Well now that we're coming to the end of our Midwinter week here I've finally got a chance to sit down and tell you what's been going on. The last couple of weeks have been full of preparations for midwinter, which becomes our alternative Christmas as it's the coldest darkest part of the year, and we missed Christmas proper as we were in the middle of relief. As a result the workshops have become the most popular places on base, full of people cutting, polishing, varnishing, welding, breaking, swearing, crying, and starting all over again. The pain was worth it though as there were some truly amazing creations, but more of that later.

Since I last wrote we've been doing our best to maintain a thin veneer of normality amongst anticipation of festivities to come. Various bits of IT equipment have done their best to maintain the status quo by failing at inopportune moments, but luckily nothing insurmountable. I've also been out and about with Jules checking the comms masts. Jules is Winter Mast Officer, so it's his responsibility to ensure none of them fall down, which involves checking the tension in the stays and making sure nothing gets buried by the snow. On the social side we've had another couple of inter-base darts matches, managing a win against Rothera, but sadly losing 2-0 to KEP. These webcam matches provide a great opportunity to get everyone together in the bar, as even the self proclaimed non-players get up for their shot, and a chance to swap gossip with the other bases and remind ourselves that we're not entirely alone down here, and there is life outside our 1km comfort zone.

Simon lines up for a shot

Having lived within the confines of a 1km diameter circle for 7 months now you'd think we'd know our way about, but I very nearly got lost a couple of times while helping out on the gash run. All our waste is put out onto a platform outside the front door of the building, and then when that gets full it's all craned onto a sledge and towed out to various dump lines around base, awaiting export when the ship comes. I was gainfully employed as dozer driver and crane operator 2nd class, but sadly my navigation skills nearly let me down. It's fairly tricky driving in the dark when it's snowing at home. Now imagine doing it with no street lights and a flat white landscape, trying to locate two bamboo poles with flags on which you know are out there somewhere. Except they're not because the flags have blown off in the wind. Nevertheless we managed to get everything done, and didn't break any sledges this time so all in all a successful day.

Starting the dozer. Never again will I complain about de-icing the car.

In the last week before midwinter the base takes on something of an end of term feel as decorations start to go up and activities are organised for the week ahead. In Doc School Vicki arranged a couple of scenarios to test our knowledge, which we managed to get through without quite killing anybody, although the acting of the 'patients' was very realistic at times. Simon also ran a class in rope splicing and whipping, so we spent an enjoyable afternoon joining bits of rope together. I celebrated the end of the week by raising some catenaries, which are poles that carry cables out to the aerials and satellite dome to ensure they don't get buried by the snow.

Artistically spliced and whipped ropes

After the end of the working week it was time to get down to the important business of midwinter celebration. We had many events planned over the week, and Bob kicked us off on Saturday with a fascinating slide show of various pictures from his previous jobs working on yachts. As far as I can tell he's spent many tough years photographing female crewmates and climbing masts in order to get a better vantage point from which to take photos. Sunday was a marathon film day, having all voted on a film shortlist the final programme was It's a Wonderful Life, To Kill a Mockingbird, A Very Long Enagement, Life of Brian, and Muppet Christmas Carol. I managed valiantly to watch all five films, only one of which I'd seen before.

Monday saw the pool competition and many a cue chalked in earnest. Sadly I was knocked out in the first round, but the rest of the competition proved fascinating. The girls all did incredibly well, dominating all the rounds, with the final being between Kirsty and Fran. Fran emerged victorious, but then again she has been down here a year longer than everyone else so has had much more practise. During the day Simon unveiled the winter magazine which he has been putting together for the last few weeks. This is another tradition down here, each year the wintering team puts together a magazine to reflect what's gone on and try and embarrass as many people as possible. This years superb effort had something of a football theme, reflecting Simon's love of the game and probably also relating to that World Cup thing which apparently is going on at the moment. Tuesday included a 2 hour yoga session, after which we all felt slightly disjointed but very flexible. This proved an excellent warm up to the evening darts match against KEP.

Then came the big day. Wednesday June 21st was midwinters day in the Antarctic. Tradition dictated that John the Base Commander had to offer to deliver everyone tea and coffee in bed. I decided to decline the offer, but was up in time for an excellent brunch with Bucks Fizz to start the day. A few of us hardy souls (idiots?) decided that a naked run round the building would be the perfect way to celebrate the day, so ventured out for a brisk trot round the Laws at -40 degrees...... This wasn't actually as bad as I was expecting, and certainly blew away the cobwebs. After that we relaxed by watching The Thing, almost as scary as the sight of us circumnavigating the building but not quite. For the evening meal everyone dressed up in their best posh togs and met up for a pre prandial G & T. Nic the Chef prepared us an absolutely incredible 5 course feast and we all duly stuffed ourselves silly.

And they're off!

Table ready for the midwinter meal

After all the lovely food it was all we could manage to walk through to the lounge for the present giving. At last the waiting was over and we got to see the fruits of all those hours spent labouring away. I had drawn Vicki's name out of the hat and after much welding, metal bending and fiddling with bits of coke can I managed to produce a miniature samba drum with a model of the base on top. As coincidence would have it Vicki picked my name out of the hat so I received a lovely patchwork wall hanging of the view up from the bottom of a crevasse. There are obviously some very talented craftspeople on base as all the presents were fantastic, and very original, providing an excellent memento of our time here. After the presents it was time to sit round the wireless. Every year on the World Service there is a special Antarctic Midwinter Broadcast where friends and family can leave messages, so we had the HF radio piped through to the stereo and had half an hour listening to voices from home. If you're interested you can listen to the broadcast here

Presents all wrapped and ready

The result of Anto's expert welding tuition, and a large hammer

A not quite to scale model of Halley

Patchwork quilt on display at Halley Art Gallery

Midwinter presents on display

After the excesses of midwinter, Thursday was understandably a fairly low key affair. I successfully slept through most of Dr Zhivago and in the evening Simon hosted a quiz. Friday night was games night, consisting of Twister, Mafia and Balderdash and Pictionary. We also had another cocktail night, having fun making Antarctic creations, which tasted surprisingly good actually. Saturday night was an opportunity for more talents to come to the fore as we had the Halley Cabaret Night. There was lots of music, singing, poetry and sketches, but for me the highlight of the evening was Liz sawing Andy in half. I've often wondered how magicians do this trick and now that I've seen it performed in my own front room I can safely sayI still have no idea.

Bob aka Johnny Cash, with backing band

"Always look on the bright side of life"

Liz starts off with the power tools......

......but reverts to more traditional methods

Andy didn't feel a thing

As I write we await the result of the Photo Competition, and that will bring to a close our week of festivities as we return to work refreshed tomorrow, looking forward to seeing the sun again in a couple of months.

The adoption of electronic health record systems is not being driven by a return on investment in hospitals and physician practices, Pat Wise, vice president of Healthcare Information Systems at the Healthcare Information Management and Systems Society, said, Healthcare IT News reports.

Wise said that although ROI could be measured as a result of adopting EHRs, many health facilities that do not use EHRs do not seem to recognize their importance.

"There is a real business case to be made for [EHRs], but the word has not gotten out," Wise said, adding, "More organizations need to know that [EHRs] are a better business practice."

She cited examples, such as Evanston Northwestern Healthcare in Chicago, which had a $2.5 million increase in revenue because of improved charge capture from its EHR system. In addition, North Fulton Family Medicine in Georgia has saved $775,000 in transcription costs after adopting EHRs in 1998, and it also saves $275,000 annually because of the system.

Wise added that most health facilities have adopted EHRs to improve patient care and workflow management, and surveys indicate that "a large percentage of physician practices that don't have [EHRs] have no intention of implementing them in the near future," she said (Pizzi, Healthcare IT News, 6/27).

Article: http://www.ihealthbeat.org

By: Andis Robeznieks / HITS staff writer Story posted: May 21, 2007 - 10:56 am EDT

Part one of a two-part series

Like a recurring dream about having to take a test they didn't study for, some physicians view the idea of patients with electronic personal-health records as their own personal nightmare.

Visions of patients handing over a computer disk containing years' worth of blood-pressure readings taken every four hours along with random recollections of rashes and muscle strains that physicians are required to somehow make sense of and memorize are followed by thoughts of being sued because there was a kernel of important information missed in the deluge.

"That's why folks like me are terrified of personal health records and what patients will bring to us," internist Michael Zaroukian said earlier this year during a panel discussion at the Integrating the Healthcare Enterprise Connectathon, an event that brings electronic medical-record vendors together to solve interoperability problems (and sponsored by the Healthcare Information and Management Systems Society, the Radiological Society of North America and the American College of Cardiology).

While Zaroukian, who is chief medical information officer at Michigan State University, is now backing away from the word "terrified," he still maintains "there are certainly lots of reasons to be concerned."

The reasons for concern that Zaroukian cites include: the accuracy, completeness, usefulness and volume of the records physicians receive from patients; the hours of uncompensated work it will take to slog through them; and the potential for a misdiagnosis if something important was overlooked.

"In some ways, it's simply an electronic extrapolation of what we've seen in the paper world," Zaroukian says. "The greater the volume, the more likely it is that relevant data will be lost."

Zaroukian certainly isn't the only physician who feels this way.

"He has every reason to be frightened by that, and I don't see what he is describing as an improvement over someone bringing in an entire paper chart," says Joseph Heyman, a gynecologist and an American Medical Association trustee. "I don't blame a physician for worrying about that. I think the beauty of a personal health record is if it's a snapshot of a patient and their most important demographics—like their current condition, allergies and medications—that's entirely different from their entire medical history for their entire life."

Peter Basch, medical director for e-health at MedStar Health in Washington, says "physicians love a (hospital) discharge summary" that gives one to two pages of key points. What they may get from a PHR, however, could be something that has no resemblance to a discharge summary at all.

"Electronic records make it easier to share more information and images, so often what could be included on one page is now included on 10 and 12 pages," says Basch, an internist who serves on the medical informatics subcommittee of the American College of Physicians.

He says, though imperfect, a quick two- to three-minute oral history taken during an office visit can be more helpful than an extensive PHR.

"It's like saying to a patient: 'Tell me about the rash,' " Basch says. "Don't give me a seven-hour history of every rash you've had in your life."

Zaroukian says that while things like patient-recorded blood-pressure readings can be useful, the value is not in each particular entry, but in the average and the range of high and low readings.

He says diabetic patients often give him diaries of insulin doses and pre-breakfast blood-sugar levels recorded in meticulously arranged rows and columns, but—despite their neat appearance—the numbers are not distilled into a useable format.

"You have to skip between rows and try to average the numbers somehow, but it's impossible," Zaroukian says. "The data is so poorly organized that it not only does not improve quality, it could contribute to making a bad decision."

Nevertheless, he says that PHRs could be an important tool in developing a partnership with patients, so he "gently forces" them to use the spreadsheets—either paper or electronic—that he has developed.

"Over time, patients see how their own self-management can be improved, so over time they become more interested in doing so," Zaroukian says. He adds that the key is to make it easy to record the information in a usable format so the patient-maintained record is not "just a few jewels of data floating in a sea of debris."

Organization and quality of the data are paramount to making the PHRs useful, says Heyman, who has a solo practice in Amesbury, Mass.

"I think at the AMA, we believe there can be great value to PHRs and they can save physicians and patients a great deal of time, while helping to avoid medication errors and duplicate laboratory tests," he says. "But there is a risk of 'garbage in, garbage out,' and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient."

Basch says it's not the PHR alone that will create savings or improvements in care or efficiency, but it could be the tool that helps a motivated patient achieve those results. In fact, all the information included in the popular physician-provided PHR iHealthRecord from Medem, a San Francisco company founded by the AMA and several other medical societies, is entered by the patient (although if patients choose they can have data automatically flow into their PHR as it is entered in their physician's EMR system).

"Some patients will rise to the occasion, and some won't," he says. "But for patients with diabetes, hypertension or congestive heart failure, daily or weekly recordings of blood pressure and weight could result in useful information that could stem chronic conditions from going bad and save a lot of ER visits."

And, for these patients with chronic conditions, Basch cites key barriers to primary-care physician involvement in helping develop and maintain a patient's PHR: a lack of reimbursement for coordination of care among specialists; uncertainty over the legal responsibilities of helping a patient maintain a PHR; and knowing what the record contains.

"With personal health records, one of the issues is the core problem of financing healthcare where information management and discussions with patients are poorly reimbursable in the context of an office visit," he says. "Those are currently seen as an uncompensated burden on physicians."

Making sense of complicated and unorganized records can require four to five hours of work—whether the records are on paper or in an electronic format—Basch says, but this is accepted in most sectors because "there's an unwritten rule that a primary-care physician's time is not relevant and that information management isn't really work."

"There's no payer who will say: 'Sure, I'll pay you for your time'; they'll say 'Too bad, learn how to do it in 60 seconds,' " Basch says.

Steven Waldren, director of the American Academy of Family Physicians' Center for Health Information Technology, says PHRs haven't caught the attention of most doctors yet. But for the relatively small portion of physicians who have implemented electronic records, PHRs are known entities and these doctors' main concern is on workflow.

Establishing PHR data standards—what information to include and in what format—will be important to solving workflow and data-management problems, Waldren says, adding that it's time for physicians to get familiar with PHRs.

"PHRs are here and will continue to be," Waldren says. "If the healthcare consumer empowerment trend continues to move in the direction it's moving, we'll continue to see growth in the tools available for patients."

Waldren mentions healthcare decision-support applications as one of the tools patients are going to be using soon, and this prediction is already coming true. Earlier this month, Verizon Communications announced it was offering PHRs to 900,000 of its employees, retirees and their family members, and the system would include alerts that would inform users when their care "may not be consistent with evidence-based medicine."

See article here: http://www.modernhealthcare.com

Patients' welfare is at stake in the electronic effort, experts say.

By Daniel Costello, Times Staff Writer
February 15, 2007
Kaiser Permanente's $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees.

At times, doctors and medical staff at the nation's largest nonprofit health maintenance organization haven't had access to crucial patient information, and system outages have led to delays in emergency room care, the documents show.

Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.

Concerns about Kaiser's effort, called Health Connect, recently led the California Department of Managed Health Care to request information about the project, a first step before a possible formal investigation.

The HMO's problems come as it plans to expand the computerized system over the next two years to nearly three dozen more hospitals — most in California — where the sickest patients are treated and ensuring patient safety is most difficult. Currently, the system is fully rolled out only in two hospitals, Baldwin Park Medical Center and South Sacramento Medical Center.

Kaiser's effort, one of the largest and most ambitious electronic medical records projects in the country, is seen as a possible national model. With evidence suggesting that digitized recordkeeping can lower health costs and save lives, President Bush is pushing for every American to have an electronic medical record by 2014.

But the glitches illustrate the difficulties a massive healthcare provider might encounter trying to implement a complex computerized system.

Kaiser officials acknowledge that Health Connect has had technical challenges but say those have been resolved and patient safety has never been compromised. Patients should feel safe getting care at any Kaiser facility, they say.

They add that medical staff revert to paper records and established downtime procedures when the new computerized system isn't available.

"This is one of the largest and most ambitious efforts anywhere in the world to modernize our healthcare system," Kaiser Chief Executive George Halverson said. Considering that, he said, "it couldn't be going better."

Kaiser's size — millions of members, 12,000 physicians, 431 medical offices and more than three dozen hospitals covering nine states — makes trying to go paperless a Herculean effort. Some problems are inevitable.

And Health Connect has had early successes. During routine data analysis using its digital records two years ago, Kaiser was the first to identify problems with Merck & Co.'s arthritis drug Vioxx, which was later pulled from the market after a study showed it increased the risk of heart attack.

Because the computerized system reminds women leaving doctors' offices to return for their mammograms on time, the number of women receiving timely tests has increased throughout the system, Kaiser said.

Read Complete article here: LA Times

By: Joseph Conn / HITS staff writer
Story posted: February 13, 2007 - 10:56 am EDT

The compromise reached between two sometimes rival standards development organizations could have far-reaching implications for the development of a national healthcare information network, experts close to the effort say.

The collaboration, called the Continuity of Care Document, or CCD, is the handiwork of Health Level 7, Ann Arbor, Mich., and ASTM International, Conshohocken, Pa., which jointly announced its release Monday after required formal balloting was completed. Initial development efforts by both organizations was aimed at developing patient care summaries but has since broadened in scope.

The CCD is a melding of HL7’s broader Clinical Document Architecture, or CDA, and the Continuity of Care Record, or CCR, developed by ASTM in collaboration with the Massachusetts Medical Society. Balloting on the much-anticipated CCD began on Dec. 6, 2006, and concluded Jan. 7. It took two ballots to pass muster among HL7 members and other interested parties who reviewed the development, according to Robert Dolin, an Orange County, Calif.-based physician lead for national terminology services for the Kaiser Permanente Medical Group, a member of the HL7 board of directors and the editor-in-chief of CCD for the standards development organization.

Richard Peters, also a physician, is chairman of the ASTM International Committee on Healthcare Informatics and serves as ASTM’s lead in the collaboration on the CCD.

Peters could not be reached for comment by deadline.

“I am the primary editor, and I voted no on it on the first ballot,” Dolin said. “We had enough time so we tightened up all the constraints and the language to use to express the constraints that were a little ambiguous. We went through each section of the CCR and went through it line by line,” he said, making sure it dovetailed with the CCD.

In October 2006, the federally funded Healthcare Information Technology Standards Panel recommended to HHS Secretary Mike Leavitt its first batch of “harmonized” IT standards aimed at facilitating specific healthcare data transmission tasks chosen by HHS. Among those was a recommendation by HITSP that the then-unfinished CCD be adopted for the exchange of certain clinical information, including patient demographics, medications and allergies.

HITSP Chairman John Halamka, the physician chief information officer of Harvard Medical School, in an e-mail called the successful CCD ballot “a very significant development for healthcare IT” and “a milestone in the standards world.”

“HL7 and ASTM worked together seamlessly to incorporate the best of their standards into a work product that will now form the basis of many HITSP Interoperability Specifications,” Halamka said. “CCD was included in the HITSP interoperability specifications submitted to Secretary Leavitt last October. We'll ensure any updates to CCD are included in our next release of interoperability specifications which will be voted on in May.

Work by ASTM on the electronic CCR flowed out of an initial effort by physicians in Massachusetts to develop a standard, paper-based discharge summary for patients leaving the hospital bound for nursing homes.

Dolin said a similar interest by HL7 members to develop a standard for patient summaries led HL7 to come up with on its own Care Record Summary, or CRS. But the parallel development work of ASTM on the CCR and HL7 on its CRS led to strained relations between adherents of the two standards—what Dolin diplomatically described as “all this politics going on between HL7 and ASTM.” Cooler heads apparently have prevailed and with the collaboration leading to the successful balloting, “CRS is now sunseted by CCD,” Dolin said.

A major event at the IT trade show, Toward the Electronic Patient Record, last May in Dallas, was a demonstration of the CCR by more than a dozen vendors of electronic medical-records systems. At the time, most of the participating vendors could export documents in the CCR format and at least one vendor could import a CCR document and seamlessly place discrete data elements from the record in the fields of the receiving vendor’s EMR.

The demonstration showed the potential of peer-to-peer communication between physicians with different EMR systems.

Peter Waegemann, chief executive officer of the Medical Records Institute, sponsor of the show, said development of the compromise CCD “is really a win-win situation.”

Vendors and users of large IT “legacy” systems that are backers of HL7’s Clinical Document Architecture will gain the most benefit from the CCD because they will be able to use the CCR format in their systems, Waegemann said. But the collaboration with HL7 on the CCD further establishes the CCR, he said.

“Both have a community and both are good for the doctors and everyone else,” Waegemann said.

The American Academy of Family Physician’s Center for Health Information Technology operates an online list of EMR and personal health record system vendors that have committed to using ASTM’s CCR. The list, currently with 31 vendors, also includes the status of their CCR incorporation efforts.

By Bernie Monegain, Editor Healthcare IT News

CHICAGO – Proposed certification criteria for hospital electronic health record systems opened for public review Thursday. The comment period extends through March 16.

Materials are posted on the Certification Commission for Healthcare Information Technology Web site. Comments can be submitted on the Web site.

Also, the commission has published a test script for ambulatory EHR certification. The new test script was posted Wednesday and opened a final 14-day public comment period that runs through Feb. 28.

The new criteria will take effect May 1, and will include new requirements for electronically sending prescriptions as well as receiving laboratory test results – the first CCHIT interoperability criteria.

A pilot test to validate the 2007 ambulatory EHR test scripts was completed successfully and on time, said Alisa Ray, CCHIT executive director. The pilot test participants represented a range of company sizes and included Community Computer Service; Greenway Medical Technologies; NextGen Healthcare Information Systems; and Nightingale Informatix Corp.

Last month the commission announced certification of 18 electronic health record products, bringing to 55 the total ambulatory products certified.

CCHIT has scheduled a Town Hall meeting at Healthcare Information and Management Systems Society annual conference in New Orleans to review and take questions on current and future certification plans. The meeting is set for Feb. 27 from 9:45-11:45 a.m. Also at HIMSS, CCHIT will offer two orientation session to help companies with hospital-based EHR criteria. Those sessions are set for Feb. 27. One is from 3-4 p.m. The other is from 4-5 p.m.

Read article here: www.healthcareitnews.com

BY Brian Robinson, Published on Feb. 19, 2007 GovernmentHealth IT

Does measuring medical performance lead to better patient health?

The short answer is yes — and just about everyone understands that, at some point, information technology will be vital to the widespread use of performance measures.

But the measures need to be smartly focused. A study published in the Journal of the American Medical Association in December, for example, found that measures used in a performance measurement project run by the Centers for Medicare and Medicaid Services (CMS) were specific but not meaningfully linked to patient outcomes.

Heart attack treatments, for instance, were rated on whether someone administers aspirin and beta blockers when a patient arrived and whether someone to tried  persuade the patient to stop smoking, the study states, adding that those are not strong precursors of quality differences.

The relative performance of hospitals, clinics and physicians in delivering care to patients has been an ongoing health care question for years. But as it broadens into a national debate and the concerns become more focused, the conversation has centered on how to measure health care performance.

Many commercial and public interest groups are now attacking the problem. The American Medical Association (AMA), for example, is leading a project to develop standard performance measures that  health providers and insurance plans nationwide can use, including the Medicare program. The project has already produced more than 140 measures.

At the same time, Congress is trying to push the envelope with enticements for physicians to use performance measures.   President Bush signed bipartisan omnibus legislation in December that would provide physicians with a 1.5 percent bonus to their regular Medicare payments if they reported data to CMS based on measures that the AMA initiative is trying to develop.

The legislation, introduced by Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.), requires a quality reporting system for eligible physicians to begin using measures July 1 that CMS has already adopted to July 1. The law would initially last until Dec. 31, though Congress could extend it.

IT is essential
IT will be vital to the widespread use of performance measures. More local programs, such as the statewide pay-for-performance program in California, created by the Integrated Healthcare Association, make the use of health IT part of their measures.

Although health IT vendors are starting to look at the ramifiactions of performance measures, most are reluctant to do much work until a consensus on nationally applicable measures is clearer.

“Vendors have been putting most of their time into developing the functionality of [health IT] systems, such as being able to write and send prescriptions, rather than the tools needed to do” this kind of performance-related reporting, said Charlene Underwood, chairwoman of the Healthcare Information and Management Systems Society’s Electronic Health Record Vendors’ Association.

The problem is not a lack of experience with programs that use such measures. There are scores of pay-for-performance programs nationwide, Underwood said. Estimates reveal that more than 100 such initiatives are operating, but most of them are local.

Furthermore, many of them are programs run by single hospitals or regional provider plans. Other than California, only Hawaii and Massachusetts have statewide programs. And they depend on performance measures that are specific to their programs.

“Vendors just can’t afford to spend a lot of money in producing tools to capture the data needed for all these programs,” said Underwood, who is also director of government and industry affairs at Siemens Medical Solutions. “It’s the focus on [the national consensus on measures] that will drive things in this area.”

Good or bad?
The AMA-led Physician Consortium for Performance Improvement is addressing at least part of that first mandate. The group has been working for the past few years to develop a consensus on what national performance measures should contain and what goals they should target.

It has not been easy. The health profession has not yet decided whether performance measures overall are good or bad.

“If they act as proxies for the quality [of health care], then yes, it supports them,” said Dr. Nancy Nielsen, speaker of the AMA House of Delegates and the organization’s leader on quality issues. “If a patient has a heart attack and the performance measures say they should be given aspirin and beta blockers, then most physicians would say the measures are a good thing.”

However, doctors are wary that the measures will be used more as proxies for the cost of care, and that causes many medical professionals to balk at the notion of performance measures.

“True efficiency should be linked with value and whether patients are getting the same level of care for a lower cost,” Nielsen said. “The suspicion is that health plans will use performance measures simply to lower cost.”

REad full article here: www.govhealthit.com

Article published Feb 16, 2007 Modern Healthcare Online

I've read Andis Robeznieks' article "Using EHRs to extract data on adverse drug events." It is all true. But why isn't it a common practice? Why don't we have an EHR that all healthcare providers use? Why don't we use standards that make all this possible?

The question is, "Why are we not using these standards?" My answer is:

• The "not invented here" syndrome.
• The belief by many that Health Level 7 and its message paradigm will solve the problems, while it never can because all messages take a lot of resources to produce them and even more to implement them in all systems in a patient-safe way.
• The fact that information technology vendors and consultants make a lot of money out of the mess the message paradigm is associated with.
• HL7—the industry and consultants do a good job promoting the message paradigm as the only solution.

For more information I refer to openehr.org, an open-source community that provides a lot of background technical information and implementable specifications, plus some software.

Gerard Freriks, MD
member of EuroRec
European Institute for Health Records
the Netherlands

Article Here: www.modernhealthcare.com

Published on Feb. 19, 2007 Government Health IT

Public-sector health care organizations participate in regional health information organizations (RHIOs) at twice the rate of private-sector organizations, but lag significantly when it comes to using electronic medical records (EMRs), according to a recent survey from Citrix Systems.

The survey, which involved 99 state health care executives and 347 private-sector health care information technology executives, was designed to determine the levels of current and planned EMR adoption and RHIO participation by private and public-sector organizations.

“What we found is that progress is being made and planning is being done, but there is an awful lot of work that has to be done if we are going to meet the 2014 federal mandate for EMR adoption,” said Dave Podwojski, director of State and Local Government, Education and Health Care Markets at Citrix.

Only 19 percent of state health executives reported using EMRs and only 16 percent said their state had set a timeline to achieve broad EMR use. In  contrast, 52 percent of private-sector health care information technology  executives said their organizations were already using EMRs and another 5 percent said they were hosting EMRs for others; 30 percent of private-sector organizations are still in the planning phase, but 37 percent of those expect to deploy EMRs in less than two years.

On the RHIO side, 43 percent of state health executives said their organization participates in a RHIO, compared with 20 percent of private-sector respondents. Podwojski said government’s natural tendency to collaborate and share with colleagues is helping drive the higher levels of RHIO participation.

Nevertheless, 70 percent of state health executives said private health care providers are playing a greater leadership role in RHIO development. The majority of public-sector executives would like to see states take a more active role in RHIO development, including providing a model framework, startup funding and access to technology via an Application Service Provider model.

Several impediments, including lack of budget, cultural resistance and technical difficulty, are slowing EMR adoption, the survey reported.

Private and public-sector health organizations also see more value in pursuing in-house solutions than using outsourced or service-based models. Given the cost and complexity involved in installing and maintaining such solutions, the trend is serving to impede greater EMR adoption, Podwojski said. “It’s definitely not the easiest way to go,” he said.

Article here: www.govhealthit.com

By Heather B. Hayes Government Health IT

The physician-based electronic medical record (EMR) market is growing at a fast pace, but not as fast as many in the industry would like to believe, according to a market analysis by the consulting firm of Frost and Sullivan. The findings are based on a study of metrics, including vendor sales data and end-user surveys.

Steve Tobin, a Frost and Sullivan industry analyst who authored the report released Feb. 21, estimated that EMR adoption is climbing among all sizes of physician practices, with an overall market growth rate of about 20 percent.

"There's strong technology growth, to be sure, but we're still talking about a multiyear, even decade-long implementation for the entire market," Tobin said. "EMR solutions will continue to have a lot of market penetration, but it's just not as hyper-growth as some people have speculated that it is."

Early adopters and larger practices are driving much of the growth, he said. In smaller practices, the slow materialization of financial benefits from EMRs frequently reduces the incentive to buy. However, "current [vendor] offerings are providing different business models, such as the ASP [application service provider] model, which may help penetrate financially restrained practices," Tobin said.

Still, Tobin said he believes doctors in small practices are beginning to recognize the efficiency, clinical improvement and potential financial benefits of EMRs and are becoming more sophisticated in their knowledge. When these physicians decide to buy, they tend to demand integrated solutions from vendors, he said.

Also, many vendors are getting ahead of themselves by pushing the quality capabilities of EMR solutions; most physician practices are not ready for that step in the technology evolution, according to the report. "Those with that level of sophistication are very few in the market at this point," Tobin said. "Most physicians are still grappling with implementation, getting used to it, doing the basics and getting their practice involved with it.”

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