Online training module helps doctors with Parkinson's awareness

LONDON – A UK-based online training module for GPs and other healthcare professionals to increase awareness of Parkinson's disease has attracted more than 3000 participants, some from as far away as New Zealand.

The Parkinson's Disease Society's (PDS) 2008 membership survey showed that 50 percent of people with Parkinson's believe there is a lack of understanding from GPs and professionals about how to spot and treat the condition.

As a result the PDS commissioned BMJ Learning to produce an online module to help users increase their knowledge and skills in how to care for patients, and how to increase knowledge and skills to assess and refer people with suspected Parkinson's disease.

Daiga Heisters, PDS National Education Adviser, said: "We were delighted with the response to the training. The target of 400 participants to complete the module in the first six months was exceeded, with over 3000 completing in the first five months."

"This reflects the interest healthcare professionals have in increasing their knowledge on the management of Parkinson's, and the effectiveness of BMJ Learning's marketing campaign," Heisters said.

Course participant Alveena Igbal, from Derby City PCT, said: "As our elderly population increases so does the challenge to deal with chronic disabling conditions like parkinsonism. In this context I have found the BMJ Learning module very useful."

Dr Amal Paul from Pudsey, Leeds, said: "As a GP I have to look after a few patients with Parkinson's disease, and the need for further care management was more imperative for me when someone close to me was diagnosed. The module was very interesting, designed for adult learning, interactive and educational. My knowledge and skills have definitely improved and the module was a big impetus for further study."

This module complements the work of the Parkinson?s Disease Society's Education and Training Officers currently working with GPs and other healthcare professionals throughout the UK at a local level.

Due to the success of the pilot, a second learning module is being launched, focusing on non-motor symptoms of Parkinson's such as depression and sleep disorders.

Kentucky, Healthbridge partnership 'tip of the iceberg' for health data sharing

The Kentucky Health Information Exchange, St. Elizabeth Healthcare and Healthbridge are successfully sharing patient information. The partnership, says Trudi Matthews, director of policy and public relations for HealthBridge, is just the “tip of the iceberg” in terms of connecting healthcare providers and sharing patient information in Kentucky and healthcare markets in bordering states.

Connecting to St. Elizabeth Healthcare, one of the largest healthcare providers in the Greater Cincinnati-Northern Kentucky region with six facilities and 62 physician practices, represents a significant milestone for KHIE towards achieving connectivity throughout the state. St. Elizabeth Healthcare is also one of the first participants of HealthBridge, which was founded in 1997 and is one of the largest and financially sustainable health information exchanges in the U.S.

[See also: HealthBridge data exchange gives boost to e-prescribing, diabetes registry]

St. Elizabeth Healthcare didn’t want to duplicate its HIE activities with KHIE, so now as data flows to HealthBridge, the HIE sends a copy of the feeds – with appropriate filters in place – to KHIE, Matthews said. Authorized healthcare providers can securely access critical patient information in order to make timely, better-informed decisions.

KHIE uses a query model, enabling emergency department physicians, for example, to search and receive a matched summary of care record with health information from Medicaid and healthcare providers such as St. Elizabeth Healthcare. KHIE now has the capability to receive and send patient information from St. Elizabeth Healthcare to other participants of the statewide HIE.

For HealthBridge, this partnership also represents a significant milestone. HealthBridge serves a healthcare market that spans three states – Ohio, Kentucky and Indiana. It is already connected with the Indiana HIE and four other HIEs, including HealthLINC, based in Bloomington, Ind.

[See also: HealthBridge offers HIE advice]

“This is a perfect microcosm for inter-state exchange,” Matthews said, of the partnership. “This effort is going to grow over time.”

The Office of the National Coordinator for Health IT (ONC) funded connectivity among KHIE, HealthBridge and St. Elizabeth Healthcare through its State Health Information Exchange Program and Beacon Community Program. ONC selected the Greater Cincinnati-Northern Kentucky community as one of the 17 ONC-funded Beacon Communities. St. Elizabeth Healthcare is participating in the Greater Cincinnati Beacon Collaboration.

HealthBridge is also connecting with the Nationwide Health Information Network. It has already installed Direct and Connect, as additional means for connectivity with other exchanges. “There’s still a lot of work to do with standards to make it [connectivity] easy, but we’re showing it can be done,” Matthews said.

[See also: Kentucky health data exchange kicks off e-prescribing initiative]

Docs adopt and adapt, yet still cling to old ways

ATLANTA – The technology takeover has begun, and physicians nationwide are acclimating one step at a time, a new physician survey reveals. Laptop, smartphone and iPad usage is increasingly common among U.S. physicians, but the report finds old-fashioned methods of communication continuing to stand their ground.

The second annual National Physicians Survey, conducted by the little blue book and Sharecare, polled 1,190 U.S. practitioners representing more than 75 medical specialties. It reveals physicians' perceptions about the ongoing changes in the healthcare system and how those changes are impacting their daily practices as well as their ability to provide optimal patient care. 

Two out of three physicians (66 percent) say the integration of electronic medical records (EMRs) is among their practice challenges. Despite that, most doctors (66 percent) acknowledge EMRs will at least improve or have a neutral effect on their future business.

Almost one out of three doctors (30 percent) are using laptops regularly for e-prescribing, EMRs and more. Almost a quarter (20 percent) are using smartphones, and 12 percent use iPads, for clinical needs.

Additional survey highlights:

Peer-to-peer communication is occurring via email – despite not being a "secure channel."Thirty-four percent of physicians communicate with other clinicians via email – not defined as a "secure channel" by HIPAA.Telephone (95 percent) and fax (63 percent) are still the primary forms of communication.A dinosaur in most other office environments today, the fax is still king with physicians, supporting hand-written notes, insurance forms and lab test result transmissions.Fifty-eight percent of doctors communicate with peers in person.Five percent use social networking sitesDoctor-to-patient communication remains fairly traditional, with some online inroads.The majority of physicians (91 percent) talk with patients via phone, 84 percent in person, 20 percent via email, 8 percent via personal health records (PHRs) and 6 percent via text.Few physicians are opting for solo practices these days -- a good portion are "employed" by hospitals, large practices or accountable care organizations (ACOs).Twenty-two percent of physicians are in ACO talks, up from 12 percent last yearOf those who said they were aware of ACOs, 37 percent stated that they would participate as a member of a group practice, 27 percent as a member of a physician-hospital organization, 10 percent as a hospital-employed physician.Only 17 percent of the respondents were unfamiliar with the ACO term, down from 45 percent last year.

Doctors say new patients find them via:

Word of mouth (71 percent)Practice networks referrals (33 percent)Print directories (29 percent)Internet searches (22 percent)

Despite an onslaught of healthcare regulations and requirements and shrinking practice margins, physicians are finding some advocates.

Forty-one percent say their state medical organization/society advocates for them. Thirty-nine percent say their national medical organization/society does.But 40 percent report "no one."

Still, overwhelmingly burdened by obtaining reimbursements from insurers (81 percent) and patient approvals (77 percent), most doctors (71 percent) believe the quality of healthcare will deteriorate over the next five years.

Fifty-five percent fear they aren't spending adequate time with each patient.Thirty-eight percent are concerned they aren't seeing enough patients in a day.

"Physicians today are practicing in a healthcare environment that they never could have predicted much less prepared for," said Keith Steward, MD, senior vice president of medical affairs at Sharecare. "This year's National Physicians Survey provides valuable insight into the frustrations and opportunities of the day-to-day management of practices, administration tools doctors use, and how communication with both colleagues and patients is evolving.

"Arming doctors with innovative solutions to ease administrative burdens is a top priority for the healthcare industry," he adds. "Doctors need to get back to what they were trained to do – provide their patients with the best care possible."

[See also: Docs believe EHRs safer than paper, but patients still ambivalent.]

Even known food allergens dangerous for kids

Even when parents and caregivers are aware of infants' food allergies and have been instructed in avoiding potentially dangerous trigger foods, allergic reactions still occur, the result of both accidental and non-accidental exposures, a study finds.

Accidental exposures from unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in today's Pediatrics.

Non-accidental exposures resulted in 13% of reactions. It's not clear why caregivers would purposely give a child a known allergen, maybe "to see if (the child) has outgrown an allergy, or how allergic he is," says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

"This is a high rate of reactions and concerning," says Fleischer, noting that parents were counseled "on a regular basis about food avoidance."

Only 50% of the accidental reactions were from food provided by parents, highlighting the importance of educating all caregivers � grandparents, siblings, babysitters and teachers � about food allergies, he says.

"There is still some misunderstanding in the general public about food allergy and how serious it can be," says Ruchi Gupta, an associate professor of pediatrics at Northwestern University. She led a study published last year that found 8% of U.S. children younger than 18 have a food allergy. About 40% had experienced a life-threatening reaction, such as blocked airways or a drop in blood pressure.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. "The vast majority happened from ingestion."

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they felt that was warranted. Epinephrine helps stop reactions by relaxing muscles in the airways and tightening blood vessels.

There's often a "fear of using epinephrine, a concern that there will be side effects," Fleischer says. "In studies that we've done, parents are surprised how quickly and effectively it works."

Even known food allergens dangerous for kids

Even when parents and caregivers are aware of infants' food allergies and have been instructed in avoiding potentially dangerous trigger foods, allergic reactions still occur, the result of both accidental and non-accidental exposures, a study finds.

Accidental exposures from unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in today's Pediatrics.

Non-accidental exposures resulted in 13% of reactions. It's not clear why caregivers would purposely give a child a known allergen, maybe "to see if (the child) has outgrown an allergy, or how allergic he is," says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

"This is a high rate of reactions and concerning," says Fleischer, noting that parents were counseled "on a regular basis about food avoidance."

Only 50% of the accidental reactions were from food provided by parents, highlighting the importance of educating all caregivers � grandparents, siblings, babysitters and teachers � about food allergies, he says.

"There is still some misunderstanding in the general public about food allergy and how serious it can be," says Ruchi Gupta, an associate professor of pediatrics at Northwestern University. She led a study published last year that found 8% of U.S. children younger than 18 have a food allergy. About 40% had experienced a life-threatening reaction, such as blocked airways or a drop in blood pressure.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. "The vast majority happened from ingestion."

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they felt that was warranted. Epinephrine helps stop reactions by relaxing muscles in the airways and tightening blood vessels.

There's often a "fear of using epinephrine, a concern that there will be side effects," Fleischer says. "In studies that we've done, parents are surprised how quickly and effectively it works."

Virginia-Care: Keeping Health Insurance Costs Down for a Small Businesses

Virginia Donohue and her husband started Pet Camp in 1997 with a love of their dogs and little else. Located in San Francisco, California, they provided group play, open spaces, and a pool. Cats had disco lights to play with, aquariums to watch and wide window sills for perches. When the business became sustainable in 2000, Virginia says, it was time to provide health insurance to their employees.

�To me it�s a moral issue. People need to have health care and how we get it is through work,� she says. �I have been one of the employers out there saying, �Look, offering health care is important.��

Virginia says that when she heard about the health care tax credit for small businesses available under the Affordable Care Act, �I was really excited.�

The health care law�s tax credit for small businesses is making it more affordable for Virginia�s company offer health coverage to its employees. She uses the funds from the tax credit to offset the company�s insurance costs. The health care tax credit, she says, amounted to about $7,000 in 2010 and about $8,000 for 2011.

The tax credit is also helping her company stay competitive in the marketplace for good employees.

�We offer health insurance because we want to attract and retain the best employees that are out there, and I think to do that you have to offer quality benefits. � [F]or us, that includes health insurance � that includes bring[ing] your dog to work,� Virginia says.

13 tips for fighting mobile device threats

As threat risks continue to grow for mobile devices in healthcare — think thumb drives, smartphones, tablets and laptops — the pressure to mitigate these risks is being put on the providers. The folks at ID Experts believe now is the time to assess your mobile strategy and take charge of PHI.

Here are 13 tips for fighting mobile device threats, as compiled by ID Experts and others.

1. Consider USB locks. These can be for your computer, laptop or any other device that may contain PHI or sensitive information, said Christina Thielst, vice president at Tower Consulting Group. A USB lock can help prevent unauthorized data transfer — whether uploads or downloads — through USB ports and thumb drives. "The device easily plugs ports for a low-cost solution and offers an additional layer of security when encryption or other software is installed," she said. "The locks can be removed for authorized USB port use."

2. Try geolocation tracking software or services. Rick Kam, president and cofounder of ID Experts, said this software is a low-cost insurance policy against loss or theft that can immediately track, locate or wipe the device of all data on it. "The majority of healthcare organizations currently lack sufficient resources to prevent or detect unauthorized patient data access, loss, or theft," he said. "And lost or stolen computing or data services are the number on reason for healthcare data breach incidents."

3. Brick the device if it becomes lost or stolen. "In the last year, we have seen greater acceptability among employees of 'remote wipe' processes that 'brick' the entire device when it's lost or stolen, rather than just wiping the encrypted silo of corporate information, for example," said Jon Neiditz, partner at Nelson Mullins Riley & Scarborough LLP. The reason, he continued, that bricking the device is more acceptable is because personal data is now more frequently backed up in cloud storage, "so the bricking of the entire device doesn't result in data loss," he said.

4. Encrypt, encrypt, encrypt. All mobile devices, including often overlooked hardware, such as USB drives, should be encrypted if they are going to be used remotely, said Chris Apgar, president and CEO at Apgar and Associates. "The cost of encryption is modest and is sound insurance against what has been demonstrated to be a significant risk to healthcare organizations," he said. "Most breaches do not occur because of cybercrime – they are associated with people."

5. Forget about 'sleep mode.' According to Winston Krone, managing director at Kivu Consulting, most of the leading encryption products that organizations are "routinely installing" are configured so that once the password is entered, the laptop is unencrypted and therefore, unprotected, until it's booted down. "Simply putting the laptop into 'sleep' mode doesn't cause the encryption protection to kick back in," he said. "A laptop that is stolen while is 'sleep' mode is therefore completely unprotected."

6. Recognize that employees will use personal devices. This is true even if it's contrary to policy, said Adam Greene, partner at Davis Wright Tremaine LLP. "Healthcare organizations should consider documenting this risk in their risk assessments, identifying the safeguards in place to limit the inappropriate use of personal devices," he said. To further reduce this risk, he continued, consider the root cause of the problem. "What benefits are personal devices offering to employees that the organization's systems are lacking?"

Continued on the next page.

No Matter What the Supremes Say, We’re Still SiCKO After All These Years

Come on to Philadelphia on June 30th, if you want to know the low down on what the high court of the land says about health reform. Some real people who serve as the world�s highest profile examples of the dysfunctional healthcare system in the United States, filmmaker Michael Moore, and health insurance industry whistleblower Wendell Potter will converge for an evening of comment and conversation just as the political frenzy over the Supreme Court ruling is announced on the individual mandate for Americans to purchase health insurance that is part of the law passed in 2010.

When the Supreme Court rules, the nation will either continue on the pathway to implementation of the Patient Protection and Affordable Care Act of 2010 (or if you like, and depending on the political flavor, Obamacare/Romneycare) or it will be back to the legislative drawing board to discard and revamp the mess.

The politicos are salivating, and their media friends are right there with them. They can hardly wait to claim their ground even as real people continue to suffer illness, bankruptcy, and death trying to survive illness and injury while the medical-financial-industrial complex grows more bloated and profit-driven every day in America.

But I doubt there really will be much talk about what any of it means to real patients and their families. Except in Philadelphia on June 30th, as eight subjects from Michael Moore�s 2007 documentary, SiCKO, about the broken U.S. healthcare system, Moore himself, and Potter take the stage.

SiCKO turns five at the same time the nation will be buzzing about the political implications of whatever the Supreme Court decides. Those of us who appeared in the film and had our stories recounted for the whole world to see have a perspective that mirrors what families are facing all across the country. Moore selected each of our stories from the tens of thousands he received not because we were so unique but just the opposite � we are representative of thousands and even millions of real Americans just trying to live our lives without interference from insurance company underwriters, utilization review teams, and medical debt collection agencies hired by our doctors and our clinics and hospitals. We told the truth in SiCKO, and we�ll tell the truth again in Philadelphia after the Supreme Court decision.

Michael will be able to offer his own special commentary on the Supremes, and Wendell will give us a view from the dark side � he�ll tell us what the insurance industry insiders are probably thinking and doing in response to the high court�s decisions. It will be an evening of incredible intensity and education.

The SiCKOs so hoped we�d be part of some film archives by now. After the initial rush of our film�s opening and watching ourselves fade back into lives of often quiet desperation and continuation of the struggles that made us perfect fodder for Moore’s work, we stayed in touch with one another as part of a sort of blended family. And we invite you to join that family of Americans who don�t care much what healthcare policy does for one political candidate or another � we care what healthcare policy does for our kids, our grandkids, our parents, our neighbors, our friends and each other.

Join us in Philly (click on the link for more information). Reggie and Billy, 9/11 first responders, Julie Pierce, Dawnelle Keys, Lee Einer, Adrian Campbell Montgomery, Larry and Donna Smith. Still SiCKO. And we�re going to come together to support the work advancing healthcare justice in Vermont and with Healthcare-Now, one of the nation�s great grassroots organizations pushing for expanded and improved Medicare for all.

We�re still SiCKO after all these years, and if we�re going to change that, we�d better claim what we�re up against and get on with the work of making patients the �deciders� and not nine robed judges who will lift their corporate masters no matter which way they have ruled. On the one hand, if the mandate is thrown out, the Romney-ites will go insane with jubilation about the joy to be found in a free-market healthcare system and letting those who have the money get the healthcare needed. On the other hand, if the mandate is upheld, Obama fans will have given the healthcare corporations the hugest bail-out imaginable. For the medical-financial-industrial complex it�s a heads-I-win, tails-you-lose scenario of the highest order.

What say you? What say the patients? What say the families? What say the SiCKOs and our fearless filmmaker, Michael Moore, and his unlikely friend, Wendell Potter? Come on down or up to Philly and let�s get down to the business of real people. See you soon.

‘Big Brother’ technology has its benefits

VERO BEACH, FL – Healthcare providers looking to control waste and protect sensitive data are turning to a monitoring program to keep tabs on their employees.

SpectorSoft, based in Vero Beach, Fla., offers a range of Web-based services designed to monitor the computer workstations of employees, charting everything from the Web sites they visit to how much time they spend using an application.

"We ave one story after another of very highly aid doctors abusing the Internet," said Doug Taylor, SpectorSoft's director of marketing.

Designed about 10 years ago to help parents monitor their children's computer use, SpectorSoft's products were developed for corporate use  -  including schools, government facilities and ealthcare ettings  -  about ix years ago. The company's signature product, Spector 360, was released three years ago.

According to Taylor, SpectorSoft software is loaded into each computer and masked so that it can't be located by the user. The software generates reports on each computer that can be accessed on a dashboard by supervisors in real time.

Aside from identifying wasteful, personal or illegal Web surfing  -  a recent Gartner analysis indicates employees spend, on average, one hour of each work day on personal Web surfing  -  Taylor says SpectorSoft allows healthcare providers to monitor time spent in a particular program, identify who's doing what with sensitive data and determine when and for how long employees use their computers. Searches can be set up to identify sites visited or keywords (such as "confidential," "resume" and "sports") used.

"If we can regain just 10 minutes of that personal time, if we add that up over the course of a year, that's a full work week saved," he said.

Don Deas, IT manager for GI & Associates Endoscopy Center in Jackson, Miss., said management consulted with an attorney and their employees before installing the software.

"Obviously, there is a 'big brother' aspect to this, but we made it very clear from the beginning that the equipment and the network were company property, and we were going to monitor, and there was very little negative reaction to it," he said. "We try not to over use this with the employees, only confronting them with evidence when there is a serious breach of policy, so they don't feel it is being thrown in their face every day.  Employees were a little reluctant at first, but now everyone realizes what we are looking for, and they aren't afraid to go online the check the weather or their home Web mail. They just know not to spend all day there."

Taylor said most businesses implementing SpectorSoft see quick returns: A reduction in wasteful computer use or company time spent on personal pursuits. In many cases, he said, just knowing the software is in place acts as a deterrent.

Meas said his company doesn't necessarily target personal transgressions, but is concerned with protecting healthcare information and improving healthcare delivery.

"Our emphasis with this software has mostly focused on productivity and security," he said.  "We monitor transfers to removable media to make sure that patient data is not leaving the premises, and double check confidential charts to make sure that they are not being accessed by people with no need, etc."
 

Spanish regions to get patient management system

BANBURY, Oxfordshire – Two regional healthcare services in Spain have contracted IBA Health Group's iSOFT business to deliver clinical and patient management systems.

In a deal worth €2.64million, which will be booked over the life of the contract, iSOFT will develop clinical and patient management systems for one of Spain's most important autonomous communities (regional governments).

The company is part of a consortium providing an integrated healthcare system for 28 hospitals in a project totalling €12million over two years.

The consortium is upgrading current systems and infrastructure to provide a common platform for all administrative, clinical and patient management functions and so improve the quality of healthcare services for eight million patients. The system is designed for up to 82,000 healthcare professionals.

iSOFT's contract, which includes patient administration, theatres, electronic prescriptions and data warehousing systems and integration services, covers the initial two years of the project. There is potential for ongoing development, maintenance and support.

Gary Cohen, IBA's Executive Chairman and CEO, said: "This is a major project of significant importance in Spain, especially as other autonomous communities are planning similarly joined-up, regional healthcare systems. The project also provides a foundation for further developments such as electronic health records."

iSOFT has also won a contract worth €374,000 to develop an e-prescription solution for the Navarra Healthcare Service in northern Spain.

Under the initial one-year contract, iSOFT will provide an e-prescription solution to eliminate paper prescriptions and so save time and costs and avoid dispensing mistakes. It will also give doctors prescribing rules and lists of recommended drugs and automate invoicing and payments for pharmacists.

iSOFT is working in partnership with Madrid-based information and technology services company IECISA.

The solution will be piloted at the Mendillorri and Mutilva health centres, the Navarra Hospital and 17 pharmacies this year, before being rolled out to 56 health centres and all 500 pharmacies throughout the region in 2010.

iSOFT's contract is for the initial pilot project and is its first with the Navarra Healthcare Service.

It follows the completion of an e-prescription project for the Balearic Islands Healthcare Service in December 2008.

iSOFT's solution is now used by 55 health centres and 411 pharmacies in Mallorca, Menorca, Ibiza and Formentera.

Guillermo Ramas, managing director of iSOFT Spain, Portugal and Latin America, said: "The e-prescription project in the Balearic Islands is a huge success and now serves as a model for other healthcare services in Spain. The 600,000 people in the Navarra region stand to benefit from this investment since the solution will help save money by reducing administrative workloads and eliminating duplicate prescriptions, improve accuracy and so avoids mistakes, and give doctors more time for patients."

Boston, Philadelphia top list of best children's hospitals

WASHINGTON – Boston Children's Hospital and Children's Hospital of Philadelphia tie for first place in U.S. News & World Report's 2012-13 Best Children's Hospitals Rankings.

Much of the quality related data collected for the rankings are based on measures underpinned by health information technology, such as electronic health records.

[See also: U.S. News & World Report taps HIMSS Analytics for hospital measures]

U.S. News & World Report released the rankings on June 5.

They feature 50 hospitals in each of 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology. The rankings will also be published in the U.S. News Best Hospitals 2013 guidebook, which will be available in August.

Eighty hospitals across the country ranked in one or more specialties. In addition, the 2012-13 Honor Roll recognizes 12 hospitals with high scores in a least three specialties:

[See also: 118 'Most Connected Hospitals']

1. (tie) Boston Children's Hospital
1. (tie) Children's Hospital of Philadelphia
3. Cincinnati Children's Hospital Medical Center
4. Texas Children's Hospital, Houston
5. Children's Hospital Los Angeles
6. Seattle Children's Hospital
7. Ann and Robert H. Lurie Children's Hospital of Chicago
8. (tie) Nationwide Children's Hospital, Columbus, Ohio
8. (tie) Children's Hospital Colorado, Aurora
10. (tie) Children's Hospital of Pittsburgh of UPMC
10. (tie) Johns Hopkins Children's Center, Baltimore
10. (tie) St. Louis Children's Hospital-Washington University

For families of sick children, Best Children's Hospitals provides unparalleled quality-related information in addition to rankings, including survival rates, adequacy of nurse staffing, procedure volume, and much more, according to U.S. News & World Report. Since their 2007 debut, the rankings have put an increasing emphasis on data that directly reflect hospitals' performance over the opinions of physicians.

This year, U.S. News surveyed 178 pediatric centers to obtain data such as availability of key resources and ability to prevent complications and infections. The hospital survey made up 75 percent of the rankings. A separate reputational survey in which 1,500 pediatric specialists – 150 in each specialty – were asked where they would send the sickest children in their specialty made up the remaining 25 percent.

"The pressure on hospitals to release data that reveal their quality of care is increasing, but it is still much harder for someone caring for a sick child to dig out important facts about pediatric quality of care than to get that kind of information about hospital performance with adult patients," says Health Rankings Editor Avery Comarow. "No less than adults, children deserve the best possible care when they need it the most. Through Best Children's Hospitals, we highlight pediatric centers with that unique level of expertise."

A typical candidate for ranking in Best Children's Hospitals was a member of the Children's Hospital Association (CHA), was either a freestanding children's hospital or a "hospital within a hospital" – a collection of large, multidisciplinary pediatric departments within a medical center – and was affiliated with a medical school. Several non-CHA members were added because of specific expertise or because of experts' recommendations.
 
RTI International, the research organization that generates the Best Hospitals rankings and created the Best Children's Hospitals methodology produced the 2012-13 rankings and administered the hospital and physician surveys. The hospital survey was designed with the help of 125 medical directors, pediatric specialists, and other experts organized by RTI into working groups.

A detailed description of the methodology is available here.

Geisinger, Merck partner on patient engagement

DANVILLE, PA – Geisinger Health System and Merck have embarked on a multi-year collaboration to develop new methods and technology to spur shared decision making between patients and physicians and to improve adherence to treatment plans and clinical care processes.

First up is the development of an interactive Web application designed to help primary care clinicians assess and engage patients at risk for cardiometabolic syndrome. Cardiometabolic syndrome is a clustering of various risk factors that put an individual at risk of developing type 2 diabetes and cardiovascular disease.

[See also: Geisinger cuts readmissions with tech help]

“We believe that healthcare is most effective when patients are active partners in their care,” said Glenn Steele Jr., MD, president and chief executive officer of Geisinger Health System. “Our collaboration with Merck will allow both organizations to leverage our individual expertise and joint resources to improve patient engagement, including finding new interventions to increase the likelihood that patients will adhere to their treatment plans.”

Teams from Geisinger and Merck will work together to improve patient adherence, increase the role of patients in making decisions to help manage their conditions, share information among extended care teams and improve clinical care processes.

“When you have two leading healthcare companies that share a commitment to improve health outcomes and are focused on fundamental problems that have plagued the healthcare system for years, the results have the potential to be transformative," said Mark Timney, Merck's president of Global Human Health – U.S. Market. "We're excited about the opportunity to work with Geisinger to address these critical areas."

[See also: Geisinger cuts readmissions with tech help]

The Web application and other care management solutions that Merck and Geisinger develop will initially be tested within the Geisinger system. Geisinger has been at the forefront of the development of innovative healthcare delivery models focused on improving adherence and developing methods to better engage patients. Merck has conducted scientific research to better understand the drivers of non-adherence and develop evidence-based interventions.

”A rapid learning process will be used to integrate, evaluate and improve the performance of each solution in primary care clinical settings," said Steele. "We will closely monitor patient acceptance, treatment adherence, and other metrics to determine which tools and solutions have the ability to improve patient care and are ready to be deployed on a broader scale.”

Survey aims to 'amplify the conversation' on aging

There's no cure for growing old, but your attitude about what's important and how you feel about aging can depend in part on how old you are, a new survey finds.

The survey of 1,017 people over 18 finds, for instance, that 24% admit they have lied about their age. But of those 50-64, it's just 21%, and for those over 65, it's 18%.

The survey, out today, was commissioned by the drug company Pfizer in conjunction with about a dozen health advocacy organizations to help encourage dialogue about aging in America. In addition to the survey, the group plans to launch a website, GetOld.com, which invites users to share perspectives on aging.

Asked how they feel about getting old, the top choice was "optimistic" (39%). But not far behind was "uneasy" (36%). About 42% of those 50 to 64 are optimistic, the highest percentage of any age group.

Experts say findings are not surprising. Many adults spend more years in good health, says Nancy Perry Graham, editor in chief of AARP The Magazine.

People also enjoy more freedom as they age and stop having to prove themselves at work or in relationships, Graham says.

The survey also aimed to shed light on people's fears. Only 7% over 65 said their biggest fear was dying; 64% said they were most afraid of losing independence or living in pain.

More than half (51%) of those 18 to 65 would accept having a parent live with them, but just 25% over 65 would want to live with a younger relative if unable to care for themselves.

Freda Lewis-Hall, Pfizer's chief medical officer, says the company and partners did the survey to "shake things up."

"We think a good way to do that is to start by listening and then amplifying the conversation and learning how Americans are really tackling aging � and that's Americans of all ages."

The findings suggest that adults' priorities shift as they age: presented with a list of lifetime achievements, 45% of 18- to 34-year-olds most aspire to have $1 million, but 48% of those over 65 say they would rather see their grandchild graduate.

Linda Fried of the International Longevity Center at Columbia University says it's crucial that people deal with the realities of aging, not just the downsides. "We have such a human aversion to getting old; it's associated with death, and death is scary. But as a society, we have not had the conversations we need to have. There's huge opportunities there."

64%

over age 65 say their biggest fear is losing independence or living in pain

6 opportunities to keep hospital supply chain in line

This past March, Texas Children's Hospital in Houston opened its Texas Children's Hospital Pavilion for Women after recently expanding a new West Campus in an effort to meet growing needs and a shift in population base. And with this growth, said Rick McFee, director of supply chain management at Texas Children's, there came an excellent opportunity to streamline the system's supply chain.

"Due to both of those projects as new projects, we had the ability to look at supply chain and how we were managing all that activity," he said. "It gave us the opportunity to look at new ways of doing that."

[See also: Premier's supply chain program boosts bottom line]

McFee, based on his experiences, outlines six keys to supply chain management. 

1. IT systems should support maximum flexibility. When deciding on an IT system, said McFee, the organization chose to look, first and foremost, for one that gave them maximum flexibility. "We were making sure we could manage multiple types of items," he said. "For example, not every item can fit into the same box or container, so we needed to make sure we had maximum flexibility." Having a close-cabinet system, he added, results in more limitations than an open-cabinet system, putting the emphasis on barcoding to streamline processes. "So as long as you can grab that item and scan its barcode, or have the barcode label close to the item's location, the system works," he said. "That was one of the things we were looking for: the flexibility to manage multiple different types and sizes of projects without limitations to the physical constraint."

[See also: VA deploys robotic systems across healthcare facilities]

2. Try to manage utilization at the floor level. Within Texas Children's facilities, said McFee, a nurse can pick up an item and see barcoding from both the manufacturer and the facility itself, allowing them to scan either code and document the inventory. "From a nursing perspective, they can scan it when they're pulling it off the shelf, or when they have it in their hand," said McFee. "In all of these systems that we used, the key concept is to try to manage the utilization at the floor level to the point where the user – the nurse, the technician, whoever – is basically documenting their use of that item." And, in the background, McFee continued, the system manages the generation of, say, a replenishment request automatically, "without someone having to go up and count every shelf," he said.

3. Include nurses on compliance efforts. McFee said they both train and monitor nurses on their compliance efforts, while identifying folks who may be having issues maintaining compliance. "We're talking down to the individual level or groups of folks," he said. "So if we find an item that's consistently not being captured, we work with nursing on how we can improve that, and how [we] can handle [this] in a different way." McFee added nurses also took a hard look at their own utilization patterns, which allowed the organization to dramatically reduce numbers when shifting to a new system. "We reduced the numbers for what [nurses] thought they'd be using," he said. "In some cases, they had a 10- to 12-day supply sitting on the shelves, and they were down to three to five a day for most items. That was a dramatic reduction."

4. Be aware of utilization patterns. An advantage of using a system to help streamline supply chain efforts is having the ability to key in your "true utilization patterns," he said. "All of these systems manage those utilization numbers, and they allow you to tweak those numbers to fit the true utilization patterns," he said. Communication with nurses and this function, McFee said, played a large part in the overall reduction in the inventory sitting on the floor. "That was through a multiple step process," he said. "We went through to right-size our inventory for the right volume of activity they were expecting."

5. Review your standardization and have a strong value analysis process. This is an "old stand-by" point, said McFee, and includes making sure you don't duplicate products in your supply chains. "And that means a pretty robust value analysis process, and one that's looking for opportunities, especially where we may be using a different manufacturer for achieving the same functional requirements," he said.  "It's also looking at what you can do to reduce those number of overall lines." The value analysis process, he added, should look at any addition to the supply chain from a value perspective, while comparing it to what an organization currently has in stock. "We're always looking to use the best, most efficient and most effective product," he said. "[For example,] if you have a product and you're getting a great price on it, but in reality, you're using two or three of them when one should be working – finding these issues and those items and working closely with the clinical staff to identify those opportunities for change. It's part of what our value analysis does."

6. Don't forget about the data. Lastly, said McFee, you can't forget about the data. "Data, data, data," he said. "If you're not tracking it and you don't have your utilization activity through your ERP system or your point-of-sales system, you need that utilization data on everything." He added that purchasing systems should be linked to a point-of-sales system, allowing for a "single item master," he said. "So if someone goes to order something, if it's an item that's already out there, we may prevent them from creating a PO if they could get it from our warehouse," he said. "Or, we may have a contract established for an item with a vendor. We may not stock it, but the pricing has been established, which cuts out a significant amount of time within our purchasing function."

Panel to postmenopausal women: Don't take vitamin D, calcium

A government advisory panel's recommendation Tuesday that healthy postmenopausal women should not take daily low doses of vitamin D and calcium to prevent bone fractures is a wakeup call to millions of Baby Boomer women that more is not always better.

The panel said there is insufficient evidence to evaluate larger doses, easy to overdo with chewy chocolate supplements that can seem like candy.

In its draft recommendations, the U.S. Preventive Services Task Force also said existing research is insufficient to assess the risks or benefits of taking vitamin D � with or without calcium � to prevent cancer in adults.

Some studies link higher levels of vitamin D with lower rates of colorectal cancer and reduced risks for other cancers, including breast, prostate and pancreatic cancer. These reports are mixed and therefore inconclusive, the advisory panel said.

This is the same panel that grabbed headlines recently by recommending against PSA (prostate-specific antigen) tests to screen for prostate cancer in healthy men and told women ages 50 to 74 to have a mammogram every other year, instead of annually.

This latest report adds to many conflicting messages about the benefits and risks of vitamin D and calcium supplements.

For years, experts have been touting the health benefits of these nutrients. Both calcium and vitamin D are key nutrients for bone health.

The Institute of Medicine, which provides independent advice on health, recommends that people daily get 600-800 IUs (international units) of vitamin D and 700-1,300 milligrams of calcium, depending on their age.

Many foods, such as milk and yogurt products, are rich in calcium and fortified with vitamin D. Sunlight triggers the production of vitamin D in skin and is a major source of the vitamin for many people.

The task force's draft recommendation looked at doses up to 400 IUs (international units) of vitamin D and 1,000 milligrams of calcium for fracture prevention, and recommended against taking them, saying the nutrients slightly increase the risk for kidney stones. The authors add that there is insufficient evidence to draw conclusions about taking larger doses to prevent fractures.

Fractures are a significant health problem, the task force says; every year approximately 1.5 million fractures occur in the U.S. Nearly half of all women older than 50 will have an osteoporosis-related fracture during their lifetime.

"The science is still out for pre-menopausal women and men," with regard to low-dose supplements and fractures, says Timothy Wilt, the lead author on the panel report. "Many people take the supplements, but the science was insufficient to make recommendations for everyone."

Some health experts don't agree with the task force recommendation and say women should weigh options with their physicians based on their own ethnicity, diet and sun exposure, a major source of vitamin D.

The studies analyzed by the government panel have important limitations, says Jen Sacheck, an assistant professor and researcher in the antioxidants research laboratory at Tufts University in Boston. The research largely involved white people and no accommodation was made for how nutritional needs may vary by where a person lives, she says.

"It's a more complex picture than they're painting," she says. "If you live in New England there are many months of the year when you're not getting adequate amounts of vitamin D from the sun. I check blood levels of young and older people and find them to be low in New England."

If you're Hispanic, Asian or black, says Sacheck, or are lactose intolerant, you might not get enough calcium from dairy products. She says being overweight or obese also can also compromise the levels of the nutrients.

Taylor Wallace, senior director of scientific and regulatory affairs for the Council for Responsible Nutrition, a trade group that represents supplement makers, says research shows that supplementation with calcium and vitamin D is beneficial for bone health, particularly in post-menopausal women and the elderly. "You want try to your best to get your calcium and vitamin D from food, but most Americans do not, so when there is a gap, they can fill that gap with supplements."

He points out that last month this same government task force said supplementation with vitamin D was beneficial in preventing incidences of falls among adults ages 65 and older. "Since falls commonly result in fractures, it's common sense for the elderly to consider supplementing with vitamin D and calcium."

About 22% of U.S. adults report taking calcium supplements and 22% reporting using vitamin D supplements, the industry group says.

Most calcium supplements also contain vitamin D because the two nutrients work together, Wallace says. "Vitamin D helps pull calcium into the bones."

"We recommend consumers read the labels," on supplements, he adds. "More is not always better, including for the tasty stuff like the soft chews where people might be tempted to eat a bit more."

Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York and an American Heart Association spokeswoman, says the recommendation "changes everything. There seems to be no place for calcium for preventing cancer and fractures.

"To tell people, 'Take calcium and vitamin D to prevent fractures as you get older,' that's not panning out anymore," she says. "Even if you are at risk for a fracture, maybe you have to try other lifestyle changes, like diet and weight-bearing exercise."

Clifford Rosen, a spokesman for the Society of Bone and Mineral Research, notes that the task force discounts a finding from the Women's Health Initiative, a study of 36,282 healthy postmenopausal women, that supplements offer a 10%-11% reduced risk of fractures.

"I think the government panel's report is a little confusing," Rosen says.

JoAnn Manson, one of the Women's Health Initiative investigators, says in addition to reporting the lower fracture rate, the initiative found "bone density improved among postmenopausal women taking supplements."

Recent research has linked calcium supplements to increased risk of heart attacks, Manson says; she adds that it is best to get calcium from the diet, but some may want to add a low-dose supplement to reach recommended levels.

"The key point about calcium is that more is not better," says Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston.

The National Cancer Institute is funding a 20,000-person study to find whether taking a daily dietary supplement of 2,000 IU of vitamin D or one gram of omega 3 fatty acids reduces the risk of cancer, heart disease and stroke. Manson is directing the study and recruiting men and women for it through this year.

"The science is still out on cancer prevention," says Wilt.

Steinbaum acknowledges that consumers may feel confused and frustrated by changing recommendations. She hopes that people won't give up and feel there's nothing they can do to improve their health. The two old standbys � "eating better and exercising" � still have the greatest impact, she says.

Healthcare jobs hub in the making

NEW YORK – The New York eHealth Collaborative, the New York City Investment Fund and the New York State Department of Health have launched a $4.2 million program to foster health IT innovation and create 1,500 new jobs in the state.

Called the New York Digital Health Accelerator (NYDHA), the program’s goal is to make New York a hub for the emerging digital health technology industry.

In upcoming months, the program will choose 12 early- and growth-stage companies that are developing cutting-edge technology products in care coordination, patient engagement, analytics and message alerts for healthcare providers.

Each company will be awarded up to $300,000 along with mentoring from senior-level executives at leading hospitals and other providers in New York. The focus areas of innovation will support the development of products that help the state's Medicaid Redesign Team and its new "Health Homes" program, an initiative intended to make the state's treatment of Medicaid patients more coordinated and efficient, officials say.

"Health information technology is helping us transform our healthcare system to provide high-quality, cost-efficient, and patient-centered care for the 21st century," said New York State Health Commissioner Nirav R. Shah, MD. "The Digital Health Accelerator program will further advance New York's national leadership in health IT as it will attract leading-edge companies at the forefront of developing the technology necessary for robust electronic health records and digital care coordination systems."

"When the government and the private sector work hand-in-hand to encourage business growth in our state we see results,” added Maria Gotsch, president and CEO of the New York City Investment Fund (NYCIF).

“This Accelerator will help New York keep and attract businesses that grow our state's economy and create jobs in our communities. Our initial investment will go a long way towards attracting additional investment into New York."

As David Whitlinger, executive director of NYeC, sees it, the economy and healthcare are the two most important issues facing the state, and the New York Digital Health Accelerator will tackle both at once.

"This initiative represents the best kind of marriage between the public and private sectors,” he said. “We are leveraging New York's investment in our statewide health information exchange network and empowering it with the free market."

The NYDHA's unique feature is that it offers participants the opportunity to engage directly with a broad network of providers in New York State, officials say, including hospitals, long-term care providers, community health centers and primary care providers.

Tech companies accepted into the program will receive direct mentorship and feedback from senior-level executives with the participating providers. In addition, companies will have priority access to the technology platform that is connecting electronic health records across New York State, the Statewide Health Information Network of New York (SHIN-NY).

The program aims to create 1,500 jobs over five years. In addition, it is expected that the companies will attract upwards of $150 million to $200 million in investment from the venture capital community post-program. The NYDHA is designed to stimulate a new marketplace, creating the next generation of healthcare tools while positioning New York as the capitol of the health IT entrepreneurial sector, officials said.

Investors in the program are Aetna, Milestone Venture Partners, New Leaf Venture Partners, New York City Investment Fund, Quaker Partners, Safeguard Scientifics and UnitedHealth Group. The Empire State Development Corporation, Health Research Inc. and NYeC will provide additional funds and/or services to operate the NYDHA.

Eighteen healthcare providers have agreed to participate in the program.

More information, including an application for the program, is available at digitalhealthaccelerator.com.

Report: N.Y. school with sick teens not toxic

ROCHESTER, N.Y.�Additional environmental testing at a Le Roy, N.Y., high school where a cluster of students had unusual neurological symptoms earlier this year has found no evidence of contaminants that could be linked to the facial tics and verbal outbursts.

In a community letter released Wednesday afternoon, Le Roy Central Schools Superintendent Kim Cox said, "I have excellent news. There are no adverse health impacts from contaminants in the air, soil or water in or around our high school campus."

The additional tests were done after an outcry over the appearance of unusual neurological symptoms among as many as 18 students in the Genesee County, N.Y., district's junior and senior high schools, which share a building.

A number of medical experts eventually said the most likely explanation for the cluster was conversion disorder, a stress-related, possibly neurological condition in which patients display symptoms of psychological origin. The condition often eases over time; as of a few months ago, some students were said to be showing improvement.

On that point, Cox's letter said only "the best news of all is that our students are doing well."

Concern about the cause of the health problems prompted one round of tests last fall that found no contaminants in the structure.

But when the cluster of illnesses drew national attention in January and the furor mounted in Le Roy, Cox said more comprehensive testing would be done to allay parents' and students' fears that an environmental contaminant might have triggered the symptoms.

The resulting study by Leader Professional Services of Perinton, N.Y., made public Wednesday, said nothing unexpected was found and nothing was present at levels that could cause harm.

There was no detection of the industrial solvent trichloroethylene, or TCE, which some -- including environmental activist Erin Brockovich -- had worried might have migrated from a 1970 spill site three miles away. There also was no evidence of other contaminants such as mercury or formaldehyde and no unusual level of fungi in the schools' air.

Carbon monoxide levels were acceptable, although elevated carbon dioxide was noted. The latter is not a health concern, the report said.

Arsenic was found in soil near a school-owned natural gas well in a concentration slightly above New York state cleanup guidelines. The gas well, which is behind a chain-link fence, is one where a tank that holds brine from the well had previously overflowed. The study suggested the arsenic was naturally occurring.

Vendor Notebook: MedAssurant becomes Inovalon

MedAssurant this week announced the formal launch of its new name: Inovalon, Inc. Company officials say Inovalon is a newly-coined term, created by combining innovation, value and action; within the name are also key elements of the words nova and valor.

Atrilogy Solutions Group announce that it is expanding its health care consulting practice, adding new strategic-focused consulting services and partnerships. With the move, Atrilogy will help U.S. health providers meet increasingly time-sensitive and business-critical regulatory requirements, particularly those involving ICD-10, and electronic medical records needs, officials say.

NovaSom announced the launch of AccuSom Delive, a turnkey program for Sleep Centers offering Out-of-Center Sleep Testing (OCST). AccuSom Deliver provides a complete OCST logistics solution while the participating Sleep Center maintains complete clinical control of their patients. The new offering includes a cloud-based portal for Sleep Centers to enable efficient management of uncomplicated adult OSA diagnosis via OCST.
 
GE Healthcare announced new enhancements designed to improve how radiologists view, navigate, and process big data sets with Centricity PACS 4.0. The new product release continues to ensure other departments and locations can seamlessly connect to PACS through the Centricity Enterprise Archive, cloud-enabled, vendor neutral archive technology that stores petabytes of data for thousands of GE customers worldwide.

Napatec announced the introduction of new functionality to intelligently identify fragmented IP packets. Available on the latest Napatech network adapters, it provides OEM vendors with a powerful off-load tool to increase performance in networks with many fragmented packets.
  
Siemens has announced new updates to the syngo Workflow radiology information system (RIS) as well as syngo.via1, for advanced visualization, syngo.plaza, the agile picture archiving and communications system (PACS), and syngo Dynamics, Siemens cardiovascular imaging and information system (CVIS). In particular, Siemens recently announced the availability of the syngo Workflow Cloud Solution, which can help healthcare providers reduce the ongoing capital expenditure of maintaining on-site hardware for this departmental scheduling and report delivery solution.

eClinicalWorks announced that Christie Clinic, one of the largest physician-owned, multi-specialty group medical practices in Illinois, will transition to eClinicalWorks comprehensive electronic health records (EHR) solution for 150 providers across 16 locations. Officials say integration with the practice’s laboratory, radiology, PACS, cardio diagnostics systems, among others, will extend the benefits of this technology.   

Awarepoint Corporation announced it raised $14 million in additional financing. The Heritage Healthcare Innovation Fund (HHIF),a limited partnership operated by Heritage Group, a Nashville, Tenn.-based private healthcare investment firm, invested $7.5 million. Existing investors including Kleiner Perkins Caufield & Byers, Cardinal Partners, Venrock, Jafco Ventures, Avalon Ventures, New Leaf Venture Partners and Top Tier Capital Partners invested the balance of the round.

Avantas announced major upgrades to its labor management solution, Smart Square. Originally designed to automate the entire staffing, scheduling, deployment and reporting processes for nursing departments, this Web-hosted application is now equipped with enterprise-wide labor management capabilities for departments beyond the inpatient environment. Avantas has also enhanced the business intelligence and user interface functionality of the software, officials say.

Cabinet NG announced the availability of the industry’s first fully integrated document management, cloud-based file sharing and workflow solution. CNG-SHARE is a major component in the latest version of CNG’s document management software, CNG-SAFE 8.0, which extends secure document sharing and collaboration to non-CNG users.

MRO Corp. announced the availability of integrated patient portal technology into the company’s release-of-information software, ROI Online. MRO’s patient portals are hospital-branded and designed specifically to suit the individual needs of the healthcare facilities and their patients, officials say. The portal websites allow patients to easily utilize a secure platform to access their health information.

PerfectServe announced that it moved its satellite office in Chicago, Ill., to a larger space from the Chicago Mercantile Exchange Center to 440 N. Wells St. to accommodate its expanding team. Over the last 60 days, PerfectServe’s Chicago office team has more than doubled, with seven new hires, officials say. Since January, the company, headquartered in Knoxville, Tenn., has hired 65 new employees – more than a 60 percent increase over the past six months.

SRS announced that Western Kentucky Orthopaedic & Neurosurgical Associates (WKONA) has selected the SRS EHR for its 11 physicians across 5 locations. WKONA provides quality orthopaedic and neurological care to the south-central region of Kentucky.

New York RHIOs and HIEs team up to create 'model for the rest of the nation'

NEW YORK – The New York eHealth Collaborative (NYeC) and the New York State Department of Health announced Wednesday that three regional health information organizations (RHIOs) and three health information exchange (HIE) vendors will participate in the Statewide Health Information Network of New York (SHIN-NY), which officials say will function much like a public utility.

The RHIOs – Brooklyn Health Information Exchange, e-Health Network of Long Island and THINC – and HIE vendors (HealthUnity, IBM and InterSystems) have signed on with NYeC to facilitate information exchange across New York's downstate region, which comprises New York City's five boroughs, Long Island and the Hudson Valley, with a combined population of 13 million.

The collaboration represents a significant step, officials say, formalizing the creation of a single, unified statewide network for healthcare records. The SHIN-NY is coordinated by NYeC and will unify existing state HIE initiatives – such as within hospital systems and local RHIOs – making electronic health records secure and accessible to healthcare providers statewide.

"A health information network is relevant to all of us," said David Whitlinger, executive director of NYeC. "If we ever need to visit the ER, anytime we get an MRI or have lab work done and need to make sure our primary care doctor gets the results – our records must reach whoever is treating us as quickly as possible."

Brooklyn Health Information Exchange, e-Health Network of Long Island and THINC, each pioneers of HIE in their regions, have joined the SHIN-NY, connecting their databases and infrastructure to improve the care of the patients they serve and promote statewide health.??

"THINC has been running an HIE since 2001, and we know HIEs enhance coordination and continuity of care, improving quality and helping control costs," said said Susan Stuard, executive director of THINC. "NYeC should be commended, not only for coordinating this effort, but also for recognizing that we're not dealing with technology for its own sake. This is about supporting patient care."

HealthUnity, IBM, and InterSystems have also entered into strategic contracts with NYeC to bring their technologies to bear on the further development of the SHIN-NY and have agreed to standardization of software to permit safe and efficient interoperability, along with adherence to New York Statewide Policy Guidance.

Paul Grabscheid vice president of strategic planning at InterSystems, said his firm is "totally committed to taking connected care to the higher, more inclusive level that is essential to support optimal care delivery throughout the State of New York." To reach this goal, he added, "we need to move beyond low-level data exchange and implement strategic platforms with the intelligent aggregation and advanced analytics needed to improve individual and population health."

The secure communication enabled by the SHIN-NY will reduce time and resources currently wasted gathering disparate medical histories from multiple providers, officials say, benefitting patients with chronic conditions, who visit a variety of providers and treatment facilities, and are in need of more effectively coordinated care. It will also reduce the number of duplicate tests ordered.

The network will serve to prevent harmful drug interactions and highlight risks, allowing providers in emergency situations access to life-saving information, such as a patient's allergy and medication history. Doctors who spend less time trying to retrieve data will have more time to discuss treatment options and recovery plans with their patients.

As additional RHIOs connect to the SHIN-NY, the network will have greater reach, incorporating more secure clinical information from across the state.

The initial capability of the SHIN-NY will be that of Patient Record Look Up, a function similar to a highly secure search engine, which allows providers to search across databases within the SHIN-NY network to find health records relevant to their patient.

The next function the SHIN-NY will deploy is Direct Exchange, which works like email, where providers can query each other while collaborating on patient care.

"Many of the downstate region's 13 million people commute daily across regional boundaries," said Whitlinger. "They also seek healthcare across those boundaries, so it's a logical place for the SHIN-NY to focus first."

[See also: Albany pilot aims for direct results with Direct Project.]

"We always knew what we built would need to be flexible and able to scale, so BHIX created a robust infrastructure that the SHIN-NY can now use as the backbone for large-scale applications such as the state's Medicaid redesign efforts," said BHIX Executive Director Irene Koch. "It just makes sense for everyone to come together now to create efficiencies and expand connectivity."

"e-Health Network of Long Island is extremely excited about the collaborative approach to patients' care," said Denise Reilly, executive director of e-Health Network of Long Island. "We serve five hospitals and 13 nursing homes, and this moves our patient care to a new level."

"The work of NYeC is a model for the rest of the nation," said Paul Grundy, MD, director of healthcare transformation at IBM. "With a master view of the patient and provider allowing the linking of records, care can be more effectively coordinated."

"New York has long been a leader in health IT investment and implementation," said New York State Health Commissioner Nirav R. Shah, MD. "Today's announcement is the next step in the creation of a robust 21st century healthcare system that will better serve the people of New York. I applaud the hard work in regions around the state that has made these critical partnerships possible."

Child CT scans could raise cancer risk slightly

LONDON(AP)�Children who get several CT scans have a slightly higher chance of brain cancer and leukemia in later life, though the risk is still small and probably outweighed by the need to get the test, researchers reported.

The use of CT scans has risen rapidly since they were introduced 30 years ago. For children, they're used to evaluate head, neck or spine injuries or neurological disorders.

International researchers studied nearly 180,000 patients under age 22 who had a CT scan in British hospitals between 1985 and 2002. They followed those patients until 2008. They found 74 of them were diagnosed with leukemia while 135 had brain tumors.

The scientists didn't measure the number of scans, which were mostly of the head, but looked at data measuring radiation doses from the scans. That's because the amount of radiation received by body parts such as the brain and bone marrow depends on the age and size of the patient.

The children who later developed leukemia or brain tumors were compared to a group of people who got a very low dose of radiation to the same parts of their bodies.

"CT scans are very useful, but they also have relatively high doses of radiation, when compared to X-rays," said Mark Pearce of Newcastle University, the study's lead author, at a press briefing Wednesday. He said CT scans were warranted in most situations but more needed to be done to reduce the amount of radiation.

Pearce and colleagues concluded the risk of brain tumors was tripled if children had two to three scans and the risk of leukemia was tripled with five to 10 scans. But he emphasized these were rare diseases and that the higher risk was still small. The risk of leukemia in children is about 1 in 2,000, so having several CT scans would bump that up to about 1 in 600.

"This (risk) is important, but the CT scan may be even more important," said David Spiegelhalter, of the University of Cambridge. He was not connected to the research.

"A judgment has to be made," he said in a statement.

The researchers noted that modern CT scanners give off about 80% less radiation than the older machines used in the study. Even at low doses, the radiation can damage genes that may increase the patient's risk of developing cancer later.

The study was paid for by the U.S. National Cancer Institute and the U.K. Department of Health. It was published online Thursday in the journal Lancet.

In the U.K., laws already require radiation from medical scans be kept as low as possible. In the United States, the government is pushing manufacturers to design new scanners to minimize radiation exposure for the youngest patients. And it posted advice on the Internet urging parents to speak up when a doctor orders a scan � to ask if it's the best option or if there's a radiation-free alternative � and to track how many their child receives.

The American College of Radiology warned that fears of radiation should not prevent parents from getting necessary scans for their kids.

"If an imaging scan is warranted, the immediate benefits outweigh what is still a very small long-term risk," Dr. Marta Schulman, chair of the group's Radiology Pediatric Imaging Commission, said in a statement. "Parents should certainly discuss risk with their provider, but not refuse care that may save and extend their child's life."

CCHIT to add certification programs

CHICAGO – The Certification Commission for Healthcare Information Technology plans to expand its certification activities, Chairman Mark Leavitt announced Thursday.

Leavitt said the panel would, at the same time, remain flexible and responsive as the impact of the American Recovery and Reinvestment Act emerges.

"I believe this is the most important turning point in the history of health IT, and of our organization as well," he said. "With about $20 billion in funding and incentives for EHRs, health information exchange (HIE) and associated technologies - based on certification as a key qualification - we must be very flexible and responsive as federal health IT initiatives emerge and grow."
 
The nine new programs for launch in 2010 and beyond will extend certification to new specialties, settings and populations, while also opening the door to labeling that recognizes advanced capabilities in electronic health records as users become ready to adopt them, Leavitt said.
 
The board of commissioners voted to begin development of four programs - clinical research, dermatology, advanced interoperability and advanced quality - for launch in 2010. These are in addition to two areas previously scheduled for a 2010 launch - behavioral health and long-term care.

Four other certification programs were identified for launch in 2011: eye care, oncology, advanced security and advanced clinical decision support.

Development of obstetrics/gynecology certification was placed on a schedule for possible launch in 2012.

The final expansion roadmap and public comments are available. Volunteer work group recruitment for new and existing certification programs will begin on March 23 through April 20.
 

Public comment on e-prescribing security

A period for public comment continues through March 4 on security criteria and test scripts proposed for CCHIT's certification program covering stand-alone e-prescribing systems. The program, which has been in development since November 2008, is on an accelerated track separate from other certification development cycles as a result of legislation that provides Medicare bonus payments to clinicians using a qualified e-prescribing system with certain advanced features. The e-prescribing provisions were part of the Medicare Improvements for Patients and Providers Act of 2008.
 

HIE Certification Program

Two public comment periods begin Feb. 23 for elements of the HIE certification program, which is being introduced in phases during 2009. The public can comment on final test scripts for two transactions, a lab report document and a patient summary, through March 6. These are for the third phase of HIE certification, which began October 2008 by testing security and added in January the ability to receive and send a lab result. In addition, public comment will be taken through March 24 on a set of roadmap criteria for HIE certification in 2010 and beyond.

 

The Reward for Donating a Kidney: No Insurance

From the New York Times –

When Erika Royer�s lupus led to kidney failure four years ago, her father, Radburn, was able to give her an extraordinary gift: a kidney.

Ms. Royer, now 31, regained her kidney function, no longer needs dialysis and has been able to return to work. But because of his donation, her father, a physically active 53-year-old, has been unable to obtain private health insurance.

Like most other kidney donors, Mr. Royer, a retired teacher in Eveleth, Minn., was carefully screened and is in good health. But Blue Cross and Blue Shield of Minnesota rejected his application for coverage last year, as well as his appeals, on the grounds that he has chronic kidney disease, even though many people live with one kidney and his nephrologist testified that his kidney is healthy. Mr. Royer was also unable to purchase life insurance.

Officials with Blue Cross and Blue Shield of Minnesota refused to discuss Mr. Royer�s case because of privacy laws, but said in a statement that Minnesota residents who are rejected by private insurers can buy coverage through the Minnesota Comprehensive Health Association high-risk pool, which is what Mr. Royer said he did, though he is paying more for less comprehensive insurance.

The officials refused several requests for an interview, saying in an e-mailed statement that �healthy individuals who happen to have one kidney can and do receive coverage� through Blue Cross and Blue Shield as long as their test results are within medically accepted normal ranges.

Mr. Royer said he is baffled by the denial. �From my perspective, I�d be a good risk,� he said. �I�d just be putting in premiums and helping balance the system out.�

There is little data on how often kidney donors have trouble obtaining insurance, but advocates say the fear of being uninsurable may be a powerful deterrent to donation. A 2006 study done by an advocacy organization for transplant professionals found that 39 percent of transplant centers reported that they had had eligible donors who declined to donate because they feared having future insurance problems.

The health of living donors is seldom at issue: Though some research suggests that kidney donors may be slightly more prone to develop high blood pressure as they age, long-term studies have found donors live as long as other healthy people. One study reported that donors live even longer.

Most insurers maintain that prior kidney donation does not affect coverage decisions or premiums, but while transplant cases like Mr. Royer�s are rare, advocates and social workers who work closely with donors say the problem may be more common than is recognized. A review study published in 2007 by Canadian researchers found that as many as 11 percent of them have encountered problems with life and health insurance coverage.

It�s a problem with implications for thousands of people. In 2008, the last year for which figures were available from the National Institute of Diabetes and Digestive and Kidney Diseases, 17,413 kidney transplants were performed, most of them (11,382) from cadavers. But there were 87,820 people awaiting a kidney transplant as of February 2011, and another 2,249 waiting for both a kidney and a pancreas.

Continue reading…

U.S. ranks near last in value-based healthcare, report says

BOSTON – A report released Wednesday from Boston Consulting Group shows the United States trailing behind eight countries with regards to value-based care adoption, suggesting criticism of the U.S. healthcare system may be merited.

The Boston Consulting Group (BCG) study examined the progress of 12 industrialized countries in adopting value-based healthcare – an approach experts say would improve health outcomes while also reducing the industry’s expenditures. 

The report, title, "Progress Toward Value-Based Health Care: Lessons from 12 Countries," evaluates national health systems along two dimensions. 

The first is the degree to which key supports of value-based healthcare are in place at the national level – for example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs and high engagement on the part of clinicians and policymakers. 

The second is the quality of a country’s existing disease registries – institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure – both in terms of the richness of the data and the sophistication of the medical community’s use of the data.

“When it comes to implementing value-based healthcare, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada and the U.K.,” said Neil Soderlund, a BCG partner and coauthor of the report. “By contrast, Germany and Hungary have the furthest to go.”

The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6 percent of GDP on health care, is also one of the laggards in the group. 

Some experts say the fragmented nature of the U.S. healthcare system has limited the collection and use of national health-outcome data. “Reporting standards and clinical outcome metrics differ substantially across the system, even within the same specialty,” said Peter Lawyer, a BCG senior partner and coauthor of the report. “There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities.” 

“We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others,” said Stefan Larsson, MD, a BCG senior partner and coauthor of the report. 

The challenge for U.S. healthcare executives and regulators is how to close the gap with the rest of the world. “Notwithstanding the politics of health care reform, reimbursement is moving from a volume basis to outcomes,” noted Martin B. Silverstein, MD, a senior partner and former global leader of BCG’s Health Care practice.

For more widespread and systematic use of disease registries to take hold, key stakeholders will need to champion them, he added. “National medical societies, in particular, have a leadership role to play,” said Silverstein, “both in creating uniform standards for data collection and in securing broad support and participation of practicing clinicians.”

The federal government can also support registries, he said, “by creating a legislative and regulatory framework that facilitates their establishment and by providing seed funding to get them up and running.”

E. coli outbreak sickens 14 in six states

An outbreak of a less-common form of E. coli has sickened at least 14 people across six states and killed a 21-month old girl in New Orleans, the Centers for Disease Control and Prevention reports.

As of Friday, state health officials in Alabama, California, Florida, Georgia, Louisiana and Tennessee reported cases of the Shiga toxin-producing E. coli strain called O145. The more commonly known form is E. coli O157:H7. The first illness report came April 15, and the most recent is from June 4, the CDC says.

With E. coli infections, it can take up to two to three weeks from "the beginning of a patient's illness to the confirmation that he or she was part of an outbreak," according to the CDC.

No source of the infection has been identified. State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.

Shiga toxin-producing strains of E. coli usually manifest as illness two to eight days after a person has swallowed the bacteria. Most people develop diarrhea, usually watery and often bloody, and abdominal cramps. Most illnesses resolve on their own within seven days, but some can last longer and be more severe.

Most people recover within a week, but in rare cases, some develop a more severe infection. Hemolytic uremic syndrome, a type of kidney failure, can begin as the diarrhea is improving. HUS can occur in people of any age but is most common in children under 5 years old and the elderly.

Because the source isn't known, health officials can't give consumers specific advice on how to avoid the infection, but in general, E. coli can be prevented using these tips from the CDC:

�Wash hands thoroughly after using the bathroom or changing diapers and before preparing or eating food.

�Wash hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).

�Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160 degrees. It's best to use a thermometer, as color is not a very reliable indicator of "doneness."

�Avoid raw milk, unpasteurized dairy products and unpasteurized juices (such as fresh apple cider).

�Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools and backyard "kiddie" pools.

Join Us for an Online Seniors Health Town Hall

This past Thursday, officials from the White House and the Department of Health and Human Services held a town hall meeting to discuss how the health care law is helping women and families across the country. On Monday June 11, we will turn our attention to America�s seniors when we host a Seniors Health Town Hall.

The event will be streamed live from the White House�from 10 am to 11:30 am ET.

Similar to our Women�s Health Town Hall, this event will be an interactive, open dialogue about how the health care law, the Affordable Care Act, is improving the health and quality of life for the nation�s senior citizens by strengthening the Medicare program:

It makes preventive services available for free. This includes mammograms, colonoscopies, and an annual wellness visit where seniors can spend more time with their doctor.It makes prescription drugs cheaper. Seniors who hit the donut hole get a 50 percent discount on their prescription drugs and the donut hole will be closed completely in the years ahead. It cracks down on waste, fraud and abuse.

Submit questions using the Twitter hashtag #SeniorsHealth or on the HealthCareGov Facebook page.

Participants in the Town Hall include:

Kathleen Sebelius, Secretary of Health and Human ServicesCecilia Mu�oz, Director of the White House Domestic Policy CouncilKathy Greenlee, Assistant Secretary for Aging, HHSJonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services, HHSSandy Markwood, Chief Executive, National Association of Area Agencies on AgingJim Firman, President and Chief Executive, National Council on Aging and Chair, Leadership Council of Aging OrganizationsLouise Chang, MD, Senior Medical Editor, WebMD

The Town Hall will begin at 10 a.m., Monday, June 11, 2012.

Blacking Out Single-Payer–And Killing The Auto Industry

By Jonathan Tasini–

When the history of our current economic crisis is written, there will need to be a full chapter devoted to the willful ignorance or stupidity of the traditional media. Right before our eyes stands the solution to a huge chunk of our fiscal nightmare and a lifeline for the auto industry: single-payer health care. And, yet, there is a virtual traditional media blackout on single-payer, witness another example in yesterday’s New York Times.

In The Week In Review, reporter Kevin Sack stumbles through an entirely conventional wisdom article, with this brilliant observation:

Mr. Obama seems to recognize that the recession, with its devastating job losses, affords him the potential to accelerate public opinion. To broaden support for his plan — whatever it ends up being — he insisted last week that systematic improvements in health care would be essential to any lasting economic recovery.

Sacks goes on to chronicle some of the desperation faced by millions of uninsured and under-insured people. And, then, he arrives at the framing of the solutions:

There is a rough consensus, certainly among the Democrats who control both houses, around many key components of the Obama plan — to expand government subsidization of insurance for the poor, to stimulate competition through a new government plan, to require insurers to accept those with pre-existing medical problems and to invest in computerization, prevention and payment incentives for better care.

And…

Less certain, of course, is how to pay for it. During the campaign, Mr. Obama said he would get about half of the necessary total, estimated at more than $100 billion a year, by raising taxes on those making more than $250,000. The rest was to come from savings generated by various efficiencies (their value is a matter of considerable dispute).

Mr. Obama reaffirmed on Thursday that his proposal to roll back the Bush tax cuts might be deferred because of the recession. “We’re probably going to have to, then, find additional dollars to pay for some investments in the short term,” he said, adding that he wants his health plan to pay for itself over a decade.

Some of those dollars may be found by packaging health care initiatives as stimulus measures, a recessionary opportunity presented by the public’s acceptance of deficit spending to spur the economy. What, after all, is $100 billion for health coverage if the government can print $700 billion to bail out the banks?

What is startling–though, perhaps, it should not be by now–is that Sack cannot write the phrase “single-payer” in the entire article, even though it is the only health care plan that would SAVE money and relieve the auto industry–and the rest of the business world–of billions of dollars in health care costs.

Even The Financial Times is starting to get it, though indirectly. In an article today on the auto industry, it acknowledges that wages are pretty much the same between U.S. auto workers and non-union Japanese companies. The big difference is health care, particularly for retirees:

GM and Toyota workers earn similar wages of about $29 an hour.

The big difference is in fringe benefits, such as healthcare insurance and pensions.

The overall labour-cost figures also include retiree benefits. Thousands of GM, Ford and Chrysler workers were on pensions with generous healthcare benefits – foreign carmakers have a fraction of the number of retirees.

I wrote as far back as 2005 that single-payer was the solution to the cost issues of the auto industry. But, The New York Times, along with the rest of the traditional media, repeatedly refuses to include single-payer as a legitimate option.

This commentary is from the Huffington Post.

Healthcare IT slated for $19B in proposed stimulus package

WASHINGTON – Congress is expected to approve $19 billion toward health information technology, with $17 billion allotted to incentives and $2 billion to jump-start healthcare IT adoption, according to a Wednesday night draft of the stimulus package.

The original House version of the bill designated $20 billion for healthcare IT, with the Senate setting aside $22 billion.

The $789 billion conference agreement between the House and Senate versions of the American Recovery and Reinvestment Act (H.R. 1) still faces potential amendments before a final vote, and some healthcare provisions of the bill were not scored as of Wednesday night.

Speaker of the House Nancy Pelosi (D-Calif.) said a final vote is expected before Saturday.

The conference agreement includes measures to codify the Office of the National Coordinator for Health Information Technology (ONC) and establish an open and transparent process led by the national coordinator to develop standards by 2010 that allow for secure nationwide electronic exchange of health information.

It also would improve and expand current federal privacy and security protections for health information, such as requiring that an individual be notified if there is an unauthorized disclosure or use of his or her health information and requiring a patient's permission to use his or her personal health information for marketing purposes.

Medicare and Medicaid HIT provisions in the bill include funding for the adoption and use of health IT, such as electronic health records by providers who serve Medicare and Medicaid patients. It would provide temporary bonus payments ranging from $44,000 to $64,000 for physicians and up to $11 million for hospitals that meaningfully use electronic health records.

The bill supports Medicare and Medicaid incentive payments for critical access hospitals, federally qualified health centers, rural health clinics, children's hospitals and others and phases in Medicare payment penalties for physicians and hospitals not using electronic health records starting in 2014. It seeks a 90 percent HIT adoption rate for physicians and 70 percent for hospitals for using electronic health records and would generate savings of more than $12 billion through improvements in quality of care and care coordination and reductions in medical errors and duplicative care.

Microsoft CEO Steve Ballmer sent a letter to Congress urging quick passage of the bill.

"We believe information technology can help create a connected health system that delivers predictive, preventive and personalized care – a system that will improve the health of Americans and help control healthcare spending," he said. "Government support for rapid adoption of information technology is essential and measurable outcomes are needed to help the Administration and Congress achieve the goals of increased access, lower healthcare costs and improved quality of care."

Douglas, Patrick co-host health care forum

By Anya Huneke for NECN.com–

48 million Americans. That’s the latest estimate of how many Americans are living without health insurance. President Obama has promised to reduce that number by expanding health care coverage in the U.S. Key players in the reform debate met to do some brainstorming in Burlington, Vermont, today.

Two hours before the forum began, a crowd from all over New England gathered outside the Davis Center at the University of Vermont, seizing an opportunity to send the White House a message about health care.

The event was organized by the Obama administration, hosted by Vermont Governor Jim Douglas and Massachusetts Governor Deval Patrick, and intended to create conversation about health care reform.

This is the second of five White House regional forums on health reform. The first was in Michigan and there are three more to come in California, Iowa, and North Carolina in late March and April.

Douglas and Patrick touted steps taken in recent years to bring coverage to 92% of Vermont and 97% of Massachusetts residents, making these two states, they say, models for the rest of the nation.

White House Office of Health Reform Director Nancy-Ann Deparle says what she heard was urgency, and widespread concern about affordability and accessibility.

Deparle says health care reform is a fiscal imperative that will not be easy and may not be perfect, but is essential in turning this country around.