Schulte, Schwartz look for help investigating HIT
Filed under: Health data, Health journalism, Hot Health Headline
Regular readers know that we always keep an eye out for updates from Fred Schulte and Emma Schwartz, the duo from the Huffington Post Investigative fund that refuses to let the Obama administration’s push for health information technology proceed without scrutiny. This time, they’re following up on past work with stories on HIT-related errors and the FDA’s role (or lack thereof) in the policing of HIT.
Their most interesting update, however, concerns their effort to get HIT-related “adverse events” data from the FDA. Schwartz describes the difficulties they’ve run into, how they’ve overcome them, and how readers can help them put the whole puzzle together. It’s an interesting strategy, and an equally interesting primer on the FDA’s tricky “Manufacturer and User Facility Device Experience,” or MAUDE, database. You can also find their own version of the data here, courtesy of Amanda Zamora.
Attending Health Journalism 2010?
Schulte will be speaking about “Tracking health-related stimulus money” during a panel at 4:15 p.m. on Friday. His co-panelists will be ProPublica reporter Michael Grabell and Phil Galewitz, a Kaiser Health News reporter and AHCJ board member.
On Sunday morning, don’t miss the panel “Personal electronic medical records: What will consumers need to know?” featuring:
- Steve Gray, partner, Affiliated Computer Services Healthcare Solutions
- Bala Hota, M.D., M.P.H., chief medical information officer, Cook County Health and Hospital System
- Thomas Layden, M.D., chief, Department of Internal Medicine; professor of medicine, University of Illinois at Chicago
- Moderator: Prerna Mona Khanna, M.D., M.P.H.. visiting clinical associate professor, University of Illinois College of Medicine
Report: Smart phones are changing health care
For the California HealthCare Foundation, Jane Sarasohn-Kahn created a 23-page report titled “How Smartphones Are Changing Health Care For Consumers And Providers (PDF).” The report’s key message is that, while doctors have been slow to adopt EMRs and other forms of HIT, they’ve been quick to adopt smart phones. And thus it would seem smart phone apps could hold the most promise of practical HIT implementation in the coming years. Especially since, Sarasohn-Kahn writes, Manhattan Research has found that “the number of physicians who own smart phones will increase from 64 percent in 2009 to 81 percent by 2012.”
The speed of the uptake has been remarkable for a nation that has been traditionally slow to adopt HIT, as Figure 1 shows. Two-thirds of physicians used smartphones in 2009. About 6 percent of these were using a fully functional electronic medical record or electronic health record system — while only 1.5 percent of hospitals had a comprehensive electronic health record system as of 2008.
And the promise and popularity of health on smart phones has led to a corresponding boom in apps, Sarasohn-Kahn writes. Right now, she says, “Some of the most widely used mobile applications by physicians are drug and clinical references, and clinical tools such as dosage calculators.”
For clinicians, the smartphone offers an alternative to many health IT formats that have been cumbersome and costly to adopt, and that may interrupt their workflow. As of February 2010, there were 5,805 health, medical, and fitness applications within the Apple AppStore. Of these, 73 percent were intended for use by consumer or patient end-users, while 27 percent were targeted to health care professionals. It should be noted that, although developers usually have a principal audience in mind, all users can and do download the apps. In the “medical” category, 33 percent of apps are meant for consumers/patients, 32 percent for physicians, 17 percent for medical students, 4 percent for other health professionals, and 2 percent for nurses.
In addition to her market statistics, Sarasohn-Kahn breaks the applications down into key categories, the most interesting of which are:
- Linking physicians to up-to-the-minute safety alerts on a local and national scale
- Delivering instant lab results
- Remote monitoring of patients and their vital statistics, as well as the issuance of related alerts
- Consulting with other physicians remotely
- Monitoring patient compliance with treatment recommendations and guidelines
Patient data errors force VA to close EMR system
Nextgov’s Bob Brewin reports that errors in patient data have forced the Department of Veterans Affairs to close access to the Bidirectional Health Information Exchange, the Defense Department’s vast electronic medical record system. The bug first surfaced in February when a physician noticed that the system claimed one of his female patients had been prescribed an erectile dysfunction drug. The errors have been blamed on old code in the six-year-old system which could not handle peak usage rates.
The glitch did not cause harm to any patient, but “the potential exists for decisions regarding patient care to be made using incorrect or incomplete data,” said Jean Scott, director of the Veterans Health Administration’s Information Technology Patient Safety Office, in the alert issued on Wednesday.
… The VA clinician may see the patient’s data during one session, but another session may not display the data previously seen,” the alert noted. “This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports.”
The system is expected to go back online March 9. Until then, Brewin writes, “VA doctors will have to obtain a patients’ health information from their paper medical files, faxes or PDF attachments that are e-mailed to the physicians.”
According to its tagline, Nextgov focuses on “Technology and the Business of Government.”
So-phish-ticated scams target docs, medical records
American Medical News’ Pamela Lewis Dolan writes that sophisticated e-mail scammers are targeting doctors in attempts to get medical records and use the wealth of information they contain to facilitate identity theft.
The scammers pose as someone, such as an information technology worker, with whom a doctor regularly corresponds and exchanges sensitive information, then ask the doctor to share a password or download a piece of software that will then allow the would-be hacker to access medical records. Dolan writes that these attacks are often facilitated by disgruntled employees that can provide scammers with the inside information needed to develop a convincing ruse.
“The best way to convert data to cash is ID theft,” said Tom Cross, manager for X-Force Advanced Research, IBM’s data theft research team. Medical records provide a comprehensive portfolio for individual identification, and that can be sold, he said.
In addition to tips for avoiding these scams, Dolan gives a few recent examples.
One recent phishing case was carried out by scammers who posed as the Centers for Disease Control and Prevention and sent e-mails to patients and doctors claiming everyone had to register at an online H1N1 vaccine database. A link in the e-mail took unsuspecting recipients to a Web site that looked as if it was operated by the CDC. A warning issued later by the real CDC indicated hackers were likely sending malicious software downloads to victims’ computers.
Federal EMR budget slashed, switchover delayed?
Fred Schulte and Emma Schwartz have put together the latest installment in the Huffington Post Investigative Fund’s ongoing look at electronic medical records, this one focusing on how budget cuts could make it more difficult to meet the administration’s targets for nationwide adoption of electronic records.
In May, budget officials estimated they would spend up to $47 billion in stimulus money to help doctors and hospitals purchase the systems. But in a press briefing on Wednesday, officials said that figure had been chopped nearly in half to between $14.1 billion and $27.3 billion.
A program like this has never been done on this national scale,” Tony Trenkle, who directs the office of e-health standards and services for the federal Centers for Medicare and Medicaid Services, told the Huffington Post Investigative Fund in an interview.
Hospital’s struggle illustrates health IT woes
Filed under: Health data, Hospitals, Hot Health Headline
The University of California San Francisco Medical Center has written off more than a third of the $50 million it has spent on a system to digitize patients’ medical records, according to an article by AHCJ member Fred Schulte for the Huffington Post Investigative Fund and American University’s Investigative Reporting Workshop.
The hospital started the project more than five years ago but after “persistent technical headaches,” it is has terminated the contractor and will start over on part of the project.
The costly setback pointedly illustrates the challenges health professionals face trying to meet a government mandate to bring American medicine into the computer age.
Doctors and technology analysts are less than enthusiastic about products now available. “Early reports from some American and European hospitals, they say, suggest that some technology may prove unreliable and could even pose safety problems for patients.”
While critics are concerned about patient safetly, U.S. manufacturers say no injuries or deaths can be attributed to software failure. However, as Schulte points out, “companies manufacturing health information technology systems are under no obligation to report injuries resulting from software malfunctions to the government.”
Schulte then cites a number of examples that point to failures or problems with software systems.
Related
Survey reveals how much patient privacy is at risk
Fred Schulte and Emma Schwartz of the Huffington Post Investigative Fund report on a survey in which 75 percent of health organization say patients’ medical records were put at “risk of improper disclosure.”
The study, done for the Healthcare Information and Management Systems Society, also revealed that half of the people surveyed said they had “no plan in place to respond to security threats and many of them indicated that they are spending ‘little additional resources’ to combat the problem.”
While the federal stimulus package includes provisions to enhance the security and privacy of medical information, the survey found that many hospitals do not have and do not use tools to encrypt the data when it is stored or when it is sent over the Internet.
Schulte discussed the report on NPR’s Weekend Edition. The survey also was the subject of an iHealthBeat special report, featuring a health information technology officer, a representative of the Healthcare Information and Management Systems Society, the HHS deputy director of health information privacy and a patient advocate.
The full report is available from ID Experts but does require free registration.
Case studies show how health IT fits in today
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
Writing for content, document and knowledge management publication KMWorld, David Raths evaluates applications of health information technology, or HIT, in a set of case studies which he wraps up into a handy overview of the utility and potential of HIT and electronic medical records. Raths breaks HIT up into specific applications because, he writes, the very thing that loads HIT with so much potential – the byzantine complexity and built-in inefficiency of the American health care system – also serves as its biggest obstacle.
“The sheer complexity of the healthcare setting is off-putting,” says Alan Pelz-Sharpe, a principal at CMS Watch covering enterprise content management technologies. “Joining up the clinical and administrative, not to mention the insurance part, is a spectacular challenge.”
A hospital has many small departments and people don’t tend to think outside their department, he says. Deploying enterprise content management solutions is difficult when there are so many interlinking elements in the healthcare chain, and nobody really owns the overall process from beginning to end. “There is usually not one unifying solution,” Pelz-Sharpe says, “but lots of departmental solutions.”
A few of the solutions Raths explores:
- Systems to integrate the paper, which will inevitably be part of any system, with EMR systems. Other systems will help integrate existing paper archives with EMRs.
- Systems that speed up the decision-making process and collaboration between physicians while better recording exactly why decisions were made.
- Administrative-side systems used by hospitals to navigate through health care’s financial maze.
- Cloud-based systems that envision health IT as a service.
How will health reform affect Medicare?
Filed under: Government, Health care reform, Hot Health Headline
The Associated Press’ Carla Johnson looks at how health care reform might affect those currently covered by Medicare, focusing on five key areas: Medicare Advantage, prevention, hospitalization, electronic medical records and prescription drug coverage. Here are the basics:
- Medicare advantage is popular but relatively expensive. Some private insurers may leave the program if funding is cut, forcing some seniors to change providers. Cuts may also hit extras like hearing aids and health club memberships.
- Preventative services such as mammograms and diabetes classes will be better covered under most proposals.
- Some plans may punish hospitals with high readmission rates and encourage all hospitals to work to keep patients from coming back.
- Any move to electronic medical records and better coordination of care would benefit Medicare patients and providers, as Medicare suffers from many of the same inefficiencies as the system at large.
- As for the notorious prescription drug coverage “doughtnut hole,” the house democrats have proposed a plan that would fill it in by 2023.
Software glitch exposes VA patients to errors
As a result of software glitches, “Patients at VA health centers were given incorrect doses of drugs, had needed treatments delayed and may have been exposed to other medical errors,” the Associated Press reports.
The errors, involving faulty displays of electronic health records, were exposed after the AP received internal documents requested under the Freedom of Information act.
“The glitches, which began in August and lingered until last month, were not disclosed to patients by the VA even though they sometimes involved prolonged infusions for drugs such as blood-thinning heparin, which can be life-threatening in excessive doses.”
As the AP points out, such glitches are worrisome as the federal government is expected to strongly promote the use of electronic medical records.
While there is no evidence that any patients were harmed, there were nine reported cases in which patients received incorrect doses and nearly one-third of the VA’s medical centers reported seeing some kind of glitch.
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