e-HealthExpert.org - Primum non nocere

By Matthew Holt One of the most fun times at HIMSS last week was the MEDecision party at the Georgia aquarium. I took a few videos of the Fish and the humans—so something a little different for you all The...

By MICHAEL MILLENSON The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem. “The organization that...

By PAUL LEVY What happens next in Massachusetts with insurance reimbursement rates now that many of the facts and figures have been made public? Here's what I see. The dominant parties in the state on whose watch the disparities in...

At New York-Presbyterian Hospital, we’re building technology and influencing policy that will shape the future of health care delivery. Visionary executive leaders are driving momentum in the movement toward a connected health information technology environment—the next frontier in modern medicine....

By BILL KRAMER As the health reform effort moves into the final stages, everyone seems to be taking a whack at health insurers. Some of the insurers’ wounds are self-inflicted, such as WellPoint’s announcement of 39% premium increase for individual...

By Matthew Holt Just when we thought things were calming down in the world of Health 2.0, it’s kicking off. WebMD has been watching Everyday Health take over its spot as top Health site ranking in the ComScore rankings (cue...

By Amy Tenderich We have just opened the 2010 DiabetesMine Design Challenge. This year, we’ll be selecting THREE Grand Prize winners to EACH receive $7,000 in cash and a support package to help winners realize and commercialize their design ideas....

This Wednesday, March 10th at 4:30 CET / 7:30AM PST our FREE hour long webinar series will be highlighting the upcoming Health 2.0 Europe conference with our Parisian partner, Denise Silber of Basil Strategies. Joining in the discussion and presenting...

The abolition of GP practice boundaries will increase the importance of shared medical records, according to the Department of Health.

It's been a decade since the height of Napster's popularity, but file sharing remains rampant on the Internet through networks such as Limewire, BitTorrent and Kazaa. And that may threaten the security of personally identifiable health information, according to a new study in the Journal of the American Medical Informatics Association.

Researchers at the University of Ottawa in Canada used widely available file-sharing software to access documents containing health and financial information from patients at various locations in Canada and the United States. Lead author Khaled El Emam says that his team found that unauthorized users actively searched for files containing such data. "There is no obvious innocent reason why anyone would be looking for this kind of information," El Emam says, according to Healthcare IT News.

"Without additional protection on the health records, like encryption or elevated access controls, it is entirely possible that a mis-configured file sharing tool could gain full access to the records," Robert Grapes, chief technologist of IT security firm Cloakware, says in Healthcare IT News.

To learn more about this study:
- check out this Healthcare IT News story
- read the JAMIA paper

Related Articles:
Study: Peer-to-peer file sharing apps can expose medical data

Now that you're all back in the office following a jam-packed HIMSS10 week of networking, learning and checking out the latest health IT products, I wanted thank those of you who attended our first-ever HIMSS executive breakfast panel discussion March 2, jointly sponsored by FierceMobileHealthcare, FierceWireless and Meru Networks.

Our panel of hospital CIOs and wireless experts shared their 'been there, done that' lessons learned, and discussed the many misconceptions regarding mobile technology deployment. Although this technology has yet to reach its full potential in the healthcare setting--"we'll see tremendous explosion" predicts said Geoffrey Brown, Senior VP and CIO at Inova Health System in Falls Church, Va.--our panelists agreed that many hospitals have learned the hard way how not to deploy this technology. "If not designed right, wireless could be the weakest link," warned Ram Appalaraju, senior marketing VP at Meru Networks. (In fact, Meru is hosting a webinar on Wednesday, March 24 at 2 p.m. EST on delivering high-quality VoIP.)

Later that evening, we met hundreds of additional Fierce readers at our networking bash, held at the World of Coca-Cola. It was fantastic to meet so many FierceHealthIT readers--from hospital and healthcare system technology leaders to executives from some of the largest IT vendors in the industry. Nearly 500 of you braved the rain (and snow!) to party the night away.

This was by far our largest FierceHealthIT event to date, and reflects our tremendous growth overall. Just last year, we launched FierceMobileHealthcare and FierceEMR. In less than a year, they've become weekly must-reads for more than 30,000 subscribers. We also recently published our first eBook (it focuses on the dreaded Medicare recovery audits). Look for an EMR eBook -- and more Fierce newsletters -- publishing early this spring.

Until then, stay Fierce! And as always, feel free to contact me anytime. It's always great to hear from you.

Best,

Wendy Johnson, publisher

P.S.: If you didn't make it out to the Atlanta HIMSS show this year--or even if you did--check out our full coverage of the show at our special FierceHealthIT HIMSS10 website. Our editors fanned out across the show to bring you highlights and analysis from some of the hottest sessions!

Last week, we heard optimism from the likes of the Healthcare Information and Management Systems Society and the College of Health Information Management Executives about the prospects of healthcare organizations earning federal stimulus money for achieving meaningful use of EMRs. But, with more than 27,000 people and close to 900 vendors packed into the Georgia World Congress Center in Atlanta for HIMSS10, there were bound to be some differing opinions. Some even came from outside of Atlanta.

The Medical Group Management Association on Friday released the results of a survey saying that more than two-thirds of practice executives believe that physician productivity would decrease because of the current proposed CMS criteria for meaningful use. Though 31 percent of respondents said productivity would increase by more than 10 percent, the MGMA still was critical of the proposal. "If the final rule mirrors those outlined in the current proposal, there is significant risk that the program will fail to meet the intent of the legislation, and that a historic opportunity to transform the nation's healthcare system will be missed," MGMA chief Dr. William F. Jessee said in a statement. (Jessee also announced last week that he would retire in the fall of 2011.)

Meanwhile, Wolters Kluwer Health, which produces content for clinical decision support systems, announced the results of a survey of its own that found that only 3.8 percent of hospital clinical, IT and administrative executives viewed eligibility for stimulus funding as a key reason to adopt order sets. Leading the list was better quality of care, named by 54.9 percent of respondents, followed by advancing the practice of evidence-based medicine, at 52.8 percent.

For further information:
- take a look at this HealthLeaders Media story
- see this Wolters Kluwer press release

Related Articles:
Survey: Hospitals will struggle to meet 'meaningful use'
Blumenthal: Meaningful use will focus on goals of care, not technology

It may have been a coincidence that IBM closed on its acquisition of Initiate Systems just as HIMSS10 got underway in Atlanta last week. We're certain that it was no coincidence that IBM introduced a product called Initiate Exchange on the very same day it announced the closing of the Initiate deal. "The acquisition was driven by IBM's desire to enhance its ability to help healthcare clients draw on data from hospitals, doctors' offices and payers to create a single, trusted shareable view of millions individual patient records," an IBM  press release read.

Initiate Exchange, which itself is the result of Initiate's acquisition of HIE services vendor Accenx just last October, fosters health information exchange between health systems and physician practices. The product focuses on the master patient index to assure that health professionals have access to the right information on the right patient at the point of care. (See our story in today's FierceHealthIT on the interoperability problems between the VA and DoD to understand why this is so important.)

At HIMSS, Initiate marketing VP Gina Sandon told FierceHealthIT that Initiate Exchange would be IBM's first software-as-a-service offering in healthcare and that the target market would be integrated delivery networks, payers and regional health information organizations.

For more:
- click on this IBM press release

Related Articles:
IBM to purchase Initiate Systems
IBM offers $2B in financing for federal HIT projects

Health information interoperability efforts between the Veterans Health Administration and the Military Health System suffered another setback, as the Department of Veterans Affairs cut off access to the Defense Department's AHLTA EMR after VA officials found errors in medical records downloaded from AHLTA.

No patients were injured as a result of the inaccurate data, according to the VA, but "the potential exists for decisions regarding patient care to be made using incorrect or incomplete data," the VA said in a patient-safety alert sent out last Wednesday.

VA officials first discovered problems with the data exchange late last month when a VA clinician found a record in AHLTA indicating that a female patient had been prescribed a drug for erectile dysfunction. NextGov reports that the clinician's query actually had returned the record of another patient. "The VA clinician may see the patient's data during one session, but another session may not display the data previously seen," the VA alert explains. "This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports."

For more on this computer glitch:
- read this NextGov story
- see the VA's safety alert (.pdf)

Related Articles:
VA, DoD will meet EMR interoperability deadline
Social Security to join VA, DoD interoperability effort

The Virginia State Legislature last week unanimously approved legislation that would make the state the 12th in the nation to mandate insurance coverage for telemedicine services. The bill, sponsored by state Sen. William Wampler Jr. (R-Bristol), calls on health insurance companies, HMOs and healthcare subscription plans to provide full coverage for telemedicine services, defined as interactive audio, video or other electronic media for the purpose of medical diagnosis, consultation or treatment. Insurers are allowed to perform utilization review to determine whether telemedicine is appropriate in specific cases.

"This is one more indication that telemedicine is now fully accepted by providers, policy makers, consumers and insurers as an important way to increase access, improve quality and reduce costs in the delivery of healthcare" American Telemedicine Association CEO Jonathan D. Linkous says in a press release. The current ATA president is Dr. Karen Rheuban, medical director of the Office of Telemedicine at the University of Virginia. In the same statement, Rheuban thanked the "leaders of the state legislature who have taken the bold step to improve the lives of the residents of Virginia."

Once Gov. Bob McDonnell signs the legislation, Virginia will join California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon and Texas in requiring coverage of telemedicine services, according to ATA.

For more:
- read this American Telemedicine Association press release

Related Articles:
U.S. Army tests telemedicine at remote outposts in Germany
Federal bill would increase availability of telemedicine
Despite benefits, telemedicine barriers remain high

By David C. Kibbe and Brian Klepper A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they've fallen off Democrats' broader health reforms. David Blumenthal and his staff have...

Physicians, surprise, are less likely than risk managers to admit the occurrence of a medical error, though doctors generally are quicker to apologize to patients after an error than are risk managers, according to a study in this month's Joint Commission Journal on Quality and Patient Safety. Both groups agree, however, that reporting mechanisms leave a lot to be desired. The story doesn't explicitly say so, but we'd be willing to venture that EMRs and IT in general could go a long way toward improving reporting of adverse events--and toward guarding against human error. News brief

A quick but eventful trip to Japan from March 3-7. My trip was funded by the University of Tokyo as part of an academic visit and not related to any company or product.
Two hours after landing in Narita, I had dinner with my hosts in Tokyo at La Rochelle, a French-Japanese fusion restaurant run by Iron Chef Hiroyuki Sakai . Chef Sakai prepared several novel vegan dishes for me using fresh Japanese mushrooms and vegetables.
The joy of the 14 hour time difference between the US East Coast and Japan is that I can work the Japanese day and the Boston day in the same 24 hour period. After the welcome dinner, the Boston business day began and I worked on several projects related to Meaningful Use- Federal, State and Local.
The morning brought 12 hours of lecturing, meeting, and greeting with Japanese healthcare policy and technology experts, discussing the Japanese version of the healthcare stimulus plan. (250 billion Yen, which is approximately 2.8 billion dollars). Critical issues for the Japanese are data security, data sharing consent, standards, reducing competitive disincentives to healthcare information exchange, and lack of EHR adoption among ambulatory clinicians.
After a great conference day, I said goodbye to my hosts and had 36 hours on my own before my flight left. My evening was filled with collaboration among members of the HIT Standards Committee to finish the comments on the Interim Final Rule (will be my blog tomorrow) and putting the finishing touches on a Health Affairs article (it seems to be a yearly tradition that I go to Japan and spend my nights writing a Health Affairs article for the annual Healthcare IT issue). At 7am I left the hotel and began the adventure I described in Friday's blog - a traverse of the Takao ridges. A truly remarkable experience.
In case you find yourself in Tokyo, here's my brief description of the hike.
From anywhere in Tokyo, take the Yamanote line to Shinjuku station. From there, transfer to the Keio line, and take a limited express bound for Kitano. Once there, take a local bound for Takao-san-guchi. Exit the station to the right and you'll find yourself at the the trailhead. There are 6 possible trails up Mt. Takao. I recommend trail #1 - the longest, most scenic and less traveled. However, Mt. Takao is a very popular destination, so less crowded is relative. The good news is that few people travel the ridge beyond Mt. Takao. After reaching the top, go to the East end of the summit and take the trail to Shiro-yama, the next summit. At that point, the crowds disappear. The trail to the next peak, Kagenobo-yama is an amazing ridge filled with cedar trees (sugi). The trail to Meio-toge is isolated, wild, and follows the track of the Japanese version of the Appalachian Trail (Kanto Fureai-no-michi). The final peak is Jimba-san and its famous war horse statue. A descent via Wada pass to the Jimba Kogen-shita bus stop, a bus ride on the #32 and #5 buses to Hachioji, and a train from either Keio or JR Hachioji station to Shinjuku completes the day. Book time for the hike is 5-7 hours (plus 3 hours for train/bus travel) and the distance covered is 12 miles, with a few thousand feet of elevation gain.
This morning, I checked out at 6am, took the Chuo line to Shinjuku, stashed my bags in a locker (fully electronic - you are given a PIN number to open the locker instead of a key), took the Yamanote line to Shinagawa station, then the Keihin Kyuko Rapid Limited Express to Miura-kaigan on the Miura Peninsula, an area of wide sandy beaches, rocky coastline, and a great old lighthouse. After walking the Peninsula, I took the Zushi line train to Jimmu station and hiked the temple route (the photo above), passing plum blossoms in bloom, Jizo statues, and the peak of Mt. Takatori. I was completely alone the entire trip.
From there, I took the Keikyu line back to Shinagawa, the Yamanote line back to Shinjuku, picked up my bags, and took the Narita Express to the airport, changing from my hiking clothes into a suit while on the train. I just landed from my 18 hour commute back to Boston.
In all my travels above, a rudimentary knowledge of Japanese really helped, since most signs in the wilderness are only in Japanese, such as this one which indicates the way to the train station (good luck figuring it out since both West and South seem to the be right answers). How did I get by? The following expression:
Sumimasen (fill in the name of where you want to go) wa doko desu ka?
which translates into
Excuse me, (placename) it where is?
This saved the day many times, since maps, signs, and guidebooks were often wrong.
The Japanese people are gracious, helpful, and eager to provide directions to foreign travelers.
I succeeded in my quest to find the road less traveled. Of course, the fact that it was 38 degrees, raining and trails were ankle deep with mud may be have been a disincentive to other travelers.
A great trip! Thanks so much to my friends in Japan who made it happen.

THCB would not exist without the support of our generous sponsors. So we'd like to give a shout to our friends at Eliza, our latest corporate sponsors. "Who says nerds can't talk to people? We use technology to engage people...

Alder Hey Children's Hospital has rolled out an automated IT support platform to provide remote support to more than 2,000 PCs.