October 27, 2006

Open house for house staff

Filed under: — mlazoff

American College of Physicians Associate members (residents and house staff) can get free access to ACP Medicine (previously Scientific American Medicine, now edited by ACP and published by WebMD). ACP provides Associate members with an onlne ACP Medicine account number. The rest of us ACP members and non-members are charged a pricey amount for full access, but everyone can access ACP promo page, which includes a link under Special Features to this month’s What’s New in ACP Medicine, a worthwhile summary of several months’ old clinical information from journals and such. After clicking, look up top for a link to receive the monthly update free by email. MCR reviewed ACP Medicine back in March/April 2005, and there’s a DejaView describing their new interface July/August 2005.


Several new archived teleconferences and webinars at American Medical Informatics Association (AMIA) e-Learning Center, along with new upcoming course offerings. Some are free, others are discounted for AMIA members. Alas, no CME credit.

October 21, 2006

Journey of a 1K mile begins with a single definition…

Filed under: — mlazoff

The HHS’s National Committee on Vital and Health Statistics released a draft report on the Minimum but Inclusive Functional Requirements for the Initial Definition of a National Health Information Network. According to an entry on the Healthcare IT blog, the draft is “expected to be approved by the end of this month. The report includes a list of high-level functional requirements for a Nationwide Health Information Network [NHIH]. Recommendations include: [1] extending HIPAA privacy rules to cover health information exchanges and other forms of personal health information. [2] developing policies and procedures to accurately match people to their health records (but not recommending a national patient ID). [3] including functionality to enable patient or physician privacy requests that would follow the record regardless of location.”

The usually insightful blog is maintained by the information technology consulting firm BSTI, who advises: “If your organization can’t participate in HIEs [Health Information Exchanges such as Regional Health Information Organizations (RHIOs) or Public Health Information Network (PHIN)] and the NHIN, your patients (read customers) will probably go to an organization that does.” [ Editor’s note: I asked what organizations they are referring to, that an otherwise satisfied patient might leave if the patient can’t be among the first to link up his medical records with the local HIE? The consultants’ reply is posted on their blog.]

October 19, 2006

The ABCs of US healthcare

Filed under: — mlazoff

iHealthBeat has a nice list of links related to ABC’s weeklong nightly news segment, Prescription for Change. Most of the information pertains to cost and delivery systems, but click option 3 under the video for a 2 minute segment on Brent James, MD and electronic data collection.

AHIC’s Mini-Me

Filed under: — mlazoff

From an article posted on GovernmentHealthIT: “Through a [$2 million dollar, 1 year] contract with the National Governors Association (NGA), the Office of the National Coordinator for Health Information Technology will sponsor formation of a State E-Health Alliance in 2007…Under the agreement, NGA’s Center for Best Practices will form a high-level steering committee that includes governors and state legislators to tackle barriers to the formation of health information networks…Interim National Coordinator Robert Kolodner described the states’ project as mirroring at the state level the American Health Information Community, which is the Department of Health and Human Services’ advisory committee consisting of federal, health and corporate leaders.”

October 13, 2006

EHR Mega-meta-analyses

Filed under: — mlazoff

The answer to the title of Wednesday’s Health Affairs article, How Common are Electronic Health Records in the United States? A Summary of the Evidence, is no surprise: “…when available information is limited to studies of high or medium quality…[t]hrough 2005, approximately 23.9 percent of physicians used EHRs in the ambulatory setting, while 5 percent of hospitals used computerized physician order entry.”  Between 1994-2005, ten ambulatory studies of sufficient quality were identified, although the statistics for ambulatory EHR use cited above come from only one: the CDC’s 2005 National Ambulatory Medical Care Survey (see News&Views The Times They Are A’Changin…A Little, Take Two), an annual survey whose methodology the article supports in general, while offering suggestions for improvement. All ambulatory studies found that solo practitioners were less likely to use EHRs than were physicians who worked in larger practices. According to the article, there is no accurate national statistics on the use of inpatient EHRs, although a single high quality survey found 59% of hospitals have at least patient demographics in electronic format.

In summary, the authors, “…found distinct shortcomings in the literature including varying EHR definitions, varying quality of survey methodology, and almost no information about the use of EHRs by safety-net providers.” The article was authored by faculty from Harvard’s School of Public Health and Institute of Health Policy, and George Washington University’s Department of Health Policy, and was supported by The Office of the National Coordinator for Health Information Technology.

Medpundit links to the Washington Post article describing this study, and comments from her perspective as a solo practitioner “why EMRs have been so slow to catch on?” In addition to expense and regional trends, “…hospitals are emerging as the dominant forces in selection of electronic records systems. They’re seeking to have integrated networks in which everyone in the community (or hospital community anyway) uses the same hospital-based electronic record. That means that each doctor’s medical records are housed on the hospital’s servers and that everyone in the hospital (or at least every doctor in the hospital and probably lots of administrators) has access to them. Some doctors embrace this idea, but others are leary of having their patient records owned and controlled by someone else. Many are waiting to see how this shakes out. No one wants to invest tens of thousands of dollars in a system only to have it prove to be useless when community standard becomes a hospital-approved and sponsored record. Nor do they want to jump into a hospital partnership that could go south in a couple of years if it proves too much of a financial burden for the hospital.” See News&Views Kicking Back Anti-Kickbacks on how the federal government is now supporting hospitals and others who wish to donate HIT programs to physicians, for better or for worse.

October 10, 2006

May The Force(d Upgrades) Be With You

Filed under: — mlazoff

According to Brian Kreb’s Security Fix column in today’s Washington Post, Microsoft [Will] Push Out [Internet Explorer version 7.0 browser] IE7 This Month, “…to Windows users who download security updates through Microsoft Update or Automatic Updates.” This “long overdue upgrade” to the current version IE6 will include tabbed browsing, built in RSS feeds, tools to help identify data-stealing phishing sites, and security improvements in ActiveX. However, one new security feacture—Protected Mode, ”a ’containment wall’ to prevent the browser from installing software or changing computer settings without the user’s consent”—will not work with current Microsoft operating systems, not even XP. It will require Microsoft’s next operating system update, Vista, due out in early 2007.

Microsoft IE’s main competitor, the open source browser Mozilla Firefox, is mentioned in the article. “It will be interesting to see whether this upgrade for Windows will further increase Microsoft’s market share in the ongoing browser wars. According to numbers released today by Amsterdam-based Web analytics firm, the total global usage share of IE increased 2.8 percent since July 2006, bringing Microsoft’s share of the browser market worldwide to nearly 86 percent. The company says Mozilla Firefox’s browsers have a total global usage share of 11.49 percent, a decrease of 1.44 percent since July 2006. In the United States, the IE/Firefox ratio is roughly 80 percent to 15 percent, according to OneStat.”

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