In the past three years, 21 million people had their sensitive health records hacked in breaches that were significant enough to be reported to the federal government.

The actual number is likely far higher; millions of smaller hacks likely went un-reported. The Office for Civil Rights reported that (the “OCR”), from 2009, 477 breaches affecting 500 people or more were reported. In total, the health records of 20,970,222 people were breached, according to the OCR’s website.

At CloudBeat, we’ll be debating this in several ways. First, a panel of healthcare-technology experts will gather discuss ways to improve security for cloud-based systems. In this sector, there are still significant questions and concerns: Cloud security, cloud encryption and HIPAA requirements regularly top the list.

In the past, the most sensitive records were stored on film, tape and paper charts. As data gets digitized, hospitals, physician practice groups, software and hardware companies, consulting firms and affiliated health care organizations are grappling with how to keep it secure.

Second, we’ll be inviting the major healthcare record and billing company, McKesson, to discuss how that $22 billion company is applying new big data initiatives to its data, using things like SAP’s Hana in-memory database platform in the cloud.

(CloudBeat is unique with its emphasis on customer case-studies. It’s not abstract theories and ideas — executives will reveal their hard-frought solutions to very real technology problems.)

Get it right, and the opportunity is enormous: market and legislated demand has created $35 billion health IT market which is growing at a rate of 20% year-on-year. In the U.S. alone, approximately 900,000 healthcare providers are migrating electronic health records.

So join us for the panel to learn how Scott Whyte, Vice President of IT Connectivity at Dignity Health, the fifth largest hospital provider in the nation and the largest hospital system in California, is addressing the “perfect storm” of challenges facing today’s healthcare providers and how they are using cloud computing to help solve these technical issues.

The audience will learn about Dignity Health’s journey toward HIPPA-compliant cloud infrastructure technologies in order to meet the growing needs of hospitals and healthcare delivery partners across the country — as well as the cost savings associated with this technology leap to the cloud.

Whyte will be joined by Darin Brannan, president and CEO of ClearDATA, who will address the key technology, regulatory and privacy issues facing the various constituents in the healthcare supply chain. The panel will be moderated by VentureBeat’s own executive editor, Dylan Tweney.

In the McKesson case, we’ll discuss how its big data initiatives are letting it process its ERP and financials faster than ever before, allowing it to analyze this data realtime to track which of their customers are profitable and which ones aren’t, and to make recommendations on how to make them more profitable. The session will be moderated by VentureBeat editor-in-chief, Matt Marshall

Healthcare is a hot topic: as the market matures, more mainstream cloud providers will introduce solutions specifically designed for this vertical.

Top image via Shutterstock

Despite the huge disparities in approach, each country’s current desires in regards to changing their healthcare situation are fairly equivalent. Both nations are working towards getting better value from healthcare expenditures, encouraging providers to focus on quality with better incentives, and controlling rising health care costs, regardless of the differences in who is paying.

Telemedicine offers both systems huge advantages in the pursuit of these goals, and the two can learn from one another. In the US, telemedicine has helped curb unnecessary and irresponsible healthcare spending, an important consideration for a nation currently obsessed with combating rising costs detrimental to its economy. Abroad, electronic patient care records are managed efficiently, falling in line with the expectations of the unified, government-controlled National Health Service (NHS) responsible for administrating healthcare.

It is important to keep in mind the great differences in context between the implementation of telemedicine in the United Kingdom and here at home. Of course, the NHS provides citizens with what we have dubbed as “Universal” health care, which is free to the patient at the point of service. In contrast to the Brits’ centrally governed and tax-funded system, care in the US is available through a multitude of competitive providers and is paid for by a patchwork of public and private insurers. The fact of the matter is, telemedicine works as a solution to a myriad of challenges, and both countries are discovering new solutions every day.

Healthcare officials in both countries envision telemedicine playing prominent roles in the future of their respective systems. Perhaps in the short term, this vision will be a common ground on which to open a mutually beneficial dialogue to address the unique challenges facing each nation.

Hosted by the London School of Economics on 18 April 2012, the 12th Social Study of ICT workshop (SSIT12) looked at the past and the future of Healthcare Information Technology (HIT). The workshop series is organised by the Information Systems and Innovation Group.

The keynote speakers focused on such questions as “how helpful is information technology for patients, practice, or payers?” and “the important role of ‘open’”.  Both speakers, Ross Koppel, University of Pennsylvania, and Bill Aylward, Moorfields Eye Hospital NHS Trust, highlighted the problem of closed systems and the feeling of being held hostage by HIT vendors.

Ross Koppel gave a lot of examples of bad UI design of healthcare information systems with sometimes deadly consequences, e.g., when the dosage is calculated wrongly. He showed how people work around software issues with again sometimes bad consequences for patients.  Bill Aylward then focused on ideas of openness and transparency in open source development and bug tracking as a way of dealing with quality issues. Developers and HIT users are often very far apart during software development. Open Eyes shows how to bring them closer together in an open source project.

For Bill Aylward HIT should be more like air traffic control software with problem-focussed user interfaces and swift response times. HIT instead has its data all over the place which requires its users to wait 2-6 minutes in average for just opening a patient record. His vision: an ecosystem of apps like on iOS devices such as the iPhone where data is shared but apps are independent.

The other speakers explored the “consequences of using electronic patient records in diverse clinical settings” (Maryam Ficociello, Simon Fraser University), viewed “evaluation as a multi-ontological endeavour” (Ela Klecun, LSE), and took us on a “Journey to DOR: A Retro Science-Fiction Story on researching ePrescribing” (Valentina Lichtner, City University).  The last session closed with talks on ”Real People, Novel Futures, Durable Presents” (Margunn Aanestad, University of Oslo) and ”Awaiting an Information Revolution” (Amir Takian, Brunel University).

The speakers provided lots of evidence for the need of software that can explain (at least some of) the design rationale of the software engineer in order to bridge the gap between software engineer and user. Bringing them together like in the Open Eyes project is one way of dealing with the issue. But not all users can be included in the development. New users will not know about the design rationale and will not have access to the respective software engineers. This is where explanation-aware software design (EASD) comes into play. EASD aims at making software systems smarter in interactions with their users by providing such information as background information, justifications, provenance information.

Workshop programme

This conference will focus on learning from those who have effectively developed EPR systems at NHS Trusts. Chaired by Sean Brennan, Independent Consultant in Healthcare Informatics topics will include:

• EPR models and progress to date
• Electronic Patient Records National Update
• Clinical systems and EPR driven by clinicians for clinicians
• Best of breed EPR: capitalising on what you’ve got already
• An in house solution that gives the clinicians what they want
• EPR and the national programme: our story
• EPR and patient safety
• Integrated EPR: A Clinical Portal
• Preparing for EPR: are you ready?
• Looking ahead

Medical Recruitment Agency – Doctors, Nurses, Radiographers, Physiotherapists and Occupational Therapy Jobs

At work also, in busy London NHS hospitals, I am at my computer throughout the day. At every hospital, blood results and radiology images are accessed via a range of computer systems. Patient discharge summaries are often computerised, as are appointments, scan requests and blood test forms. Indeed, there are many hospitals throughout the world who have gone one step further, and have computerised everything, including drug charts, vital signs and the all important patient notes.

“Wonderful!” I hear you say. And so say the pundits on the radio this morning, celebrating University Hospital’s Birmingham’s findings that their advanced IT systems could save 17,000 lives if rolled out nationwide, and have halved medical errors. Whilst I applaud any innovation which aids patient safety, my first response to this announcement was mixed.

Technology and computers are not intrinsically good, indeed poorly designed, inappropriately deployed IT systems can cause more trouble than they are worth. On the flip side, when design and technology mesh precisely with a user’s needs, then the results are truly game-changing. Just look at Apple, a company whose serial revolutions in computing (desktop navigation with a mouse, the PC, the iPod, the iPhone, the iPad, Apps) were not technological developments, but frame-shifts in design which allowed people to use technology in new and exciting ways.

My current hospital was a pioneer in IT, and has one of the earlier online prescribing systems, which is integrated with the blood results, investigation requests and discharge summary software. There is no doubt that it does offer some huge benefits to patient care. Nurses, pharmacists and doctors can all access the same data remotely, rather than all competing for the same paper drug chart. Drug names and doses cannot be misread due to poor handwriting. Auditing administration of medications is simpler. Therapeutic drug monitoring is integrated, and less error-prone. Drug charts need never be re-written as they are never lost, damaged or run out of room! What an ideal system!

Except… it is not perfect. As always, it is not the technology, but the design. Computer drug charts have changed the way doctors interact with the drug chart, and not completely for the better. In the ‘old days’ (i.e. last year, at my previous hospital), whenever I saw a patient on a daily ward round, or popped to see a patient, I would quickly grab the paper drug chart at the end of their bed, and review their medications. You could see, at a glance, all the medications a patient was on, and whether they had been given, and if not, why not. Careful reviewing of medications became a daily task, instinctive and quick. Paper worked.

Now with our computer charts, teams do not review medications as often, or as carefully. This is because barriers have now appeared between the doctor and the drug chart. You have to find a computer, and log in. You have to try to find a tablet computer, and get it to work with the wi-fi. You have to show the tiny screen to all the members of the team. Instead of being able to see all the medications at once, you have to scroll down the list to see all the medications. You have to access a different screen to see discontinued medications. You have to access a different screen to see if medications have actually been given. Overall, I am a fan of the online prescribing, but in my experience it is not a panacea for medical error. Imperfect design, not technology, is the barrier to better patient care here, with a computer system which lacks some of paper’s flexibility.

Sometimes, technology is not just a mixed blessing, but a curse. My hospital trust as developed an automated switchboard system with voice recognition. Cool! Not cool at all. I wanted Tissue Viability, Not Tessa Lyall. I wanted the speech therapy bleep number, not their landline extension. It is a terrible system which fails in its simple task of connecting people correctly and quickly. When you do hold for an operator, you wait minutes for the poor person at the other end who covers several hospitals, and who does not know the hospital well and so often cannot help you.

In comparison, the ‘backwards’ hospital I worked in previously employed several operators in switchboard. They had worked their for years, knew the hospital, the staff and the systems. They were colleagues, who you recognised and would say hello to, and who would work hard to solve your problems. They were flexible, intelligent, and knew what you meant by Tissue Viability. Here, the old system worked much better than the current one.

The final destination for computerised patient care is a fully electronic patient record, including electronic patient notes. My hospital has a brilliant system of comm. notes, where health care professionals can make short notes about a patient remotely, which are saved in perpetuity. It complements the written notes (although throws up the problem of having two records, and not knowing where something is recorded). However, fully computerised notes must be designed around how people need to use them. When I pick up the 3 inch think notes of a patient, I can summarise all the salient points in maybe ten minutes, by being able to quickly skim through old clinic letters, clerkings, doctor’s summaries, plans and reviews, because I can quickly recognise what is important to me at that time, and what is not. I can get a great deal of information from doctors’ pictures; diagrams of respiratory or abdominal examinations, drawings of injuries to legs or hands or faces, and surgeons’ intra-operative diagrams of anatomy.

When hospitals implement computerised notes, as I am sure they will, we must be sure that the design is as good as the technology. We must make sure that we can draw, and freetype and skim-read, and see information graphically, and categorise it easily, just as the human brain can do with a set of paper notes. We must also make sure that the infrastructure is there, that computers are fast, and reliable, and available. Systems must be flexible, and modifiable, so when the inevitable sea of problems arise, they can be quickly and smoothly ironed out.

Birmingham should rightly be proud of their developments, and I am a supporter of all technology that allows healthcare professionals do their jobs more safely and effectively. I am proud to work in a hospital which has embraced technology. But we should all be cautious about implementing systems without considering their design. We need to be like Apple, creating technologies which seamlessly fit into clinicians’ working lives. If we do so, the benefits to patients will be incredible.

The United States government is moving towards putting patient records online, but if an electronic patient records program is going to succeed in this country, program administrators need to have the cooperation of a wide variety of individuals throughout the organization.  Ultimately, this is what makes the individuals feel as though they are key stakeholders in the outcome of the project.  Involvment from other departments of the organization (i.e. legal, human resources, operations, etc.) will ensure that the program is comprehensive enough to sustain its overall objectives for the long-term.

Follow this link for the full text

Date of publication: 8 September 2011

Publication type: News story.

In a nutshell: NHS South East Essex has created a shared electronic patient record across primary, secondary and community care for patients with COPD.
With patient consent, clinicians at Southend Hospital update records using GP codes. They can then share the information with community services, including specialist respiratory and long-term care services, by email.

Length of publication: 1 web page

There are, of course, ethical considerations. Maintaining patient confidentiality is key, and data needs to be securely stored. Obtaining individual consent for retrospective use of data not is pragmatic for the researcher, but some patients may rightly object. These are not small considerations.

But it can be argued that it’s unethical not to use this data. Say I have a hypothesis that a particular surgical procedure is causing harm. I could set up a study and recruit the relevant patients, getting them to sign consent forms. I may not plan to collect any data beyond what is already in the care record. It might take me 5 years to recruit enough patients to help me answer the question. Alternatively, I could look at the last five year’s worth of existing data. Patients would not need to be hassled, admin costs could be avoided and spent on other research, answers could be found sooner, and clinical practice improved to provide better care without such a long delay.

There are things we can do to protect patients. I will never see directly identifiable data such as names, addresses and NHS numbers, for example. To have access to data from which a nosey person could deduce identity (e.g. by combining birth and death dates with the first part of the postcode) requires justification and extra safeguards. The actual data is a lot drier than you might imagine, and the identity of individual people behind the records is far from my mind as I’m grappling with statistical package commands.

There’s a lot of potential here. The technology is available, and the methodology is there, although there are areas for improvement in its deployment. The governance, however, hasn’t quite caught up. To do this kind of work, one must (quite rightly) apply to an ethics committee for approval. Any researcher can tell you that ethics application forms are long, repetitive and at times puzzling, but at least if you’re setting up a clinical trial the questions are well-tailored. The kind of work I will be doing does not fit neatly into some of the standard questions, which makes the ethics application process somewhat confusing, especially as the data is from a nationwide database, and ethics and governance structures tend to have a local focus.

Just to add to the fun, my lack of NHS or university contract requires me to obtain a ‘research passport’. The first trip to HR with a bundle of paperwork enabled me to prove that I don’t have a criminal record (a fair request). The second trip included presenting paperwork from occupational health not only declaring me fit for work but listing all my vaccinations. I thought that was the end of it, but apparently the next stage is to get the form signed by the ‘relevant NHS trust’. Is that the trust in which I live? The two who are partners on the grant that funds me? The one in which the clinical lead of the database I will work with is based? Or every trust in the country, given that the data is nationwide? These processes aren’t clear, and finding the right person to give the correct answer is not always easy.

In the same way that the specific ethical considerations of, say, clinical trials, are reflected in how they are governed, I think there is a need to refine the process for working with electronic patient records, as this work will become increasingly common. There is a risk, otherwise, that the broad focus of these processes will distract from some of the issues more pertinent to this area.

Follow this link for the full text article

Date of publication: November/ December 2010

Publication type: Article

In a nutshell: The introduction of an end-of-life care register will provide a mechanism for a much more precise measure of activity involving palliative care services. Given the current economic climate in the UK, there will be considerable pressure to examine the efficiency of service delivery, and the necessary service redesign will have to produce both measurable savings and an increase in quality and safety. The author suggests the use of Electronic Patient Records (EPR) will demonstrate that the adoption of new technology brings better and safer care, and can act as a model for the modernisation of other services

Length of publication: 1 page

Several major hospitals have already said positions will go and more announcements are expected to follow detailing further job cuts. This cull of jobs will undoubtedly have a huge impact on patient care within the NHS and yet there are many cost effective solutions that could be introduced to allow the NHS to make substantial savings without large cuts to staffing.

Already many NHS Trusts and Boards in the UK are using digital dictation and speech recognition solutions to boost administrative efficiency, with the result being significant time and cost savings. At Voice Technologies, we have developed our own digital dictation software, WinVoicePro, which provides NHS staff a solution to meeting the healthcare targets, as well as budgets.

The system offers benefits to doctors, clinicians, typists and, most of all, patients, who receive medical correspondence much sooner. With documents being sent electronically for review and sign off either internally or externally, the delays of printing and distributing can be avoided. Letter templates are created through use of an automated system that links with Electronic Patient Records or Patient Administration Systems to save typists’ time in formatting templates.

For more information on WinVoicePro click here.

www.voicetechnologies.co.uk

Fade Fave: use of electronic patient record (EPR) system data for emergency care, quality improvement and research – things not to take for granted

Fade Skinny: This issue continues the discussion within our journal about how we can legitimise the use of the routinely collected data for research. We have some of the best long-term computer records in the world – which are potentially goldmines for research. However, we are currently working through how to codify this process.

(NHS Athens is required to access this article online)

Fade Fave: First official citywide electronic record system for patients is launched in London

Fade Skinny: Electronic summary care records with crucial medical information about patients are being launched across London this week. The rest of England will follow during next year.

(NHS Athens is required to access this article online)

As HITECH swings further into motion, the time has come for the healthcare industry and its constituents to prepare for the impending changes. The beginning stages of HITECH’s strategic plan calls for tighter requirements in regard to security and privacy. As a result, the framework of HIPPA will be redefined in accordance to more stringent compliance requirements.

Global MedData is staying on top of the new developments to ensure continued compliance with HIPPA, and supporting customers through the process of change.  As pioneers of leading-edge technology, GMD understands that progress is an art form. The company has been driving healthcare change through timely, innovative, and intelligent technology solutions for 10 years.

“The time is ripe for innovation while ensuring compliance with the HITECH Act,” says Ravi Narayanan, CSO of Global MedData.  “Leading healthcare constituents talk to us at GMD when they want to stay on top of regulatory and EHR compliance developments. They work with us since we understand and provide insights and changes they can make today to their internal processes and systems.”

Global MedData is a provider of digital transcription services and modular EHR to physician practices, clinics, and hospitals in the U.S. and the National Health Service facilities in the U.K.

For more information or for a free trial—email us at sales@globalmeddata.net

The Obama administration’s ambitious plan to accelerate the adoption of electronic patient records will be a “steamroller” that drives the consolidation of the health technology industry and threatens many small physician practices, predicts Leonard M. Fuld, head of a large competitive-intelligence firm.

In an interview on Wednesday, Mr. Fuld summarized the conclusions of a “war game” his firm organized last month, “The Battle for Healthcare Information,” and added some postgame observations of his own.

The 35 participants in the business strategy-and-forecasting exercise were students from four graduate business schools — the Wharton School at the University of Pennsylvania, the Graduate School of Business at Columbia, the Sloan School of Management at the Massachusetts Institute of Technology and the Kellogg School of Management at Northwestern.

The government’s $19 billion plan to hasten the use of electronic health records in hospitals and doctors’ offices is intended to improve care and curb costs. But the government pump-priming will also set off an acquisition spree as large technology companies buy health information-technology specialists to grab market share, the war-game participants concluded. Allscripts, Epic and Cerner, they said, could well be targets for larger companies like I.B.M., Microsoft, Oracle and McKesson.

Hundreds of thousands of doctors in small practices, Mr. Fuld said, will be forced to join larger groups in part because of the expense and complexity of adopting computerized health records. “It’s an unintended consequence, I think, of the administration’s policy,” Mr. Fuld said. “Many doctors don’t like computerized health records, but they know they have to adopt them over the next several years.”

The computerized record technology, Mr. Fuld predicts, will be “a steamroller” that changes the organization of American health care.

SOURCE: NY TIMES

The HIT components of the stimulus package converged to form the Health Information Technology Act for Economic and Clinical Health Act (HITECH Act).  HITECH authorizes $20 billion in grants, loans, and incentive payments in an effort to meet the substantial challenges of implementing a new digital infrastructure head-on. 

Beginning in 2011, incentive payments for physicians and hospitals participating in the Medicare program will be eligible to receive a capped amount of $15,000 for the first year of participation contingent upon demonstrating that they are “meaningful EHR users” of certified technology. This means they must submit “quality measures” and other reporting information on the use of EHR to the Department of Health and Human Services.  Each successive year beyond 2011 decreases available allotments; $12,000 for the second year; $8,000 for the third year; $ 4,000 for the fourth year; $2,000 for the fifth year and $0 for any succeeding years.

Fewer than 17% of doctors and 10% of hospitals have full-fledged EMR systems in place due to a myriad of obstacles:  their affordability, the lack of uniformity among software, the daunting technical and logistical challenges of installing, and maintaining, and updating them, the potentially dangerous disruption to clinical practice and patient care, and concerns about the security and privacy of electronic health information. 

Even with the new federal incentives in place, most independent physicians and small practices may not be able to afford the cost of buying in-house systems. Health information technology and solution providers like Global MedData can make it extremely cost effective and simple to deliver a targeted and timely system to all constituents of health care; including the patient themselves. 

“Global MedData can help doctors leverage their existing legacy data through customized EMR systems reinforced with open standards, interoperability, and seamless integration,” explains Global MedData CSO, Ravi Narayaran.  “Our user interface ensures consistency and accuracy while streamlining operations of workflow management and improving quality of patient care.”

Global MedData is a provider of digital transcription services and HER to physician practices and clinics in the U.S. and to the National Health Service Hospitals in the U.K.  For more information email us at: sales@globalmeddata.net  

Sources:

 http://content.nejm.org/cgi/content/full/NEJMp9091592

http://www.bassberry.com/communicationscenter/newsletters/

Cisco’s virtualization push could benefit consumers

E-prescribing to soar with new spending

Future shock: The PC of 2019

http://en.wikipedia.org/wiki/Electronic_medical_record

http://abcnews.go.com/print?id=6606536

http://www.dotmed.com/news/search.html/?search_author=79468&key=Joan+Tombetti

http://foxmeadowselectronicmedicalrecords.blogspot.com/2009/02/president-obama-continues-to-push-for.html

Asking patient consent, they argued, was destructive for research because it introduced selection bias. Those patients who agreed to take part in research would not be representative of the whole population from which they were drawn. So it was therefore necessary to give patient data to researcher without consent.

But this was not only necessary they said – it was also legitimate. This was because studies had shown that the vast majority of patients supported research instruments like the national cancer registry which records all cancer cases without asking consent. “Hold on”, thinks I, “if the vast majority of people support the instruments why are you bothering to compel people in the first place? If you are so sure that the public supports research, why not trust them to make up their own minds?”

Personally, I think that the argument that ‘no one minds doing X, so there’s no problem forcing everyone to do so’ is about as weak as they come. But it comes up more and more. Why not keep an eye out for it?

- Prevents privacy violations with digital data generated and collected by individuals and organizations
- Enables data sharing for data mining without worrying about revealing individual identity
- Facilitates compliance with various privacy regulations like HIPAA security rule*.

GTInc. is looking for Health-Care organizations that share patient data with external organizations for data analysis and clinical research. These organizations are vulnerable to data snoopers and miners who can easily abuse individual privacy with digital snooping or combining two data sources. Participation is FREE for limited time due to grant from National Science Foundation.

Please contact Luvai Motiwalla at 603-889-8833 or luvai@gti.com for more info.