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.”
FDA to regulate health information technology?
Fred Schulte and Emma Schwartz, the Huffington Post Investigative Fund duo who have made it their business to stay in front of all stories related to the federal push for the adoption of health information technology, now look at the possibility of federal regulation of health IT.
Schulte and Schwartz write that “In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems,” and officials say those voluntary reports represent just the tip of the iceberg. In case you’re interested, here are the transcripts from the relevant government hearing.
… digital medical systems are not risk-free. Over the past two years, the FDA’s voluntary notification system logged a total of 260 reports of “malfunctions with the potential for patient harm,” including 44 injuries and the six deaths. Among other things the systems have mixed up patients, put test results in the wrong person’s file and lost vital medical information.
Schulte and Scwartz summarize the three possible regulatory approaches outlined by officials:
- Option 1: FDA requires HIT makers to register, submit safety reports and correct problems.
- Option 2: FDA requires HIT makers to report safety concerns and sets minimum quality guidelines.
- Option 3: FDA makes HIT “subject to the broader regulatory actions that new medical products must face before they ever reach the market.”
Many manufacturers argue that such regulation could be counterproductive.
The manufacturers of the systems generally have opposed regulation by the FDA, arguing in part that imposing strict controls would slow down the government’s campaign to spur widespread adoption of the technology.
Regulation will not necessarily create a “safer” electronic medical record “and might actually limit innovation and responsiveness when it is needed most,” Carl Dvorak, executive vice president of Epic Systems Corporation, a Wisconsin-based company that builds the systems mainly for hospitals and large medical practices, said in his prepared testimony for Thursday’s hearing. The hearing is being held by an advisory group created by the stimulus law.
Government Health IT also is following the issue and points to some problems the Veterans Health Administration has run into and how it dealt with the lapses.
FCC’s broadband plan includes wireless health tech
The Federal Communications Commission will release a report next month outlining a national broadband plan that is expected to include measures for promoting and facilitating the use of mobile devices in health care, Mary Mosquera of Goverment Health IT reports. The plan was mandated as part of the stimulus package.
The FCC plan will describe “where government has a role to reduce some of the hurdles to these technologies both in connectivity and to promote innovation in applications,” said Dr. Mohit Kaushal, digital healthcare director of the FCC’s Omnibus Broadband Initiative.
The American Recovery and Reinvestment Act called for the FCC to develop a plan for establishing broadband connections to the Internet as a way to spur business development, job creation and improvements in healthcare.
To demonstrate a few possible uses of such technology, Mosquera also talks to organizations, hospitals and doctors who are taking advantage of current resources.
Patient 2.0 empowers patients, worries doctors
Filed under: Health data, Hospitals, Hot Health Headline
Writing for Time, Bonnie Rochman digs into the ramifications of patients sharing information and tips online, an “empowerment movement” she calls “Patient 2.0.” In the piece, she profiles the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.
One private-sector initiative already has about 50,000 patients inputting their symptoms and treatment regimens and updating details of their disease progression. Wonder how others are coping with your particular ailment? PatientsLikeMe.com spells it out via color-coded charts and graphs. “When you need help, privacy is a terrible thing,” says Jamie Heywood, who co-founded PatientsLikeMe in 2004 before his brother died of Lou Gehrig’s disease, or ALS.
Rochman demonstrated the strength of PatientsLikeMe in an anecdote in which data from the site’s users allowed administrators to reach clear conclusions about the effectiveness of lithium in the treatment of ALS six months ahead the formal clinical trials that were testing the same thing.
While medical professionals like those at the Society for Participatory Medicine have embraced the patient power movement, “plenty of doctors are worried about the quality of the information that is being assessed as well as patients’ ability to understand it,” Rochman wrote. A few have taken it upon themselves to fill the gaps, banding together to weigh in on the effectiveness of certain off-label treatments via Twitter, and to produce patient seminars on the reasons for clinical trials and the efficacy of various treatments.
NCHS: Patient 2.0 most popular use of health tech by far
The National Center for Health Statistics recently (Feb. 2) released statistics for the first half of 2009 on “Health Information Technology Use Among Men and Women Aged 18-64.” The stats show that “searching for health information online” is still the only use of health information technology embraced by a majority of American adults.
The numbers:
- From January through June 2009, 51% of adults aged 18-64 had used the Internet to look up health information during the past 12 months.
- Over 3% of adults aged 18-64 had used an online chat group to learn about health topics in the past 12 months.
- Among adults aged 18-64, women were more likely than men to look up health information on the Internet (58.0% versus 43.4%) and were also more likely to use online chat groups to learn about health topics (4.1% versus 2.5%).
- From January through June 2009, almost 5% of adults aged 18-64 had communicated with a health care provider by e-mail in the past 12 months.
- During the first 6 months of 2009, 6% of adults aged 18-64 requested a refill of a prescription on the Internet, and almost 3% had made an appointment with a health care provider in the past 12 months using the Internet.
- Among adults aged 18¬64, women were more likely than men to request a prescription refill on the Internet (6.6% versus 5.3%), make an appointment using the Internet (3.5% versus 1.8%), and communicate with a health care provider over e-mail (5.6% versus 4.2%).
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.
Neurosurgery conference ditches paper for iPods
The Philadelphia Inquirer’s Stacey Burling reports that neurosurgeons will be skipping the paper for their next meeting, relying instead on iPod Touches pre-loaded with conference materials.
Reading on the iPod Touch. Photo by Ben Kraal via FlickrIt will be only the second conference to have done so (a group of Canadian filmmakers was the first). Registration fees were hiked by $100 to cover the cost of the devices, and local Apple staff will be on hand to answer questions. Burling describes the process:
When they register at the American Association of Neurological Surgeons meeting, the doctors will be given iPod touches already loaded with everything they’ll need, including the program (165 pages last year), summaries of research presented at the meeting, advertising and information from exhibitors. Doctors will be able to use the iPods for messaging and for interacting with presenters during meetings. The convention also attracts 3,500 exhibitors and guests who will not be given the devices.
Gawande, Google and health systems analysis
Filed under: Government, Health data, Health policy, Hospitals
Earlier this month, New Yorker writer and surgeon Atul Gawande brought his checklist gospel (video) to the President’s Council of Advisors on Science and Technology. Writing for AAAS’ science-policy blog ScienceInsider, Jeffrey Mervis chronicled the encounter, paying special attention to the observations of council member and Google CEO Eric Schmidt.
Google CEO Eric Schmidt. Photo by World Economic Forum via FlickrTo Schmidt, the challenge of creating a system that synthesizes patient history and creates a list of standardized recommendations boils down to a simple “platform database problem,” something he says computer scientists are very good at.
Gawande’s take is that programmers don’t quite understand the vagaries of a typical clinical encounter. The technological capability may exist, but it’s going to be hard to make an information system that is able to generate recommendations brief and practical enough to be of use to a typical super-busy physician who has to suss out six different problems in one 15-minute visit.
In the course of the discussion, Gawande and the council also bemoaned the relatively low status of the health systems analyst and brainstormed ways to raise the profile and effectiveness of the specialization.
Grassley questions hospitals for HIT investigation
Filed under: Health policy, Hospitals, Hot Health Headline
Fred Schulte and Emma Schwartz continue to stay on top of the stimulus/health information technology/Sen. Charles Grassley investigation story for the Huffington Post Investigative Fund, this time explaining how and why the Grassley-driven inquiry into plans to spend an estimated $19 billion in stimulus money on HIT is now asking leading hospitals for input on their experiences with EMRs. The reporters also posted a copy of Grassley’s Jan. 19 letter.
Sen. Charles Grassley
Grassley sent the 11-question letter to 31 hospital organizations and requested that they respond by Feb. 16.
At this point, Grassley seems focused on technical issues that threaten patient safety, as well as potential conflicts of interest. Here are some of his more prominent lines of inquiry:
- How hospitals make purchasing HIT decisions.
- Potential financial or incentive-based relationships between HIT vendors and hospitals.
- Whether or not hospitals rely on outside contractors for HIT implementation.
- Procedures for and costs of training staff on new technology.
- Quality control and bug/problem-reporting procedures.
- Communication with tech vendors, peers and government officials.
- The relative liability of vendors and hospitals for HIT-related problems.
Grassley also asked hospitals to “provide a list of HIT problems or complaints that have been identified by or reported to your facility since January 2008 that directly or indirectly impacted patient safety or the delivery of care, including any complications or adverse events that have occurred as a result of HIT product design and/or usability.” He also requested that they “provide examples of contracts with HIT vendors that include non-disclosure clauses” and list any payments or discounts the hospitals received from those vendors.
Related: Fla. docs, vendors battle over EMR headaches
Sammy Mack’s piece for Health News Florida is a lively recounting of the complete meltdown that occurred between a group of Florida doctors and an EMR vendor, one rich in scandalous details like cease and desist letters and collection agencies. Mack’s work highlights the cultural divide between tech-savvy IT specialists and medical professionals and points out that the number of such conflicts is likely to increase as EMR adoption rises. Here’s Mack’s description of one such conflict, a dispute which happens to have a unique connection to journalism, medicine and ethics:
In another complaint against [EMR vendor Joe] Castranova, Dr. Linda Kaplan said she too was surprised by charges on her invoice. When they first met, Castranova recognized her as a former medical editor at the local NBC television affiliate. She said he offered to waive her software and training fees if she would endorse the product.
Kaplan agreed, but she said she was unimpressed with the system once it was installed in her Hallandale Beach office. She was reluctant to drum up business when she wasn’t a satisfied customer.
Kaplan said Castranova was displeased with her lackluster endorsement and locked her out of some 600 patient records on his server. He billed for the software system anyway.
Castranova said he gave her four months’ notice before locking her out – plenty of time to retrieve patient files.
Denmark sees results from electronic records
In The New York Times, Sindya Bhanoo examines Denmark, a country which has adopted health information technology to a high degree. Bhanoo finds that, while Denmark is in some ways an exceptional case, it can also provide a few principles to guide America’s proposed adoption of the same technology, chief among those being patience, persistence and a gradual pace.
Photo by juhansonin via Flickr
While Denmark does not have a standardized electronic medical records system, it does have a national patient registry and a wealth of examples of hospitals adopting innovations such as telemedicine (including remote monitoring and diagnosis), paperless prescriptions and electronic modeling. “Virtually all” Danish primary care physicians use electronic records, Bhanhoo writes, and nearly half of Danish hospitals have adopted them as well. To put those numbers in perspective, Bhanoo mentions that “about 10 percent of American hospitals and about 17 percent of American doctors use electronic records.”
Bhanoo writes that while the decade-long Danish push into HIT has not been perfect – it’s fragmented and hampered by budget constraints – it has achieved measurable success.
Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.
In the end, Bhanoo concludes that while these same successes will be harder to achieve in the significantly larger and more complex American system, experts believe that a modified Danish roadmap should be able to produce results in the United States.
Daschle pushes health IT to Obama, clients profit
Filed under: Conflicts of interest, Hot Health Headline
South Dakota Democrat and former Senate Majority Leader Tom Daschle is not registered as a lobbyist, and has not held public office since he lost a re-election bid in 2004. Instead, Fred Schulte and Emma Schwartz report for the Huffington Post Investigative Fund, that Daschle has existed in a nebulous limbo that’s allowed him to pivot deftly from pushing electronic medical records as an almost-HHS secretary to helping private firms profit handsomely from their implementation.
Daschle, as Obama’s first choice to head the Department of Health and Human Services last year, was a forceful advocate for using billions of dollars in economic stimulus money to help doctors and hospitals buy electronic medical records systems.
Tax problems led him to withdraw his name from consideration for the cabinet post. Then, a few weeks after Obama signed off on a stimulus plan that provided some $45 billion for digitizing the health system, Daschle began assisting private clients seeking to profit from the new law.
Public interest groups take issue with Daschle’s activities:
“He was in a position to drive public policy and develop connections within HHS that could provide his clients with an unfair competitive advantage in receiving taxpayer dollars, at the same time he and his firm benefits from his previous activities,” said Scott Amey, a lawyer with the Project on Government Oversight.
In the rest of the solid, in-depth piece, the reporters track both the breadth of Daschle’s influence (he has the ear of the president) and the impact he’s had on bottom lines across corporate America.
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