News&Views

September 29, 2006

50 Ways to Leave Your…Local EHR System

Filed under: — mlazoff

Goal is Electronic Health Records. Path is State by State” is an article published last Wednesday in the NYTimes; iHealthBeat summarized this article. Regarding the strategies of governors and state legislators to encourage the use of electronic health records (EHR), quoting from the Times: “More than half the states are in the midst of a planning process, said Janet M. Marchibroda, chief executive of eHealth Initiative, a nonprofit group in Washington that works with a variety of states and communities. In the last year and a half, she said, there has been “a huge uptick and intensity of state activities.” By the group’s calculation, 38 states are now participating in statewide or community discussions, while as many as 21 are leading the coordination of efforts. By definition, many of these efforts are in the early stage. Most states are still trying to develop a plan for a technology system and are months if not years from carrying it out. Health experts say it will be some time before there are tangible signs of success.” The article goes on to describe states’ concerns over how much cost should be born by the state (vs federal government), and in ensuring interoperability of EHRs across the region (given hospitals’ and doctors’ desires to choose their own systems rather than having them dictated by the state). “…[H]ealth experts caution that many of these efforts have a long way to go toward meeting the federal government’s goal of having interoperable electronic health records by 2014.” For more on state vs federal fricton, see Are All (HIT) Politics Local? from two weeks ago.



September 26, 2006

Public Privacy

Filed under: — mlazoff

NYTimes’ registrants (free) can read more about the Action Sought Against Employees Who Pried Into Records. “The city’s Health and Hospitals Corporation said that dozens of workers at Woodhull Medical and Mental Health Center in Brooklyn opened a patient’s file in the hospital’s computer system, though they had nothing to do with the case. They ranged from doctors and nurses to technicians and clerks…the case was a high-profile one. When reporters concluded that the person was almost certainly Nixzmary [a seven year old with multiple reports of abuse who was beaten to death last January in her Brooklyn apartment, allegedly by her mother and stepfather], city officials confirmed that it was.” The article quotes a hospital official who felt that the “unauthorized prying was motivated by ’sheer curiosity,’ and that there was no sign that the employees were trying either to deflect blame or blow the whistle on mishandling of the case.”

The remedy? “Spurred by this case, corporation officials said they had adopted a new practice of auditing a random selection of patients’ files, which keep a record of who has opened them…The corporation is seeking 30- to 60-day unpaid suspensions. The tough penalties, aimed at so many people, were clearly intended to send a message to other employees.” The article ends with a curious uncertainty: “There are state and federal laws on patient privacy, but it is not clear whether they would apply to doctors and nurses looking at records, particularly when the patient has died.” See  HHS’ Office of Civil Rights - HIPAA and New York City Health and Hospitals Corporation Privacy Notice.



Resuscitating Anne’s great great grandchildren

Filed under: — mlazoff

The September issue of International Review of Information Ethics (IRIE) is on Ethics in Information Technology in Medicine and Health Care. Recommended: the article by two Finnish information technologists on The Use of Extremely Anthropomorphized Artefacts in Medicine, which examines the implications of using human-like robots in training medical students—far more natural appearing than today’s familiar CPR training mannequin, Anne. “Before the technology reaches its peak and the students can practice with artefacts that respond exactly like human beings we must define principles and ensure in practice that the transition from “manikin to man” goes with as few complications as possible…the instructors should be able to orient the students into a right state of mind prior to actual training.” IRIE does not describe itself as open access, though its contents are available to those who register (free).



September 21, 2006

Interim announcement

Filed under: — mlazoff

According to an article posted last night on the healthcare business news site Modern Healthcare, “HHS Secretary Mike Leavitt announced the appointment of Robert Kolodner [MD] as HHS’ interim national coordinator for health information technology. Kolodner, previously chief informatics officer at the Veterans Health Administration, replaces David Brailer, the first occupant of the HHS post, who resigned in May. A physician, Kolodner was involved in the VA’s VistA information technology system and has been instrumental in the development of the VA’s overall electronic medical records system.”



The Sound of Music

Filed under: — mlazoff

For those who use, or are thinking of using, portable recording devices to dictate and such, lend an ear to an article in today’s New York Times (free registration required) on Some Hot Recorders for Those Cool Podcasts. The article describes recorders that use nonvolatile flash memory, the same memory used in digital cameras and many PDAs. The article explains: “Flash has no moving parts to make noise while you record, and it is compact. An SD flash card, not much bigger than a postage stamp, can hold as much as four gigabytes or up to 130 hours of compressed monaural audio…Compact Flash cards can store up to eight gigabytes. Also, data on a memory card can be easily transferred to a PC or a Mac with a U.S.B. cable or by removing the card from the device and putting it in a PC card reader. Once on a PC, the file can be edited, e-mailed or posted to a server.”

The article describes the three types of digital flash recorders currently on the market. “There are digital voice recorders like the Olympus VN-3100PC ($69) that are mostly used for dictation and other voice-recording tasks. Also, some digital music players, like the iRiver T30 ($40 for the 512-megabyte model), have recording abilities, and there are accessories for the iPod like the TuneTalk Stereo for iPod ($69) from Belkin. While those can be used for podcasts, the sound quality and versatility will not be as good as the higher-end dedicated systems like the Marantz PMD 660 ($499), the Edirol by Roland R-09 ($399) and the M-Audio MicroTrack 24/96 ($350).” Mini-reviews of these three higher-end systems close the article. 



September 14, 2006

Are all (HIT) politics local?

Filed under: — mlazoff

Today’s iHealthBeat  includes Health IT at the Crossroads, a literate commentary by attorney Bruce Fried. The final sentence summarizes the disharmony Mr. Fried describes between individual regional health information organizations (RHIOs) and even smaller local health organizations, and the National Health Information Network (NHIN), which many envision as a daisy chain of RHIOs forming one centralized backbone technology.  “It looks to me like the national, state and local efforts to build an HIT system are at a crossroads. In one direction, there is a return to a fragmented, every-man-for-himself strategy. In the other direction, there is a shared vision that fosters collaboration and coordination. Which way shall we go?” Mr. Fried shares other insights: the shift from “the administration’s roundly embraced objective…to digitize health care to achieve greater patient safety, better quality of care and administrative efficiencies” to HIT as “a prop to support CDHC [consumer driven health care],” and increasing partisan poliitcs that characterize recent Congressional HIT bill activity. 



According to multiple news sources…

Filed under: — mlazoff

…by the end of next week, the HHS will announce an acting National Coordinator for Health Information Technology. This is the position previously (first) held by David Brailer, MD.



Joba potato

Filed under: — mlazoff

Those who subscribe to the Wall Street Journal might enjoy today’s article, For a Workout, Just Sit Down, which describes a new fitness craze in Japan that is now “cantering” into the U.S market. The Joba (Japanese for horse-back riding) is a “saddle-like” exercise device that can be used while watching television.  “Part of the potential attraction, for countries like Japan (and increasingly the U.S.) with aging populations, is that a Joba workout doesn’t take much effort…While a Joba session doesn’t burn many calories — about 50 in 15 minutes — using the machine for about 15 minutes a day, three days a week, tones muscles, improves posture and increases metabolism, according to studies by Matsushita [a Joba manufacturer] and a handful of universities. Riders work their abdomens to maintain their balance and strengthen their thighs by squeezing to keep from falling off the saddle.” The article provides an extensive history on similar devices that lost bets in decades past, and quotes a Japanese fitness trainer as describing the Joba as “better than nothing.” Still, the latest herd of devices are clearly not horsing around. “Because straddling a pitching saddle looks less than genteel, the device isn’t always taken seriously at first sight. Some female customers find it suggestive. Club Northwest, a large sports club in Grants Pass, Ore., has two core trainers, and ‘In the beginning, [customers] were all laughing,’ said club director Laurie Cingle. ‘People would get on and say ‘Yee-ha!’ like a cowboy. But then they realize that it feels really good.’ Now, she says, the trainers are used almost all day.” Hammacher Schlemmer has trotted out its $2000 model, a Mechanical Core Muscle Trainer



Capitali$m by Remote Control

Filed under: — mlazoff

The Business section in last Saturday’s New York Times included Remote Control for Health Care, an article describing the competition among companies betting on the future of remote-control medical technology. Examples of such technology include implanted heart devices for arrrhythmias, electronic beds that weigh, a handheld blood pressure device that plugs into a telephone, and a subcutaneous catheter for blood sugar monitoring. Companies compete for the technology itself; what the technology measures (for example, three companies have competing views on the best sign for impending heart failure); and on the data collection services run by the device companies and independent monitoring services that interact wirelessly with these devices, for data storage and to communicate the data to physicians and patients. The article notes that “[a] Veterans Affairs study that followed 70 patients over three months found that remote monitoring of their heart implants freed up eight days of time doctors would otherwise have devoted to office visits.” Still, the article describes healthcare practitioners concern over uncompensated time spent analyzing each patient’s data, and an increased risk of malpractice, should the data collection services fail to notify them of warning signs. The optimistic article closes with the same patient that opened the article: a 42 year old woman with chronic heart and kidney problems. “Mrs. Huntoon says longer stretches between hospitalizations would be enough of a life change to make her happy. She says she hopes her doctors can add remote monitoring of her potassium levels to her routine, thus increasing the chances of stabilizing her unreliable heart. The hospital employees know her so well they treat her like family, Mrs. Huntoon said. ‘But I don’t want to be a part of that anymore.’”



September 8, 2006

Google for everyone

Filed under: — mlazoff

For those who cannot see to read and navigate Web sites visually, Google recently unveiled a still work-in-progress Accessible search engine in its Google Labs section. According to its FAQ section, “Google Accessible Search looks at a number of signals by examining the HTML markup found on a web page.” Though not a true validator, “…[i]t tends to favor pages that degrade gracefully — pages with few visual distractions and pages that are likely to render well with images turned off…Accessible Search is a natural and important extension of Google’s overall mission to better organize the world’s information and make it universally accessible.”



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