I am leading a major process change initiative (named the eRecord Programme) at one of the biggest foundation Trusts in the UK. This programme encompasses the development of a strategy for the long term future state of clinical informatics support. Our main aim is to enable better healthcare outcomes for the people of our region and to improve on the experience of patients and staff as they journey through the healthcare system.

In this role I am often asked about the significance of press articles that question the quality of the computer applications being implemented in the "Connecting for Health" NHS initiative and I sometimes despair that, as we come close to the end of the first decade of the 21st century, so many people seem to think that it is the computer applications (electronic information systems)  that will make a difference in their organisations, rather than the fundamental changes in process that are enabled by access to the right information, at the right time and in the right place.

Computerised applications are simply tools, they never, ever, in and of themselves, provide a return on investment and anyone who thinks that they will is destined for disappointment. The same sort of disappointment that will occur if one thinks that anywhere in healthcare there is a one-size-fits-all suite of products that will support all of their healthcare information management challenges.

For those that are interested this is an overview of the work that I am currently engaged in:

Why an eRecord?

In 1999 and 2003 two publications were released by the US Institute of medicine, they highlighted a shocking level of misadventure that resulted ultimately in untimely deaths in that country.

While there are no formal studies on the same scale in the UK it is generally accepted that the causes of adverse events in healthcare are effectively the same. Some of them are:

• poorly defined processes that either encourage bad behaviour, or fail to encourage good behaviour;
• ineffective communication, collaboration and inclusion across the healthcare sector; and
• paucity of reliable information at the right time, in the right place and for the right people to support effective decision making.

Further it is widely recognised that healthcare outcomes improve if duplication is reduced, information is shared effectively, and processes are standardised, measurable and understood by participants in those processes. When these things are achieved all stakeholders can, through analysis, monitoring, and identifying trends, improve their own performance or that within their domain of control.

First Steps

The core of the eRecord programme that i am leading is to ensure that we know what the patients within our Trust have experienced or are experiencing on a real-time basis. What treatment have they received, who has or is providing it, and how they responded to interventions.

To do this we must ensure that the recording of information is a key part of the care process and that this occurs as and when that facts become known or change.

The Approach

Our programme of change will be supported through implementation of a software application supplied by a large US based company although, in the same way that a Vauxhall will get you from A to B as effectively as a Rolls Royce, it could as easliy have been supported by any number of applications in the marketplace with a shorter or longer list of "features". This tool will provide all users with a vehicle to access demographic information about Trust patients, the results of tests performed for Trust patients, the attendances that Trust patients have had, and their current location if they are an inpatient. It will also enable users to order clinical tests consistently, quickly and simply for Trust patients and to record who is responsible for our patients at any specific time.

The programme will also be supported through our partnership with a large US healthcare system who have completed a significant amount of work in this area before, through the support of our IM&T Department, and through the support of the Trust’s training and communication team in Human Resources.

There are two key parts to the programme, the delivery of an Electronic Patient Record for the Trust that will:

• support processes in all Inpatient, Outpatient, and Day Patient areas
• provide a definitive source of data regarding the location of the patient and their demographics
• support work order processing and results reporting for clinicians and enable access to this information ubiquitously
• support improved medicines management through standardised prescribing, dispensing, and administration processes
• support better utilisation and scheduling of theatres
• support improved emergency and trauma management processes and the processes of admitting patients to the hospitals

The second part of the programme will involve automating the capture of outputs from various electronic diagnostic devices (such as EEG, ECG, and Lung function equipment) so that they can be linked to the patient record electronically and the task of ensuring that the large number of systems that support specialist care within our Trust are effectively integrated with our core source of demographic information or replaced with something that meets the users’ needs and is integrated.

We also know that we will want some visibility of information that is kept by healthcare providers and allied health providers who are affiliated with, but not under the authority of, our Trust.

Carers need this complete view, and our first steps of capturing and recording information about major care events that happen across all of our Trust operations is a cornerstone of delivering it.

The computer application tool that we are putting in place will provide the authoritative source of data for Trust information about our patients’ demographics, encounters in the Trust, tests and results, medicines, procedures, allergies, and alerts.

The next step for us is to incorporate, for clinical staff providing care, a view of clinical information that is stored in specialist clinical systems, examples of this type of clinical information include mole maps maintained by dermatologists, growth charts maintained by paediatricians, and birthing records maintained by midwives. In the longer term the clinical history of the patient when they have not been under the care of our Trust must also be available through such a view so that information essential to providing high quality healthcare can be seen by authorised carers.

All of this can technically be made accessible and presented via a single interface to the core Trust patient record. However there are a number of challenges as we move toward the target.

The first and most significant of the challenges we face is the realisation that we cannot replace all clinical applications with a single solution. Not only are there no solution packages that cater for every specialty but there are very human issues of proprietorship which ultimately impact buy-in and support for collaborative strategies.

We must recognise the need for authoritative sources of patient demographic information and clinical history; and that these authoritative sources, to deliver benefit, must be integrated rather than “owned” or controlled. When this occurs we will be committed to a strategy of integration rather than replacement in most cases.

Integration of patient demographics held in all systems is essential, currently this information can be updated and out of synch across literally dozens of systems within our own Trust. This situation makes it almost impossible to tie-together patient information and to present a single view of that information. A program of work has begun to identify how this integration will occur, how data will be cleaned up, and to obtain the resources and tools that will be needed.

The second key tool in developing a holistic view of patient information is one that will enable a federated view of information held in systems that are not either managed centrally or even run within the Trust at all. Our partners use a product designed specifically to achieve this and this tool, or something like it, will become a key part of our kit to develop the right information to our clinicians, at the right time and in the right place.

Progress will be discernable through the achievement of critical success factors. These include enabling co-existence and managed transition from the old state to the new; and maintaining a balance that ensures the ownership and commitment of stakeholders to the outcome. The challenges inherent in both will rely on our ability to deploy the right tools, to engage and communicate effectively with stakeholders and to define a well supported path to success.

Not a destination…

This programme of work is a journey, it is not a destination that will be reached within 3, 4 or even 5 years. The development of tools that enable delivery of information to clinicians; that support decision making of the most complex and critical nature will be ongoing, as information becomes ever more plentiful, the challenges of filtering and presenting it sensible and meaningfully continue to increase.

Elsevier's PathConsult is now available through xPert for Pathology - Enhancing pathologists' ability to confirm diagnosis and improve productivity. 

Click on the image to read about this new solution!

And Microsoft also wants your health records as well. The New York Times reports on the NEJM article warning about the entrants of mega-players GOOG and MSFT as purveyors of your private healthcare information. These are not altruistic enterprises - they have to turn a profit on this somehow. So it does make one wonder about their product strategy - will Google flash consumer health ads at you while you review your meds and shots? Will Microsoft create a new Health Passport ID to qualify your access to your medical records on their servers? So, who will the early adopters be?

There are so many questions -  Have you actually tried to locate and consolidate your medical records? Unless you're a veteran and on VistA, have you noticed they are paper? So, will Google scan them for you as well?  What happens to your records if you leave the country or die? What if laws change and you don't know about it? Can your doctor get to your online records, and will they have to have a separate ID for all their patients?  Why can't people just put all their records on a flash drive, that gets updated at the doctor's office, and then keep it physically with them - and a backup on the laptop? What's the real value-add of the big players here?

The NEJM authors consider the trend toward personal health records a positive development for personal responsibility for healthcare:

Despite their warnings, Dr. Mandl and Dr. Kohane are enthusiastic about the potential benefits of Web-based personal health records, including a patient population of better-informed, more personally responsible health consumers.

“In very short order, a few large companies could hold larger patient databases than any clinical research center anywhere,” Dr. Mandl said in an interview.

But the authors see a need for safeguards, suggesting a mixture of federal regulation — perhaps extending HIPAA to online patient record hosts — contract relationships, certification standards and consumer education programs.

Today you'll see almost 200K Google hits on "personal health record." The growth in this "space" in one year has been truly amazing. Remember that Microsoft bought Medstory a year ago, (and there's been no news from them since). However, if the US had a national healthcare system (or even statewide systems), a feature of patient and cost management would be your access to personal versions of electronic health records, such as those available on the aforementioned VistA system. Your tax dollars already built VistA and it is a public domain application. Veterans already have personal eHealth records through My Health eVet (such a bad brand name, but you get the idea). In this area, government and veterans are at the leading edge, and not consumers.

Information services providers might consider the "records aftermarket," rather than records access -  helping consumers make sense of their health records. The medical records themselves are used as intra-practice documentation, and are not easily readable by patients or family members. Perhaps this is the direction the big players want to go, but there's a lot of gray area in the reading and interpretation of medical tests, procedure, physician orders and notes, etc.  Doing this well is an editorial process - currently services such as Medstory do a good job getting you to qualified information, but the level of difficulty of interpretation and sensemaking remains daunting.

Boston, MA—Lakeridge Health, Rouge Valley Health System, The Scarborough Hospital and Sunnybrook Health Sciences Centre have selected mTuitive's xPert for Pathology synoptic reporting solution to meet Cancer Care Ontario's 2008-2009 CAP/CS aligned data standards for pathology reporting.  Thunder Bay Regional Health Sciences Centre and North York General are currently undergoing final testing and will soon be in live production.

Standardized pathology reporting increases the availability and consistency of cancer pathology information that is essential for treatment decisions, evaluation, and research.

mTuitive complies with the 2008-2009 CAP/CS aligned data standards developed by Cancer Care Ontario in conjunction with the College of American Pathologists (CAP) Cancer Committee, the Centers for Disease Control and Prevention and the American Joint Committee on Cancer. The CAP checklists1 for breast, lung, colorectal, prostate and endometrium were amended to include the mandatory pathological collaborative staging elements.

xPert for Pathology interfaces with all available Laboratory Information Systems on the market which lends itself to wide use throughout the province.

About mTuitive: mTuitive, Inc. develops data capture and synoptic reporting software to assist health care professionals in recording clinical findings and maintaining compliance with established protocols and guidelines. Our unique method of capturing structured information provides valuable data for pathology, oncology, and cancer staging applications. Established in 2003, mTuitive, Inc. is based in Massachusetts. See us on the Web at www.mtuitive.com.

1. This material includes the Cancer Checklists and Cancer Protocols which are copyrighted works of the College of American Pathologists. Encoded within the Checklists are portions of the copyrighted work of the International Health Terminology Standards Development Organization, SNOMED CT. © 1998-2007 IHTSDO. The Cancer Checklists and Cancer Protocols are used with permission of the College of American Pathologists – which has also authorized use of SNOMED CT as encoded in the Checklists.

Wow - The Wii earns my respect as a serious haptic interface. A University of Arizona team has shown improvements in fine hand motor skill developed from exercises in continuous practice of the Wii for simulated laproscopy.

I've interacted with the virtual gall bladder removal and cauterization simulation at Riverside Methodist hospital's Virtual Care Unit. It tallied a game score just like a Wii game - but the Wii interface may have leveled the playing field by making it possible to learn and tune fine-grained motor skills in the context of purposeful (and cheap) simulations.

The virtual OR lab at the National Center for Collaboration in Medical Modeling and Simulation has been developing alternatives to learning hands-on procedures, primarily based on practice of motor routines in roughly simulated situations. Mark Scerbo, human factors psychologist (and a Cincinnati grad), explains:

"It's like doing very sophisticated surgery with chopsticks in your hands," Scerbo said. "It takes a lot of training to look at a two-dimensional display and understand what your instruments are doing. There's a real need to train doctors, and not on patients."

Surgeon Leonard Weireiter said: "It turns out you don't need the high-fidelity haptics. It's the repetitive practice of the motion that counts."

Consider the similarity to sports psychology research that shows significant performance improvements from visualization exercises and mental practice. The brain-body system entrains toward the optimal physical movements, timing, and interaction with devices over practice, even when roughly simulated.

Impact on Medical Practice?

Healthcare informatics and e-Learning are rapidly evolving, from several directions -  clinical decisionmaking, patient eMR and personal healthcare records, consumer health information, drug information, resident education, specialist informatics, nursing education, genomics, institutional workflow, finance and insurance integration, and collaborative diagnostics. (I'd link all these to examples, but this was a handful just to type - if I get a reply, I'l do the links!)

Healthcare services and institutions represent a massive information ecology and infoconomy. A significant activity for design research involves understanding these resources and content sources as living, growing players in an ecosystem that cannot be designed, but rather interfaced, linked, connected, and metadatabased. We need ways to visualize the resources, ontologies/taxonomies and information objects available in the overall emerging system - a picture of the stable niches, emerging services, publishers and providers, institutions and their drivers, the relationships among these, and the size/impact of each service in the overall scheme of things. (Let me know if you find one!)

What does that really mean? Here's the reference, from this week's NY Times: Google and Microsoft Look to Change Health Care (And since they charge for content once its a few days old, I've posted a few paras fair-use style below).

I see the possible head-on collision of supply-side healthcare information services with the recognition of individual health needs. The fact is that people also use Google to search for sites that might contain valid information or perspectives on a disease condition. That does not ipso facto lead to people storing their healthcare records with Google's servers.

In the US insurance system, I would not even want my search history of healthcare related issues to be available. Trust Google with personal information requiring that level of privacy? Would you trust your permanent record with Google?

The article suggests some powerful directions for systems and services designers to consider: Healthcare must become more collaborative. Patients with chronic disease conditions interact with multiple healthcare professionals, and ask different questions and express different needs at different times. With the U of T Laboratory for Collaborative Diagnostics we are exploring diagnostics tools and collaborative informatics for collaborative practice. We are also creating new tools for engaging the individual as a central participant in their healthcare intervention. Not just patient-centered medicine, but individual-centered collaborative healthcare.

What will Google and Microsoft do? Well, Microsoft has already purchased Medstory - We should start exchaning our experiences with using it for real clinical issues. (I'm not sure it helps any more that a straight Google search for the trials I've made with it.) So, what else do we think Google or Microsoft will show up with? Are these strategic acquisitions?

Here's some of the article, from Steven Lohr - who covers this beat for the Times:

In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

By combining better Internet search tools, the vast resources of the Web and online personal health records, both companies are betting they can enable people to make smarter choices about their health habits and medical care.

“What’s behind this is the mass consumerization of health information,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration, who now heads a firm that invests in health ventures.

It is too soon to know whether either Google or Microsoft will make real headway. Health care, experts note, is a field where policy, regulation and entrenched interests tend to slow the pace of change, and technology companies have a history of losing patience.

And for most people, typing an ailment into a Web search engine is very different from entrusting a corporate titan with personal information about their health.

Google and Microsoft recognize the obstacles, and they concede that changing health care will take time. But the companies see the potential in attracting a large audience for health-related advertising and services. And both companies bring formidable advantages to the consumer market for such technology.

Microsoft’s software animates more than 90 percent of all personal computers, while Google is the default starting point for most health searches. And people are increasingly turning to their computers and the Web for health information and advice. A Harris poll, published last month, found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001.

If the efforts of the two big companies gain momentum over time, that promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.

Today, about 20 percent of the nation’s patient population have computerized records — rather than paper ones — and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide. Neither company will discuss their plans in detail. But Microsoft’s consumer-oriented effort is scheduled to be announced this fall, while Google’s has been delayed and will probably not be introduced until next year, according to people who have been briefed on the companies’ plans.

A prototype of Google Health, which the company has shown to health professionals and advisers, makes the consumer focus clear. The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.

Google executives would not comment on the prototype, other than to say the company plans to experiment and see what people want. “We’ll make mistakes and it will be a long-range march,” said Adam Bosworth, a vice president of engineering and leader of the health team. “But it’s also true that some of what we’re doing is expensive, and for Google it’s not.”

At Microsoft, the long-term goal is similarly ambitious. “It will take grand scale to solve these problems like the data storage, software and networking needed to handle vast amounts of personal health and medical information,” said Steve Shihadeh, general manager of Microsoft’s health solutions group. “So there are not many companies that can do this.”

This year, Microsoft bought a start-up, Medstory, whose search software is tailored for health information, and last year bought a company that makes software for retrieving and displaying patient information in hospitals. Microsoft software is already used in hospitals, clinical laboratories and doctors’ offices, and, Mr. Shihadeh noted, the three most popular health record systems in doctors’ offices are built with Microsoft software and programming tools.

Microsoft will not disclose its product plans, but according to people working with the company the consumer effort will include online offerings as well as software to find, retrieve and store personal health information on personal computers, cellphones and other kinds of digital devices — perhaps even a wristwatch with wireless Internet links some day.

Mr. Shihadeh declined to discuss specifics, but said, “We’re building a broad consumer health platform, and we view this challenge as far bigger than a personal health record, which is just scratching the surface.”

Yet personal health records promise to be a thorny challenge for practical and privacy reasons. To be most useful, a consumer-controlled record would include medical and treatment records from doctors, hospitals, insurers and laboratories. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes.

The efficient way would be for that data to be sent over the Internet into a person’s digital health record. But that would require partnerships and trust between health care providers and insurers and the digital record-keepers.

Privacy concerns are another big obstacle, as both companies acknowledge. Most likely, they say, trust will build slowly, and the online records will include as much or as little personal information as users are comfortable divulging.

A person might start, for example, by typing in age, gender and a condition, like diabetes, as a way to find more personalized health information. If a person creates a personal health record and later has second thoughts, a simple mouse click should erase it. The promise, the companies say, will be complete consumer control.

There are plenty of competitors these days in online health records and information from start-ups like Revolution Health, headed by AOL’s founder, Stephen M. Case, and thriving profit-makers led by WebMD.

Potential rivals are not underestimating the two technology giants. But the smaller companies have the advantage of being focused entirely on health, and some have been around for years. WebMD, for example, traces its lineage to Healtheon, a fallen star of the dot-com era, founded by the Netscape billionaire Jim Clark.

Google and Microsoft are great companies, said Wayne T. Gattinella, WebMD’s chief executive, but “that doesn’t mean they will be expert in a specific area like health.”

Specialized health search engines — notably Healthline — are gaining ground and adding partners. AOL recently began using Healthline for searches on its health pages, even though Google is a close partner.

Still, 58 percent of people seeking health information online begin with a general search engine, according to a recent Jupiter Research report, and Google dominates the field. “Google is the entry point for most health search, and that is a huge advantage,” said Monique Levy, a Jupiter analyst.

Indeed, it is the market reach and deep pockets that Google and Microsoft can bring to consumer health information that intrigues medical experts, and has lured recruits. Dr. Roni Zeiger, a graduate of Stanford’s School of Medicine, a medical informatics researcher and a former primary care doctor, joined Google last year. The 36-year-old, who still sees patients some evenings and weekends at a nearby clinic, said, “At Google, I can use my expertise and knowledge to potentially help millions of people each day.”

Beta launch of 2collab - Elsevier's new social bookmarking and networking tool has been released in Beta. I've registered and started tagging some articles - I'm finding it very simple to get in and working with it. Try it out yourself and see -

On June 26, the beta version of 2collab was launched to the Scopus and ScienceDirect Development Partners. 2collab is a new collaborative research tool that enables researchers to share bookmarks, references or any linked materials with their peers and colleagues. Users can share, collaborate and discuss resources either in private groups or openly with the wider scientific community.

A common scenario involves a researcher writing an article with co-authors around the globe. Using 2collab he/she can store and share information resources such as research articles centrally so colleagues can access them. Bookmarks can be tagged to allow new ways of searching and accessing information. In addition, researchers can comment, rate and evaluate these resources in their groups. This makes collaboration more efficient and helps researchers share, connect and explore. All without the need for long and complex email strings!

"2collab beta is just the starting point," says Michiel van der Heyden, Senior Product Manager, ScienceDirect. "We plan to create a platform that allows researchers across the globe not just to collaborate on evaluating information but also to help them build new networks, share expertise, and discover new information resources. And we gain from having an opportunity to observe and learn from their behavior."

While I realize Elsevier's ScienceDirect and Scopus are the flagship services here, 2Collab would seem to be a great fit with Scirus. Since 2Collab tags open resources that others can locate from your tags, Scirus' indexing across open science resources would be a good for the early discovery stages of lit research.  Also, Scirus recommends terms to you drawn from the search results. I know tagging is supposed to be user-specified, but the idea is to use meaningful tags recognized by other users - Scirus has a great index already from its (linked) suggested terms.  How about an icon to display Scirus terms accessible to 2Collab?

Nothing but medical procedures. No tagging, no RSS feeds, no social networking. (Not yet anyway.) The innovation was in discovering exactly what was required for the intensive education of doctors in residency programs, delivering these capabilities and minimizing all other distractions. Here the user experience is in the transparent immersion in the details of anatomy, positioning, approach and entry points, techniques, and simulations of all the internal parts you never could see even with live patients.
Elsevier released ProceduresConsult this month, to institutional subscribers. This e-learning service provides animated and acted video and text details for common internal medicine procedures, so you can learn to do arthrocentesis at home. (Hopefully, only if you are in a residency program). Medical residents in internal medicine (and soon Orthopedics and Anethseia will be able to locate detailed interactive procedures education with extraordinary video produced by Harvard's Dr. Todd Thomsen.

Both 320 (on-page) and 640 (video player) videos are provided for every procedure. Text is shown in two full-scrollable pages, Quick Review and Full Details. Navigation was based on how residents typically work with one procedure at a time - while you can search, browse and jump around, the nav model focuses attention within the procedure and limits the opportunity to link away from the page.

We started on this service from nearly scratch 10 months ago, and leveraged an existing platform (based on Elsevier's Nursing Skills product) to deliver the testing and tracking capabilities rapidly. The interaction design was totally drawn from user research, from multiple interactions with physicians and residency program staff. The content design was generated in collaborative design with the product manager (the indefatigable Rolla Couchman), Dr. Thomsen, and the product and editorial team. We conducted multiple onsite user research sessions, evaluating the site structure and navigation, visual and interaction design, content layout, video interaction, and administrative tools in a series of iterations and increasingly-defined prototypes. Jez Alder of Elsevier produced the visual design, over multiple iterations. Look for navigation and content enhancements soon.

By: Grant Gross 7/06/2007 www.intergovworld.com

U.S. President George Bush's administration gets high marks for its vision in pushing electronic health records, but the U.S. is far from implementing a national health IT system, according to an author of a government report released Thursday.

Although the U.S. could see significant benefits from more use of IT in the health-care industry, including fewer deaths from medical errors, more work needs to be done to create standards for electronic health records and other health IT initiatives, said David Powner, director of IT management issues for the U.S. Government Accountability Office (GAO).

The U.S. government still faces an "enormous challenge" in getting electronic health records to patients, Powner told the U.S. House Committee on Government Reform.

Asked to grade the Bush-created office of the National Coordinator for Health Information Technology, Powner gave the office an "A" for leadership and vision but an incomplete grade for implementation. In January 2004, Bush called for the U.S. health-care industry to embrace electronic health records, with the records available to all U.S. residents by 2014.

Powner's report to the committee called for the Bush administration and the U.S. Department of Health and Human Services to push for health IT standards that don't yet exist. "Otherwise, the health care industry will continue to be plagued with incompatible systems that are incapable of exchanging key data that is critical to delivering care and responding to public health emergencies," Powner wrote.

The Bush administration is working toward setting standards, said Dr. David Brailer, the national coordinator for health IT in the U.S. Department of Health and Human Services. Next week, Brailer's office will announce a federal government partner to harmonize health IT standards, he said.

In addition to standards, the cost of implementing electronic health records, and a lack of technical expertise, is holding up adoption at many small health-care facilities, Brailer told the committee. While existing research has sent "mixed signals" on the ability of electronic health records to cut costs, health IT can "save lives, improve care and improve efficiency in our health system," he said.

Part of his office's job is to convince health-care providers and patients of health IT's benefits, Brailer added. Some health-care providers have been slow to adopt electronic health records because they're paid per patient visit, and they aren't paying the bills, he said. "It is against the financial interest of many providers to improve quality or to improve efficiency, because we pay by volume, and greater efficiency and quality, by definition, reduce volume," he said.

Committee member Jon Porter, a Nevada Republican, said he plans to introduce legislation in the next couple of weeks that will require electronic health records for people using U.S. government health insurance coverage. With about 9.5 million members on the federal health plan, the requirement would push adoption to the private sector as well, Porter said.

Porter repeated concerns that the lack of electronic health records is adding to medical errors. "We are so far behind in our technology, we are costing lives of many Americans," he said.

In 1999, the Institute of Medicine, a nonprofit health analysis organization, issued a study saying between 44,000 and 98,000 U.S. residents die each year due to medical errors.

Continue article here: http://www.intergovworld.com/

• Use of Internet in Healthcare (2007)
  An article looking at the adoption and impact of Internet Technologies in Healthcare

• Re-looking Nursing Informatics (2007)
  This article examines the importance of Nursing Informatics and its role in the modern healthcare industry

• RFID in Healthcare : Losing Cables, Making Waves (2007)
  An exploratory article that highlights the benefits of RFID in the healthcare setting

• Laboratory Information Systems: Opportunities in APAC (2007)
  This article looks at the LIS market in Asia Pacific as well as the factors of successful LIS implementations

• Telesurgery in Asia - Are we there yet? (2006)
  An article that looks at the adoption rate of Telesurgery in Asia

• Telesurgery: Are They Operating in Singapore Yet? (2006)
  An article that looks at the adoption rate of Telesurgery in Singapore

• IT Security in Biomedical Imaging Informatics : The Hidden Vulnerability (2005)
  An oral paper presented at the 7th Annual NTU-SGH Symposium, Singapore

• Image Quality Management in a PACS Environment (2005)
  An oral paper presented at the 20th Singapore-Malaysia Radiographer's Conference (SMRC)

• IT Security in Healthcare Informatics : The Hidden Vulnerability (2005)
  An abstract I submitted for the Second Middle East Conference on Healthcare Informatics.
  The paper was not presented due to the inability to attend the conference in Dubai

• Rethinking PACS security -- The Unusual Suspects (2004)
  An article discussing the dangers that modality-based equipment could bring to your PACS Network