News about EPR / EHR and PHS

Pilot Project Uses EHRs To Boost Reporting of Rx Drug Side Effects

Source: iHealthBeat – www.ihealthbeat.org
05 Jan 2009

Pfizer is partnering with two Boston hospitals on a pilot project to determine whether electronic health records can help federal regulators identify dangerous side effects of prescription drugs, the Wall Street Journal reports.

Massachusetts General and Brigham and Women's hospitals are encouraging 30 of their doctors to report serious medication side effects to FDA when they fill out patients' electronic charts.

Pfizer has agreed to pay the hospitals $226,806 for the project. In addition, the drugmaker has given $117,000 to support groups that developed the technology.

Physicians' reports on prescription drug side effects have been a key part of FDA's drug-safety efforts. However, studies indicate that only a small percentage of doctors submit the voluntary drug-safety reports.

According to the Journal , widespread use of the electronic reporting approach could make it easier and less expensive for pharmaceutical companies to meet some new monitoring requirements for FDA-approved drugs after they go on sale.

Expanding the Project - Supporters of the Boston project said it would not be difficult to expand the project to other physicians and hospitals that use EHRs because the technology already is developed and easily could be added on to an EHR system.

Eli Lilly is sponsoring a similar pilot at the Indiana University School of Medicine to determine if the Boston project could be easily replicated.

In addition, Pfizer has approached several other pharmaceutical companies about expanding the Boston project, according to Michael Ibara, a drug safety official at Pfizer (Rockoff, Wall Street Journal , 1/2).

Europe Launches Large-Scale Health Data Exchange Pilot

Source: iHealthBeat (California Healthcare Foundation Magazine)
06 Oct 2008

The project is akin to the building of a nationwide health information network, or NHIN, that is under way also in the United States .

A health data exchange pilot project in Europe aims to ensure interoperability among 12 European countries' e-health systems, Healthcare IT News reports.

Every member country has its own system of storing healthcare information, yet these systems often can't 'talk' to each other . Anyone who falls ill in one country should have access to his or her health information in other European countries, the epSOS team noted.

The three-year "European Patient Smart Open Services"(epSOS) pilot is being supported by the European Commission .

"Interoperability is obviously a key factor in this, and some countries struggle with interoperability within their own state, let alone beyond their boarders ," Fabio Colasanti, European Commission director general in charge of information society and media, said, adding, " With the epSOS large-scale pilot, we are trying to identify, then test, the relevant tools to make things happen ."

"The challenge of the increasing mobility of European citizens in the context of healthcare has been addressed by the European Commission ," said Fabio Colasanti .   "Together with the launch of its proposal for a 'directive on the application of patients' rights in cross-border healthcare, the issue of its July recommendation on the cross-border interoperability of electronic health record systems and the start of the epSOS pilot, the European Commission is laying the groundwork for improved healthcare options for traveling EU citizens."   The Swedish health ministry has been fundamental in setting up the epSOS pilot, he noted.

The goal of the epSOS pilot is "to improve patient safety. Citizens should be able to trust any healthcare system in any country they visit or work in," said Daniel Forslund , head of the section on e-health in Sweden 's Ministry of Health and Social Affairs.

The countries involved in the epSOS project are Austria , the Czech Republic , Denmark , France , Germany , Greece , Italy , the Netherlands , Slovakia , Spain , Sweden and the UK .   The plan is to connect what already exists. The countries will look at all of their systems for electronic health records and see what can be shared.

RELATED STORIES

09/11/2008 - British Doctors Group Calls for IT To Facilitate Cross-Border Care

09/09/2008 - HIMSS Task Force Details Worldwide EHR Implementation Trends

09/18/2008 - Global Thoughts on Waking the Health Care IT 'Sleeping Giant'

Physicians, Hospitals Need Access to EHR Systems

Source: iHealthBeat (California Healthcare Foundation Magazine)
7 Jul 2008

According to a Boston Globe editorial, recent personal health record initiatives are an important part of providing consumers with access to their personal health data, but what is "more important is getting doctors and hospitals connected into a single system."

Blue Cross Blue Shield of Massachusetts' recent agreement to allow its members to access their personal health records through Google Health is "part of a movement to put consumers in charge," but it is "unclear, however, whether patients want this control," according to an editorial in the Boston Globe .
"What's more important is getting doctors and hospitals connected into a single system," the editorial states. But "private companies are taking the lead on electronic health records because of the failure of many U.S. health care providers to embrace the Internet," according to the editorial.
The editorial warns patients about using PHRs, noting that patients should be concerned that they are not covered by federal privacy laws.

eHealth Collaborative

According to the editorial, "The most impressive [health IT] program" in Massachusetts is the " eHealth Collaborative ", which has established EHR pilot programs to connect physicians and hospitals in North Adams, Brockton and Newburyport, Mass.
The collaborative is funded through a four-year, $50 million grant BCBS. However, the grant will run out Dec. 31, and "there will still be much work to be done in the three communities," the editorial states.
The Massachusetts state budget's recent agreement to include $25 million to advance the creation of EHR systems "doesn't specify who should get the money," but the editorial states that the eHealth Collaborative should gain state support and identify other communities willing to participate in the EHR initiative.
The editorial adds that "$25 million won't buy much software or many computers," but the funds "will lay the foundation for a more expensive program requiring a combination of public and private funds"

Editorial:
U.S. Doctors Need To Catch Up With Others in EHR Adoption

Source:  iHealthBeat  (California Healthcare Foundation )
24 Jun 2008

If the U.S. "does not accelerate the conversion from paper" to electronic health records, "many of the gauzy promises of health care reform made by politicians and health planners will become irrelevant," according to a New York Times editorial.

The editorial cites last week's New England Journal of Medicine study, which found "a paltry 4% of the doctors [surveyed] had a 'fully functional' [EHR] system that would allow them to view laboratory data, order prescriptions and help them make clinical decisions, while another 13% had more basic systems."
The Survey represents a "startling contrast with other industrialized nations," including Australia, Great Britain, the Netherlands and New Zealand, where the majority of physicians use EHRs, according to a 2006 Commonwealth Fund survey -  the editorial states.

The editorial also highlights Denmark's comprehensive health information exchange, which allows physicians to view patient health and prescription histories "that most American doctors lack."

"Other industrialized nations have moved faster because of strong national leadership in setting standards and helping to finance adoption," according to the editorial.

In addition, both presidential candidates are urging greater use of health IT, and Sen. Barack Obama (D-Ill.) has even called for investing $50 billion over five years to help physicians adopt IT.

The editorial concludes, "It is time to drag private physicians out of the paper age" ( New York Times , 6/24).

Economic Impact of Interoperable Electronic Health Records and ePrescription in Europe

• study website: http://www.ehr-impact.eu/
• Call closed - 2007 /S 100-122426
  Complete Information (Invitation to tender, Tender Specifications, Template Service Contract, FAQ)

Legal framework of Interoperable eHealth in Europe

• Call closed - 2007 / S 139-171121
  Complete Information (Invitation to tender, Tender Specifications, Template Service Contract, FAQ)

Europe sets goal of EHR interoperability by 2015

In: Healthcare IT News (http://www.healthcareitnews.com/story.cms?id=9489)
07 Mar 2008
By  Bernie Monegain, Editor

BRUSSELS, BELGIUM - Europe is setting its sights on the interoperability of electronic health records by 2015. The European Commission on Wednesday issued a recommendation on cross-border interoperability.

The initiative is akin to work under way in the United States to create a nationwide health information network for sharing medical information throughout the country.

In its recommendation, the commission has put forth guidelines with a view to creating a minimum level of steps to ensure that an EHR can cross borders effectively within the EU.  These cover: emergency data and patient summaries, the sharing of data among different EU healthcare systems based on a limited range of applications already in use, and the building of networks that fulfill required legal, operational and educational aims .

The European Commission places responsibilities on member states that include research, inter-country dialogue, analysis of risks, provision of resources and implementation. It also calls for conformity in testing procedures for EHRs across the European Union.

"Travelling around the European Union is taken for granted until something goes wrong, (which) is why the EU's initiatives on e-health intend to remove linguistic, administrative and technical barriers, by making it easier for people to receive treatment even when they are away from their home country," said Viviane Reding , commissioner for Information Society and Media."I expect our recommendation to make an important contribution to saving patients' lives in emergencies."

"The benefits of interoperability are clear," said Ilias Iakovidis, deputy head of ICT (Information and Communications Technology) for Health."There will not be, and should not be, any monopolies within e-health - there are too many players. Industry needs to deal with interoperability as soon as possible ."

Iakovidis will address healthcare industry leaders on behalf of the European Commission at the World of Health IT Conference and Exhibition in Copenhagen later this year. (2008)

Australia - OpenEHR: The World's Record need

in Australia 's "Pulse+IT magazine"  ( http://www.openehr.org/)
by Heather Leslie, Nov 2007

In a world where connectivity reigns, our health information is largely still caught up in silos and, in the main, is not shareable by clinicians.

Shared electronic health records ( SEHRs ) are increasingly needed to provide timely, comprehensive and coordinated healthcare. Over many years there have been ongoing and thorough attempts to achieve the sharing of health information in order to support the improvement of health outcomes, but this incremental approach, gradually building on previous experience, has not been wholly successful. Progress has been made; however despite enormous investment and resources, the solution has been more difficult than most ever anticipated. Healthcare provision does not seem to fit into the same kind of data sharing model that has been successful in other domains, such as banking or financial services.

In order to support interoperability of health information, SEHRs need clinical content to be standardised . This supports standardised communication of complex health information between systems and the opening of these vertical domain and organisational silos, allowing accurate and semantically computable health information flow. Inevitably the shared clinical content specifications begin to influence the information models within clinical applications. open EHR is an electronic health record architecture based on many years of research and development, and is designed to work in partnership with all vendor systems, organisations and providers to facilitate semantic interoperability of health information. It is a comprehensive and transformational solution, which applies to the capturing and sharing of information from the most complex and dynamic knowledge domain – health.

Why Are Health Records So Difficult?

The problem is twofold – firstly, the evolving clinical needs and requirements for a SEHR are difficult to pin down, and secondly the technical issues related to a SEHR solution.

Why are clinical requirements so difficult to capture and transform into an electronic health record (EHR)? Certainly no-one will argue that our experience of healthcare delivery is changing – hospital in the home projects; supported self-management; patient requests for access to GP and hospital clinical records; personal health records; service coordination; clinical care plans; preventive health priorities... The list goes on, mirroring the rapidly evolving change in clinical EHR requirements needed to support these new paradigms of healthcare delivery. These new ways of delivering care require a coordinated approach – healthcare providers need to collaborate efficiently in real time, which is not adequately supported by traditional methods, such as meetings and phone calls. We really need an interoperable and integrated patient record in which all healthcare providers can participate, within a framework providing governance, authorisation and security measures. (Read more...) 

USA-Health and Human Services Department (HHS) considers genetic information to EHRs

Source:  HealthImaging.com ( http://www.healthimaging.com )
12 Jun 2008

The American Health Information Community ( AHIC ) is recommending that the federal government start preparing for the capability to electronically store a patient's genetic makeup so that doctors can match medical treatments to their genes.
According to "Government Health IT" , the connections between patients'genetic characteristics and responses to particular medications are beginning to be understood by scientists. For example, certain breast cancers are linked to the patient's genes, and those cancers can be treated more effectively now that the connection is understood.

If Health and Human Services Department ( HHS ) Secretary Michael Leavitt accepts AHIC's recommendations, genetic information will be included in EHRs and research databases.
One of the recommendations calls for HHS agencies and the National Institute of Standards and Technology to clarify and determine the role that each would play in standardizing pharmacogenetic data . AHIC also recommends that HHS agencies identify the genetic data that EHRs should contain.

AHIC has recommended that The National Library of Medicine, which already has taken a lead role in some HHS work on genetic information, head the effort to integrate genetic information into EHRs or personal health records, reported Government Health IT . 
Another recommendation calls for the National Institutes of Health and other federal agencies involved in research to develop best practices for patients to consent to uses of their genetic data.

“HHS should work with stakeholders, including professional associations representing clinicians, clinical laboratories, pharmacists and others, to develop a white paper on the opportunities and challenges associated with dispensing pharmaceutical drugs based on pharmacogenomic test-derived interpretations in inpatient, ambulatory and mail-order services,” according to a letter from AHIC to Leavitt.

AHIC's Personalized Health Care Workgroup, an HHS advisory committee, developed the recommendations.

"Economic impact of interoperable electronic health records and ePrescription in Europe"

The study is carried out by "Empirica" for the European Commission, DG Information Society and Media, Unit H1: ICT for Health
Obs : the "EHR IMPACT" Study should be viewed as closely linking to the EC- Empirica Study "FINANCING eHEALTH"

Source: EHR IMPACT Study Web Site -  http://www.ehr-impact.eu/index.htm
15 May 2008

• The "EHR IMPACT" Study has started in the 1st of January 2008, and its ending date is 31 December 2008.
• Key dates relating to the EHR IMPACT work are as follows:  

May 2008:  The case study of the computerised clinical information system at the University Hospitals in Geneva (HUG) , Switzerland, was presented at the European Union Ministerial Conference on eHealth 2008 in Portorož, Slovenia. Findings from the "Financing eHealth" and EHR IMPACT studies were illustrated on the basis of HUGs experience. The discussion focused on insights of strategic eHealth investment decisions , as well as the costs and benefits associated with complex, interoperable electronic health record (EHR) systems. The presentation material is available on the EHR IMPACT Study website:  www.ehr-impact.eu.

April 2008: First findings of the EHR IMPACT study will be presented next month at the European Union Ministerial Conference on eHealth 2008 in Portorož, Slovenia. The case study of the computerised patient record system at the University Hospitals in Geneva, Switzerland will be used as an example to illustrate the benefits, as well as lessons learnt for future investments in interoperable EHR and ePrescribing systems. The session will be shared with the Financing eHealth study, which focuses on the investment aspects of eHealth.

March 2008: The EHR IMPACT study team currently finalised the conceptual framework of the study, developing and adapting the eHealth IMPACT methodology. The goal is the evaluation of the socio-economic impact of eHealth in the specific setting of interoperable electronic health record and ePrescribing systems. The first two evaluations have started. These are the computerised patient record system at the University Hospitals in Geneva, (Switzerland), and the Scottish Emergency Care Summary Programme, in the UK.

• About

• Context
• Goals
• Approach
• Administrative details
• Study team
• Downloads
• Links

Should CCHIT Influence Your EHR Selection?

Feb 2008
An Article writen by Don Fornes
(founder and chief executive officer of Software Advice )

The Certification Commission for Healthcare Information Technology (CCHIT®) has gained substantial momentum since the organization's founding in 2004. As a result, buyers of electronic health records (EHRs) – or electronic medical records (EMRs), as they are also known - often ask me what role CCHIT certification should play in their purchase decision. The answer is not always simple, so I decided to explain what CCHIT is, what it is not, and why some participants have passionate views for or against it.

What is CCHIT?
CCHIT is a private, non-profit organization formed to certify EHRs against a minimum set of requirements for functionality, interoperability and security. It was founded in 2004 by three industry associations ( HIMSS , AHIMA and the Alliance ). It was subsequently funded further by the California Healthcare Foundation and a group of payers (e.g. United HealthGroup ), providers (e.g. HCA ) and software vendors (e.g. McKesson ). In 2005, CCHIT was granted a $2.7 million contract by the Department of Health and Human Services (HHS) to support its mission. A number of other medical associations have since supported CCHIT. Despite the HHS contract, CCHIT is not an extension of the federal government.

As of February 2008, Eighty-some ambulatory EHRs received certification against the 2006 CCHIT criteria and sixteen EHRs received certification against the more rigorous 2007 criteria. We estimate this equates to roughly 30% of all ambulatory EHRs being certified, while additional EHR vendors are currently pursuing certification for their systems. ( read the ful Article )

Integrated Patient Records System being used across Portuguese Health Centers

iSOFT Spain, an IBA Health Group company (Australia), has installed its hospital information solution at four health centres and one hospital in Portugal for private healthcare group ESSAUDE in a project worth €519,000. The system was installed in just four months. Running on a single database, the solution provides integrated patient management, clinical and financial applications across the five centres. iSOFT's hospital information solution allows patients' medical histories to be managed electronically with clinical tools which provide accurate information for point-of-care tests as well as providing access to previous diagnoses and test results.

The Povoa de Varzim, Vila Nova de Cerveira, Amarante, Porto health centres and the Santiago-Setubal Hospital were acquired by the Portuguese group Espirito Santo Saúde (ESSAUDE) last year. iSOFT has worked with ESSAUDE since 2000 beginning this latest project in September 2007. Within a month all five centres were using patient administration systems in outpatient, inpatient, infirmary, and pharmacy departments.

At the beginning of 2007, ESSAUDE expanded its hospital division considerably, acquiring Hospor, one of the most important hospital networks in Portugal, which comprised these four health centres and one hospital. As ESSAUDE's technology partner, iSOFT has supported its growth strategy by installing x-HIS as the corporate hospital information system for all its centres.

iSOFT has worked with ESSAUDE since 2000 and became its technology partner in 2002 after a formal agreement, worth €300,000 a year, to install solutions at all ESSAUDE hospitals and health centres. ESSAUDE's growth strategy is based on acquiring and building new hospitals and is underpinned by iSOFT's solutions. Last year iSOFT completed projects for ESSAUDE worth €733,000. Julio Bou of iSOFT Spain said: "Our solution has proven to be versatile and transferable to other health systems. Proof of this is the success of the projects carried out in Portugal with ESSAUDE and in Mexico. We will continue to work with ESSAUDE, providing the support, knowledge and experience that iSOFT has in the development of international information technology applications, the main purpose of which is the improvement and optimisation of health services provided to patients and in this case, private health care."

About iSOFT
Following a merger completed on Tuesday 30 October, iSOFT is now part of the IBA Health Group (Australia). For further information, please visit http://www.ibahealth.com .  also  http://www.isoftplc.com .

NEWS on Electronic Health Record's Boosting efficiency of health EU Market [fr]

Source:  EurActiv News
Published: 19 Dec 2007
Updated: 15 Jan 2008

Patients' health records saved in databases could boost the efficiency of health markets in the EU but pose major challenges regarding interoperability and safeguarding patient privacy. 

Background:

Electronic Health Records (EHRs) are records, stored in electronic format, of a patient's health information as it evolves over a certain timespan. Their main source is Electronic Medical Records (EMRs): the legal records created in hospitals and ambulatory environments in the course of medical treatments or care delivery. EHRs can include information on patient demographics, treatment progress, problems, medications, vital signs, past medical history, immunisations, laboratory data and radiology reports. 

For doctors, hospital operators, medical personnel and caretakers, the advantage of the electronic health record is the opportunity it provides to structure, automate and streamline their workflow. It can generate a complete record of encounters with clinical patients and support other care-related activities. 

Issues:

Patient mobility

As patients become more mobile within Europe, EHRs that are readable by clinicians in different settings and languages could enable safer treatments and reduce costs. 

The issue of mobility is closely linked to  interoperability : If standards for EHR remain confined within one country's borders, they will raise new barriers to patient mobility. This means, however, that standards would have to overcome not only language barriers but also differences in countries' healthcare systems, from medical treatments to the way pharmaceuticals are marketed.  (read more...)

Document Management: "Imerge Consulting" Healthcare Technology Transfer Partners

Source: Infotivity
Nov 2007

Read the INDUSTRY REPORT

Industry agrees standardised interface for EPRs

Source: eHEALTH Europe
20 Nov 2007

After one year of negotiations - faster than expected - more than 30 health IT companies have agreed on a new standardised interface for electronic patient records (EPR). The agreement will make it easier for EPR-solutions of different vendors to share personal medical data.

The new interface was being developed under the umbrella of the intiative EPA NRW in the German federal state of North-Rhine Westfalia. Companies involved include, among others, Agfa Healthcare, Careon, CompuGroup, DocExpert, fliegel, IBM, ICW, Microsoft, Siemens and T-Systems.

Like other federal countries, Germany is moving towards a system of regional eHealth networks of different providers with a high demand for interoperability. The basic concept is to have, next to each other, hospital-owned case records, life-long web-based personal health records (PHR), and regional server-based records for managed care-scenarios. All these electronic patient record solutions of different kinds will have to share data. This means that both a standardised interface and semantic standards are needed. 
(read more...)  

Perspectives on the Future of Personal Health Records

Source: California Healthcare Foundation
June 2007
Christopher J. Gearon

As a hub of information and information-management tools controlled by the patient, personal health records present a number of promises, perils, and challenges in the years ahead. In this report, six experts share their views on the future of PHRs, from the perspective of the technologist, informed patient, physician, employer, and public health professional. The ideal PHR holds tremendous potential, according to these experts. It could receive and evaluate information from a patient's lab results or monitoring devices; store a patient's observations about physical and social environment; link with a clinician's electronic health record; and much more. On a grander scale, PHRs could also make health care more affordable by urging prevention and wellness, and by streamlining care delivery. But some worry that PHRs might disrupt the doctor-patient relationship, saddle overburdened physicians with unreimbursed information-management duties, and overload consumers with data. The full report is available under Document Downloads below.

Document Downloads
Perspectives on the Future of Personal Health Records (311K)

France Could Be Model for U.S. Health Data Exchanges, Experts Say

Source:  iHEALTHBeat (California Healthcare Foundation)
Date: 18 October 2007  

France and its Ministry of Health, since 2004 has supported electronic health record projects across its 22 regions.  However, like the U.S., France has yet to develop an interoperable platform to allow the regional health data exchanges to share information with one another, Healthcare IT News reports.
Ilan Freedman, vice president of marketing for dbMotion, said the U.S. could learn some lessons from the French model because while each hospital in France has its own CEO, each region's Regional Hospitalization Agency acts as a single, decision-making entity for the budgets of all hospitals in the region.
Gerard Manrique, business development manager for Healthcare and Life Sciences Innovation IBM France, said the key to connecting the existing enterprise applications is using open standards-based technology, Healthcare IT News reports.

In terms of having a sustainable model for exchanging health data, Freedman said that France's Regional Hospitalization agencies are similar to integrated delivery networks in the U.S. He added that it makes sense for hospital systems in U.S. metropolitan areas to connect internally and effectively build connections to other IDNs to become part of the Nationwide Health Information Network (Monegain, Healthcare IT News , 10/18).

Doctor Motivation Influences Degree of EHR Adoption
A new study in the American Journal of Medical Quality

Source:  iHealthBeat  (California Healthcare Foundation)
By:  Kate Ackerman,  iHealthBeat Associate Editor
October 09, 2007

Today's electronic health records have more available functions to protect patients and control costs than EHRs of a decade ago, but a new study indicates that early adopters are more likely than newcomers to deploy that technology.

Health IT insiders disagree on the attainability of President Bush's goal for most U.S. residents to have electronic health records by 2014. Numerous studies have assessed the state of EHR adoption in the U.S., but the findings vary significantly depending on how the studies define both "EHRs" and "adoption."

A new study in the American Journal of Medical Quality suggests that more focus should be given to the type -- not the number -- of EHR systems that are being adopted. The study, called "Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions," found that Florida physicians who recently adopted EHR systems were more likely than early adopters to use incomplete systems that lack key patient-safety and cost-control functions.

The study noted that by failing to account for partial adoption scenarios, policymakers potentially could threaten achievement of their goal to use health IT to boost clinical outcomes, increase patient safety and control costs. (read more....) 

Open Source Technology Could Boost Interoperable Health IT

The Certification Commission for Health Care IT, a not-for-profit certification body, and MITRE, a not-for-profit research and development firm, recently announced that they are teaming up to build an open source tool to test electronic health record networks for interoperability. The project signifies an important step in the development, testing and certification of EHRs, and its significance lies not only in the fact that the tool will be used to support and test interoperable EHRs, but also in that the format is open source.

Mark Leavitt, chair of CCHIT, said that his organization wanted to develop an open source tool "because open source software development is the equivalent to the open and transparent process we follow in developing our criteria."

But what exactly is open source? And how does it work? In open source, the source code, which is the instructions that are written for the computer, is available for everyone to see, Leavitt explained. That is, to everyone who has accepted the conditions of the license. MITRE will license the project under an Apache 2.0 open source license, which allows CCHIT, EHR vendors, health information exchanges and other interested stakeholders to use the EHR testing framework and source code (Read more...)

Report on the State of Developing Electronic Patient Summaries in European Union Member States and Beyond 

Source:  ehealthnews.eu
Date: 22 June, 2007

The Report analyses the current state of developing electronic patient summaries in European Union Member States and beyond. It highlights the benefits of such summaries and also the difficulties that need to be overcome to make use of patient summaries in different countries. Patient Summaries are a key component for eHealth roadmaps in several countries.

The concept of a Patient Summary is not yet universal and fixed, and thus the features of the summaries largely depend on the eHealth programme in which they are embedded. The overall scenarios for deployment of Patient Summaries depend on strategic decisions in each national and regional jurisdiction, which influence the format and the usage of clinical documents.

Besides Patient Summaries, most eHealth programmes also involve various kinds of clinical documents in electronic formats, such as prescriptions and diagnostic reports. A precondition for the success of patient summaries is the deployment of suitable infrastructures to identify citizens and professionals, to make available repositories and registries for the management of clinical documents across healthcare facilities, and to apply confidentiality measures.

All results will consecutively be made available at the eHealth ERA website (www.ehealth-era.org).  The report is the outcome of research in the context of eHealth ERA, which is implemented by empirica GmbH (co-ordinating partner, Germany), STAKES (Finland), CITTRU (Poland), ISC III (Spain), CNR (Italy) and EPSRC (United Kingdom), based on a Coordination Action contract with the European Commission.

Read the eHealth ERA Report at :
"Analysis of the situation of electronic patient summaries in European Union Member States and beyond" ( eHealth ERA Report, pdf, 308 KB)

Bangalore Heart Center Uses Passive RFID Cards to Track Outpatients

The EPC-based system, from Aventyn, has helped the facility increase patient throughput, reduce the use of paper forms and better track equipment.

The Bhagwan Mahaveer Jain (BMJ) Heart Center in Bangalore, India, is using passive UHF RFID tags to help maintain patient records, monitor patient flow and care, and track assets throughout the hospital's outpatient department.  Since the fall of 2006, the cardiac hospital—part of the Vivus Group —has employed the Clinical Information Processing Platform (CLIP), from Aventyn , a wireless technology company based in San Diego, Calif. The facility now tracks an average of 100 new patients a day, as well as returning patients, as they check into its outpatient department.

"We were aware of some hospitals in the United States using [RFID] for asset tracking," says Dr. Satish Chandra, BMJ's director of noninvasive cardiology, "and were interested in how this could really benefit patient care." The Web-based CLIP system includes software and EPC Gen 2 interrogators and tags. In addition, Aventyn helps its customers plan for and implement the software and hardware. In May, the company announced an updated version of its CLIP solution, able to support Microsoft's BizTalk RFID platform for managing auto-ID devices. (read more...)

(PHS)Personal Health Systems 2007 - Conference Report

EC - eHealth News Thursday, 14 June 2007

For almost a decade the European Commission activities in eHealth have supported a vision of person-centric healthcare systems - a vision that breaks away from the current way of delivering healthcare. This vision is best expressed by the so-called Personal Health Systems (PHS). PHS represent a new generation of eHealth systems in the form of, for example, wearable and portable systems and tools in the hands of patients (or citizens). PHS are realised by integration of ICT such as: biomedical sensors; micro- and nano- systems; mobile, wireless and broadband communications; user interfaces; digital signal processing and intelligent algorithms. This conference aimed to consolidate the results of this period of research, development and service validation in the area of PHS in Europe and to further demonstrate the impact of PHS on the prevention and management of diseases, citizen empowerment and independent living of people in need. In addition the conference aimed to stimulate the debate on issues relating to market development and policy support to Member States and regions in deploying PHS systems. Although the vision for PHS to take healthcare out of the hospital, bring it to the home and embed it into people's lives is clear, little deployment has happened so far. The barriers to deployment originate at different levels and are associated with a multitude of technological, cultural, legal, political and market-related factors. Equally poly-parametric is the way of addressing them and will require active participation of all stakeholder groups.

In summary, although significant scientific challenges still remain, technology is not any more the limiting factor. Several directions must be explored and education has to play a bigger role to improve performance and disseminate the potential of the new technologies. The deployment has to be done within the Member States, but this procedure needs time.  It is important that national policy should have ICT at its core. There are still many things to do, although many technologies have been demonstrated to be already available. We need to continue, and take initiatives being pushed spontaneously (without any funding from the EU) to pave the way towards a successful innovation.

For further information, please visit:  PHS 2007 Conference Report (with full report download link)

Related articles: Personal Health Systems 2007 Conference online speakers' presentations

Adapting an EHR for Europe

Forword by EHTO

Barriers on the EU policy on interoperability, still exist across "Member States' eHealth Systems". Beyond the political ones, privacity, etc., the technical, structural and semantic impeachments are the ones that have to be jointled solved at European level.   Most of them derive from a wide fragmented use of Standards, but also from many individual implementations of Regional eHealth solutions, that happened in the past.  

In the last May 2007  meeting - "EU-US Achieving Cooperation for competitiveness" - an "Authority for Certification of interoperable eHealth Systems" was a major result from convergencies attained, as well as a decision on the use of compatible Standards for EHRs.   That will also create an impact in the development of Personal Health Systems (read this ARTICLE )

Report: Fragmentation /Unlinked Hospitals ePrescribing Systems Exacerbates Drug Error Risks

Source: California Healthcare Foundation (www.ihealthbeat.org)
(By: Robeznieks, Health IT Strategist, 8th March) .
Date: 09 March, 2007

Fragmented systems and a lack of oversight raises the risk of medication errors, according to a report released this week by the U.S. Pharmacopeia Center for the Advancement of Patient Safety, Health IT Strategist reports.

The report did not include specific technological solutions to the problem. However, the report found that computerized physician order entry systems may not be helpful in reducing medication errors in the outpatient setting because they might not be linked or affiliated with a hospital's electronic prescription system, radiology department or lab that dealt with the patient, so all relevant patient data may not be provided. The researchers used Medmarx software -- an anonymous, Internet-based program -- to analyze more than 11,000 medication errors that occurred between 1998 and 2005 at 590 facilities across a variety of surgery settings.

"Even if the best technology is available in the physicians' offices, laboratories' radiology centers and (outpatient settings), there is still a lack of integration among those settings," the report stated. The settings included outpatient surgery, preoperative holding areas, operating rooms and post-anesthesia-care units.

The researchers found that 5% of errors resulted in patient harm and four errors were fatal. Nearly 12% of pediatric medication errors also caused patient harm in these settings. The report gave its strongest technology recommendation for automated dispensing systems and bar-coding systems for the post-anesthesia-care units, where medication errors were found in 11% of sample cases, including two errors that required life-saving interventions.

The report also recommends that more research is needed to discover how CPOE and electronic health records can lower medication errors in surgery.

Ontario Health Network Links Region's Hospitals

Source:  California Healthcare foundation ( www.ihealthbeat.org )
( by Hammond, Ottawa Sun , March, 8)
Date:  8th March, 2007

A health network in Eastern Ontario, Canada, recently has begun sharing electronic health records among 18 of the region's 20 hospitals, according to Wilmer Matthews, chair of the health network, the Ottawa Sun reports.

The Champlain health network is the first of Ontario's 14 health regions to create an interoperable, online EHR system that also is compatible with the province's health care database. All 20 of Champlain's hospitals are expected to be linked together by next fall, Matthews said.
Matthews also said Champlain is looking to expand its electronic database beyond hospitals to "doctor's offices, long-term care homes and other service providers."

According to health officials, accessible EHRs are a key factor in patient wait times and how quickly test results can be obtained, the Sun reports

HRSA Provides Funding for EHR Implementation Initiative

Source:  FEDERAL TELEMEDICINE NEWsLetter (www.federaltelemedicinenews.com/)

Date:  25th March 2007  
By: Carolyn Bloch, Editor

Health Record funding opportunity (HRSA-07-125) will be used to support an electronic health record to meet the President's Health Center Initiative and the goal for universal adoption of electronic health records by 2014. The goal is to use electronic health records and other forms of health IT as tools to improve quality of healthcare and health outcomes. The implementation of the EHR will take place in the context of the HRSA Quality Initiative.  

The estimated amount for the competition is $6,000,000 with eight awards. The average size of the award is $550,000. The application was available March 15, 2007, the letter of intent is due April 5, 2007, and the projected award date is September 1, 2007.

Eligible applicants include public and non-profit organizations, but applicants must be from health centers or be from operational networks acting on behalf of the health center.

For more information, contact Susan Lumsden at sl umsden@hrsa.gov

UK Nurses urge caution over EU patient record sharing

In “ANIA” – American Nursing Informatics Association (www.ania.org)
Source: Computeract!ve
Date: 13 Feb 2007
By: Anthony Dhanendran

European Commission discusses scheme for sharing medical records across the continent

The Royal College of Nursing (RCN) has hit out at plans to make national healthcare databases accessible in all European Union (EU) states, saying it could compromise patient care and safety.

The scheme, proposed by the European Commission, would enable medical staff in EU member states to access patients' data currently held on their own national health service databases. The forthcoming NHS database, ' Spine ', would be included in the scheme.

Although, in theory, the aim is to improve medical care for people travelling within EU member states, the RCN said it had concerns about differing standards of care and also the qualifications of medical staff in other countries.

Sharon Levy, the RCN's IT advisor, told Computeractive that although the scheme could potentially benefit patients by allowing doctors and nurses access to information that is vital for safe treatment, there were fundamental differences that needed to be addressed.

“There are questions over credentials [of doctors and nurses in other countries] where standards of care are different. When patients return to the UK, we may have to base our care on records we don't have faith in.”

Levy also pointed out that the NHS in England is struggling to get clinicians and patients to buy into Spine, which will contain details of English patients' allergies and major treatment histories.

This will not be helped by a comment from one of the executives responsible for setting this up, who recently questioned whether the NHS project would actually work.

Andrew Rollerson, of Fujitsu Services , told a healthcare conference: “What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn't working. And it isn't going to work.”

HL7 coming to interoperability in HCare - final White Paper

Date: 2 Feb 2007

Executive Summary

The characterization of “interoperability” offered in this White Paper is based on an analysis of how the term interoperability is being defined and used in actual practice. Over 100 definitions were collected and the 65 definitions from organizations were closely analyzed. Most definitions were from standards development organizations, health care organizations, professional societies, and government agencies. Of these, approximately two thirds were from organizations relating to health care and about two thirds were from organizations which affect the United States . Substantial differences in how interoperability is defined were identified based on organization type (health care vs. non-healthcare) and, for health care organizations in the United States , based on longevity (years since founding). Three principal types of interoperability were identified: technical interoperability, semantic interoperability, and process interoperability.

(read the White Paper )

Improving the efficiency of electronic patient records

Source: EC-IST Results (Based on information from DICTATe)
Date: Sept 2006

Improving the efficiency of electronic patient records Transcribing dictated notes from clinicians is a hugely expensive and time-consuming process. One possible cure could be a new solution under validation that offers speech recognition and secure wireless communication for electronic-patient-record systems. (more)

Software Can De-Identify EHRs for Research Use

Source: IHEALTH Beat (www.ihealthbeat.org)
Date: 13 March, 2006

A study by Harvard University researchers has found a way to de-identify electronic health records so they can be used for research projects, eWeek reports.

Most existing de-identifying software is either proprietary or can remove only one type of patient information, eWeek reports. The study examined an open-source software program created to remove 19 identifiers including patient, institution and physician names, addresses, dates and medical record numbers from 1,800 pathology reports.

The software removed more than 98% of the identifiers, eWeek reports. It missed 19 HIPAA-specified identifiers - most of which were consult accession numbers and misspelled names - and 41 non-HIPAA identifiers, which were mainly partial institutional addresses and ages. The researchers found performance variation across the three participating institutions and noted that site-specific customization is necessary.

( Lawrence , eWeek , 3/8).

IP Conference: 8th Annual Information Technology Law Update

CLT (Central Law Training) is organising the Conference "Annual Information Technology Law Update " to be held in London (UK) on 21 March 2006 .

The topics that will be covered in the conference include software patenting in the US , the UK and Europe ; the battle between Microsoft and the European Commission; the protection of personal data and of commercial databases or IT contracts and the growing impact of US regulation.

More information and registration

US ACADEMIA PRESS: Key Capabilities of an EHR System – Letter Report 2003  
(Book extract – pg. 5)
Source: Institute of Medicine, 2001, 2002a, 2002c

In response to the request from DHHS in May 2003, the charge to the IOM Committee on Data Standards for Patient Safety was expanded as follows:

European Commission To Evaluate E-Health
Source: www.newmediamedicine.com
Date: 22/10/04

The EU is to investigate 'best practices' in e-health across the continent, the European Commission has announced. The aim of the study is to provide the Commission's Information Society Directorate with a report on the impact of e-health services in Europe.

The study will cover several areas including:
Identification identification of best practices in health IT, especially those contributing to 'efficiency and cost benefits';
Devising a common approach to evaluate e-health products and services;
Contributing to the EU's e-health action plan.

The Commission started work on an e-health action plan earlier in 2004. The aim is to ensure that new IT, such as an electronic patient record, is interoperable across Europe. The Commission also wants to make governments and the public more aware of the benefits of e-health.

www.newmediamedicine.com

Project "SUSTAINS" - The Medical Record on the Internet

· Would the patients benefit from instant access to their own medical record?
· How would the doctors react to such a scenario?

Those were two of the questions asked when the County Council of Uppsala set off to explore the effects of giving the patients access to their own medical record via the Internet. Other questions asked were; what are the security and integrity implications? Is sufficient technology available?
One of the most important objectives was to encourage patient involvement. A basic condition for patient involvement is to have access to that same information as the providers.
The project, founded by the EC and the Swedish Knowledge Foundation, launched a system that deals with all the technical, security and integrity matters.(more)

In the healthcare arena there has been considerable discussion lately about documents. There were paper documents seized that are said to support the government's case against Columbia for alleged fraudulent billing practices. Acute care facilities are moving to electronic patient record (EPR) systems. These EPR systems ultimately combine electronic copies of all documents created from admission to discharge with electronic reports, usually clinical testing or billing information, into a single electronic folder. They reduce labor, eliminate lost files and loose sheets, improve access to authorized users, increase security (with a 100% audit trail), and provide quicker documentation for claims.(more)

The Evolving Electronic Patient Record System
by Robert Golden

If there's one constant in the healthcare industry, it's change. The very model of healthcare is steadily evolving as the industry faces complex issues like managed care and capitation. Additionally, healthcare providers are driven to find new ways to cut costs while improving care. To meet these challenges, healthcare organizations are rethinking their view of information technology. After decades of spending well below other industries, healthcare is turning to information systems to control costs, improve overall efficiency and enhance patient care.(more)

New Program for Medical Transcription Businesses
Origin: www.medrecinst.com
Date: 9 March 2004

New this year to TEPR 2004 is a program to assist Managers of Transcription Services and others concerned with transcriptions. Transcription costs are rising everywhere. TEPR will be addressing the
efficient management of transcription services in a full educational program. In addition, a Medical Transcription Recognition Award Program has been added. Individual judges will recognize the top companies. It is the first of its kind where MT businesses were invited to complete a questionnaire about their services and characteristics. The questionnaire was then given to a panel of independent judges evaluate and identify three finalists.

Witness on Tuesday morning, May 18, at TEPR 2004, where each finalist will have a 15 minutes presentation/demonstration.

This program is designed to help transcription managers and managers of health information management to address the integration of transcription into IT applications.

Register now for a discounted rate at www.tepr.com.

Fifth Annual MRI Survey of Electronic Health Record (EHR) Trends and Usage
Origin: www.medrecinst.com
Date: October 2003
(read the report)

The National Health Service in the UK Working on Electronic Health Records
Origin: Federal Telemedicine News
Date: 07.11.2001

The NHS is trying to make better use of modern information and communication technology so that everybody in the UK will soon have access to their electronic health records.

Each individual record will have information about previous treatments, ongoing condition, current medications, allergies and the date of any future appointment. The idea is for all patients to take control of their own healthcare.

Patients at the Bury Knowle Health Centre in Oxford already have access to their records. The patients use computers to access their record with practice staff present to discuss the content. Patients in the past have been concerned about whether or not their health records are up to date. By having access to the electronic version, they have greater control.

When people are worried about their health, going to the physician can be stressful, making it difficult to take in all the information being discussed. The option of being able to go back to the records after the appointment can be helpful. Patients with access to their records feel that they have created a partnership with their doctor.

Health professionals have access to a patient’s record and by sharing this health information with the doctors and nurses who may treat the patient at various times, treatment during emergencies will improve.

Ways to make sure the records are secure are being tested. For example, at the Bury Knowl Health Centre, some patients use a special mouse that reads a fingerprint to confirm a patient’s identity before granting access.

By March 2005, the NHS hopes to provide everyone in the UK with their electronic health record.

Federal Telemedicine News
Date: 20.08.2001

HRSA’s Bureau of Primary Health Care (BPHC) in conjunction with the Health Center Information Systems Workgroup is providing Community Health Centers with information on Electronic Medical Records and Disease Management to assist with implementing systems to support clinical data management. (more)

Privacy rules delayed
May 16, 2001
(Source: TIE)

An article in the February 27th New York Times, Health Secretary Delays Medical Records Protections says that the new Health and Human Services Secretary, Tommy G. Thompson, has said that he will delay and reconsider HIPAA rules issued in December by the Clinton Administration.

On 28 February he re-opened the final rule for the protection of identifiable health information for a 30-day public comment period before the regulation goes into effect on April 14, 2001. Under the Clinton Administration, the proposed rule evoked more than 52,000 comment letters. However, in his February 23 announcement the Secretary stated, "The department will review the comments it receives to determine whether changes in the final rule are needed."

The privacy regulation issued by the Clinton Administration in December 2000 was originally scheduled to go into effect on February 26, 2001, but was delayed since it was not transmitted first to Congress for review. The public has until March 30, 2001, to submit comments to HHS on the regulation. Comments will be received either electronically or via mail at:

U.S. Department of Health and Human Services, Attention: Privacy I, Room 801 Hubert H. Humphrey Building, 200 Independence Avenue, S.W. Washington, D.C. 20201

November 29, 2000 

The Medical Records Institute is proud to announce the availability of the Second Annual MRI Survey of EHR Trends and Usage. This survey is based on the results from 530 respondents gathered from May the 6th through July 23rd, 2000.
This comprehensive survey is available in three versions:

The Overview Version:

This version includes the answers from 299 respondents who identified themselves as being exclusively from Provider, Integrated Delivery Networks or Managed Care Organizations. It includes questions that address:

• Management, Administrative, and Clinical Motivations Driving the Need for Electronic Health Record Systems
  
• EHR Applications and Functions Being Implemented
  
• Network Platforms Being Used to Support EHRs
  
• Web-based Applications Being Considered
  
• Major Barriers to EHRs and the User Strategies to Address Them
  
• EHR Migration and Implementation Plan
  
• Data Security Concerns and Implementation Plans

We invite you to review this information at http://www.medrecinst.com/resources/survey/2000/index.shtml at your convenience at no charge.

The Trends and Vendor Selection Version:

This version expands upon the Overview Version by comparing the survey data from 1999 and 2000. It also identifies the vendors selected by the respondents for clinical workstations, data repositories, document imaging and data warehouse systems. These representations include the vendor names, solutions and the respondent reasons for selecting each vendor. This version also identifies the names of the consultants selected by the respondents for strategic planning, vendor/systems selection, implementation assistance and data security planning and design. Finally, this version includes a summary of the strategic insights gleaned from this comprehensive survey. This version is available from the MRI for only $200.00.

The Market Segments Version:

This version represents all of the data gathered from the year 2000 as three separate market segments. These segments are Acute care, Ambulatory care, and Integrated Health Delivery Organizations/Managed Care Organizations (IHDO/MCOs). All of the questions in the Overview Version, plus the vendor selection responses are separated into results by market segments. This version is also available from the MRI for only $200.00

The Combined Version:

This package will include both the Trends and Vendor selection Version and the Market Segment Version of the MRI Survey of EHR Trends and Usage. The Combined Version is available from the MRI for only $300.00.

After you have reviewed the Overview Version of the Second Annual MRI Survey of EHR Trends and Usage at http://www.medrecinst.com/resources/survey/2000/index.shtml, you may wish to place your order for one of the more comprehensive versions. Just follow the instructions at the web site.