Download Transforming Health Care: The President`s Health

Group II: How technology will influence the future of Healthcare and new
Millennium
http://www.seniors.org/doc.asp?id=831
The Robert Wood Johnson Foundation Forecasts the Future of Health Care
To recognize the 25th anniversary of its founding, The Robert Wood Johnson Foundation
asked the Institute for the Future (IFTF) to forecast the future of health and health care in
America for the period between now and the year 2010.
The purpose of the forecast is to provide a description of critical factors that will
influence health and health care in the first decade of the 21st century.
The report singles out the trends most likely to influence the course of Americans' health
and the state of the American health care delivery system between now and the year
2010.
-------------------------------------------------------------------------------Some Highlights
The drivers of this system are relatively stable and predictable from now to 2005. Beyond
2005, and through to 2010, the future of health and health care is much more volatile.
To cope with the uncertainties that exist for these later years, IFTF has created three
different scenarios that describe emerging visions of health care in this country. They are
titled Stormy Weather, The Long and Winding Road and The Sunny Side of the Street and they are described in the first chapter of this report.
The findings of the study are hoped to be of value to community service organizations,
hospitals, providers, payers and researchers in the long-term planning processes that
support their own visions of the future.
This forecast is organized in the following way:
Health and Health Care Forecast -- This first chapter provides an overview of the
important issues covered in greater detail throughout the forecast. It functions as an
executive summary of the topics that are covered in greater detail in the subsequent
chapters.
Demographic Trends and the Burden of Disease --In 2010, the American population will
be older and more ethnically and racially diverse. The burden of disease is shifting
toward chronic illnesses that stem from our behaviors. This chapter draws attention to the
importance of these shifts.
Health Care's Demand Side -- The growth rate of American health care costs steadily
increased from 1960 through the early 1990s, then slowed dramatically. This chapter
reviews the historical factors that drove these changes and forecasts the health care cost
increases in both the public and private sectors over the next 10 years.
Health Insurance -- Changes in the health insurance system and in the numbers of the
uninsured are discussed in this chapter. The growth of Medicare and Medicaid, as well as
new versions of managed care products, are projected through the year 2010.
Health Care Providers -- There will be continued change in the way health care is
organized and delivered over the next 10 to 15 years. The surplus of hospital beds will
contribute to a buyer's market, and a new role for intermediaries will emerge. This
chapter examines in depth the battle that will evolve in the medical management arena.
Health Care Workforce -- There has been little real change in the way physicians practice
medicine since the invention of the telephone. Although physicians are still the central
figures in American health care, the current oversupply of doctors and the emergence of
new health care provider roles may create changes in the health care delivery system over
the next decade. The supply and demand of these providers are projected through 2010.
Medical Technologies -- New medical technologies have been one of the key driving
forces in both the cost and the organization of 20th-century health care. This chapter
reviews eight new medical technologies that will affect the provision of patient care in
the next 10 years and examines both their potential positive effects and the barriers that
may stand in the way of their adoption.
Information Technologies -- The health care industry has lagged behind other industries
in implementing information technologies that streamline business and clinical processes.
They forecast that changes in information technology as applied to health care will be a
prime catalyst of change in the future.
Health Care Consumers -- As a new, educated generation of informed consumers begins
to use more health services, it is demanding more information, choice, and control than
ever before. These empowered consumers have the capacity to change dramatically the
culture of health care. In addition, the press of health care cost containment may lead to a
three-tiered system of access to care that seriously disenfranchises people who do not
have insurance.
Public Health Services -- Modern public health is practiced in an environment of
increasing globalism and resource scarcity. New developments in technology, public
health strategy, and public-private partnerships will shape future successes and failures in
public health. This chapter examines and forecasts the future of public health services,
including organizational and environmental health issues.
Health Behaviors -- Our health behaviors, namely smoking, poor dietary habits, lack of
exercise, alcohol abuse, the use of illicit drugs, and violence, influence up to 50 percent
of our health status. Although we do not anticipate radical improvements in these health
behaviors in the coming decade, the emphasis that managed care has placed on
prevention will help us begin to decrease these harmful behaviors. In addition,
community-based programs that change or restrict the environment will also be very
important.
Expanded Perspective on Health -- A definition of health must have equal applicability to
everyone: to the fully well, to people who are unwell because of disease or illness that is
treatable or curable, and to that growing segment of the population with genetic or
acquired impairment, such as people with chronic disease or disability. Over the next
decade, our view of health will be expanded to encompass mental, social and spiritual
well-being.
Wild Cards -- Wild cards are events that have less than a 10 percent chance of occurring,
but will have a tremendous impact on society and business if they do occur. The point of
wild cards is not to predict an outcome but to expand peripheral vision regarding the total
range of possibilities; to offer a larger context within which to consider mainstream
forecasts; and to prepare for surprises in the event they do come to pass.
http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html
Transforming Health Care: The President’s Health
Information Technology Plan
“By computerizing health records, we can avoid dangerous medical mistakes, reduce
costs, and improve care.”
--President George W. Bush, State of the Union Address, January 20, 2004


President Bush has outlined a plan to ensure that most Americans have
electronic health records within the next 10 years. The President believes that
better health information technology is essential to his vision of a health care
system that puts the needs and the values of the patient first and gives patients
information they need to make clinical and economic decisions – in consultation
with dedicated health care professionals.
The President’s Health Information Technology Plan will address
longstanding problems of preventable errors, uneven quality, and rising costs
in the Nation’s health care system.
http://www.medscape.com/viewarticle/421161
Critical Choices Face Healthcare in How to
Use Information Technology
May 20, 1999
from Medscape General Medicine [TM]
Kent Bottles, MD
Healthcare in the United States will be drastically changed by the
introduction of computer and Internet technology. The healthcare industry
has been slow to adopt sophisticated information technology techniques
that have already had a major impact on other companies.
Wal-Mart and Charles Schwab are cited in the computer literature as
companies which have transformed their work processes with the use of
information technology. Randy Mott, Chief Information Officer of Wal-Mart,
quotes Sam Walton as saying, "People think we got big by putting big
stores in small towns. Really we got big by replacing inventory with
information."[1] Wal-Mart's information technology gives management 8.4
million updates a minute on what individual customers are buying. Every
receipt of every purchase is viewed as intelligence that can help
management and local store associates maximize sales in each store.
Wal-Mart shares this enormous amount of information not only at all levels
of its organization but also with its vendor partners. By allowing vendors to
analyze buying patterns, vendors help manage inventory in each Wal-Mart
store.[2] Charles Schwab uses information technology to develop activitybased costing that allows the company to accurately figure costs of
products that have contributions from dozens of departments. Schwab
labeled this system "Model for Understanding Schwab Economics
(MUSE)," and it has given the organization a competitive edge in the
financial services industry. Used by employees at all levels, MUSE allows
real-time data analysis for gauging efficiencies, changing marketing
strategies, cutting costs, and modeling costs for new products.[3]
There may be advantages to healthcare's coming relatively late to the
information age. Langdon Winner has coined the term "mythinformation" to
describe "the almost religious conviction that a widespread adoption of
computers and communications systems along with easy access to
electronic information will automatically produce a better world for human
living."[4] Microsoft's Bill Gates in The Road Ahead believes the information
superhighway will improve democracy, spread education to all, and create
a world of "low friction, low overhead capitalism."[5] When television was
first introduced, pioneers like David Sarnoff believed it would be a force for
truth, culture, democracy, and education.[6] Pioneers of new technology
may not be in the most unbiased position to accurately predict the positive
and negative impact of new technology on society.
Winner has described how technologies build order in our lives and also
influence how people work, communicate, and use healthcare. Robert
Caro related how Robert Moses built low bridges on his Long Island
parkways so that minorities who relied on buses for transportation would
not be able to visit the public park Jones Beach. By making sure the
overpasses would allow cars but not larger vehicles, Moses made a
conscious choice of using road-building technology to support his racial
prejudices.[7] Technology is not a neutral, apolitical way to increase
efficiency. Marshall McLuhan described every technology as having
"service" effects and "disservice" effects (positive and negative effects on
the world).[8] Neil Postman in Technopoly writes that each technology has
an "embedded ideology" and that machines create unintended
consequences because once they are introduced they have a mind and
destination of their own.[9] Technologies are used in ways that enhance the
power, authority, and privilege of some over others.[4] The technology
choices that are made will affect who the winners and losers are in the new
information technology-"improved" healthcare system.
The Institute for the Future's A Forecast of Health and Health Care in
America prepared for the Robert Wood Johnson Foundation predicts that
information technology will have its greatest impact on healthcare in
process management systems, clinical information interface, data analysis,
and telemedicine and remote monitoring.[10] The Kennedy-Kassebaum Act
created regulatory incentives for healthcare providers to automate the
basic business processes among providers, intermediaries, and patients.
The electronic medical record will store all of a patient's medical
information in one place that is available at all times; it would also require
data input only once.
An analysis of why the electronic medical record has not been
implemented as rapidly as some predicted may illuminate why healthcare
has lagged behind business in utilizing information technology. The
obstacles to the electronic medical record can be classified as
organizational problems, data problems, cultural problems, and capital
problems. A business like Wal-Mart is organized in an understandable way
around a coherent goal and thus is better able to implement information
technology programs than the healthcare system. The mixture of
physicians, allied health professionals, hospitals, medical schools,
government, and third-party payers that we optimistically call a system is at
best a loose confederation of proud members who do not share the same
goals. It should not be surprising then when they cannot agree on a
standardized platform and nomenclature, prerequisites to make a portable
electronic medical record most useful for patients who move from San
Francisco to New York City.
The data are quite different in most businesses other than healthcare. WalMart and Charles Schwab are successful in handling and mining large
volumes of data with well-structured information requirements. But the
complexity of the data in the business model pales in comparison to the
data requirements of medicine. In medicine each specialty has its own
jargon and very different data requirements (OD means more to an
ophthalmologist than to a cardiac surgeon). The history and physical
performed by an experienced clinician is a constantly changing, fluid
process whereby clues guide the physician to certain questions, tests, and
diagnostic possibilities. The diversity of the information makes utilizing
information technology much more challenging in medicine than using a
hand-held computer to complete the return of a rental car at an airport.
The physician and hospital culture has also been an obstacle to the rapid
introduction of information technology in the healthcare system. It is not
surprising that physicians who are not salaried employees of a system balk
at efforts to record the data from the clinical visit into a computer when it
takes twice as long for the physician as scribbling some notes on a pad of
paper. Voice-recognition technology may go a long way to removing this
cultural barrier by allowing physicians to input clinical data into the
computer as quickly as they can dictate. The Industry Standard has
described physicians as perhaps the least wired of all professionals;[11] the
1997 Health Care Outlook Physicians Survey, which found that less than
20% of physicians record histories directly into the database, transmit
information to other doctors electronically, and receive computerized
treatment protocols, seems to support that observation.[10] The hospital
culture has also contributed to the problem by being risk-adverse and not
willing to invest as much capital in information technology as the private
sector.
I. Health Diseases and policies, health promotion and Disease Prevention
Heart Disease:
http://healthsystems.engr.wisc.edu/heartcare/HeartCare_grant.htm
The aims of this project are to develop HeartCare, an Internet-based cardiac recovery
resource, and evaluate its effects on nursing practice and patient outcomes. HeartCare is
designed to help nurses with the in-hospital discharge planning and teaching
responsibilities and post-hospital self-monitoring, motivation, and home management
necessary for recovery among patients who have undergone coronary artery bypass graft
surgery (CABG). HeartCare extends nursing practice by linking patients in their homes to
computer communication pathways and information resources located world wide on the
Internet. We will develop methods by which HeartCare can be personalized for each
cardiac patient, and by which HeartCare's effectiveness can be tested, demonstrated, and
replicated. We will examine the effects of computerized home care tools on the nursing
care of persons following CABG and on selected patient outcomes
*
http://www.americanheart.org/presenter.jhtml?identifier=3033252
2006 State and Local Public Policy Priorities
The policy initiatives listed below are the 2006 proactive state and local policies for this
upcoming year. Each state will assess, identify and develop individually tailored
strategies focused on those priorities that present the greatest opportunity for policy
success.
Public policy efforts can be divided into two categories: Proactive Policy and Reactive
Policy.
Proactive policies are issue areas in which AHA actively pursues, individually and
through collaborations with other organizations, opportunities to promote and achieve our
policy objectives.
Reactive policies are issue areas in which the Association has an interest and/or previous
policy investment. State and local AHA advocacy staff monitor these issues and if
necessary, intervene to preserve previous public policy or protect our Association’s
interests.
o Obesity Prevention
o Funding for Heart Disease and Stroke Research and Prevention
o Stroke
o Women and Heart Disease
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/CoronaryHeartD
isease/fs/en
Coronary heart diseaseCoronary heart disease (CHD) is a preventable disease that
kills more than 110,000 people in England every year. More than 1.4 million people
suffer from angina and 275,000 people have a heart attack annually. CHD is the biggest
killer in the country. The Government is committed to reducing the death rate from
coronary heart disease and stroke and related diseases in people under 75 by at least 40%
(to 83.8 deaths per 100,000 population) by 2010.
http://circ.ahajournals.org/cgi/content/short/113/6/e85#TBL1
Preliminary mortality data show that CVD as the underlying cause of death accounted for
37.3% of all 2 440 000 deaths in 2003 or 1 of every 2.7 deaths in the United States. CVD
as an underlying or contributing cause of death (1 408 000 deaths in 2002) was about
58% of all deaths that year.
Since 1900, CVD has been the No. 1 killer in the United States every year but 1918.
Nearly 2500 Americans die of CVD each day, an average of 1 death every 35 seconds.
CVD claims more lives each year than the next 4 leading causes of death combined,
which are cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus.
The 2003 overall preliminary death rate from CVD was 308.8. The rates were 359.1 for
white males and 479.6 for black males; 256.2 for white females and 354.8 for black
females. From 1993–2003, death rates from CVD (ICD/10 I00–I99) declined 22.1%. In
the same 10-year period actual CVD deaths declined 4.6%.
Other causes of death in 2003—cancer 554 643; accidents 105 695; Alzheimer’s disease
63 343; HIV (AIDS) 13 544. (preliminary data)
http://www.micromedcv.com/
According to American Heart Association statistics, 20,000-40,000 patients in the United
States would benefit from a heart transplant. The MicroMed DeBakey VAD®, jointly
developed with Dr. Michael DeBakey, Dr. George Noon and the National Aeronautics
and Space Administration (NASA), has the potential to keep many of these people alive
until a donor heart becomes available.
http://www.deseretnews.com/dn/view/0,1249,650208286,00.html
Heart disease
http://www.ee.columbia.edu/ln/dvmm/researchProjects/MultimediaIndexing/DEVL/DEV
L.htm
One important and very common medical imaging modality is the Echocardiogram video,
which captures the function and the structure of the heart from different viewing angles.
Echocardiograms are highly structured, rendering rich spatio-temporal patterns in the
video sequence. We exploit this structure to create statistical models of their content.
These models are then used to parse the echocardiogram videos into their constituent
units of structure. By recovering the structural elements of the echocardiogram video we
can summarize its content for efficient browsing and access. See image for a snapshot of
the browsing interface where the user could navigate the summary of the echocardiogram
and only watch the video segments of interest. The elements of the content of the
echocardiogram could be linked to a synchronized 3D graphic model for a more intuitive
interface, and to the contextual text information usually accompanying these videos.
http://www.americanheart.org/presenter.jhtml?identifier=3018468
Federal Advocacy - Summary of 2003
At the heart of the American Heart Association’s advocacy successes in 2003 lies the
strong relationship between the staff working at the American Heart Association and the
volunteers who give their time, efforts and resources. Never has this been more apparent
than this past year, when we witnessed several important federal health policies,
including those authorizing new programs and those funding existing programs, become
realities that will help advance the fight against heart disease and stroke.
During difficult economic times, looming terror threats and war abroad, volunteers with
the American Heart Association continued to let their elected leaders hear their voices,
telling Congress and the President they care about America’s health – today and
tomorrow. Below are some of the noteworthy events that took place in 2003:
Legislation:
o STOP Stroke Act introduced in both the U.S. Senate and House of
Representatives
o Preventive Cardiovascular Screening included in the Medicare reform
legislation signed into law by the President
o IMPACT Act (obesity fighting legislation) passed in the Senate
o Safe Routes to School legislation aims high -- the House Transportation and
Infrastructure Committee introduces its six-year funding package for
transportation reauthorization, and includes $1.5 billion for Safe Routes
programs over six years; the Senate Environment and Public Works
Committee approves $420 million
http://www.americanheart.org/presenter.jhtml?identifier=3010937
STOP Stroke Act
Congress has a unique opportunity to dramatically advance the fight against stroke - our
nation’s No. 3 killer and a leading cause of significant, long-term disability.
The American Heart Association and its American Stroke Association division is leading
the effort to advance legislation called the Stroke Treatment and Ongoing Prevention Act
(STOP Stroke Act). The goal of the STOP Stroke Act is to help ensure that stroke is
more widely recognized by the public and treated more effectively by healthcare
providers.
The STOP Stroke Act was initially introduced in Congress in 2001. The legislation was
passed unanimously in the Senate in 2002, and a slightly different version of the bill was
passed by the House of Representatives by voice vote in 2004. Unfortunately, Congress
did not complete action on the STOP Stroke Act before adjourning for the year.
The 109th Congress (2005-2006) presents another opportunity for Congress to enact the
STOP Stroke Act. On February 17, 2005, Representatives Chip Pickering (R-MS) and
Lois Capps (D-CA) re-introduced the STOP Stroke Act (H.R. 898) and it has been
referred to the House Energy and Commerce Committee. In the Senate, Senators Thad
Cochran (R-MS) and Edward M. Kennedy (D-MA) re-introduced the STOP Stroke Act
(S. 1064) on May 18, 2005, and it has been referred to the Senate Health, Education,
Labor, and Pensions Committee. The legislation is awaiting action.
http://healthit.ahrq.gov/search/ahrqsearch.jsp
Not all heart attack patients benefit from costly angiography and angioplasty
http://www.njleg.state.nj.us/bills/BillView.asp
New Jersey Bills on Heart Diseases
o A1864 Establishes registry of stroke cases in State.
Cancer
*
http://www.cmaj.ca/cgi/reprint/172/2/210.pdf
Breast Cancer Screening, diagnostic accuracy and health care policies
http://www3.cancer.gov/legis/feb02/healthcare.html
HEALTH CARE: BENEFITS AND PATIENT RIGHTS
The legislation that is described in this section covers many issues related to health care
policy.
o Providing coverage for, or reducing the cost of, prescription drugs (S. Res. 74,
H. R. 698, H. R. 758, H. R. 828, H. R. 1387, H. R. 1400, H. R. 1512, S. 358,
H. R. 1862, S. 812, S. 925, S. 1135, H. R. 1839, S. 880)
o Providing incentives for drug manufacturers to improve the safety and
efficacy of pharmaceuticals for children (S. 838, H. R. 2887, H. R. 3047, S.
1789)
o Providing coverage for oral anticancer drugs (H. R. 1624, S. 913)
o Permitting drug reimportation (S. 1229, H. R. 698)
o Providing a tax deduction for health care coverage - H. Con. Res. 37, S. 575,
H. R. 1127)
o Reforms to the health care system (Medicare - H. R. 803, S. 357; managed
care and other health coverage - H. Con. Res. 37, S. 575)
o Allowing access to medical care (H. R. 1142, H. R. 1200)
o Mandating coverage for specific procedures (H. R. 1520, S. 710) See also
Women's Health section for bills mandating coverage for specific procedures
relevant to women.
o Requiring health insurance coverage of cancer screening (H. R. 1809, S. 868)
o Allowing access to medical imaging and radiation therapy procedures (H. R.
1011)
Introduced during this quarter, S. 1789, like several similar measures, represents an effort
to make more pharmaceuticals available for the treatment of children. Among other
provisions, it extends patent exclusivity to drug manufacturers when they test their drugs
in children, and contains directives for DHHS and NIH to take specific steps toward
ensuring that drugs are tested in children. The legislation was very popular, rapidly
passing both chambers, and receiving the President's signature on January 4, 2002.
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Cancer/fs/en
CancerInformation, policy documents and advice for healthcare professionals involved
in the prevention, diagnosis and treatment of all types of cancer. The Department’s
overall cancer strategy is set out in the September 2000 ‘NHS Cancer Plan’.
http://www.ahrq.gov/research/nov05/1105RA10.htm
Some State-level policies are associated with women's mortality rates for certain
diseases
The four leading causes of death for women in the United States are heart disease,
lung cancer, stroke, and breast cancer. According to researchers from the Oregon
Health & Science University, some State-level policies are associated with women's
mortality rates for these diseases. Researchers, supported by the Agency for Healthcare
Research and Quality (T32 HS00069), worked with experts in women's health and health
policy to examine State policies affecting women's health in four areas: reproductive
issues (for example, State requirements for private insurers to cover Pap and cervical
cancer screening), economic issues (for example, child support payments), access to care
(for example, Medicaid eligibility and expansion efforts), and ensuring healthy
communities (for example, gun control, aid to women who are victims of violence, and
tracking hazardous environmental exposures).
http://www.njleg.state.nj.us/bills/BillView.asp
New Jersey Bills on Cancer Diseases
o A1191 Requires insurance coverage for magnetic resonance imaging for
women at high risk for breast cancer.
http://www.njleg.state.nj.us/2006/Bills/A1500/1191_I1.HTM
Financial Institutions and Insurance
o A1417 Concerns workers' compensation for firefighters with cancer.
Labor
o A1628 Requires SHBP to cover prostate cancer screening.
o A2580 Supplemental appropriation of $10 million to DHSS for breast cancer
screening.
o A1975 Requires health insurance coverage for hair headpieces for patients
receiving chemotherapy treatment for cancer.
o A2225 Establishes ovarian cancer public awareness campaign in DHSS;
appropriates $75,000.
o A2371 Establishes Breast Cancer Screening Access Program in DHSS;
appropriates $10 million.
Diabetes
*
http://www.ncsl.org/programs/health/diabetes.htm
State Laws Mandating Diabetes Health Coverage
Updated: September 2006
A leading cause of blindness, kidney disease, heart disease and amputations, diabetes
claims the lives of more than 193,000 Americans each year. According to the CDC, it is
the country's sixth leading cause of death by disease. Approximately 21 million
Americans have diabetes, but 29 percent of those are undiagnosed. This statistic is a
slight improvement as reported by HHS, which had prioritized diabetes awarenes and
prevention and treatment since 2001.
As of December 2005, forty-six states have some type of laws requiring health insurance
coverage to include treatment for diabetes. Most states require coverage of both direct
treatment and the costs of diabetes treatment equipment and supplies often used by the
patient at home. The states not included are Alabama, Idaho, North Dakota and Ohio.
The laws in three other states are limited to requiring that insurers offer coverage, but not
necessarily include the coverage i
*
http://ndep.nih.gov/diabetes/pubs/NDEP_FactSheet.pdf
HRSA: Changing the way diabetes is treated
http://www.njleg.state.nj.us/bills/BillView.asp
New Jersey Bills on Diabetes
o A942 Establishes special license plates to fund diabetes research and
education. Transportation and Public Works.
http://www.njleg.state.nj.us/2004/Bills/S1500/1309_I1.HTM
o A2014 Requires training in diabetes care for certain school employees and
use of medical management plans in schools for students with diabetes.
o A2403 Directs school nurse to develop individual health care plan for
students with diabetes and allows certain diabetic students to test blood and
administer insulin in the classroom.
o AR216 Recognizes November 2006 as "American Diabetes Month."
Obesity
http://www.healthinschools.org/sh/obesity.asp
Keeping Kids Healthy: Overweight, Nutrition & Physical Exercise
Recent research studies as well as publications targeted to front-line child health
professionals, parents and educators have focused public attention on the epidemic in
childhood overweight in the United States. While studies debate how to apportion blame
among potential causal agents, a consensus has emerged that trends in childhood obesity
bode poorly for the health status of children now and as they age to maturity. The
following sections provide links to basic information on the problem, prevention
strategies and key government documents. Future additions to this section will present
summaries of model programs and evaluated interventions.
*
http://www.healthinschools.org/sh/obesity.asp#lp
Laws and Policies
California Center for Public Health Advocacy.
Gives examples of how California activist have originated the approach of using specific
local data on children's obesity and diabetes risk as a lobbying tool.
http://www.publichealthadvocacy.org
Center for Disease Control and Prevention.
Database that lists state legislative initiatives on nutrition and physical activity.
http://apps.nccd.cdc.gov/DNPALeg/
Health Policy Tracking Service.
In 2004, the Health Policy Tracking Service noted a considerable increase in the amount
of legislation introduced regarding nutrition, obesity, and physical activity. This year-end
report provides a recap of significant state initiatives . The main focus during 2004 was to
prevent obesity among children by setting nutritional standards for food and beverage
items sold through vending machines.
http://www.rwjf.org/research/researchdetail.jsp?id=1257&ia=138
National Conference of State Legislatures.
Database that is useful for looking up state legislation on health topics.
http://www.ncsl.org/programs/health/childhoodobesity.htm
http://www.publichealthadvocacy.org/
Landmark Legislation
California Limits School
Soda & Junk Food Sales
The enactment of SB 12 and SB 965 in 2005 was the culmination of years of public
education and policy advocacy by individuals and organizations throughout the state
committed to assuring that California public schools are part of the solution to childhood
obesity, rather than part of the problem. . .
http://apps.nccd.cdc.gov/DNPALeg/
Welcome to the Nutrition and Physical Activity Legislative Database! Search for
state-level bills related to nutrition and physical activity topics.
http://www.rwjf.org/research/researchdetail.jsp?id=1257&ia=138
Many factors contribute to the epidemic of obesity in the United States - environmental,
social, technological, and commercial. Although research provides insights into the
problem, successful strategies to reverse this trend are less well known. RWJF-funded
research focuses on improving our understanding of the complex interplay of factors
contributing to obesity as well as effective public policy responses.
http://www.rwjf.org/research/researchdetail.jsp?id=3170&ia=135
In order to address overall nutritional health, including increases in numbers of
overweight children and adolescents, the San Francisco Unified School District
implemented a progressive nutrition policy beginning in August 2003. The authors
reviewed this policy and focused on its impact on school and district revenues and
students’ participation in the federally subsidized school lunch program. Changes in
menu items and the consequent effects of these changes on student eating patterns and
school revenues at Aptos Middle School in San Francisco were examined. This case
study and additional district data show that provision of healthy menu options led to
increased student participation in the federal school lunch program.
http://www.njleg.state.nj.us/bills/BillView.asp
New Jersey Bills on Obesity
A1613 Requires managed care plans to cover treatment of overweight and obesity in
adults on fee-for-service basis.
Financial Institutions and Insurance
II. Technology: Policies/ implications/references
http://www.hhs.gov/ocr/hipaa/
Medical Privacy - National Standards to Protect the Privacy of Personal Health
Information
o HIPAA Regulations & Standards
o The Privacy Rule
o HIPAA Statute
o The Security Rule
o Transactions and Code Set Standards
o Identifier Standards
o Compliance & Enforcement
http://www.cms.hhs.gov/PrivacyActSystemofRecords/
Systems of Records
The Centers for Medicare & Medicaid Services has published in the "Federal
Register" a system notice that describes the data collected and maintained by the agency
and covered by the Privacy Act. These systems include the following types of data
collections:
Patient and Beneficiary Health Records, Claims Records, Complaint Files, Grants
Management Records, Research Records, and Administrative Files
A description of the information to be collected must be published in the "Federal
Register" 40 days before the data collection begins.
For each of these systems of records, a specified agency employee, known as a system
manager, is responsible for the business requirements of the data maintained in the
system, for answering any questions about seeing the records, and amending or correcting
information contained therein. The system manager, along with his or her mailing
address, is listed in the Federal Register Notice.
http://www.dol.gov/dol/topic/health-plans/portability.htm
Department of labor: Portability of Health Coverage (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) provides rights and
protections for participants and beneficiaries in group health plans. HIPAA includes
protections for coverage under group health plans that limit exclusions for preexisting
conditions; prohibit discrimination against employees and dependents based on their
health status; and allow a special opportunity to enroll in a new plan to individuals in
certain circumstances. HIPAA may also give you a right to purchase individual coverage
if you have no group health plan coverage available, and have exhausted COBRA or
other continuation coverage.
http://www.jointcommission.org/JointCommission/Templates/GeneralInformation.a
spx?NRMODE=Published&NRNODEGUID=%7b61473764-08B9-40DC-B6916F06026B8545%7d&NRORIGINALURL=%2fPatientSafety%2ffacts_patient_safet
y%2ehtm&NRCACHEHINT=Guest#5
Patient safety research
The Joint Commission’s Division of Research includes the Center for Patient Safety
Research (PSR) that works with external collaborators and consultants to advance the
field of patient safety research and adverse event reporting systems. Current initiatives
include:
Using health information technology to improve patient safety reporting, data
analysis and learning from errors, and to promote a national reporting system for adverse
events through the use of standardized patient safety taxonomy and ontology.
Developing an International Patient Safety Classification (IPSEC) to facilitate the global
exchange and dissemination of information among users of disparate incident reporting
systems
Developing Best Practices for Patient Safety, a collaboration with the Center for Health
Policy and the Center for Primary Care and Outcomes Research at Stanford University.
This project involves developing and implementing a survey of hospital organizational
culture as a tool for assessing determinants of patient safety.
http://www.ostp.gov/
Reports: Office of Science and Technology Policies
o 2006
The National Science and Technology Council (NSTC), Subcommittee on
Biometrics, Announces Launch of www.biometrics.gov
8-29 Dr. Marburger Visits South Carolina's ICAR Research Center to Discuss
ACI.
7-26 White House Announces 2005 Awards for Early Career Scientists and
Engineers image
7-20 President George W. Bush today announced his intention to nominate
Dr. Sharon Hays to be an Associate Director of the Office of Science and
Technology Policy
7-07 President Applauds House Action on American Competitiveness
Initiative
7-07 President Honors Nation's Leading Math and Science Teachers
6-08 U.S. and European Commission Renew Task Force on Biotechnology
Research
5-25 President Applauds “Critical First Step” for American Competitiveness
Initiative
o 2005
The National Nanotechnology Initiative at Five Years: Assessment and
Recommendations of the National Nanotechnology Advisory Panel
o 2004
IT Manufacturing and Competitiveness
Science and Engingeering Capabilities
S&T Collaboration: Ideas for Enhancing European-American Cooperation
Federal-State Cooperation: Improving the Likelihood of Success
o 2003
"Technology Transfer"
"The S&T of Combating Terrorism"
o 2002
"Maximizing the Contribution of Science and Technology within the
Department of Homeland Security"
"Assessing U.S. R&D Investment"
“Building Out Broadband”
Energy Efficiency
http://www.intel.com/healthcare/policy_proposals.htm
Intel's Healthcare Policy Proposals Approved at the World Congress on
Information Technology
At the 15th World Congress on Information Technology (WCIT) which convened in
Austin, Texas this past May, Intel's Digital Health Group submitted and presented three
policy proposals to the delegation of 2,000 IT executives and government officials from
around the world.
The delegates voted to adopt and promote these policies, and the policies have been
published by WCIT 2006 and The World Information Technology and Services Alliance
(WITSA) to global leaders in technology, government, and academia.
Healthcare in the 21st century
The aging population along with epidemiological challenges and chronic disease are
straining the worldwide healthcare system. Information technology—coupled with
standards-based interoperable solutions—will be the key requirement to effectively meet
these growing challenges. We encourage all participants in the healthcare system to
embrace these principles.
Policy proposal 1
As delegates we should seek to accelerate the deployment of technologies in the delivery
of healthcare outside of the traditional hospital mainframe.
Summary of position:
Given the worldwide age wave that will double or even triple the number of retiring
seniors in many countries, we feel that new investment in home health technologies is
key. The convergence of medical and consumer electronic technologies offers new
possibilities for early detection of chronic disease and in helping patients to receive care
in their own homes through personal, adaptive home health systems that deliver just the
right assistance at just the right time.
Policy proposal 2
Interoperable, standardized technologies within traditional points of care are critical to
improving the quality and reducing the cost of healthcare.
Summary of position:
According to the Institute of Medicine, between 44,000 and 98,000 Americans die in
hospitals each year as a result of preventable medical errors. A major cause of this death
rate is due to the lack of digitized health data at the point of care. We resolve that all
individuals demand better healthcare through the deployment of standardized,
interoperable electronic health records and electronic prescribing. As information
technology leaders, we call on the industry to introduce interoperable healthcare solutions
to the market.
Policy proposal 3
We propose that steps be taken to contribute to the reporting of real-time, real-place
health information—a new cartography of global health.
Summary of position:
With roughly 50 million people displaced each year by famine, war, or other catastrophe,
the aggregate annual country-by-country indices of health usually published unavoidably
"smooth out" important granular health fluctuations spatial and temporal dimensions.
Likewise, blurring of national boundaries occurs with the spread of disease, pests,
pollution plumes, or health beliefs and behavior patterns. By replacing country-bycountry health maps with dynamic "weather maps" of health risk and outcomes, we can
better prioritize, design, and target health interventions, such as community outreach and
education, immunization programs, location of health facilities, or other resources.
http://www.corporate.coventry.ac.uk/cms/jsp/polopoly.jsp?d=441&a=4206
Technological advances in healthcare
http://www.rwjf.org/research/researchdetail.jsp?id=3171&ia=140
Clinical Information Technology Gaps Persist Among Physicians Issue Brief No.
106
Grossman JM and Reed MC
Center for Studying Health System Change, November 2006
Physicians in smaller practices continue to lag well behind physicians in larger practices
in reporting the availability of clinical information technology (IT) in their offices,
according to a new national study from the Center for Studying Health System Change
(HSC). The proportion of physicians reporting access to IT for each of five clinical
activities increased across all practice settings between 2000–2001 and 2004–2005.
Adoption gaps between small and large practices persisted, however, for two of the
clinical activities—obtaining treatment guidelines and exchanging clinical data with other
physicians—and widened for the other three—accessing patient notes, generating
preventive care reminders and writing prescriptions. In contrast, clinical IT was generally
as likely or more likely to be available to physicians in practices treating larger
proportions of vulnerable and underserved patients as other physicians, a pattern that did
not change between the two periods.
http://www.rwjf.org/research/researchdetail.jsp?id=3081&ia=140
How Common Are Electronic Health Records in the United States?
A Summary of the Evidence
Jha AK, Ferris TG, Donelan K, DesRoches C, Shields A, Rosenbaum S and Blumenthal
D
Health Affairs (Web Exclusive), w496-w507, October 2006
Electronic health records (EHRs) are promising tools to improve quality and efficiency in
health care, but data on their adoption rate are limited. The authors of the study identified
surveys on EHR adoption and assessed their quality. Although surveys returned widely
different estimates of EHR use, when available information is limited to studies of high
or medium quality, national estimates are possible. Based on surveys conducted between
1995 and 2005, the authors found that approximately 23.9 percent of physicians used
EHRs in the ambulatory setting, while 5 percent of hospitals used computerized
physician order entry. Large gaps in knowledge, including information about EHR use
among safety-net providers, pose critical challenges for the development of policies
aimed at speeding adoption.
http://www.corporate.coventry.ac.uk/cms/jsp/polopoly.jsp?d=441&a=4206
Technological Advances in Healthcare
Bioinformatics, genomics and neuroinformatics
Computational biology and high-performance computing
Multimedia, virtual reality, visualization and advanced imaging
Clinical knowledge management, terminology and ontologies
Mobile healthcare technologies
Advances in digtal hospitals
Integrated-care pathways, E-health internetworking and home healthcare
Intelligent systems in diagnosis, prognosis and patient management
Ethical, legal and security aspects
http://www.himss.org/ASP/topics_integration.asp
Integration and interoperability
The benefits of electronic health records, and the appropriate sharing of health
information among patients, physicians, and other authorized participants in the
healthcare delivery value chain, are nearly universally understood and desired. However,
the level of adoption of electronic health record systems in primary care settings remains
low. The automated functions implemented in secondary and tertiary care settings
generally fall far short of the expectations of clinicians. Further, there is only negligible
sharing or exchange of health information concerning individuals or communities
between the disparate electronic health record systems employed by provider
organizations. Few systems take advantage of the full potential of the current state of the
art in computer science and health informatics. The consequences of this situation include
a drain on financial resources from the economy, the inability to truly mitigate the
occurrence of medical errors, and a lack of national preparedness to respond to natural
and man-made epidemics and disasters. HIMSS has convened the Integration and
Interoperability Steering Committee to guide the industry on allocating resources to
develop and implement standards and technology needed to achieve interoperability
http://www.rwjf.org/research/researchdetail.jsp?id=3008&ia=140
Health Courts" and Accountability for Patient Safety
Mello MM, Studdert DM, Kachalia AB and Brennan TA
The Milbank Quarterly, 84(3): 459-492, September 2006
Proposals to move medical injury compensation from the tort system to an administrative
compensation system have been on the policy agenda since the early 1990s. This article
describes a current proposal for “health courts” that has caught the attention of both state
and federal lawmakers. The authors compare various designs for health court systems and
endorse a smaller scale demonstration project covering only a single liability insurer or
group of insurers. They believe that this system will have several advantages over the tort
system:
The use of explicit decision aids and maintenance of a database of previous decisions
would promote consistency in decisions across cases involving similar injuries.
Replacing the negligence standard used in malpractice suits with an avoidability standard
would open eligibility for compensation to a wider range of patients than in the tort
system.
Controls on the size of award in the health court system would benefit cost control, even
if more claims are filed.
Patient safety would gain from the new system in a variety of ways. For example,
evidence-based decision guidelines would improve the system’s accuracy and increase
the likelihood that suboptimal care will gain attention.
In a health court system, a culture of disclosure by health care providers of information
about medical injuries that occur is also more likely to develop, because avoidability has
fewer moral connotations than negligence. Furthermore, the associated liability insurance
system would have built-in financial incentives to prevent recurrences and a centralized
database of claims would aid patient safety analysis. In weighing proposals for health
courts, policy-makers will continue to debate cost, fairness and feasibility issues. But
when it comes to patient safety, the scale is tipped heavily in favor of a new approach.
http://www.rwjf.org/research/researchdetail.jsp?id=2412&ia=140
Growing the Field of Health Impact Assessment in the United States:
An Agenda for Research and Practice
Dannenberg AL, Bhatia R, Cole BL, Dora C, Fielding JE, Kraft K, McClymont-Peace D,
Mindell J, Onyekere C, Roberts JA, Ross CL, Rutt CD, Scott-Samuel A and Tilson HH
American Journal of Public Health, 96(2): 19-27, February 2006
Health impact assessment (HIA) methods are used to evaluate the impact on health of
policies and projects in community design, transportation planning, and other areas
outside traditional public health concerns. At an October 2004 workshop, domestic and
international experts explored issues associated with advancing the use of HIA methods
by local health departments, planning commissions, and other decision-makers in the
United States. Workshop participants recommended conducting pilot tests of existing
HIA tools, developing a database of health impacts of common projects and policies,
developing resources for HIA use, building workforce capacity to conduct HIAs, and
evaluating HIAs. HIA methods can influence decision-makers to adjust policies and
projects to maximize benefits and minimize harm to the public’s health.
http://www.rwjf.org/research/researchdetail.jsp?id=2533&ia=140
Regulatory and Policy Barriers to Effective Clinical Data Exchange:
Lessons Learned from MedsInfo-ED
Gottlieb LK, Stone EM, Stone D, Dunbrack LA and Calladine J
Health Affairs, 24(5): 1197-1204, September 2005
MedsInfo-ED is a proof-of-concept clinical data exchange project that uses prescription
claims data to deliver patient medication history to emergency department clinicians at
the point of care. This patient safety initiative, while limited in scope and scale, has been
crucial in identifying numerous policy and regulatory barriers to successful clinical data
exchange. The lessons learned and strategies to overcome the barriers are the focus of
this paper. Through commitment and effective collaboration, MA-SHARE was able to
address some of these barriers that are embedded in existing government regulations and
corporate business practice.
http://www.ahrq.gov/research/jan97/ra1.htm#head11
Interactive videos help heart disease patients choose the treatment that's right for them
Interactive video programs can help undecided patients with heart disease to select a
treatment and increase confidence in their treatment decision, according to a pilot study
by the Ischemic Heart Disease Patient Outcomes Research Team (PORT) supported by
the Agency for Health Care Policy and Research (HS06503). Patients who are more
active in decisions affecting their health generally fare better than more passive patients,
explain the Duke University Medical Center researchers, who are led by Elizabeth R.
DeLong, Ph.D. In fact, patient participation is receiving increasing attention by clinicians
as a means to improve patient outcomes. One approach is use of an interactive video such
as the Shared Decision-Making Program (SDP) for Ischemic Heart Disease (IHD).
The SDP-IHD compares three treatments: medication, angioplasty, and bypass surgery,
through a physician narrator, patient testimonials, and empirically based, patient-specific
outcome estimates of short-term complications and long-term survival. The video's
interactive format uses a videodisk player, microcomputer, touchscreen video monitor,
and printer, which can be wheeled to the patient's bedside.
On the basis of each patient's severity of illness data, the SDP estimates the risk of inhospital mortality for bypass surgery and angioplasty and 5-year survival with all three
treatments. The program also provides an overview of ischemic heart disease, treatment
descriptions, and explanations of possible complications.
http://www.thehealthcareblog.com/the_health_care_blog/technology/index.html
TECH: The best treatments for heart disease?
I’d never heard of EECP as a treatment for heart disease. Apparently it works, according
to this UCSF analysis. But Debra Braverman’s letter to the NY Times says it all (other
than mistaking the drug industry for the medical device...
PODCAST/TECH: Health2.0 Communities
Moving on from the Health2.0 conversation about search and transactions, this week I've
moved into the really new, new thing. Both the companies on this podcast are at the cusp
of health and communities, and both have offerings whose age...
November 10, 2006
TECH: Big practices using IT, less so in smaller ones
Another incomplete but useful study from HSC on physician technology use. Essentially
the investments made by big groups in EMRs are showing up in the data, with nearly half
those in groups of 50 and above using ePrescribing—perhaps the key...
http://www.thehealthcareblog.com/the_health_care_blog/2006/10/tech_the_best_t.html
http://www.dhs.gov/xoig/assets/mgmtrpts/OIG_CyberspaceRpt_Jul04.pdf
http://www.dhs.gov/xlibrary/assets/HSSTAC_MtgMinutes_23-24Aug05.pdf
Homeland Security: Cyber Space Policies: coordinate efforts to develop best practices
and create cyber security policies with other ...
http://www.dhs.gov/xutil/gc_1157139158971.shtm
Privacy Policy
Thanks for visiting the Department of Homeland Security website and reviewing our
privacy policy! Our privacy policy is plain and simple. We collect NO personal
information like names or addresses when you visit our website. If you choose to provide
that information to us it is only used to fulfill your request for information. We do collect
some technical information when you visit to make your visit seamless. The section
below explains how we handle and collect technical information when you visit our
website.
III: Key Players in advancing technology
http://www.sandia.gov/media/robotic.htm
Leaders in robotics community to discuss ways to advance U.S. robotics
technologies
ALBUQUERQUE, N.M. -- Seven experts representing the R&D community, robotics
equipment suppliers, U.S. manufacturing industries, Congress, and organized labor are
scheduled to participate in a first-ever panel discussion on needed advancements in
robotics May 12 in Detroit. The panel discussion is part of the robotics community's two
major conferences of the year, which for the first time are being held simultaneously in
the same city.
The Robotics and Intelligent Machines Coordinating Committee (RIMCC) is sponsoring
the forum to help accelerate the advancement of key robotics technologies by linking the
nation's government- and university-based research establishment with the vast
community of U.S. robotics systems users and robotics equipment suppliers. The IEEE's
Robotics and Automation Society and the Robotic Industries Association jointly
chartered RIMCC in 1993. (More about RIMCC is available at
www.sandia.gov/isrc/What_is_RIMCC.html.)
"Intelligent machines technology is poised, right now, to offer national defense and
commercial applications so profound they will fundamentally transform many aspects of
our everyday lives," says Patrick Eicker, RIMCC Chairman. "This forum brings together
many of the key players in the future of robotics, in the home town of U.S.
manufacturing, to find innovative ways to speed that transformation." Eicker is Director
of the Intelligent Systems and Robotics Center at the U.S. Department of Energy's Sandia
National Laboratories.
http://www.healthcareitnews.com/story.cms?id=4207
Top five healthcare IT stories of 2005
Healthcare information technology is suddenly the centerpiece of national strategies to
protect the health and well being of Americans.
Here's what we mean: If you look back at 2004 and earlier years, the main arguments for
investing money in healthcare IT were saving lives and saving dollars. It's hard to
imagine more potent arguments than those, and yet almost everything that is the subject
of policy debates in Washington, D.C. , these days promises to do the same.
In 2005, Health and Human Services Secretary Michael Leavitt and David J. Brailer,
MD, the national coordinator for healthcare information technology, amped their
arguments up a notch. IT wasn't just good for healthcare, it was a front line tool for our
national defense and welfare. To gauge how important this shift is, look where the money
is spent these days. According to the watchdog group Public Agenda, defense gets the
biggest portion of the budget pie – about 20 percent. The Department of Homeland
Security got more than $40 billion in funding in FY 2005 and is one of the fastest
growing budget lines in the budget.
These aren't bad horses to hitch the healthcare IT wagon to. Not only because it is
expedient, but also because it's true: as challenges to our national welfare mount, building
a 21st century healthcare system is essential.
Of course, as our other top news stories demonstrate, there's much more to the industry
than what goes on within the Beltway. Personal health records have begun to take hold in
the minds of consumers. If you can manage your book-buying or banking online, why not
your health? And the latest news from the world of healthcare IT vendors – GE
Healthcare's acquisition of IDX – shows just how the industry is maturing.
We hope you enjoy this look back at 2005. More importantly, we'd love to hear from you
if you disagree with out list. What's important to you?
1. Government awards contracts for health network prototypes
If 2004 was the year the federal government developed a blueprint for advancing
healthcare IT adoption in the United States, 2005 was the year construction began on
those plans.
HHS in 2005 awarded several healthcare-IT related contracts, including four contracts for
the development of a prototype for a national healthcare information network, a contract
to develop and test certification of electronic health records and a contract to help
harmonize standards in healthcare software applications.
To deal with the thorny issue of how to make disparate IT systems communicate
throughout the healthcare system, the government created the 17-member American
Health Information Community, a federally chartered advisory board with players from
government agencies, payers, provides and patient groups. The group is charged with
making recommendations on ways to harmonize healthcare IT data standards and IT
projects that could provide immediate benefits to the healthcare system.
2. Leavitt named HHS Secretary
Michael Leavitt, who took over as HHS Secretary in early 2005, made clear from the
beginning that healthcare IT would be a major priority of his administration. Less than
one day into his new role, Leavitt joined President Bush on a trip to the Cleveland Clinic
to tout the benefits of computerized medical records. In an address to the American
Hospital Association, Leavitt called for a "forced march commitment" to develop
national standards for healthcare IT systems, laying the framework for HHS’ 2005 plans.
Among other healthcare-IT related activities, Leavitt released $18.6 million in contracts
to develop prototypes for a national healthcare information network and three contracts
totaling $17.5 million to develop a method to certify healthcare IT tools, harmonize
health information standards and address state variations in privacy and security laws.
Leavitt also unveiled the American Health Information Community, a federal advisory
body that will make recommendations on ways to encourage IT adoption in healthcare.
3. Hurricanes highlight need for electronic records
Hurricanes Katrina and Rita put the spotlight on medical records and prompted HHS
Secretary Michael Leavitt to call for a greater focus on healthcare IT. Paper medical
records were lost or destroyed during the hurricanes. Doctors who were treating the sick
had no access to medical history or medication information after Katrina struck the Gulf
Coast on Aug. 29.
“If there was ever a case to be made for electronic medical records, this disaster, this
incident underscored that need,” Leavitt told an audience at a conference in Washington
D.C. at the beginning of September. Hurricane Rita hit on Sept. 24, adding even more
urgency to Leavitt’s plea.
4. Key acquisitions signal market consolidation ahead
GE Healthcare announced on Sept. 29 it would acquire Burlington, Vt. -based IDX
Systems. The $1.2 billion deal, approved by IDX shareholders at the end of December,
was slated to close Jan. 4, 2006. Industry insiders view this move and others in 2005 as
signifying more consolidation ahead in a still-fragmented market.
Large companies, such as IBM and chipmaker Intel, also announced in 2005 they
intended to be key players in the healthcare sector. Intel launched its health division in
January 2005, and it plans this year to have several hundred employees developing
products and exploring ways to tie Intel architecture to healthcare. In April, IBM
announced the acquisition of Healthlink, a Houston-based healthcare IT consulting firm.
IBM executives said the acquisition of Healthlink would significantly boost IBM’s
capabilities as a healthcare consulting and services leader.
5. PHR momentum gains steam
The move to implement personal health records also picked up momentum this year.
Consumer interest in the records increased, while payers and the government began to
look for ways to implement such approaches. Natural disasters, such as Hurricane
Katrina, gave healthcare organizations opportunities to try personal health records as a
way to provide continuity of care.
American consumers seemed ready for the approach. A national survey of consumers
conducted for the Markle Foundation found widespread support for online personal
health records, mirroring results of a similar survey by Connecting for Health earlier in
the year. Companies and provider organizations, such as IBM and BJC Healthcare,
offered employees free online health record services. And this summer, the Center for
Medicare and Medicaid Services formally requested information on ways that it could
speed PHR adoption.
http://www.microsoft.com/presspass/press/2006/mar06/03-07IntelSMSPR.mspx
Intel and Microsoft Outline Plans for Advancing Benefits of New Management and
INTEL DEVELOPER FORUM, SAN FRANCISCO — March 7, 2006 — Intel
Corporation and Microsoft Corp. today outlined plans to connect computer network
management technologies and also to work together to advance promising virtualization
technology that will bring businesses new capabilities and cost savings.
In a move to bring unique management benefits to the broad number of users of
Microsoft® Systems Management Server 2003 (SMS) for the first time, Intel plans to
connect its new Intel® Active Management Technology (Intel® AMT) with Microsoft
SMS, substantially enhancing customers’ ability to more thoroughly protect their
computers from viruses and to help significantly lower maintenance costs.
Intel and Microsoft have also joined together to extend Intel® Virtualization Technology
(Intel® VT) to include support for mapping I/O devices to virtual machines with a new
specification, published today, called Intel Virtualization for Directed I/O (Intel VT-d).
Part of the Intel VT family of technologies, Intel VT-d helps improve the reliability,
flexibility and performance of I/O in a virtualized environment. Microsoft has
collaborated with Intel on development of the specification to help ensure it provides
optimal functionality for users.
“Intel AMT and Microsoft SMS will mean relief for the millions who manage computer
networks who have struggled to effectively control virus outbreaks, audit networked PCs
or handle computer problems without affecting users’ productivity,” said Pat Gelsinger,
Intel senior vice president, general manager, Digital Enterprise Group. “In addition, the
combination of hardware virtualization in Intel VT-d working with Microsoft operating
systems, management tools and Windows® hypervisor technology promises dramatic
new capabilities and efficiencies.”
“Microsoft is pleased that customers using SMS 2003, including our recently announced
SMS 2003 R2, can take advantage of the new capabilities delivered through Intel AMT
and Intel’s Professional Business Platform via the Intel-developed add-on software for
SMS,” said Bob Muglia, senior vice president of the Server and Tools Business at
Microsoft. “This enables customers to better manage their environments and computing
infrastructures by reducing many challenges they face today. Similarly, Microsoft is
increasing its investments in the Microsoft System Center family of products to address
resource optimization and virtual machine life-cycle management so customers can
manage their physical and virtualized environments from one toolset.”
Availability of Unique Management Capabilities Expanded
Intel has worked with Microsoft to make Intel® AMT interoperable with the Microsoft
SMS change and configuration management solution. Microsoft SMS 2003 helps
simplify computer network management by providing the tools to IT administrators for
streamlining the deployment of software applications and updates, managing digital
assets, and patching security vulnerabilities. As a result, IT administrators can spend
more time on strategic projects and less on more routine tasks.
Intel AMT enables network managers for the first time to perform these and other
functions all PCs on their networks equipped with Intel AMT, even if the computers are
turned off, or have a failed hard drive or operating system. Until now, network
administrators could only perform security updates and maintenance procedures remotely
if PCs were turned on, and they often required the user’s cooperation.
In addition, the Intel AMT component of a PC cannot be accessed by the user, helping
prevent users from crippling management software. As a result, network managers can
account for the Intel AMT-equipped PCs that are on the network and inventory the
versions of software on them.
Existing users of Microsoft SMS 2003 will be among the first to employ the new
capabilities provided by the collaboration, allowing them to update their systems to work
in conjunction with Intel’s upcoming Professional Business Platform, code-named
“Averill,” which will be in PCs later this year. Intel’s Professional Business Platform
combines Intel’s latest microprocessor, chipset, communications and software
technologies to meet the needs of mainstream businesses.
Improved Reliability, Flexibility, Performance for Virtual Computing
Intel today published the specification for Intel VT-d, which complements work being
done in the PCI SIG I/O Virtualization Work Group. VT-d significantly improves
performance and robustness of data movement in virtualized environments.
“Microsoft is collaborating with Intel on the design and specification of VT-d,” said
Muglia. “VT-d provides another critical hardware foundation for the Windows
virtualization architecture. The VT-d hardware foundation combined with future versions
of the Windows hypervisor will help provide customers with increased scalability and
higher-performance I/O by enabling direct assignment of devices to virtual machines.”
Virtualization enables a single computer to function as multiple computers, each with its
own operating system in a in a separate environment. Intel® Virtualization Technology
builds support for virtualization into the chip, helping accelerate industry innovation, and
enhancing manageability, ease of use and security on server and client platforms. Intel
Virtualization Technology will be supported on the Windows platform with Virtual
Server 2005 R2 service pack 1, which is scheduled for beta release within 90 days. With
the service pack, Microsoft customers will be provided with better interoperability,
strengthened isolation to help prevent corruption of one virtual machine from affecting
others on the same system, and improved performance for non-Windows guest operating
systems. This service pack also provides existing Microsoft Virtual Server customers
with an important transition to the Windows hypervisor, which will be delivered in the
wave of the next version of Windows Server™, code-named “Longhorn.”
References: Use of Technology
Utility of a Web-based Intervention for Individuals With Type 2 Diabetes: The
Impact on Physical Activity Levels and Glycemic Control
KIM, CHUN-JA RN, PhD; KANG, DUCK-HEE RN, PhD, FAAN, CIN Volume
24(6), November/December 2006, pp 337-345
Abstract
Despite the numerous benefits of physical activity for patients with diabetes, most
healthcare providers in busy clinical settings rarely find time to counsel their patients
about it. A Web-based program for healthcare providers can be used as an effective
counseling tool, when strategies are outlined for specific stages of readiness for physical
activity. Seventy-three adults with type 2 diabetes were randomly assigned to Web-based
intervention, printed-material intervention, or usual care. After 12 weeks, the effects of
the interventions on physical activity, fasting blood sugar, and glycosylated hemoglobin
were evaluated. Both Web-based and printed material intervention, compared with usual
care, were effective in increasing physical activity (P < .001) and decreasing fasting
blood sugar (P<.01) and glycosylated hemoglobin (P < .01). Post hoc analysis for change
scores indicated significant differences between Web-based intervention and usual care
and between printed material intervention and usual care, but not between web-based and
printed material intervention. The findings of this study support the value of Web-based
and printed material interventions in healthcare counseling. With increasing Web access,
the effectiveness of Web-based programs offered directly to patients needs to be tested.
Community Hospital Successfully Implements eRecord and CPOE
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND,
JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS, CIN,
Volume 24(6), November/December 2006, pp 307-316
Abstract
Despite media attention on converting the nation's paper-based medical record systems to
electronic systems, few hospitals, and even fewer community hospitals, have done so.
University of Pittsburgh Medical Center St. Margaret has converted to a comprehensive
electronic health record system, known as eRecord, in a short time. The authors describe
key factors that were critical to the success of the conversion, along with positive results
on quality of care.
Nursing Administrators' Experiences in Managing PDA Use for Inpatient Units
[FEATURE ARTICLE]
LEE, TING-TING PhD, RN, CIN, Volume 24(5), September/October 2006, pp 280287
Abstract
The adoption of information technology in patient care has become a trend in healthcare
organizations. The impact of this technology on end users has been widely studied, but
little attention has been given to its influence from a management perspective. The
purpose of this study was to explore nurse managers' perceived experiences in
implementing a policy to adopt personal digital assistant technology. A descriptive,
exploratory qualitative approach (one-on-one, in-depth interviews) was used to collect
data from 16 nurse managers of inpatient units at a medical center in Taiwan. Interview
data were analyzed according to Miles and Huberman's data reduction, data display, and
conclusion verification process. The results revealed that nurse managers experienced the
limitations of technology, training issues, doctors' obstructive influence, role conflict, and
improvement of future personal digital assistant use. These results can be used to improve
strategic organizational planning and in-service training programs to implement
information systems.
Expert Clinical Rules Automate Steps in Delivering Evidence-based Care in the
Electronic Health Record
[CONTINUING EDUCATION]
BROKEL, JANE M. PhD, RN; SHAW, MICHAEL G. BSN, RN; NICHOLSON,
CINDY MSN, RN, CIN, Volume 24(4), July/August 2006, pp 196-205
Abstract
A working framework is presented for interdisciplinary professionals for designing,
building, and evaluating clinical decision support rules (expert rules) within the electronic
health record. The working framework outlines the key workflow processes for eight
health system organizations for selecting, designing, building, activating, and evaluating
rules. In preparation, an interdisciplinary team selected expert rules for their
organizations. A physician, a nurse, and/or pharmacy informatics specialists led the team
for each organization. The team chose from a catalog of expert rules that were supported
by regulatory or clinical evidence. The design process ensured that each expert rule
followed evidence-based guidelines and was programmed to automate steps in planning
and delivering patient care. Expert rules were prioritized when improving the safety and
quality of care. Finally, clinical decision support rules were evaluated for abilities to
improve the consistency and currency of assessments and follow-through on patient
findings from these assessments.
Nurses' Acceptance of the Decision Support Computer Program for Cancer Pain
Management
IM, EUN-OK PhD, MPH, RN, CNS, FAAN; CHEE, WONSHIK PhD, CIN, Volume
24(2), March/April 2006, pp 95-104
Abstract
This article describes nurses' acceptance of a decision support computer program for
cancer pain management and explores the relationships between the nurses' acceptance
and their sociodemographic characteristics. A feminist perspective was used as a
theoretical guide for the research process. This was an Internet intervention study among
122 nurses working with cancer patients. Nurses' acceptance of the decision support
computer program was measured using the Questionnaire for User Interaction
Satisfaction. The data were analyzed using descriptive and inferential statistics, including
analysis of variance and correlation analyses. There were significant differences in the
total scores of user satisfaction by sex, religion, ethnicity, job title, and specialty. The
results suggest that nurses do welcome decision support systems and that nurses'
sociodemographic and professional characteristics should be considered in the
development of decision support systems.
An Exploratory Study of Predictors of Participation in a Computer Support Group
for Women With Breast Cancer
SHAW, BRET R. PhD; HAWKINS, ROBERT PhD; ARORA, NEERAJ PhD;
McTAVISH, FIONA MS; PINGREE, SUZANNE PhD; GUSTAFSON, DAVID H.
PhD, CIN, Volume 24(1), January/February 2006, pp 18-27
.
Abstract
This study examined what characteristics predict participation in online support groups
for women with breast cancer when users are provided free training, computer hardware,
and Internet service removing lack of access as a barrier to use. The only significant
difference between active and inactive participants was that active users were more likely
at pretest to consider themselves active participants in their healthcare. Among active
participants, being white and having a higher energy level predicted higher volumes of
writing. There were also trends toward the following characteristics predictive of a higher
volume of words written, including having a more positive relationship with their
doctors, fewer breast cancer concerns, higher perceived health competence, and greater
social/family well-being. Implications for improving psychosocial interventions for
women with breast cancer are discussed, and future research objectives are suggested
EKG BASIC RHYTHM ANALYSIS
OVERVIEW, Computers, Informatics, Nursing
EKG Basic Rhythm Analysis is a CD-ROM that provides basic information on cardiac
dysrhythmia interpretation. Created for healthcare professionals (nurses, physicians,
emergency medical technicians, and paramedics) who are responsible for EKG
interpretation as a part of the care they provide, the instructional material provides a
review of the background information necessary for interpreting common cardiac
dysrhythmias. Typical treatment is included in the instructional material.
Wireless Technology Improves Nursing Workflow and Communications
BRESLIN, SUSAN MSN, RN; GRESKOVICH, WILLIAM MBA; TURISCO, FRAN
MBA, Computers, Informatics, Nursing
Abstract
Inpatient healthcare delivery involves complex processes that require interdisciplinary
teamwork and frequent communication among physicians, nurses, unit secretaries, and
ancillary staff. Often, these interactions are not at a nursing unit, or near a phone. In an
effort to address the inefficiencies of these workflow processes and communications, St.
Agnes HealthCare, Baltimore, MD, installed a new hands-free communications system
that uses a wireless network, voice recognition, and a small wearable badge. Developed
by Vocera, the communications system permits one-button access to others on the system
or connects to outside phones through PBX integration. While many agree that today's
technology has the potential to positively impact nursing care delivery, St. Agnes
HealthCare and Vocera, with assistance from First Consulting Group, decided to conduct
a comprehensive benefits study in December 2003 to quantify the impact of this
communications system on workflow and communications. The results identified a
number of significant findings that demonstrate its value from a quantitative and
qualitative standpoint. The following article describes this study and its findings.
Point of Care Use of a Personal Digital Assistant for Patient Consultation
Management: Experience of an Intravenous Resource Nurse Team in a Major
Canadian Teaching Hospital, Compurters, Nursing, informatics
BOSMA, LAINE BScN; BALEN, ROBERT M. PharmD; DAVIDSON, ERIN BScN;
JEWESSON, PETER J. PhD, FCSHP
INTERNATIONAL
The development and integration of a personal digital assistant (PDA)-based point-ofcare database into an intravenous resource nurse (IVRN) consultation service for the
purposes of consultation management and service characterization are described. The
IVRN team provides a consultation service 7 days a week in this 1000-bed tertiary adult
care teaching hospital. No simple, reliable method for documenting IVRN patient care
activity and facilitating IVRN-initiated patient follow-up evaluation was available.
Implementation of a PDA database with exportability of data to statistical analysis
software was undertaken in July 2001. A Palm IIIXE PDA was purchased and a threetable, 13-field database was developed using HanDBase software. During the 7-month
period of data collection, the IVRN team recorded 4868 consultations for 40 patient care
areas. Full analysis of service characteristics was conducted using SPSS 10.0 software.
Team members adopted the new technology with few problems, and the authors now can
efficiently track and analyze the services provided by their IVRN team.
Online Cancer Support Groups: A Review of the Research Literature
KLEMM, PAULA DNSc, RN, OCN; BUNNELL, DYANE MSN, RN; CULLEN,
MAUREEN BSN, RN; SONEJI, RACHNA BSN, RN; GIBBONS, PATRICIA BSN,
RN; HOLECEK, ANDREA MSN, RN, OCN
Abstract
This article explores current research on online cancer support groups. A review of the
literature revealed 9 research articles (describing 10 research studies) that focused on
computer-mediated or Internet cancer support groups. The researchers in 9 of the 10
studies concluded that online cancer support groups helped people cope more effectively
with their disease. Most of the research studies had small sample sizes. Six of the 10
studies did not include men, and six focused on Caucasian women with breast cancer.
Information seeking/giving was prevalent in the online groups. Gender differences,
negative psychological effects, and barriers to using online groups were identified. The
few studies that were found in the literature suffered from a lack of experimental design,
small and homogenous samples, and lack of outcome measures, thereby limiting
applicability of results.
Maximizing a Transport Platform Through Computer Technology
HUDSON, TIMOTHY L. MSA, MEd, RN
Abstract
One of the most recent innovations coalescing computer technology and medical care is
the further development of integrated medical component technology coupled with a
computer subsystem. One such example is the self-contained patient transport system
known as the Life Support for Trauma and Transport (LSTAT(tm)). The LSTAT creates
a new transport platform that integrates the most current medical monitoring and
therapeutic capabilities with computer processing capacity, creating the first “smart
litter.” The LSTAT is built around a computer system that is network capable and acts as
the data hub for multiple medical devices and utilities, including data, power, and oxygen
systems. The system logs patient and device data in a simultaneous, time-synchronized,
continuous format, allowing electronic transmission, storage, and electronic
documentation. The third-generation LSTAT includes an oxygen system, ventilator,
clinical point-of-care blood analyzer, suction, defibrillator, infusion pump, and
physiologic monitor, as well as on-board power and oxygen systems. The developers of
LSTAT and other developers have the ability to further expand integrative component
technology by developing and integrating clinical decision support systems.
BIOTERRORISM SIMULATOR
[CINPlus: Software Reviews] Volume 21(1), January/February 2003, p 55
Dorman, Todd MD, Reviewer
BIOTERRORISM SIMULATOR Anesoft Corporation 18606 NW Cervinia Court
Issaquah, Washington 98027 Telephone: 877-287-0188 E-mail: [email protected] Web:
http://www.anesoft.com Price: $89 (single), $449 (network), $1399 (departmental
license)
Since September 11, 2001 it is obvious to every clinician that not only has the world
changed but that most clinicians are ill prepared to triage, diagnose, and treat the
conditions related to biological and chemical terrorism. Few medical, nursing, or
ancillary health schools provide sufficient education in biological and chemical agents
and only recently have training programs and continuing medical education courses
begun to include pertinent information. Anesoft Corporation, through the release of
Bioterrorism Simulator, attempts to fill that void
Reporting Medication Errors Through Computerized Medication Administration
LOW, DEBRA K. MS, RN; BELCHER, JAN V. R. PhD, RN, Volume 20(5),
September/October 2002, pp 178-183
Abstract
The incidence of medication errors has risen dramatically during the last decade to an
alarming number. Nurses report only 5% of significant errors, those considered life
threatening. 1 Little research has been done related to medication errors at the
administration stage or reporting methods. The purpose of this study was to compare
medication error rate per 1,000 doses administered before and after the implementation of
a bar code medication administration system. The study was conducted on two medical–
surgical units at a midwest government hospital 12 months both before and after the
implementation of the Bar Code Medication Administration system. The medication error
rate per 1,000 doses administered by a nurse after implementation of the Bar Code
Medication Administration system showed an 18% increase. The results probably do not
indicate an increase in medication errors but rather an increase in the number of
medication errors reported.
Older Adults Living Through and With Their Computers
CLARK, DEBORAH J. MSN, MBA, RN, CIN, Volume 20(3), May/June 2002, pp 117124
Abstract
Using computers and the Internet to alleviate or reduce loneliness and social isolation and
using online methods of data collection in the forms of online surveys and chat room
interviews are in their infancy and require a descriptive qualitative study of the
experiences of older adults who are online. The purpose of this pilot study was twofold:
(1) to describe the experiences of completing an online questionnaire and participating in
an online interview and (2) to determine if the methodology of collecting interview data
in a chat room setting can yield thick rich qualitative data to support future qualitative
investigations into the Internet’s potential use as a deterrent to social and emotional
isolation.
Accelerating U.S. EHR Adoption: How to Get There From Here. Recommendations
Based on the 2004 ACMI Retreat
Blackford Middleton, MD, MPH, MSc, W. Ed Hammond, PhD, Patricia F. Brennan,
DNSc, RN, and Gregory F. Cooper, MD, PhD, Am Med Inform Assoc. 2005 Jan–Feb;
12(1): 13–19. doi: 10.1197/jamia.M1669.
Copyright © 2005, American Medical Informatics Association
Abstract:
Despite growing support for the adoption of electronic health records (EHR) to improve
U.S. healthcare delivery, EHR adoption in the United States is slow to date due to a
fundamental failure of the healthcare information technology marketplace. Reasons for
the slow adoption of healthcare information technology include a misalignment of
incentives, limited purchasing power among providers, variability in the viability of EHR
products and companies, and limited demonstrated value of EHRs in practice. At the
2004 American College of Medical Informatics (ACMI) Retreat, attendees discussed the
current state of EHR adoption in this country and identified steps that could be taken to
stimulate adoption. In this paper, based upon the ACMI retreat, and building upon the
experiences of the authors developing EHR in academic and commercial settings we
identify a set of recommendations to stimulate adoption of EHR, including financial
incentives, promotion of EHR standards, enabling policy, and educational, marketing,
and supporting activities for both the provider community and healthcare consumers.
An Evaluation of the Current State of Genomic Data Privacy Protection Technology and
a Roadmap for the Future, Bradley A. Malin, MS, MPhil, J Am Med Inform Assoc. 2005
Jan–Feb; 12(1): 28–34. doi: 10.1197/jamia.M1603.
Copyright © 2005, American Medical Informatics Association
Abstract
The incorporation of genomic data into personal medical records poses many challenges
to patient privacy. In response, various systems for preserving patient privacy in shared
genomic data have been developed and deployed. Although these systems de-identify the
data by removing explicit identifiers (e.g., name, address, or Social Security number) and
incorporate sound security design principles, they suffer from a lack of formal modeling
of inferences learnable from shared data. This report evaluates the extent to which current
protection systems are capable of withstanding a range of re-identification methods,
including genotype–phenotype inferences, location–visit patterns, family structures, and
dictionary attacks. For a comparative re-identification analysis, the systems are mapped
to a common formalism. Although there is variation in susceptibility, each system is
deficient in its protection capacity. The author discovers patterns of protection failure and
discusses several of the reasons why these systems are susceptible. The analyses and
discussion within provide guideposts for the development of next-generation protection
methods amenable to formal proofs.
http://www.benton.org/publibrary/health/six.htm
This report discusses the synergy between information technologies and new trends in the
health care delivery system as health care is brought online. It identifies some of the
opportunities to improve health care delivery through increased use of information
technology, and discusses some of the conceptual, organizational, and technical barriers
that have made technology’s adoption so uneven.The report identifies key technologies
and shows how they are being used to communicate clinical information, simplify
administration of health care delivery, assess the quality of health care, inform the
decisionmaking of providers and administrators, and support delivery of health care at a
distance (telemedicine
http://www.staterhio.org/documents/Final_Report_HHSP23320064105EC_090106_000.
pdf
Development of State Level Information Initiatives
http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5554&mode=2&holderDispla
yURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/communities/k_o/kno
wledge_library/key_topics/health_briefing_04052006112504/health_information_exchan
ge_policy_issues.html
Health Information Exchange Policy Issues
http://ehr.medigent.com/assets/collaborate/2005/04/14/April12MedStar%20final.pdf
Do you think you could relook at the paper to remove much of the explanation of
modalities-it is very comprehensive but we can't educate them all on ekgs etc. Have you
thought about putting anything in about EBT testing for calcium and plaque? Do you
have
data that is more current than 2003 from AHA? I believe the trends are that card cath as
a diagnostic modality will decrease as we have better scans like 64 slice CT and EBTsgood news less invasive-are there any stats about this? I also think the trend for open
heart is projected to go down too?On page 4 any info on the trend that with malpractice
radiologists are getting out of interventional work and most of the stenting is being done
by interventional cardiologists. Anything about gene therapy in diagnosis as well as the
drugs and nutrition aspects? Any policy implications about organ donations going from
state to national shared networks?