM Personal Pension Plan and the IBM Corporation have filed a notice with the United States District Court for the Southern District in Illinois.
768157
Biogen presents at the JPMorgan Healthcare Conference.