Is It Finally Time to Put Patients&#39; Medical Records Online?
87413
WEDNESDAY, Dec. 22 (HealthDay News) -- Although it has been a long time coming, physicians are beginning to consider the Internet an integral part of their practice.
522910
(InfoWorld) - Two large health insurance trade groups based in the U.S. have released a model for personal health records, a portable, Web-based tool that includes a customer's insurance claims, immunization records, medication records and other health information. America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association, whose members provide health insurance to about two thirds of U.S. residents, unveiled the personal health record model Wednesday. The two groups saw the importance of working together on the project, said Susan Pisano, vice president of communications for AHIP. "This is really an effort that cries out for collaboration," she said. U.S. President George Bush has pushed for electronic health records to be available to all U.S. residents by 2014. Backers of such records say they will improve the efficiency of the U.S. health-care system and cut down on errors such as drug interaction problems. Personal health records, or PHRs, "may be one of our most important contributions to helping improve health care," Ronald Williams chairman, chief executive and president of insurer Aetna Inc., said in a statement. PHRs are similar to other electronic health records, although they include less specific treatment information. Electronic health records typically are used by health-care providers to store and manage detailed clinical information. Patients will be able to enter information into their PHRs, in addition to information from pharmacies, laboratories and medical providers, the groups said. The model released Wednesday includes definitions of data elements that should be included in PHRs, such as risk factors, family history, health-care facilities and medications taken. The model also includes standards for the PHRs to be portable between insurers and providers, and rules about when insurers can share the information. Insurers can send the information to a new insurer only after the patient gives consent and has enrolled in the new insurance plan, Pisano said. Those tight sharing rules were designed to address concerns about the PHRs used by insurance underwriters, she said. The PHR model also set 2008 as the deadline for insurers to incorporate the data elements and adopt the portability standards, she added. The groups said the U.S. is still "many years" away from a fully interoperable health records system. But Dr. Robert Kolodner, interim national coordinator for health information technology at the U.S. Department of Health and Human Services, praised the groups' efforts. The new model is a "step forward in the national health IT agenda," he said in a statement. Earlier this month, five major corporations -- Applied Materials Inc., British Petroleum America Inc., Intel Corp., Pitney Bowes Inc. and Wal-Mart Stores Inc. -- announced plans to fund the development of a Web-based system that would allow their employees and retirees to access and maintain personal medical records. The companies said the plan could help them cut health-care costs.
704298
(InfoWorld) - The U.S. needs new medical privacy rules as the country moves toward greater use of IT to store health records, a group of health-care experts said Wednesday. "Thousands" of databases that contain U.S. residents' health records exist, and patients don't have any way to keep their personal information from being shared with third parties, said Dr. Deborah Peel, a psychiatrist and founder of the Patient Privacy Rights Foundation. Private companies have been data-mining prescription records for years, she added. The Health Insurance Portability and Accountability Act (HIPAA), passed by the U.S. Congress in 1996, sets security standards that health-care providers must follow, but the law leaves major gaps in privacy, Peel said at an electronic health-records privacy forum sponsored by public relations firm Dittus Communications. HIPAA gave many organizations with ties to health-care vendors, including offshore transcription vendors, insurance brokers and credit bureaus, authorization to use health care-records, she said. "Because of this confusion that HIPAA engendered, data is being exchanged and used for reasons that have nothing to do with people getting well," she said. "People think this is the wild west because of HIPAA, and every piece of data that's not nailed down can be used for some other purpose." While panelists at the forum seemed to agree that some type of privacy policy for e-health records is needed, they did not agree on how to accomplish it. Peel called for the U.S. government to create a national standard, but David Merritt, project director at the Center for Health Transformation and the Gingrich Group, called for private groups to develop privacy standards. The U.S. Department of Health and Human Services has proposed moving a privacy commission to the private sector, but a bill sponsored by Senator Edward Kennedy, a Massachusetts Democrat, would keep that commission in the federal government. In addition, Kala Evelyn Ladenheim, program director for state health policy leadership at the National Conference of State Legislators, called on the federal government to allow states to develop their own privacy policies. Some states may create stronger protections than a national effort would, she said. But 50 state privacy policies would be difficult for health providers to comply with, countered Tom Wilder, senior regulatory counsel for America's Health Insurance Plans, a trade group representing health insurance providers. In most other industries, private organizations have developed privacy policies, Merritt said. He called on a public and private partnership to create privacy standards. "The government is really good at creating commissions and creating advisory boards ... and studying an issue," he said. "What the government is not good at, and what we shouldn't ask it to do, is to lead and to act." Peel disagreed, saying health-care providers would have conflicts when creating privacy standards, and HHS employees may not have the public's best interest in mind. "We would actually say the problem is that the government is not in the lead," she said. "Unelected officials, bureaucrats and conflicted industry representatives shouldn't be making decisions about privacy."
222144
Six years ago, when my primary care physician suggested I have an MRI to help figure out why my left fingertips kept tingling, I went straight home, sat down at the computer and typed "tingling fingers MRI" into my Web browser's search box.
242634
A new website is being launched in an attempt to strengthen patient choice.
480305
(InfoWorld) - 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. IBM's New Paradigms for Using Computers 2007 workshop focused on health care interfaces. Previous years' workshops have covered such topics as Web 2.0 and mobile computing. "Health care is moving in the direction of computerization, but there's so many difficult issues in the user interface in particular that have not been addressed," said John Barton, manager of Interaction Science at IBM. Right now, health care is plagued by bad interfaces, said Paul Tang, vice president and chief medical officer at the Palo Alto Medical Foundation in Palo Alto, Calif. "It's really driving under the influence of terrible interfaces," he said. Tang cited studies that estimated 44,000 to 98,000 deaths per year in the United States resulting from medical mismanagement in hospitals. Patient safety would be enhanced by having better information available, he stressed. Information is fragmented. "There's almost no way a single individual could put this stuff together," but health depends on it, he said. Rather than just throwing computers at what are now paper processes, ethnography would help in figuring out what information is needed, said Tang.Â  At Palo Alto Medical Foundation, a Web site, PAMFOnline, provides patients and health care persons access to the same records. Patients can enter information and access data like test results. But patients can only add to personal, not official, health records, Tang said. About 45 percent of the foundation's patients are signed up. Should they choose, patients can pay $60 year to send messages to their doctors via the site, said Tang. He said he did not expect to ever see a centralized national health record database because of public concerns over privacy and security. "To put all information into one database just puts too much at risk," Tang said when interviewed after his presentation. Introduction of electronic health records is a nice way to make doctors and nurses more efficient, but it takes more time to use a computer than paper, said speaker Jakob Bardram, a professor at the IT University of Copenhagen who has been involved in health care. Paper records will not go away, he said. It is easier, however, to retrieve information on computers than on paper, Bardram said. Hospital persons need to be able to move about the building and enter information on different systems rather than being consigned to a single terminal for data entry, he said. PDAs, for their part, are not much of a solution because they do not have batteries that will have last a full seven-hour shift, said Bardram. "I think [PDAs] have a hard time in hospitals," Bardram said. But PDAs are being used in hospitals, he said. He urged development of middleware or operating systems that support mobility in hospitals and extend to health care workers' homes. Through a concept dubbed "Activity Roaming," health care workers could move between different computers and systems. A middleware platform has been developed for this, but it has not been deployed yet, said Bardram. IBM efforts in health care have included work on standards such as HL7 (Health Level 7) as well as participation in the Nationwide Health Information Network. The company is seeking to connect islands of information, such as patients, clinics, and hospitals. Also the event, Barbara Bennett, a health care business and transactional lawyer, said the IT industry has no clue what it means to delve into health care because health care is heavily regulated and IT has had little of this "It's overwhelming" to people used to a business has been essentially unregulated, Bennett said. She listed key legal risks to watch for in developing products for health care: * Privacy and security, including overlapping federal and state laws. * FDA regulations that govern how medical devices, including software, can packaged, labeled, marketed, and sold. * Medicare reimbursement, in which products must be reimbursable if they are to be sold. * Fraud and abuse, in which influencing patient or physician choices can be seen as an attempt to steer health care product referrals. This factor can affect a product design and sales strategy. * Malpractice. Technology can be seen by users as potentially causing mistakes rather than preventing them.
389678
The head of the U.K. National Health Service has defended plans to build a centralized database of patient records following another embarrassing loss of personal information by the government.The U.K. Department of Health admitted this weekend that nine of its regional NHS trusts have reported losing patient data. One of the trusts, the City and Hackney Primary Care Trust, in east London, lost the medical records for about 160,000 children, according to newspaper reports. The total number of records has not been disclosed.The losses emerged as part of a wider review following similar government blunders, and have revived questions about the security of building a centralized patient records database, part of the U.K.&#39;s National Programme for IT (NPfIT). But David Nicholson, chief executive of the NHS, said the project is essential and should go ahead.&quot;It&#39;s vitally important that when a doctor is sitting in front of a patient they have all the information they need at their fingertips, and that&#39;s what&#39;s been driving us through all this,&quot; Nicholson told BBC Radio 4&#39;s Today program on Monday.The proposed system will not be a single large records database, but a series of interconnected regional databases, he said. And the security system will be more rigorous than that used with most Internet banking systems, according to Nicholson.&quot;You&#39;d need a user name, a password and a smart card [to access patient records] and you would have role-controlled access,&quot; he said. &quot;So a nurse on a ward with a smart card and a password could only access a relatively small number of patient records.&quot;The information that was reported lost over the weekend was encrypted and so not vulnerable to misuse, Nicholson said.But Ross Anderson, a security expert at the University of Cambridge, told Radio 4 that whether the data is encrypted is not the main issue.&quot;One of the questions you have to ask here is not whether the data was encrypted or password protected, but why someone was able to have access to 160,000 children&#39;s records,&quot; he said. &quot;In private industry ... if someone tried to make off with hundreds of thousands of records the alarms would sound.&quot;Opposition leaders pounced on the latest misstep as evidence that the Labour government can&#39;t be trusted with its citizens&#39; data. They called for further studies to show how the proposed patient records system would protect privacy.The incident comes after the U.K.&#39;s HM Revenue and Customs lost personal records for 25 million Britons, and the Driving Standards Agency lost records for more than 3 million learner drivers.&quot;The power of technology means it can be very easy to use the information, but also very easy to lose the information,&quot; the Information Commissioner Richard Thomas said on the Today program. &quot;The events of the last few weeks have woken up everybody to the importance of taking these matters seriously.&quot;&#160;
288013
By Jeffrey Kelley, Richmond Times-Dispatch, Va.  Jun. 18--Virginia Commonwealth University Health System is installing a network that allows doctors to exchange electronic medical records wirelessly and patients to send e-mail and use the Internet from bed.
434978
WASHINGTON - 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.   "If privacy protections aren't built in at the outset, there could be harmful consequences for patients," said Emily Stewart, a policy analyst at the Health Privacy Project...
718013
When folks in the health-care field start crapping all over a major data collection institute such as the Canadian Institute for Health Information, you know that they&#39;re a little on the defensive.
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?"
452377
Doctors in Massachusetts would be able to access patients&#39; records from any hospital or clinic in the state by computer under an initiative announced Monday.
645501
HIMSS 2007 -- In just over a decade the Internet has changed the way they manage their health and helped make them healthier, a sizeable group of Americans report. But they complain that physicians haven't really embraced e-Health and aren't offering the online health services that they want.
50356
Questions, questions, questions The third annual Care Record Development Board get-together got underway yesterday (Thursday), bringing together "key stakeholders" in the government's proposed digitising of the UK's medical records.â¦
534442
NHS IT - money, well, spent... The NHS's new Choose and Book system, it says here, is a "national electronic referral service which gives patients a choice of place, date, and time for their first outpatient appointment in a hospital or clinic." Ever wondered why they're called "patients"? Well, in recent weeks The Register's Mystery Croaker has had the opportunity to road test Choose and Book, and to find out.â¦
442452
WASHINGTON - Medical milestone or privacy invasion? A tiny computer chip approved Wednesday for implantation in a patient's arm can speed vital information about a patient's medical history to doctors and hospitals. But critics warn that it could open new ways to imperil the confidentiality of medical records...
723587
Five major US corporations have joined forces to create a "medical Internet" on which some 2.5 million workers can bring together their personal health records in one secure location, providing access to everything from prescriptions and cholesterol readings to medical histories.