Christina's Considerations

CAeHC webinair on FBI's Cyber Program

Those who are interested in health information exchange (HIE) privacy and security may want to check out the next CAeHC webinar on Tuesday, November 10 at 1:00 PST.  The speaker is Special Agent James Harris, supervisor of the FBIs Sacramento Cyber Program.

I'll be driving back from an interview and hopefully (if the mountains don't get in the way) can listen.

Cross-Enterprise Document Sharing and PHRs

My writings are sometimes cited in the work of others in an effort to build upon our collective knowledge.  The most recent example is a study titled Using Cross-Enterprise Document Sharing protocol to build the prototype of Personal Health Record Systemby researchers from the National Yang-Ming University. 

The authors believe the idea behind a PHR is that the individual should take care of his or her physical condition, rather than leaving it to healthcare providers.  The paper seems to start a conversation and I'm interested in what my readers have to say about the study.

EHR Saving Lives

Now, here is some good news for those of us working to move the adoption of EHRs along.  A Kaiser study found EHRs were at the core of saving cardiac patient lives.

The two-year randomized trial of 421 patients found that patients discharged from the more intensive portion of the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.  Other achieved results, include:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

The most exciting finding from the study, after saving lives, was that the outcome came by Kaiser providing a more efficient, yet equally effective, option to help guide patients.  While the clinical measures are important, so are the cost (resource) measures.  Saving money will lead to improved access for all!

If you are aware of other studies that have measured outcomes from implementation of EHRs, lets add links to the post and start a listing.

Inventory for Consumer Education and Engagement on HIT

The Consumer Education and Engagement Collaborative (CEE), which is part of the national HISPC effort has released the  HIT consumer education and engagement inventory.  This compliments the work of State of Georgia.  My hope is that consumers are learning about the future of information technology in healthcare and are being engaged by the HIE projects across the country, and world.

Health Improvement Technology and Efforts

Health Management Technology had a great article on  Health Improvement Technology and I want to share a few of the highlights below.  I also want to call my readers attention to developments related to regional healthcare improvement efforts around the country.  These collaborative organizations are forming as regionally-based, multi-stakeholder organizations that are working to improve the quality and value of health care delivery.   A national coalition, NRHI, of these organizations has formed and their site makes it easy to identify those in your area.   The work of these organizations (towards a value-driven coordinated care delivery system and severity-adjusted episode-based or comprehensive payment system) fits in nicely with HIE efforts and I recommend that you include them as a stakeholder.

Our challenges:

• Our current delivery system, as well as, the information systems that run them, were never designed to expertly manage chronic disease or improve population health.  (They were designed to treat acute illness, injuries and perform procedures.)
• Consumers are effectively disengaged from their own health and not in the habit of proactively improving their health habits and making value-based decisions or managing their own health risks and conditions. (Many still want the healthcare system to take care of them.)
• Neither hospitals nor physicians are rewarded for keeping patients healthy or preventing chronic disease from developing in the first place.  (They are rewarded for treating disease.)

We can't afford this any longer and change is needed, starting with collaborative team processes between payers, providers and consumers.  We need:

• to digitize, re-design and commoditize the collaborative processes driven by people and teams that erase inefficiencies, drive down operational and medical costs and improve personal and population health.

• a focus on collaborative processes and consider data and information merely as valuable inputs to those processes, but not the end goal.

• technology to follow providers and consumers wherever they go and adapt to their analog and digital worlds.

Connecting Consumers

Consumers of healthcare are key stakeholders in efforts toward the electronic exchange of health information for patient care decision making.  An opportunity for payors, providers and others to explore the vital role of the consumer will take place in Carlsbad, CA on February 23 and 24th at the World Health Care Congress 2nd Annual Leadership Summit on Consumer Connectivity and Web Empowerment.

Participants will examine technology as a key enabler of system wide reform and identify strategies to revolutionize health care through the integration and adoption of eHealth applications and personal health management tools.  Strategies, such as, web-based technologies, including PHRs, physician/patient portals, social networks, and online decision support tools shift the power in health care to consumers and offer solutions to accelerate quality initiatives, increase access and help control escalating costs.

Please join me in Carlsbad to learn more about these exciting new tools.  And, if you want to save an extra $200 off the current registration rate, contact World Health Care Congress at 800-767-9499 and use promotional code PDG485.

A New Federal HIT Strategic Plan

The HHS and the Office of the National Coordinator recently released a new Federal Health IT strategic plan and a summary for 2008 - 2012 at http://www.hhs.gov/healthit/resources/reports.html.   The plan includes two main goals, patient-focused health care and population health.  These two goals have four common objectives, but they are applied to each goal differently.  Not surprisingly the objectives are:

• Privacy and Security
• Collaborative Governance
• Interoperability
• Adoption

The plan includes the products of an ONC work group that recently completed a process of developing common definitions of HIT terms.  Without knowing, I actually contributed to this work with my column on electronic, personal and virtual health records in the Journal of Healthcare Management.

It is very exciting to see the progress continue and I'm really happy to have contributed to the effort, even if it was in a small way!

PHRs Transforming Health Care

Congressman Patrick Kennedy has a nice article in Most Wired on Personal Health Records.   We agree that:

Most individuals see PHRs as a lot of work with little benefit.  Patients may input their diagnoses and medication histories, but few -- if any- providers ever access them.  If doctors begin using PHRs to interact with patients, consumers will get something out of them.

The consumer needs to be in sole control over who has access to the record, a feature that will address many of the privacy concerns that often are raised by health IT.

As patients realize that the convenience of PHRs is a real possibility, they will seek out providers who use them.

Over time, however, consumer demand for the convenience and advantages of health IT will transform health care and give providers the incentive to make further investments in electronic medical records and other information technologies.

Trends in Health Information Technology

I've been invited to write an annual column for the Journal of Healthcare Management on Information Technology.  The column will address issues and trends that practicing healthcare executives are currently grappling with or will encounter in the near future.  And, it will offer basic and new information, as well as, practical solutions, resources and recommendations in each of the six issues in 2007.

I will draw from my own scan of the broader healthcare environment and experiences at the county hospital and system. My first submission is due December 4th for the January/February Issue and it will be more of an overview, but will include a review of EMRs and EHRs.   If you would like to offer up some suggestions for topics for me to address over the next year, please do leave a post, or two.

Teens, Technology and Transforming Healthcare

Earlier this year I read about research on use of  health information technology by high school students in Florida and was eager to see their findings published.  I still haven't seen the findings, but the latest issue of Patient Safety & Quality Healthcare has another article on the student survey and it goes into a little more detail.

The bottom line is that teens are already using the web to find medical and health information and they will continue to rely on this tool as it continues to develop.  Expect to see this generation of adults, and those that follow, driving consumer demand for health information technology.

Role of Individuals in Determining the Future of Personal Health Records

David Lansky, Senior Director for Health Programs and Executive Director of the Personal Health Technology Council at the Markle Foundation was interviewed not long ago by iHealth Beat.  (The complete transcript of the interview is available online. The complete audio of the interview is available online for download in mp3 format.)

In the interview he emphasized the role of individuals in determining the future of personal health records.  He believes health information originates with and belongs to individuals, but not enough work, such as focus group surveys or evaluation studies, are being conducted to "really understand where is the value or where is the risk as perceived by the patient."

He goes on to state that "Ultimately, the constituency for a RHIO, the basis of payment for a RHIO, the enthusiasm for sharing information and pressuring local stakeholders to share is going to come from the public.  And, conversely, if the public thinks this is not a trustworthy system and they're unwilling to allow their data to be shared across the community, these things will be gone in a heartbeat...  So it's extremely important that the consumer representatives be fully involved at the get-go." (De ja' vu anyone?  This sounds like "melt away into the air" from a couple of days ago!)

So I agree with Mr. Lansky!  iHealthRecord did ask me to complete a survey about my experience with my PHR, but I think they could do more to find out how to make this thing work.  Because right now, from my perspective it was/is a waste of my time!

As for RHIOs, I don't see enough representation of consumers at stakeholder meetings.  I also see little engagement of consumers and patients in any sustainable way!

For example, Santa Barbara seems stuck with getting all of the providers to sign the agreements -- and these are the people who have bee en sitting around the table for years!  (Yes, the board members!)  What if they threw a little consumer involvement into the mix?   And, a little data gathered from focus groups, surveys, key informant interviews, etc?  A few believers here and a few advocates there might help convince our large provider organizations to take the next step -- because it is what we want!   

The current efforts are focused on getting physicians to sign-on and use the care data exchange, but our large and influential providers (except for two:  Cottage Health System and Santa Barbara Regional Health Authority) are dragging their feet with the agreements!  Our physicians and consumers want/expect/deserve to see real collaboration among all of our community's healthcare leaders!

Hummm!  I guess my post on consumer involvement ended with a little (well deserved) rant! 

Santa Barbara:  lets get on with it!

What consumers want: quality information about health care

According to findings from a survey commissioned by California benefits provider WageWorks, consumers prefer quality information about health care over hands-on help from financial advisers.  The survey of more than a thousand Americans revealed an urgent demand for health care data, with "clear" and "better" information ranking as first (33%) and second (28%) priority.

The way to give these consumers what they want is to incorporate electronic health information tools into our healthcare provider organizations and networks!  However, we must also ensure that the data that comes out of these systems is "clear" and "better" that what patients are getting currently!

To read the full report... Download wageworks_omnibus_annotated_and_topline.doc

Informing Consumers and Improving Health

My the world is flat!  I have some international readers and one is from across the pond at Infomaticopia.  Rod Ward reviewed the book Consumer Health Informatics:  Informing Consumers and Improving Health Care and you can read it here.  Rod points out that the book's writers are from Canada and the US and I think it might be worth reading, especially if you are associated with a RHIO.

Oh, and it makes me wonder if Dr. Brailer has read this book and would like to contribute his review!

Drowning in Data!

Sometimes I feel like I'm drowning in data!  But today, while going through the pile on my desk I came across an article from Stanford Social Innovation Review and it focused on a real story -- of "Joe"!  It reminded me that sometimes the best tool is not more data, but a story of how whatever will impact real people. 

Those of us involved in health information technology these days are busy gathering data on the return on investment or business case to support our presentations.  However, I think a couple of stories about our own "Joe" or "Josephine" might go a long way toward gaining support for the electronic exchange of health information.

Download I want You to Meet Joe:  How a riveting story can get your message across.pdf by Alessandra Bianchi (Spring 2005)

Santa Barbara County Care Data Exchange

Well, it finally happened!  As a result of my visit to an emergency room in Santa Barbara County on Friday afternoon, I am a patient/consumer of the Santa Barbara County Care Data Exchange (SBCCDE)!  I checked into the emergency room and of course had to repeat health history information found on my personal heatlh record (PHR) (which no one in the ER had access) to the various caregivers.  I had a lot of lab tests, an ultrasound, a CT Scan and then the x-ray. 

The technician asked whether I had a history of radiology tests and then mentioned that he did not see any at other providers here in Santa Barbara.  I asked if he knew this because he was using the SBCCDE and he said "yes" (a bit surprised by my question).  I explained that I had worked on the project and was really excited to learn that it was being used in my care.

The staff at the hospital were great!  I saw many examples of technology being used in my treatment, but also saw opportunities for improvement -- access to the information on my PHR is the biggest.  However, it takes time to put all of the pieces into place.  I'm just happy to know that the SBCCDE is available for me!

Oh, and I will be fine!