Francis S. Collins, Director of the National Institutes of Health, talks about two new ways of getting disease treatments to market faster: Repurposing existing drugs, and testing on fabricated human tissue.

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Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, US Department of Health and Human Services gives an animated Ignite talk at last years Health Foo

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Even when it comes to their own health, consumers trust online information, with three in ten Americans reporting that they "always" or "frequently" turn to the Internet to find answers to medical questions and 65 percent of those seeking medical information online saying they trust the information, according to a new survey from Wolters Kluwer Health. Among consumers seeking medical information online, 63 percent claim to have never misdiagnosed themselves when using online medical information resources.

Easier access to online medical information may also have a positive impact on the doctor-patient relationship, with two-thirds, 67 percent, of Americans that seek medical information online stating that this has made them better informed as patients. Nearly half, or 48 percent, of consumers say they turn to the Internet to find answers to medical questions in order to be more informed about a medical condition before a doctor's visit. Interestingly, with so many consumers seeking medical information online, only 4 percent report having experienced "cyberchondria" - a term coined to describe how people become convinced that they have an illness or condition they don't actually have based on information they read on the Internet.

Findings come from a recent Wolters Kluwer Health survey conducted by IPSOS among more than 1,000 U.S. consumers ages 18 and older. Survey questions focused on uncovering consumer perceptions of and practices around using online resources and information to answer medical questions as well as exploring consumer self-diagnosis habits.

An earlier survey conducted in late 2011 (Wolters Kluwer Health Point-of-Care survey of more than 300 U.S. physicians, also conducted by IPSOS) shows some interesting comparison points between physician online habits and views and those of consumers. Like consumers, physicians also turn to the Internet for much of their information, citing general browsers such as Google and Yahoo as a frequent source of information for 46 percent of survey respondents. Professional journals remain the number one resource for physicians, however, used by 68 percent as a frequent source.

While consumers claim to rarely misdiagnose themselves, physicians will often change a diagnosis based on information they find online. In fact, 63 percent of physicians surveyed reported having changed an initial diagnosis based on new information accessed via online resources and support tools. Meanwhile, while most physicians believe easier access to medical knowledge by patients has had a positive impact on the doctor/patient relationship, one in five say that this has been detrimental, leading to misinformation and incorrect self-diagnosis.

"The prevalence of online resources and information in the healthcare industry has led to significant changes in how physicians and consumers alike research and access healthcare information and has even impacted how clinicians practice medicine," said Linda Peitzman, Chief Medical Officer, Wolters Kluwer Health. "Clinical decision support tools have changed the medical industry for the better in many areas, eliminating manual errors and measurably improving quality of care, but all resources are not created equal. This is why it's critical to always consider the source."

Among other findings:

Among Americans who would rely on the Internet to diagnose an illness, more than three-quarters (77 percent) say they would then discuss the information with their doctor to verify a diagnosis

Only 15 percent of Americans who turn to the Internet for medical information say they at least sometimes misdiagnose themselves

Twenty nine percent of those who go online for medical information, including 38 percent of those between the ages of 18 and 34, cite "accessibility" as the reason they would turn to the Internet versus visiting a doctor to diagnose or treat an illness

For more information on the survey and to download an executive summary of survey findings, visit http://www.wolterskluwerhealth.com/News/Pages/MediaSource.aspx .

Survey methodology for consumer survey

The Wolters Kluwer Health survey was a blind telephone Omnibus survey conducted by IPSOS of more than 1,000 consumers in the U.S. ages 18 and older. Interviews were completed March 9-12, 2012. Data were weighted to ensure the sample's regional and age/gender composition reflects that of the actual U.S. population according to data from the U.S. Census Bureau.

Survey methodology for physician survey

The Wolters Kluwer Health Point-of-Care survey was a blind, in-depth phone survey conducted by IPSOS of more than 300 physicians in the U.S. from a national sample of qualified AMA members. Respondents were nearly evenly split between Primary Care Physicians (PCPs) and Specialists. The specialist category included the following specialty areas: Anesthesiology; Cardiology; Emergency Medicine; Gastroenterology; Neurology; Nephrology; Obstetrics/ Gynecology; Oncology; Orthopedics; and Radiology. Interviews were conducted in August 2011.

via Wolters Kluwer Health

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With an investment of $1.9 billion from the Federal government Oregon is looking to save $11 billion in healthcare costs over the next 10 years. The $1.9 billion Oregon is receiving from the CMS for its CCO program will be spread out over five years with $620 million coming in July and roughly $320 million in years two through five of the grant.

Coordinated care organizations, also known as CCOs (an ACO with an Oregon Duck's cap on :) are the backbone of the reforms the Legislature put in place with the passage of House Bill 3650 and Senate Bill 1580 in the last two sessions. CCOs are expected to integrate the physical, mental and dental care of Medicaid patients by creating patient teams. Roughly 16% of the state's total population and 39% of its children are served through Medicaid.

For more on Oregon's healthcare transformation see: http://cco.health.oregon.gov/Pages/Home.aspx

Governor Kitzhaber and the Obama Administration announce an agreement in principle to coordinate care for Medicaid beneficiaries in Oregon, through a new model of care that will reduce the cost trend in Oregon's Medicaid program by at least two percentage points within two years, achieving $11 billion in savings, while improving health outcomes.

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HHS Agencies Can Now Use ARCHeS Tool To Conduct Large Scale Analyses To Evaluate Health Spending, Treatment, and Effectiveness

To put high-powered mathematical analytics in the hands of its agencies, the U.S. Department of Health and Human Services (HHS) has contracted with Archimedes Inc., a healthcare modeling company based in San Francisco CA.  The contract will put the Archimedes model at the fingertips of its agencies, enabling them to research, analyze, and evaluate the effects of specific health care interventions more quickly and accurately.

 The Archimedes Model, developed initially with support from Kaiser Permanente, is the most advanced mathematical modeling tool available to answer complex questions on health and health care. Under this contract, HHS will make a new web-based interface called the Archimedes Healthcare Simulator (ARCHeS) available to its agencies, including the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, the National Heart, Lung & Blood Institute and the Food & Drug Administration in order to help better:

• Analyze prevention activities and management of chronic conditions for patients;
• Design guidelines, performance measures, and incentive programs, such as pay-for-performance;
• Assess technologies and compare the effectiveness of different treatments;
• Design clinical trials;
• Analyze and improve health processes;
• Forecast the costs of healthcare; and
• Estimate the cost effectiveness of interventions.

HHS’ ability to offer agencies widespread access to this revolutionary tool in clinical care and research was spurred by the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio, which, in 2007, provided a $15.6 million grant to support the creation of ARCHeS, which makes the Archimedes Model more accessible and affordable for public policymakers and nonprofit users.

“When we initially made this grant, I said that the development of ARCHeS would usher in a new era in medical decision-making that we believe has the potential to transform health and health care,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “By getting ARCHeS in the hands of HHS and all of its agencies, we’ve taken a very big step toward realizing that potential. Our goal has always been to create access to this innovation for the public policymakers and researchers best positioned to use it to inform decisions that will improve health and health care for all Americans. We now see that happening.”
 
“The quality and cost of health care are determined by decisions made by policymakers, physicians and others. To make those decisions wisely, decision makers need to know the consequences of the different options they face.  For a high proportion of decisions, the only feasible way to get the needed information is to use mathematical models that integrate existing evidence, and are validated against evidence,” said David Eddy, MD, PhD, Founder and Chief Medical Officer of Archimedes. “This agreement with HHS puts the analytical power of advanced health care modeling on the desks of decision makers in the federal government. By combining this tool with their own insights and experience, decision makers will be able to understand much better the effects of different policies, and be able to design policies that achieve the twin goals of improving quality and controlling costs.”
 
In one of a number of important analyses already performed by Archimedes, Kaiser Permanente used forecasts from the model as the impetus to launch a program to provide a bundle of aspirin, lovastatin (a cholesterol-lowering drug), and lisinopril (a blood pressure-reducing drug), to high-risk members.  This analysis was used in informing the implementation of Kaiser Permanente’s ALL/PHASE program.  The result was a more than 60% reduction in heart attacks and strokes over a two-year period.

As a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Patient Protection and Affordable Care Act, the use of modeling and simulation platforms is in high demand for policymakers and researchers.  Both of these laws include new requirements for use of data in the design of health benefits; comparative effectiveness of quality, cost, and outcomes; and evaluation of population health efforts. In March, the federal government launched a major research initiative in big data computing for a number of agencies, including the National Institutes of Health.

"The federal government sees a growing need across all of its agencies for innovative resources to aid in research, policy analysis and evaluation,” said Todd Park, former Chief Technology Officer for HHS, and newly appointed Chief Technology Officer to the United States.  "We’re excited that ARCHeS will now be available to staff across the Department of Health and Human Services. It gives us an important new tool to analyze a wide variety of health policy questions and quickly compare different scenarios and outcomes.”

For more information about the contract, go to:  here

via http://www.archimedesmodel.com

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Continua Health Alliance, the international industry organization dedicated to advancing personal connected health by promoting end-to-end, plug-and-play connectivity of personal health devices and establishing industry standards for interoperability, today announced the availability of its most recent Design Guidelines (2011, 'Adrenaline') to the public as a free download. The Design Guidelines were previously available only to Continua members during Interoperability Testing. Continua Design Guidelines help technology developers build end-to-end, plug-and-play systems more efficiently and cost-effectively by facilitating seamless connectivity between personal connected health products and services, such as smart phones, gateways and remote monitoring devices.

"Making the latest Continua Design Guidelines available to the public for free is an important milestone, enabling vendors to create devices that make the collection and sharing of personal health data convenient and secure for consumers and health care providers. Availability of our Guidelines will also promote creativity among systems integrators to develop novel solutions," said Clint McClellan, Continua Board President and Senior Director of Strategic Marketing, Qualcomm Life, Inc. "Our Design Guidelines are proven to decrease time-to-market and reduce development costs, further supporting the widespread adoption of personal connected health solutions.

2012 Design Guidelines: First Bluetooth Smart Implementations
Continua's 2012 Design Guidelines ('Catalyst') were available to Continua members in March 2012, and are currently undergoing Interoperability Testing. For the first time, Continua's Guidelines include products that incorporate Bluetooth Smart, the low energy technology at the heart of the Bluetooth v4.0 specification. The ultra-low power consumption, security, and reliability of Bluetooth Smart products makes them ideally suited for health and fitness devices, vital signs monitoring systems (i.e., heart rate, blood pressure, temperature) or on-body sensors. Continua plans to publicly release the 2012 Guidelines, at no cost, at the end of this year.

"Continua and the Bluetooth Special Interest Group worked together to make Bluetooth Smart fully compliant with open Continua selected standards, so that Bluetooth Smart devices and systems will be 'Continua-ready,'" added McClellan. "This will facilitate more efficient connectivity, advancing our vision to create an ecosystem of plug-and-play products and services for health self-management and health care delivery. Devices powered by Bluetooth Smart technology use a fraction of the power of Bluetooth Classic, and, in many cases will not require recharging for over a year, making this an important technology for health and wellness monitoring programs."

Continua Design Guidelines are developed by Continua and complete an eight month, internal pilot program before public release. Each set of Guidelines is subject to interoperability testing to ensure Continua certified products and services connect to other products or systems without restrictions or specific implementation. Continua issued its original Design Guidelines in 2008 and 2010, and is working to release additional Design Guidelines each year.

Continua Health Alliance also provides free test tools and access to Certified Continua Experts (CCEs) to help members certify their products, and offers a testing and certification program that actively supports technology teams seeking certification. Certified products display a recognizable logo that signifies interoperability according to industry standards. Continua certification enables more efficient, standardized development and new market opportunities for interoperable products such as smartphones, dedicated wireless hubs, the Internet and personal health devices that can be used to collect and relay vital health information and education.

About Continua Health Alliance
Continua Health Alliance is an international not-for-profit industry organization enabling end-to-end, plug-and-play connectivity of personal health devices and services. These services will empower information-driven health self-management and facilitate the incorporation of health and wellness into the day-to-day lives of consumers. Continua is a pioneer in establishing industry standards and security for connected health technologies such as smartphones, gateways and remote monitoring devices. Its activities include a certification and brand support program, events and collaborations to support technology and clinical innovation, and outreach to employers, payers, governments and care providers. With nearly 250 member companies reaching across the globe, Continua is comprised of technology, medical device and health care industry leaders and service providers dedicated to making personal connected health a reality. For more information visit: www.continuaalliance.org.

SOURCE Continua Health Alliance

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Where we live impacts our health, and while medical care is important, much of what affects health occurs outside of medical care settings. This is the message of the 2012 County Health Rankings, released today by the Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation. The project assigned a ranking to all but two of the 58 counties in California based on health outcomes and the various economic, social, behavioral and environmental factors that influence health. According to results, residents of Marin, Santa Clara and San Benito have the best health outcomes, while Siskiyou, Del Norte and Trinity are among the lowest. For the various health factors that can impact these outcomes, the strongest rates were seen in Marin, Placer and San Mateo counties, while Tulare, Kern and Yuba counties fell towards the bottom.

"The Rankings show that residents in Trinity County are almost three times as likely to die prematurely than those living in Marin County," said Mary Pittman, DrPH, president and CEO of the Public Health Institute (PHI), which is helping to promote the Rankings in California. "By highlighting these health disparities across California counties, the Rankings inform a larger and critical discussion about what can be done to reduce them." The Rankings offer a picture of the health status of nearly every county in all 50 states. In California, only Sierra and Alpine counties were not included due to data limitations. Using a well-researched model for measuring population health status, each county is given two rankings. The first ranking, health outcomes, is based on summary data for the average length of life and quality of life among county residents.

A second ranking is provided for health factors, which include health behaviors (e.g., smoking, diet and exercise), quality of and access to clinical care, socioeconomic factors, and the physical environment. According to developers of the Rankings model, health outcomes point to current health status while health factors provide an indicator of the future health of a county's population. Similar to last year, several counties in the Bay Area including Marin, Santa Clara and San Mateo ranked in the top five healthiest counties in the state for both health outcomes and health factors. Other high ranking counties include Placer County (#4 for health outcomes and #2 for health factors), San Benito County (#3 for health outcomes) and El Dorado County (#5 for health factors). Among the lowest ranking counties, those in the North Coast and Sierra Cascade regions (Lake, Siskiyou, Del Norte, and Trinity counties) have some of the poorest health outcomes, while counties in Gold Country (San Joaquin and Yuba) and the Central Valley (Tulare and Kern) had the lowest health factor rankings. For the full California Rankings report, visit: www.countyhealthrankings.org .

The Rankings are intended to stimulate conversation among California residents, health leaders and policy makers on the action steps they can take to improve the health of their communities. The data provide a "call to action" to make strategic investments in policies and programs that will improve the health of all Californians, no matter where they live.

In addition to supplying the Rankings, the Robert Wood Johnson Foundation awards Roadmaps to Health grants to counties to implement programs that improve the economic and social factors underlying a county's health ranking. The deadline for this year's funding is May 2 and an informational webinar will be held on April 10. For more information, visit: www.countyhealthrankings.org/roadmaps .

Last year three California counties received Roadmaps grants: Alameda County was funded to increase consumer-focused banking services, Shasta County executed a college preparedness campaign, and Contra Costa County implemented a reintegration program for former inmates. The Roadmaps to Health website offers an "Action Center" with free tools and resources to help communities take meaningful action towards health improvement. PHI will hold a webinar to further discuss how California counties can use the Rankings to inform effective public health action and to showcase last year's California Roadmaps grantees. More information will be available in the coming weeks. Check www.dialogue4health.org for updates.

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At White House event, NSF Director announces new Big Data solicitation, $10 million Expeditions in Computing award, and awards in cyberinfrastructure, geosciences, training

Hurricane Ike visualization created by Texas Advanced Computing Center (TACC) supercomputer Ranger. Credit and Larger Version

National Science Foundation (NSF) Director Subra Suresh today outlined efforts to build on NSF's legacy in supporting the fundamental science and underlying infrastructure enabling the big data revolution. At an event led by the White House Office of Science and Technology Policy in Washington, D.C., Suresh joined other federal science agency leaders to discuss cross-agency big data plans and announce new areas of research funding across disciplines in this field.

NSF announced new awards under its Cyberinfrastructure for the 21st Century framework and Expeditions in Computing programs, as well as awards that expand statistical approaches to address big data. The agency is also seeking proposals under a Big Data solicitation, in collaboration with the National Institutes of Health (NIH), and anticipates opportunities for cross-disciplinary efforts under its Integrative Graduate Education and Research Traineeship program and an Ideas Lab for researchers in using large datasets to enhance the effectiveness of teaching and learning.

NSF-funded research in these key areas will develop new methods to derive knowledge from data, and to construct new infrastructure to manage, curate and serve data to communities. As part of these efforts, NSF will forge new approaches for associated education and training.

"Data are motivating a profound transformation in the culture and conduct of scientific research in every field of science and engineering," Suresh said. "American scientists must rise to the challenges and seize the opportunities afforded by this new, data-driven revolution. The work we do today will lay the groundwork for new enterprises and fortify the foundations for U.S. competitiveness for decades to come."

NSF released a solicitation, "Core Techniques and Technologies for Advancing Big Data Science & Engineering," or "Big Data," jointly with NIH.  This program aims to extract and use knowledge from collections of large data sets in order to accelerate progress in science and engineering research. Specifically, it will fund research to develop and evaluate new algorithms, statistical methods, technologies, and tools for improved data collection and management, data analytics and e-science collaboration environments.

"The Big Data solicitation creates enormous opportunities for extracting knowledge from large-scale data across all disciplines," said Farnam Jahanian, assistant director for NSF's directorate for computer and information science and engineering. "Foundational research advances in data management, analysis and collaboration will change paradigms of research and education, and promise new approaches to addressing national priorities."

One of NSF's awards announced today includes a $10 million award under the Expeditions in Computing program to researchers at the University of California, Berkeley. The team will integrate http://amplab.cs.berkeley.edu/">algorithms, machines, and people to turn data into knowledge and insight. The objective is to develop new scalable machine-learning algorithms and data management tools that can handle large-scale and heterogeneous datasets, novel datacenter-friendly programming models, and an improved computational infrastructure.

NSF's Cyberinfrastructure Framework for 21st Century Science and Engineering, or "CIF21," is core to strategic efforts. CIF21 will foster the development and implementation of the national cyberinfrastructure for researchers in science and engineering to achieve a democratization of data. In the near term, NSF will provide opportunities and platforms for science research projects to develop the appropriate mechanisms, policies and governance structures to make data available within different research communities. In the longer term, what will result is the integration of ground-up efforts, within a larger-scale national framework, for the sharing of data among disciplines and institutions.

The first round of awards made through an NSF geosciences program called EarthCube, under the CIF21 framework, was also announced today. These awards will support the development of community-guided cyberinfrastructure to integrate big data across geosciences and ultimately change how geosciences research is conducted. Integrating data from disparate locations and sources with eclectic structures and formats that has been stored as well as captured in real time, will expedite the delivery of geoscience knowledge.

"EarthCube is a groundbreaking NSF program," said Tim Killeen, assistant director for NSF's geosciences directorate. "It represents a dynamic new way to access, share and use data of all types to accelerate and transform research for understanding our planet. We are asking experts from all sectors--industry, academia, government and non-U.S. institutions--to form collaborations and tell us what research topics they think are most important. Their enthusiastic and energetic response has resulted in a synergy of exhilarating and novel ideas."

NSF also announced a $1.4 million award for a focused research group that brings together statisticians and biologists to develop network models and automatic, scalable algorithms and tools to determine protein structures and biological pathways.

And, a $2 million award for a research training group in big data will support training for undergraduates, graduates and postdoctoral fellows to use statistical, graphical and visualization techniques for complex data.

"NSF is developing a bold and comprehensive approach for this new data-centric world, from fundamental mathematical, statistical and computational approaches needed to understand the data, to infrastructure at a national and international level needed to support and serve our communities, to policy enabling rapid dissemination and sharing of knowledge," said Ed Seidel, assistant director for NSF's mathematical and physical sciences directorate. "Together, this will accelerate scientific progress, create new possibilities for education, enhance innovation in society and be a driver for job creation. Everyone will benefit from these activities."

In addition, anticipated cross-disciplinary efforts at NSF include encouraging data citation to increase opportunities for the use and analysis of data sets; participation in an Ideas Lab to explore ways to use big data to enhance teaching and learning effectiveness; and the use of NSF's Integrative Graduate Education and Research Traineeship, or IGERT, mechanism to educate and train researchers in data enabled science and engineering.

A webcast of the Big Data Rollout was on the Science360 Web site on Thursday, March 29 at 2 pm ET.

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Office for Civil Rights (OCR) announced March 26 that the long-awaited rule updating Health Insurance Portability and Accountability Act has been sent to the Office of Management and Budget (OMB).  The omnibus rule, which covers four previously released proposed and interim final rules, is expected to take a full 90 days permitted for OMB review.    

The omnibus rule will include the final rules for the following: 

• the breach notification rule ( the interim final rule was released in August 2009);
• the final HIPAA enforcement rule (the interim final rule was released in October 2009);
• the final rule implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act’s changes to the HIPAA privacy and security standards (the notice of proposed rulemaking was released in July 2010); and
• a final rule implementing the Genetic Information Nondiscrimination Act’s modifications to HIPAA’s privacy rule (the proposed rule was released in October 2009). 

OCR Deputy Director for Health Information Privacy, Susan McAndrew, made the announcement at the 20th National HIPAA Summit.  If OMB does take the full 90 days for its review, the final rule will be issued in late June 2012.

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Health IT security is vital to protecting health information. Learn more about health IT security research in SHARPS at http://www.HealthIT.gov and http://www.SHARPS.org.

Across a variety of settings, the Strategic Health IT Advanced Research Projects on Security, or SHARPS, are creating mechanisms to protect patients and their information, including better security in pacemakers and insulin pumps, stronger protections for mobile health devices and software containing patient data, and auditing services to allow providers to track access to patient data.

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The CMS Innovation Center received approximately three thousand applications for the Health Care Innovation Challenge , representing tens of thousands of clinicians, information technology entrepreneurs, medical suppliers, health centers, hospitals, community-based organizations and individual citizens from every corner of the nation. As they review these proposals, they recognize that a diligent and thorough process means that final determinations of awards will not be possible by March 30, 2012, as stated in the Funding Opportunity Announcement. Therefore, the anticipated award date for this opportunity will be delayed by several weeks. Please note, that no determination will be made regarding a second round of funding until the first round of awardees have been announced.  

If you have any questions, please contact us at InnovationChallenge@cms.hhs.gov.

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Brochures will help consumers and clinicians better utilize PHRs to manage their healthcare

Key healthcare organizations are teaming up to help take the mystery out of using personal health records (PHR) by rolling out two new informational brochures to help promote the understanding and use of PHRs among consumers and clinicians. The new brochures:  "Your Personal Health Record," and "A Clinician Guide to a Personal Health Record," are available online at BCBS.com.

PHRs are valuable online tools for making better informed healthcare decisions and enhancing care coordination.  The brochures, which include screenshots of PHRs, user testimonials, and an informative Q&A, were created through a collaboration of healthcare groups including the Blue Cross and Blue Shield Association (BCBSA), the American Health Information Management Association (AHIMA), the American Cancer Society (ACS), the American College of Physicians (ACP), the American Diabetes Association (ADA), the American Heart Association (AHA), the American Osteopathic Association of Medical Informatics (AOAMI), and MGMA-ACMPE.

As recent reports show, when more healthcare data is available to consumers, their caregivers and doctors, it can help improve the coordination of care.(1)  By making these brochures available, key healthcare stakeholders hope to increase the adoption and use of PHRs by showing  consumers how they can use PHRs to store vital health information such as medical conditions, allergies, medications, and doctor or hospital visits in one convenient and secure place.  For clinicians, the brochures describe the benefits of using PHRs to help them deliver quality care to their patients and make their practices run more efficiently.

With PHRs, individual patients and their designated caregivers can take charge of their healthcare choices by viewing and managing their own health information.  PHRs also enable patients to quickly and readily share healthcare information with their providers, which allows for better tracking of chronic diseases and helps their provider determine the most appropriate treatment plan.

To encourage the continued growth of PHR usage, these brochures were designed to help improve consumers' familiarity and comfort level with PHR tools and encourage more participation and adoption.

For more information about PHRs or to download copies of the PHR Quick Reference Guides for consumers or providers, please visit www.bcbs.com/phr_brochure, http://www.aoami.org/phr_brochure.cfm or http://www.mgma.com/phrguide/.

(1) Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, "Personal Health Records: What Health Care Providers Need to Know", http://healthit.hhs.gov/media/about-phrs-for-providers-011311.pdf.

via BCBS

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The March 2012 issue of Health Affairs explores how the nation's progress in health IT adoption is progressing

Adoption of health information technology (IT) throughout the health care system is "on the march," according to Farzad Mostashari, the national coordinator for health IT. Nearly 2,000 US hospitals and more than 41,000 doctors have now met the standards for achieving meaningful use of health IT, and have received $3.1 billion in federal incentive payments as a result.

In an interview published in the March Health Affairs with David Brailer, the first national health IT coordinator, Mostashari predicts that 50 percent of primary care providers will have adopted basic electronic health record (EHR) systems within a couple of years--up from just 20 percent in 2009. He adds that 90 percent of hospital chief information officers say that meeting federal meaningful-use standards for EHRs is one of their top two priorities. And with the second stage of meaningful-use regulations now rolling out, Mostashari says the federal government's goal is to make sure that all of America's health care providers make the grade. "Our goal is to do whatever we can to see to it that no one gets penalized" for not using health IT in 2015, the year after federal incentive payments end and when providers who haven't adopted the technology and demonstrated meaningful use will face lower Medicare and Medicaid payments.

Additional papers in the March issue examine adoption of EHRs and other forms of health IT as well as ways to support the broad exchange of health information that is considered so crucial to transforming health care. The papers also highlight areas of health care where EHRs and other forms of health IT still have a minimal presence--and point out the limits of health IT in transforming care in the absence of other changes, such as payment reform.

The other papers in the health IT cluster are as follows:

• The importance of health information exchange. To capture the benefits of health IT, the information it captures, through EHRs and the like, has to get into the hands of the people who need it. That means, for example, that a primary care doctor needs hospital discharge data about her patient, so she can help manage that person's care and prevent her from being readmitted to a hospital unnecessarily. The sad truth is that there is little such electronic information sharing today in proportion to what is needed.

• In an article by Claudia Williams and colleagues from the Office of the National Coordinator for Health Information Technology (ONC), the ONC discusses steps it will take during 2012 to advance the health information exchange agenda. One example: leading the development of policies to advance "query-based exchange," such as when someone arrives at an emergency department with sudden chest pain, and a physician seeking information about the patient's cardiac history requests access to an EHR from another health care provider. The article notes that "giving every provider the means to securely send and receive patient information to support better care coordination [is] a top priority for 2012."

• Achieving ambitious goals for the adoption of EHRs and the nationwide exchange of health information will require overcoming a number of hurdles, writes Marsha R. Gold of Mathematica Policy Research and colleagues. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the trade-offs between sharing information electronically and still safeguarding patients' privacy and the security of their data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.

• One key goal of health information exchange is to use it to improve the health of individual patients as well as the health of populations--but to do so in a way that still protects patients' privacy. Robert Miller of the University of California, San Francisco, writes about nine principles for electronic information exchange formulated by 16 organizations representing patients and consumers in California and his study of whether five health care organizations were conforming to those principles in early 2011. His study found that there had been only modest progress in exchanging information among unaffiliated organizations, and that patients had little control over their data. He advocates establishing clear rules--for example, spelling out which data can be shared, how, and with whom--as well as launching campaigns to educate patients about health information exchange so that they will demand more of it from their providers.

• Federal and state agencies are investing considerable resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange data about patients' care across hospitals and physician practices. Could mergers of medical groups and formation of accountable care organizations reduce the usefulness of these community-based exchanges and lead to more use of private health information exchanges that would only share information selectively among providers? A study by Robert S. Rudin of the RAND Corporation suggests not because even the largest medical groups in a given community account for only a small percentage of health care transitions, so private exchanges would have little utility. On the other hand, the community exchanges will still need to recruit many medical groups in a given community to make sure they can perform a useful role in fostering information exchange among independent community providers.

Is the nation reaping the projected benefits of health IT? A number of papers in the March 2012 issue of Health Affairs focus on areas of the health care system in which health IT is not spreading fast enough, on some claimed benefits of health IT that don't always pan out, and on other steps that will need to be taken to capture other benefits.

• Federal meaningful-use incentives aimed at increasing EHR adoption are clearly having an impact on many hospitals and physician practices. But a large segment of providers--including long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals--are ineligible for those incentives and their rates of EHR use are "dismally low," according to a study by Larry Wolf of Kindred Healthcare and colleagues. Policy makers should consider other ways to encourage EHR adoption among these providers, the study authors say.

• A study by Harvard Medical School's Danny McCormick and colleagues raises questions about whether greater electronic access to imaging and lab test results will result in some expected health IT-related cost savings. The study found that--contrary to widely held expectations--giving office-based physicians electronic access to their patients' imaging and lab results did not decrease test orders; in fact, such access was associated with a 40 to 70 percent greater likelihood that imaging tests would be ordered. The findings "raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it," possibly because features of electronic systems actually encourage more tests ordering, the authors say.

• Since health IT is quickly becoming a fact of everyday care, physicians need to be trained in how best to use EHRs and other computerized tools. Pierce Graham-Jones of the ONC and colleagues propose a plan for incorporating health IT training into all levels of physician education and professional development, and suggest six opportunities for professional organizations involved with physician education and training to incorporate health IT-related learning and skills into their requirements.

• Most EHRs capture aspects of medical encounters between patients and practitioners, but only from the perspective of those practitioners or from payers. To understand and improve health outcomes, these records will need to incorporate information from patients about areas such as their health habits, including tobacco use and, in particular, their mental health or distress and any behavioral concerns. Russell E. Glasgow of the National Cancer Institute and colleagues argue that "patient-reported measures" covering these areas need to be incorporated into EHRs and outline a plan for adding them. Incorporating such measures will help build awareness that "the ultimate outcome that health care should be working to achieve is quality of life," the authors write.

via Health Affairs

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Study Finds Progress But Patients Need Greater Access To Their Electronic Medical Data & Stronger Privacy Protections

Healthcare organizations need to do more to help patients realize the full benefits of electronic data from emerging health information exchange systems, according to a new study commissioned by Consumers Union that appears in the March 2012 Health Affairs.  The study examines how well five major California health care organizations are meeting the needs of patients and communities in the use of their electronic data and offers important lessons for the rest of the country. 

"Electronic health information exchange holds great promise for improving patient care and outcomes," said Mark Savage, senior attorney for Consumers Union, the nonprofit advocacy arm of Consumer Reports.  "Health care organizations are making progress developing these systems but they must provide patients with greater access to their electronic medical data and the ability to monitor who is accessing this information to maximize benefits and limit potential privacy risks.  Patient and public health must be at the center of these efforts."

The study was funded by the California HealthCare Foundation and assesses the extent to which these efforts are meeting the needs of patients and communities based on a set of principles developed by California organizations representing consumers and patients.  The independent study was carried out by Robert H. Miller, Ph.D., a health economist and faculty member at University of California, San Francisco.

In June 2010, Consumers Union joined fifteen other organizations representing California patients and consumers to develop nine principles for electronic health information exchange.  The principles aim to improve patient and population health care by increasing the availability and use of patient data while protecting patients' privacy.

The consumer principles balance patients' various needs—for example, coordinating health care and information among the patient and diverse providers in multiple organizations; ensuring the security and privacy of personal health information; designing systems that can be easily used by non-English speakers and person with disabilities; and accessing safety and quality data about providers and treatments. 

The 2009 stimulus bill passed by Congress provided up to $27 billion in incentives for physicians and hospitals to adopt electronic health record systems.  The law also provided an additional $2 billion for activities that encourage meaningful use of electronic health information exchange.  It set a strategic goal of achieving electronic health records for every person in the United States by 2014.

In theory, electronic health information should enable a patient's providers to share information about the patient's health status and current medications and to remind themselves about services the patient needs.  The patient should be able to review health records via a web-based patient portal; possibly correct or add information; communicate with providers; view reminders of needed services; and access educational materials tailored to various health issues.  Despite its potential benefits, electronic information sharing can entail risks for patients, especially loss of privacy and misuse of data. 

The study examined five different health care organizations that collectively serve a full range of California patient populations:  Kaiser Permanente, Nautilus Health Care Management Group, Santa Clara Valley Hospital and Health System, Inland Empire Health Plan, and the Santa Cruz Health Information Exchange.   

Each organization is considered a health information technology leader for the patient population it serves.  The study found that the organizations relied on different approaches and were at different stages of developing their systems, which provided varying benefits to both providers and patients.  

Overall, exchange of electronic data among a patient's providers in different organizations was limited, which limited benefits to patients from the use of that data for their care.  Moreover, of the five health care systems evaluated, only Kaiser and Nautilus had patient portals that enable patients to review some of their health record data.  But neither organization had done much to inform patients -- particularly in their own language -- about patients' personal health information rights, remedies, and responsibilities.  Patients of the five health care organizations examined had little ability to monitor who was accessing their data. 

The study found that a lack of clear "rules of the road," including behavioral norms for health information exchange participants, legal agreements, and technical standards, was preventing quicker implementation of health information exchange systems that could benefit providers and patients alike.  Little progress has been made when it comes to using electronic health information to improve the health of the public and communities at large. 

The study recommends a number of policies to end the marginalization of patients and consumers in current health information exchange efforts.  For example, launching campaigns to increase health information technology literacy could increase patients' demand for health information exchange, forcing organizations to respond better to their needs.    

In addition, the study calls on state and federal governments to enact new policies that set timetables for organizations to offer patient-friendly web-based portals; create rules that enable consumers to easily understand who has accessed their information and correct data; and fund and publicize timely evaluations of health information exchange systems, including the benefits and risks for patients. 

SOURCE Consumers Union

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Eric Dishman, Director of Health Innovation and Policy, Intel Corporation spoke at the USRio+2.0 Conference hosted on Feb 2-4 at the Stanford Knight Management Center. He addressed an audience of international ministers from developing countries, technology and NGO professionals convened by the US State Department and the Stanford Graduate School of Business to discuss how connection technologies can support sustainable development.

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