Thursday, November 22, 2007
Savings of $4.28 billion annually
Fierce Health had some interesting comments on this.
More related items:
California is the apparent leader in telemedicine. CA will be working on important issues such as reimbursement.
Telehealth Technologies Report Good discussion on the savings and benefits of telemedicine in various care settings: nursing homes, hospitals, correctional facilities etc.
Wednesday, November 21, 2007
receives nearly 600 email a day ! All of which he says are legitimate. John also responds to all of his emails the same day!
Certainly, with the few emails that I have exchanged with John, he always got back to me the same day. He describes in his blog the rules he uses to go through all his emails. I found his method very useful, and have started using some of his techniques in my own email management strategy.
The types of medical errors that will not be reimbursed are:
•Surgery on wrong body part
•Surgery on wrong patient
•Wrong surgical procedure
•Unintended retention of a foreign object
•Patient death or serious disability associated with air embolism that occurs while being treated in a health care facility
•Patient death or serious disability associated with a medication error
•Patient death or serious disability associated with a hemolytic reaction due to administration of incompatible blood or blood products
•Artificial insemination with the wrong donor sperm or wrong egg
•Infant discharged to the wrong family.
This list will be expanded according to the article as more experience is gained in implementing this policy. I did not see much Grey in the list, its fairly black and white. These are all events which are definite errors. Where there may problems, would be in the case of wounds and infections. In these cases, its hard to know if an error actually led to the adverse event. This is the "Grey" area where the implementation of this policy could be problematic.
Friday, November 16, 2007
Wednesday, November 14, 2007
Here is a diabetes blog with good information on this topic thats worth looking up.
Sports, especially football and baseball with their wealth of statistics, are a great application of business intelligence.
Monday, November 12, 2007
ScanGuru, a collection of Document Management information. I found this site to have a wealth of information on document management
From ScanGuru, Network Scanners: evaluations of 3 network scanners. Price range is $2000-3000. Network scanners allow scan to email, network folder or network fax.
Kodak Scan Station 100: High Volume Network Scanner
- A review of product here.
- Scans direct to search-able PDF, TIFF, folder on network, email or to USB drive.
- Cost approx $2200-2600
- Daily scanning Volume of 1000 pages/day
Document Management Solutions
SpringCM a "SaaS" document management solution
1/14/2010: CVISION, OCR software. Can use for PDF conversion, can watch a folder for changes. Looks like a great product. Can download eval software. I will add more once I test drive it my self.
1/14/2010: Interesting stats on document imaging here. Also see this.
Thursday, November 8, 2007
Thanks to Christina for these links:
HIM Principles in Health Information Exchange (Practice Brief)
AHIMA HIM Priciples in Health Information Exchange, Case Scenarios good discussion on MPI, typical use cases. Has some nice diagrams
Continuity of Care (CCR)
Learn more about the Continuity of Care
Update on the CCR Standard TEPR 5/2007
AAFP Center for Health Information IT Has CCR resources
HIMSS Electronic Health Records Vendor Association
"The Continuity of Care Document Quick Start Guide (QSG) is provided free of charge by EHRVA, as a service to vendors and others who will be implementing healthcare documents based on the CCD" : Continuity of Care Document (CCD) Quick Start Guide
Wednesday, November 7, 2007
"...Yahoo chief under fire over Chinese dissident ...". Apparently Yahoo provided personal Email data from a Chinese dissident that led to his imprisonment . It really should make you think about just how much of our personal information is out there and what some of the consequences can be when our privacy is compromised.
And just today, I also just read about the Candid CIO's enthusiasm about Google's new StreetView:
"Only a nerd like me would be excited about this"
"It allows you to see 360 pictures of the streets in Google maps. Google has mostly taken pictures of the streets in big cities."
"Yesterday, Just as I was arriving home from work there was a car with a fancy camera mounted on a pole that extended high above the roof. On the side of the car was a magnetic Google sign."
I don't know about you, but I'd get a bit nervous about having Google or any one else having even more info on me. And to think now that we are too also have them keep our personal health records (PHR). We really need to think this through carefully.
Tuesday, November 6, 2007
hl7-info.com – General HL7 issues, debugging HL7 messages and how BizTalk interacts with the messages
biztalk-info.com – general BizTalk issues, HIPAA related issues
Monday, November 5, 2007
I would prefer if they let physicians buy their own EMRs and not have it subsidized. It will be interesting to see how things work out over the next 3-5 years. Technology is changing rapidly. Microsoft and Google are also getting more into healthcare. EMRs available today may appear ancient compared to the new crop of EMRs coming out over the next few years. Buying an EMR today compared to in a few years may be like buying a DOS based system to a Windows system.
Sunday, November 4, 2007
This is a new service that allows users to upload various documents for sharing. You can even embed documents in your web pages as shown below. Think of it like a Youtube for documents.
For more information, take a look at FierceHealthIT, Physicians see expected 10 percent Medicare cut.
Saturday, November 3, 2007
Using Office Open XML Formats to Support Electronic Health Records Portability and Health Industry Standards
It includes sample code
Here is a description taken from the site:
"Empowering patients and consumers to securely exchange Electronic Health Records is a big debate in the Health industry across the globe. In this article, we discuss some techniques that use Office Open XML Formats and how to embed custom XML formats to exchange data securely. This particular scenario shows the use of Health Level Seven (HL7) Clinical Document Architecture (CDA) to represent the Electronic Health Record in an industry standard format. It also shows how to include the data in a secured document, based on Office Open XML Formats, for portability across multiple care providers."
Example: Patients who present with low back many times have the expectation that they will need an MRI. Even if I'm able to convince them that an MRI is not justified in the acute stages of low back pain, if they are not better in the next few weeks, they will demand an MRI. In many cases, the doctor will go ahead and order the MRI at that point. In this low back pain case, the cost of healthcare goes up steeply after the MRI is ordered. Now will there be any improvement in any outcome measures of back pain as a result? Most likely no. Studies have repeatedly shown this to be the case. In fact, for most back pain cases, patients get better with simple, low cost conservative treatment such as back rest.
A similar case of low back pain treated in a third word country would likely have a similar outcome as in this country- the patient gets better after a few months of conservative treatment. In this country however, we will have spent money on countless office visits, MRIs, physical therapy etc, while in a third world country, the only cost would have been a single office visit. So does this mean that our healthcare system has inferior outcomes? No, its just that our healthcare users have a different set of expectations from their healthcare system than in other countries.
As far as "defensive medicine" and costs, when there's an unfortunate healthcare outcome for example, in this country it's automatically assumed in many cases that it's the fault of the healthcare provider. Remember the recent ex-Patriot coach, Charlie Weis's lawsuit? Situations like this natuarally effect the practice of medicine by our healthcare providers.
For better or worse, our healthcare dollars do not all go towards improving outcome statistics. The cost of healthcare, as well as happiness in general, is just higher in this country.
Friday, November 2, 2007
Go take a look at Roberto Ruggeri's blog item: Getting Started with HL7 Version 3 and BizTalk Server 2006 (R2) for more information.
Here is the link to the sample code. Here is the whitepaper on getting started with BizTalk and HL7 v3.
Thursday, November 1, 2007
HealthVault Lays a Foundation to Build Scale for Telehealth
Today, telehealth applications are based on point to point
relationships: home health agency to patient; disease management company
to patient; health system to patient.
Telehealth devices and their
connectivity are similar. There is a proprietary chain of key components for a
remote patient monitoring (RPM) solution: 1) the RPM device; 2) a gateway
-- which could be mobile like the Biotronik
Cardio Messenger or static like a personal computer -- to aggregate data
from multiple devices and move data to a server-based application; and 3) the
server application that stores and manages the data in accordance with the
application, e.g., glycemic control, medication compliance, etc.
The back office "practice management" function (the medical billing) is a far easier nut to crack. Most doctors are already submitting claims electronically (directly or via a billing service). The EMR piece is more of a challenge and in some ways more "art" than science.
My feeling is that Athena Health should spend their efforts more on creating an interoperable "Practice management" platform in the same way Microsoft created Healthvault as a "PHR platform" rather then a PHR application. With Microsoft's approach, PHR vendors will use HealthVault as a backend platform to perform core PHR functions. In other words, Microsoft is not trying to take over the PHR space, but rather be a part of every PHR.
By creating a "Practice Management Platform", EMR vendors may design their systems to integrate with Athena Health's practice management functionality (this is done via a set of web services). The reason I say this is because those who know EMRs best are not the same people who know practice management functionality. If I was to design an EMR (which I am doing BTW), I'd much rather integrate well with a solid Practice management system than design my own.
Thin vs Thick clients is always a great discussion. Microsoft has the "Smart Client" platform which is essentially a thick client UI that uses web services on the back-end to connect with the data-store. This has the benefit of allowing the "Smart Client" application to work in distributed environment, just like a typical web application.
The "rich" windows UI of the Smart Client is the advantage over a web UI. Ajax however is making web applications look more like a rich Windows-like UI. Just check out, for example, the new Yahoo mail (my personal email platform).
The Smart client distinguishes itself by allowing for an "off-line" mode, which is great in scenarios where Internet access is not always available. Installation and deployment however is the downside of the Smart Client, although it has been made easier with this platform. This is where pure web applications shine.
I wonder if Microsoft is still committed to the Smart Client now that they have another UI platform in the works, code name "Silver-Light", which will further bridge the gap between a Windows and Web UI. We'll have to just wait to see how things sort out in the end.