Health care record needs cited at an IBM conference
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(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.
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IBM will supply Florida International University with hardware and software so the university can do research on how technology can be used to better protect patient privacy and reduce waiting room time.
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(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."
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US IT giant IBM and a number of research organisations have launched the World Community Grid, a global humanitarian effort that applies the unused computing power of individual and business computers to help address the world&#39;s most difficult health and
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(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?"
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IBM's global services organization is adding "health check" services to its repertoire of technical services for SOA deployments, looking to assist users dealing with issues resulting from poor planning or partnerships with inexperienced or so-called proprietary IT vendors.The company also is offering its "identity-aware ESB," which is an enterprise service bus that combines existing IBM products to provide identity management capabilities.Health-check services and software will be offered in two workshops to be held at customer sites, featuring specialized diagnostics and triage capabilities to help identify potentially unhealthy areas and recommend cures for problem areas."We try to bring a real breadth of capability from the best practices that we've learned into these workshops," said Marie Wieck, vice president of middleware services at IBM.With some clients, IBM has had to perform somewhat of a rescue mission after clients have done an initial application and then had problems with scalability or performance, Wieck said.Workshops, which are priced in the $50,000 range or less, include IBM SOA Applications and Services and Healthcheck Workshop and Infrastructure Healthcheck Workshop for SOA. Both are 2.5-day engagements intended for midmarket and large enterprises.The applications and services workshop is intended to provide assurance that an SOA can expand beyond pilot projects. Factors such as application reuse and service use will be assessed, as will identification of rogue services as part of a governance policy. Security also will be checked for service controls and identity management.The infrastructure workshop features an assessment of infrastructure supporting applications and services layers in an SOA. Elements examined include infrastructure flexibility, the ability to adapt to spikes in demand, and verifying SOA configurations for connectivity. A service management review ensures that services are being monitored.IBM's identity-aware ESB combines WebSphere ESB products with Tivoli security and identity management software to help ensure that access to information, services, and applications is protected. Auditing of identity and access activity is enabled."Identity management is very critical so that you can ensure that only the right people get access to these services," Wieck said.An analyst briefed on IBM's efforts lauded both the SOA and ESB programs."Customers who have started with a SOA need checkpoints to have an outside source assess what they are doing and how it compares to best practices," said Judith Hurwitz, president of Hurwitz &amp; Associates. "Companies are investing a lot of money, resources, and political capital on SOA, and management wants to make sure they are on track and doing the right thing."Governance is a huge issue for customers in regards to SOA implementation. This is especially true since SOA is as much a business strategy as it is a technology strategy," Hurwitz said."In terms of ID-aware ESB ? clearly security and identity management are huge issues for companies because of governance issues related to security," she said.IBM offers information about its SOA programs at its Web site.Also on Monday, IBM is announcing an initiative to help business partners increase revenues and better serve customers. Grow Your Business (GYB) with IBM Software provides cross-brand sales scenarios across the IBM software group's product portfolio.The GYB tool recommends scenarios that utilize business partners' existing areas of expertise. Partners through the initiative can analyze software products, get descriptions of business value, and determine return on investment via an online tool. Information is aggregated into one place.An online guide to marketing and sales materials also is highlighted.
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Medical research often leads to unexpected breakthroughs in other peripheral areas.Based on the success being enjoyed by a project developed among a handful of leading pharmacy industry players, some experts say that you can add enhanced data security to the long list of advancements attributable to the health care industry.Founded in 2001, RxHub was the brainchild of three of the nation's largest pharmacy benefits managers (PBMs) -- companies responsible for handling the unseen legwork necessary to allow pharmacies to dole out prescriptions to eligible consumers, and for customers to employ their health care benefits to cover related expenses.Those companies -- AdvancePCS (since acquired by CVS-Caremark), Express Scripts, and Medco Health Solutions -- were looking for a way to better facilitate the massive volumes of data transfer needed to match customers with their medical, insurance, and payment records to cut costs and eliminate potential mistakes.In creating RxHub, a joint venture that serves as an electronic clearinghouse responsible for gathering the medical and benefits data needed to serve customers, people involved with the project claim that the pharmacy companies also pioneered an information-sharing model that other businesses may want to emulate to relieve their own data security headaches.At its core, RxHub claims to be a universal communication framework that links health care providers, insurance companies, the PBMs, and local pharmacies for the purpose of sharing electronic records and prescription data.One of the most attractive side benefits of the venture, backers claim, is that it in addition to streamlining that process, the effort has also helped the partners pilot a new manner in which to access and correlate sensitive information to protect the interests of the many businesses and customers they serve.Rather than forcing any of the firms in the prescription drug food chain to create additional databases for the purpose of providing records to their various external partners, RxHub serves in a data transport role that mines information from all the sources in real time to process transactions, without ever aggregating the information itself.Built around master data management software provided by vendor Initiate Systems, the RxHub infrastructure allows the involved parties to perform all the records validation work necessary for pharmacies to verify prescription and payment information in a matter of seconds, without demanding that anyone in the ecosystem create or retain any additional records.In doing so, the system allows the companies to live up to the demands of regulations, including the Health Insurance Portability and Accountability Act (HIPAA), while protecting themselves from potential data leakage incidents, RxHub executives said."The idea was to create a hub for all of this sensitive data without ever creating a master database where the information itself would be stored; we're more like FedEx, we look at the routing information, handle the package, and get it there reliably," said JP Little, chief executive of RxHub."We've been very careful about how we architected these systems and our business itself from the get-go in terms of not wanting to retain any data," he said. "This work was being done before we existed, but there was no hub; serving that role in the middle, the responsibility for security and controls remains with that various stakeholders, and the risk is lowered across the entire process."RxHub effectively specializes in real-time data mining, built on Initiate's Enterprise Master Person Index (EMPI) technology.When a patient requests a prescription at a pharmacy using the tools -- which currently cover an estimated 135 million U.S. consumers -- the transaction is pushed through RxHub, which in turn verifies the involved person's information wherever it is stored by the various PBMs and health care providers involved.Rather than creating a central record of all of that data, or storing any related information itself, the company merely delivers the relevant results regarding eligibility and payment details to the pharmacy, which can dole out the involved medicines and patient benefits.?By eliminating the need to create additional databases of patient information throughout all the businesses involved, both the companies themselves and consumers covered by the system are less likely to become victimized by leakage events or attacks, proponents of the system say."A hacker would need to break into one of the PBMs or some other element of the overall prescribing system to get this data, we don't actually have it," Little said. "The idea is to eliminate the need to create additional databases; we access the data needed to carry out the transaction from all these different sources, but we never retain it; that's the beauty of this type of an industry hub model."Officials with Initiate say that the distributed architecture approach being utilized by the pharmacy sector is catching on throughout a number of other areas within the health care industry, including some government projects.Driven primarily by concerns around HIPAA and other regulations in the health care sector, company officials said that similar mandates in other markets such as the financial services space and even the law enforcement industry are driving interest from other types of organizations."With this type of data mining, companies are able to tie together separate systems in a real-time environment without putting themselves at risk of a data leakage event or an attack on the information," said Scott Schumacher, chief scientist for Initiate."Companies can create centralized registries for these types of customer records that gather the data from source systems without ever disturbing it, or retaining anything that could be used to carry out fraud," he said. "We believe that along with a number of other benefits to business, this approach also creates a more dynamic security model for data sharing, and we're hearing from many different types of organizations today who have an interest in doing something similar."Schumacher said that Initiate typically competes for deals with IT industry giants IBM and Oracle, which have built similar systems for fostering secure information federation among business partners.And some industry watchers agree that the strategy adopted by RxHub in the pharmacy business could appeal to other types of firms, in particular retailers, as they struggle with issues of data retention, protection, and regulatory compliance."This type of approach is already being used in the public sector, intelligence community, and in the financial services industry," said Ray Wang, analyst at Forrester Research. "Whether it is tracking down suspects or identifying risk among credit bureaus, in effect, the idea is to find a quick match and link without the saving of data to ensure that no information is inappropriately saved, or can be leaked."
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Biogen presents at the JPMorgan Healthcare Conference.
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When Dr. Craig Cleveland returned to solo practice, he knew he&#146;d need efficient technology to help him manage patient care. His solution of choice includes electronic medical records and practice management solutions running on a Mac. It &#147;works exactly the way a doctor thinks,&#148; and helps him provide the best of care for his patients.
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Top US health officials asked families on Monday to use their Thanksgiving gatherings to discuss and record the medical histories of their parents, grandparents and other kin.
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SAN FRANCISCO  - IBM, Intel, Microsoft and other tech companies are increasingly betting that the health care industry will help them grow as their traditional markets mature. Microsoft CEO Steve Ballmer is to kick off a health care tech conference in New Orleans today. The health care Information and Management Systems Society show is expected to draw 900 exhibitors and 25,000 doctors, hospital staffers and others.
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IBM (NYSE: IBM) today announced that it has developed software interfaces that will make it easier for assistive technologies to provide those with disabilities access to advanced features in software programs -- such as editing functions, hyperlinks, charts and menus.
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InfoWorld - IBM's global services organization is adding "health check" services to its repertoire of technical services for SOA deployments, looking to assist users dealing with issues resulting from poor planning or partnerships with inexperienced or so-called proprietary IT vendors.
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IBM and the University of Florida are working on technology that lets doctors remotely monitor patient health.
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Digital patient records could become building blocks in a nationwide biomedical computer network for assembling and distributing up-to-the-minute studies of disease.
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IBM (NYSE: IBM) has contributed a new social computing software called 'Many Eyes' for use during the OECD (Organization for Economic Co-Operation and Development) World Forum on Measuring and Fostering the Progress of Societies, this week in Istanbul.
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An advocacy group representing several tech vendor CEOs has been meeting with U.S. presidential candidates and getting a positive reception to the policies it's pushing, the group's executive director said.ADVERTISEMENTIBM Information On Demand 2006Industrial Industry Leaders, please join us at IBM's premier information management global event, IBM Information On Demand 2006, October 15-20, Anaheim, CA. More IBM business and technical solutions content in one place than ever before! Select from  over 800 sessions. Register today!