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Archive for March, 2010
Health Content: There’s an App for That in EHRs
- Posted March 20th 2010
- Comments (0)
- by Janice
Approximately 30,000 people convened in Atlanta last week for the HIMSS conference. HIMSS stands for Health Information Management Systems Society, and its annual event has become the meeting place for vendors and users of electronic medical and electronic health records systems (EMR/EHR). This year’s conference program had a major focus on the impact of the ARRA HITECH[1] funding and incentives for adoption of new EHR systems. One of the most common topics of discussion at the event was “meaningful use” of EHRs.
I’ll reveal my bias upfront. My background is in digital information services, and I’ve always viewed information management systems as tools for increasing the utility of the content that flows through these systems. An information system that doesn’t optimize the utility of the content in a way that adds efficiency to a process or leads to better outcomes is not all that compelling to a user.
With EHR systems, it has been long apparent to me that their value would be far higher to the clinicians who use them if the knowledge embedded in medical textbooks, scholarly research publications, and other reference sources were incorporated into the EHR systems at or near the point of care. Over the past 10-15 years, we’ve witnessed the gradual migration of information that had been stored in separate online reference systems to systems that physicians and other clinicians can access on their handheld devices or EHR/EMR screens. Epocrates for drug reference information on early PDA devices was a pioneer. Now, nearly all the reference and research content is digitized, but most of it hasn’t been incorporated into EHRs in a manner that maximizes its utility for clinicians.
At this year’s HIMSS conference, there were myriad signs of accelerating convergence of EHR systems and health content. EHR vendors are eager to embed clinical information into their systems to demonstrate the value of incorporating accepted clinical guidelines, procedures, lab values, drug dosing suggestions, regulatory benchmarks and any other useful clinical reference content that would save the clinician’s time and lead to improved outcomes. Embedding the accepted rules and guidelines into an EHR system also provides the ability to customize recommendations based on the patient’s characteristics (sex, weight, other drugs being taken, allergies, and increasingly personal genome). The advantages of having the appropriate rules and guidelines embedded in the software are obvious. Just think TurboTax. [Note, I am focusing on clinical content in this post; benefits for administrative/performance improvement applications are equally compelling.]
Granted, medicine is more complex than the tax code. (It may be hard to believe anything is more complex than the tax code, even taking into account the state-wide variations, but it’s true!). Hospitals will continue to follow different procedures, guidelines will remain suggested guidelines to allow for individual variations, and new medical knowledge will be acquired daily. Nonetheless, the value of automating the practice of applying widely accepted medical rules and guidelines is immense-for practitioners and patients.
Medical publishers have been slow to adapt their content for usage in EHR/EMRs. Zynx Health, a Hearst Business company, was a leader in providing order set workflow systems that incorporate content. Their sister company, First DataBank, also proved the ground for transforming drug information to medication management systems. Based on my discussions at HIMSS, other medical publishers are accelerating their efforts to create clinical decision support systems from their collections of content that can be embedded in EHR/EMR systems. Elsevier, Thomson Reuters, and Wolters Kluwer, the big 3, have made great strides.
HIMSS is still a very technology-centric event with limited focus on health content and relatively few publishers exhibiting. Along with the big 3, a handful of other publishers, including EBSCO/DynaMed, Lexi-Comp, PEPID, and several patient education publishers (ExitCare, Healthwise, Patientedu.com) were present. And, of course, MedTech, the publisher of Healthcare IT New and Healthcare Finance News, which also publishes the Exhibit Guide and the daily HIMSS10 Guide, was there. BNA, a publisher of regulatory information, had a booth, too.
However, I see 2010 as a turning point for health content publishers. They have to learn to adapt their information for inclusion in EHRs. A digital version of a reference work is no longer good enough. The content has to become an “app” that can be incorporated into electronic systems.[2] Standalone content that doesn’t plug in to a user’s system or get embedded into clinical decision support systems will be left on the sidelines. By the time HIMSS11 rolls around next year, expect to see more health content publishers among the exhibitors and more clinical decision applications that can be integrated into healthcare information systems on display. Soon it will be difficult to identify where the content ends and the technology begins.
______________________
1 Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act (ARRA) bill of 2009 (aka, the Stimulus Bill). For details see: http://healthit.hhs.gov/.
2 Official standards for Meaningful Use that include use of evidence-based order sets and other clinical decision support systems by 2012-2015 will fuel this trend.
Headline Commentary Mar 1- Mar 19
- Posted March 19th 2010
- Comments (0)
- by Janice
RT @HealthVault: Register today for the Microsoft Connected Health Conf May 19-20. https://www.msconnectedhealth.com/SiteLogin.aspx
iVillage’s new Health site w/ content from Healthwise & Cleveland Clinic: http://bit.ly/ciOVt9 /Still looks like woman’s magazine 2 me
Detrioit’s largest nonprofit hospital 2 B acquired by for-profit Vanguard Health: http://bit.ly/aDIKjS /more consolidation amg providers
RT @HealthBizBlog: Health Wonk Review blog carnival at RWJFs Health Reform blog http://tinyurl.com/ybq6ow7
RT @SusanCarr @ctorgan: e-patient conference April 6-7, in DC. By NLM, at NIH http://www.fnlm.org/Events-2010-Conf.html
RT @iHealthBeat: Cleveland Clinic Project Finds Benefits in Linking Devices With Physicians - http://bit.ly/9vYBOb
Stephen Schoenbaum, MD, MPH’s testimony to Mass. Division of Health Care Finance & Policy on costs of healthcare in MA. Slidedeck links included. Thanks to Paul Levy for pointing to this info.
NIH creates public database, Genetic Testing Registry (GTR)that will help consumers and providers determine best options for genetic testing. Goal of GTR is to have providers of genetic test enter info on the tests and identify laboratories that perform the tests.
Study by MedPAC reports that hospitals that lose money on Medicare/Medicaid reimbursements have higher fees and higher profit margins and represent large hospitals with strong negotiating power. They charge commercially insured patients higher fees to compensate for losses on CMS patients. But, majority of hospitals have incentive to keep fees lowers and manage to make money on Medicaid/Medicare patients. Consistent with Paul Levy’s post today.
Very nice case study of how Vida y Salud has grown their brand and achieved substantial audience growth in under a year. Emphasizes importance of quality unique data and a cross-media marketing campaign.
Matt Holt interviews Glen Tullman at HIMSS10. Glen does nice job of describing how Allscripts have some footprint with 1/3 of US doctors and is working toward interoperability and connected care. Slams Epic.
RT @healthblawg: RT @Paulflevy: Cost Driver Hearings in MA are worth viewing: http://bit.ly/a8M7FN ^ cf background http://bit.ly/9JC7Qx
Massachusetts is holding hearings on drivers of healthcare costs. Paul Levy, CEO of Beth Israel/DMC, provides links to prepared statements & points out that higher costs are correlated with market power/negotiating strength of hospitals and not to type of payment system (global payments vs. fee-for-service).
Coke tries for compatibility between its health insurance plans and its wellness programs–with some success. Hm, wonder if cutting out sugary softdrinks buys points in wellness programs.
Emdeon, a large revenue cycle management (RCM) company, acquires Healthcare Technical Management Services, a health IT consulting fimr that assists insurers in purchasing and implementing IT. Services to aid in transitioning to ICD-10 seem to be the major attraction in this acquisition. Emdeon to pay $11M with additional cash payments of up to $14M based on financial performance.
RT @roskadigital: Text4Baby surpasses 22,000 users, 500k msgs sent http://ow.ly/1nqbW #hcsm CDC, J&J backed
RT @wroush: Top national players in #healthIT (Sebelius, Blumenthal) coming to Boston next month for conference. http://bit.ly/9EyvQg
RT @tgoetz: why does technology drive costs UP in medicine? @huffpo http://bit.ly/ayMAtt /I agree w/ lack of transparency, but not scale
Interesting counterpoint — or complement– to my latest blog post about how healthcare content is being transformed into apps for integrated systems. Guerra questions whether the healthcare sector will accept a plug-and-play environment. I’m a bit more optimistic than he, based on external incentives.
Official gov’t site with summaries of recent HIT Standards Committee meetings.
RT @VinceKuraitis: Here’s the health care chapter of the FCC Broadband expansion report! http://bit.ly/92hv61 #healthit via @mobilehealth
Lates recommendations from HIT Policy Committee to the ONC re: meaningful use, certification/adoption of EHRs, and privacy & security.
RT @HITNewsTweet: Professional registration at #HIMSS10 saw an increase of 9 percent http://ow.ly/1lccO #healthIT
More evidence that the health IT sector is healthy. Registrations were up 9% in 2010 for a total of 27,855.
RT @healthcentral: Google allegedly polling AdSense sites on showing pharmacy + liquor ads http://bit.ly/axCicw
Reviews recent survey by Surescripts, the largest e-prescribing network, on adoption of e-prescribing by physicians. Even with $$ incentives from CMS that started in Jan 2009, uptake has been slow. Combo of CMS incentives and inclusion of e-Rx app in an EMR seems to be biggest driver of growth.
Dr. Kevin Pho addresses some of the drawbacks of tying physician compensation to patient satisfaction survey scores. Hospitals do receive incentives from CMS to report survey results. But there are other measures that should help balance the issues raised in Dr. Pho’s article. But I agree that assessing quality of care of a physician by averaging patient satisfaction scores is dicey.
RT @ahier: Premier comments on #MeaningfulUse (pdf) http://bit.ly/aTRj4z /Long…but enjoyed the section on Problem lists & codes.
Finally posted my comments on #HIMSS10 from my “health content” perspective: http://bit.ly/9CVkjo #in
RT @robertloakes: RT @jimmyweeks: Thoughts on #HIMSS10 http://post.ly/S9Kv /thx for the notes, Jim. Wish I had seen Thurs keynotes.
RT @SusannahFox: What if food inspection results were searchable? Drug approvals? http://bit.ly/9Qk6zb (via @nwatzman) #gov20 #datacontent
RT @ClinicalCafe: CMS orders UC Irvine Medical Center 2 improve medication mgmt (Via @PSeditor @AbbieCitron) http://bit.ly/9fFQOh #ptsafety
RT @ePatientDave: Beth Israel Deaconess “learned from implementing EHR as a service” http://is.gd/afFCK
WebMD launches core community feature, WebMD Health Exchange with group of medical experts who will provide info on a range of topics. But, primary purpose is to encourage peer-to-peer patient/consumer sharing. It will be interesting to see how successful WebMD is in building patient communities. Most patient community sites started small with tight focus.
RT @Health_IT: From MicrosoftMD, Crushing Complexity from Healthcare, http://bit.ly/bR1LJv #healthIT
RT @healthblawg: Patient safety not taught in medical school? Lucian Leape Institute releases report… http://bit.ly/94R424
RT @knowledgevision: Gr8 use-case: Emerson Hospital using KnowledgeVision 4 Dr. briefings http://ow.ly/1gP4B /Fmr colleagues lead new MA co
RT @Eclipsys: Video of Eclipsys’ Phil Pead on CNBC to discuss the benefits of electronic medical records. http://bit.ly/c0HHKA
RT @KentBottles: RT @iHealthBeat: British Medical Group Calls for NHS To Halt EHR Database Project - http://bit.ly/bTD1M8
RT @john_chilmark: Why I’m not crazy about the WebMD Exchange http://wp.me/p6shx-CC Poor SM execution
RT @GlobeHealth: Few drug studies meet comparative effectiveness definition - http://b.globe.com/co6JTr ;yea but it’s f(RCT) process.
» Survey shows nurses spend most of their time on paperwork | Healthcare IT News
RT @ahier: Survey shows #nurse’s spend most of their time on paperwork | http://bit.ly/asw1Vq (via @HITNewsTweet) /Need workflow apps
RT @PracticeFusion: Use of e-prescribing nearly tripled in 2009 http://tinyurl.com/yzjex4b /Driven by Gov’t incentives; will it work for #MU
RT @patientslikeme: PLM & Novartis launch free online community 4 organ transplant recipients: http://bit.ly/cZyqNo
RT @vaibhavb: “Checklists” and Rapid Innovation with Amalga http://bit.ly/cjpwyT #HIMSS10 #HIT /Nice video demo.
Recent Harvard School of Public Health study points to increased risk of heart disease & diabetes from eating processed meats. Unprocessed meats didn’t have same association to heart disease. This was meta-analysis of previous studies. Wonder if AAFP still advertises Buddig & Boar’s Head on their Healthy Living pages.
RT @healthblawg: Dr. John Glaser, CIO Partners Health Care, speaks w/ David Harlow about health. http://bit.ly/bgcetK /Look fwd to reading.
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