New Leader at Vocollect Healthcare

Pittsburgh-based Vocollect Inc. has named Jim Rock as president of its Vocollect Healthcare Systems unit, which sells the AccuNurse voice-based communication system for nurses and other caregivers.

SPOTLIGHT: Nursing inefficiencies

Nurses have long suspected that they spend far too much time shuffling paper and chasing down equipment rather than caring for patients, and now there's some data to back them up. A new survey from Jackson Healthcare in Alpharetta, Ga., finds that hospital-based nurses across the country can devote as much as 25 percent of their time filling out forms, documenting patient encounters in multiple locations and hunting down supplies and medical devices. Many of the more than 2,400 nurses and nursing managers surveyed recommended solving this problem with additional staff support, elimination of redundant regulatory requirements and, yes, hospital-wide communications technology. It will be interesting to see if the federal HIT stimulus changes these conditions. Summary

Meaningful use for nursing. Six themes regarding the definition for meaningful use.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 12-30-2009 at 04:26 AM
Read more [Nursing Informatics News]

Narrowing PubMed searches to nursing-related articles.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 12-18-2009 at 04:09 AM
Read more [Nursing Informatics News]

The new fundamentals in nursing: introducing beginning quality and safety education for nurses' comp

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 02-24-2010 at 04:10 AM
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[Promoting nursing competitiveness: introduction to the digital divide.]

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 02-04-2010 at 04:08 AM
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The Alliance for Nursing Informatics: A History.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 02-26-2010 at 04:16 AM
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Manager of Nursing Informatics - iMethods - Jacksonville, FL

Forum: Recruiter Posted Informatics Jobs Posted By: cgambino Post Time: 01-21-2010 at 03:32 PM
Read more [Nursing Informatics News]

On the horizon: dialogues for the nursing academy.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-27-2010 at 04:24 AM
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[Standardized nursing language: the bedrock of computerized nursing records]

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-13-2010 at 04:18 AM
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Collaborating to optimize nursing students' agency information technology use.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-29-2010 at 04:45 AM
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A state profile of IT sophistication in nursing homes.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-09-2010 at 04:35 AM
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Korean nurses' experiences: the Influence of NNN (NANDA-I, NIC, NOC) terminologies on nursing workfl

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-09-2010 at 04:35 AM
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Identifying logical clinical context clusters in nursing orders for the purpose of information retri

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-09-2010 at 04:35 AM
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Representing nursing assessment documentation with ICNP.

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 01-09-2010 at 04:35 AM
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26 ways to grow your healthcare IT business

ExecutiveBiz.com has nice post this week on 26 ways to grow your healthcare IT business. There are some good ideas in the posting and are summarized here.

1. Recognize healthcare IT as more than an IT opportunity.
2. Maintain specific focus on each and every customer.
3. Help your team see the larger picture.
4. Speak the language of your customers.
5. Participate in the standards-setting conversation.
6. Broaden your vision of potential health IT partners.
7. Keep in mind that web based-information technologies are the future.
8. Develop domain expertise capability.
9. Proactively bring innovation to the table.
10. View yourself as long-term partner.
11. Demonstrate a multidisciplinary approach to technology.
12. Embrace open source as the wave of the future.
13. Wear two hats — as a taxpayer and investment collaborator.
14. Put yourself in the beneficiary’s shoes.
15. Keep in mind medical records aren’t the only game in town.
16. Healthcare IT isn’t just about the providers.
17. Get to know the big players.
18. Offer a combination of technologies.
19. Leverage commercial best practices.
20. Focus on cybersecurity.
21. Look to other industries.
22. Draw on expertise from commercial and global markets.
23. Look beyond hardware or software affiliations.
24. Get the sociology right.
25. Remember the end goal.
26. Stay actively involved.

There’s not a whole lot of detail on each item at the ExecutiveBiz post but it is worth reading if you’re in the healthcare IT business.

1.) Recognize healthcare IT as more than an IT opportunity.
Innovation doesn’t begin at a keyboard; it begins from a clinic floor. For contractors, that means garnering feedback from physicians, nurses, informaticists, and other key players who know the ins and outs of business processes and workflow.

2.) Maintain specific focus on each and every customer.
No two customers are the same. So, it’s essential to think beyond one-size-fits-all solutions. They don’t exist. Every case requires coming up with solutions that mesh with a particular customer’s business processes.

3.) Help your team see the larger picture.
That’s especially true for your software development team. Many may be fresh out of college. Or a few years out. Remind them that what they do could impact their grandparents and parents, and eventually, them.

4.) Speak the language of your customers.
Speaking that language requires you go beyond discussion of IT technology implementation to put yourself in your client’s environment. Gaining that familiarity also requires you bring clinicians to the table.

5.) Participate in the standards-setting conversation.
A lot of states have put together workshops to help determine how they’ll spend government healthcare IT funds as it comes down the pike. Get involved in standards committees and workshops; they’re a great forum to get your ideas heard.

6.) Broaden your vision of potential health IT partners.
Healthcare IT is presenting partnership opportunities that companies might not otherwise have considered. So, broadening your vision of potential healthcare IT partners will be key.

7.) Keep in mind that web based-information technologies are the future.
Top tools include personal health records, patient portals, and electronic medical records. They’re all the wave of the future.

8.) Develop domain expertise capability.
All the technology expertise in the world won’t mean much unless it’s accompanied by domain expertise. That’s especially true when dealing with the VA, DoD, and other federal agencies.

9.) Proactively bring innovation to the table.
It’s easy to loosen the reins and ask government customers, “What would you look me to do?” But what they really want is innovation. That requires you looking over the horizon and pointing customers to where you think healthcare is headed next. Don’t just respond to the Federal Register. Make it a point to proactively bring ideas and technologies to the table.

10.) View yourself as long-term partner.
Beyond the immediate need, think of yourself as a long-term partner. Bid on those opportunities. Because, if you’re going to deploy resources and systems, you’ll want to be there for the long run.

11.) Demonstrate a multidisciplinary approach to technology.
When it comes to deploying information technology, having a multidisciplinary approach is essential. Are your current investment initiatives adequately addressing that need?

12.) Embrace open source as the wave of the future.
The proprietary nature of systems is becoming increasingly obsolete. Which means your customers are embracing open source at a rapid rate, and so should you.

13.) Wear two hats — as a taxpayer and investment collaborator.
The complex nature of healthcare requires viewing it from various vantage points. As a taxpayer, on the one hand; and an investment collaborator, on the other.

14.) Put yourself in the beneficiary’s shoes.
Whether the beneficiary is a military health personnel, veteran, or child support recipient, it’s critical to envision what can help meet a customer’s mission objectives.

15.) Keep in mind medical records aren’t the only game in town.
Contractors will play an increasing role in data analytics. It’s of importance to the Centers for Medicare and Medicaid Services, for instance, which needs all the help it can get leveraging solutions to help detect instances of fraud, waste, and abuse in reimbursement programs.

16.) Healthcare IT isn’t just about the providers.
The public is getting more sophisticated about managing their own health. With that comes a growing demand for tools that can help individuals better understand their particular set of health challenges and how to address them in between doctor visits.

17.) Get to know the big players.
If ever there was a time for small businesses to develop relationships with primes, this is it. Many big players have significant small business set-asides for healthcare IT.

18.) Offer a combination of technologies. It’s critical to bring the power of a combination of technologies — information management, services, and security — forward, in order to support customer mission and goals.

19.) Leverage commercial best practices. We’re likely to see a drive toward adoption of commercial best practices within both commercial and government spaces. There will also be more data sharing among government agencies whose missions are interconnected.

20.) Focus on cybersecurity. Whatever the outcome with healthcare reform legislation, it’s undeniable that security will play an important role in the implementation of healthcare reform as well as in current initiatives being undertaken by federal agencies.

21.) Look to other industries. Cybersecurity, cloud computing, and identity management — all critical to the healthcare IT conversation —are used in other industries, such as the financial community. Look to those industries for best practices.

22.) Draw on expertise from commercial and global markets. Just being a government healthcare contractor isn’t enough to stay competitive. Commercial, government, and global healthcare practices are all interrelated. Each has similar problems. Learn about them for crossover purposes.

23.) Look beyond hardware or software affiliations. System integrators will continue to play a critical role in bringing “best of market” solutions to government clients. Don’t let proposed solutions be determined first and foremost by hardware or software affiliations, however.

24.) Get the sociology right. In many ways, the technology aspect of healthcare IT is easy; much harder is the sociology of it. Which means that approaching an EHR or HIE project as a purely technology project will sow the “seeds of failure.”

25.) Remember the end goal. Remember the ultimate mission isn’t a technological solution; it’s to improve healthcare and lower costs. That’s the fundamental outcome that needs to emerge from electronic health records.

26.) Stay actively involved. It’s not enough to preside over a project. You have to stay actively involved in its implementation and in customer reaction. Also be sure to have on-the-ground intelligence. You need people you can trust to deliver good news and the bad.

Its Not About Meaningful Use

With the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version.  Now it is not to say these concerns are not justified, it just may be that they are misplaced for the vast majority of those who currently do not use an EHR, small physician practices and clinics.  It is within these small practices, which are really just small businesses, that the majority of patient care occurs and where possibly the biggest benefit may be derived in the use of EHRs. It is also here where we may find the highest adoption hurdles, and those adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR.

This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont.  There facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic.  Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on.  For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.

It is stories like this that concern me.

This is a clinic trying to do the right thing, trying to use an EHR in a meaningful way (note, did not say meaningful use) and they are struggling. Yes, they do want to deliver the best patient care, but at the end of the day, they, like any business have bills to pay.  They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice.  Maybe instead of guaranteeing that their application(s) will meet MU criteria, EHR vendors should guarantee that the productivity hit of using their solution will not exceed HITECH incentive payments.  Now that would be an interesting value proposition.

Thanks to Michael Jahn of Jahn & Associates for the MU cartoon.

Addendum:

This post was picked up by The Health Care Blog (THCB) and there is quite a lively discussion occurring in the comments area.

Survey shows nurses spend most of their time on paperwork

A new survey of hospital nurses found that they estimate spending one quarter of their 12-hour shift on indirect patient care, with paperwork taking up much of the rest of their time.

Video of Econo-Keys Washable Keyboard Demo at HIMSS 10

I must admit that the thing I probably wanted to see most on the HIMSS exhibit floor was these washable keyboards. I can’t tell you how many times my nurses have asked for a way to wash their keyboards. Plus, it didn’t hurt that I had a way to get a free washable keyboard for myself too.

You can check out the washable keyboards I found from Econo-keys at their website. They have some pretty creative products when it comes to keeping keyboards clean. I tried out the typing myself and didn’t have any problem adapting to the keyboard. I thought it might be a challenge, but it wasn’t. Ok, enough of my talk, check out this video showing off the product and then read to the bottom for the free giveaway:

This video coverage of HIMSS 10 sponsored by Practice Fusion and their Free EMR.

The best news of all is that I was able to convince the good people at Econo Keys to give me a couple extra free washable keyboards to give away on EMR and HIPAA. Yes, that’s right. Your very own free washable keyboard.

In order to enter to win, all you have to do is promote EMR and HIPAA in some way. Maybe you tweet a link, maybe you link to EMR and HIPAA from your blog. Maybe you link to it from an EMR group on LinkedIn. Maybe you’ll be more creative than I. Just let me know what you did to promote the site in the comments and I’ll choose a couple winners from there.

7 more videos from HIMSS on the way shortly.

Related posts:

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3. Video of Dock and Lock System at HIMSS I first came across these laptop carts when I first...

John Glaser, CIO of Partners Health Care, speaks with David Harlow about health IT and meaningful use in a $7.9 billion health system

What does a large health system CIO worry about if his system is already fully up to speed in the day-to-day use of EHRs?  Using them in ways that improve communication of information across a diverse group of clinicians, and that enable the integration of additional interesting and useful data as time goes on -- such as the integration of genetic testing data into the diagnostic and treatment logic built into the EHR.

John Glaser explains how Partners uses its EHR system to leverage knowledge for the benefit of patients, and describes some of the ways in which decision support systems are being used today and may be used in the future.  

Tools in place at Partners now:

[T]here is for example a monthly report put out on dozens and dozens of quality measures and they are coded red, yellow, green depending where we are relative to the national benchmarks and that . . . allows us to focus on areas that do need some attention.  In addition to that you can use the systems like CPOE or the EHR to introduce logic at the time of care, so to make sure that an order is a safe order or that an overdue health maintenance activity has been noted and followup is occurring.

...

[L]argely at this point focused on cancer . . . we do have decision support that says before you order this chemotherapeutic agent you should run this genetic test because that will tell you whether the agent will or will not be successful.  We do have a piece of software called the patient genome explorer which sits right beside the results viewer for chemistry results, and this allows you to look up genetic test results and understand the ramifications for the patient you are treating.

Glaser acknowledges the difficulties that may be faced by smaller provider organizations in gearing up to meet the meaningful use criteria related to EHR implementation, but notes that for him, there is no separate ROI calculation for implementation of these tools, saying

I mean, what’s the ROI of email? Beats me but, nonetheless, few of us could get through a day without it.  At other times the ROI is quite tangible because you could say golly, we are cutting real costs here or making real revenue.  At times the outcome is tangible - it may not always be expressible in terms of dollars.  You can, but that’s not the point. . . .  So I think we will see a return broadly speaking . . . .  I think at the end of the day it is one of those things which you say listen, this is a given.  It is hard to imagine that we would sit here today and say if ten years from now we ran our health care system on paper that would be okay or a good thing.

The Partners team has the luxury of being able to spend significant time on R&D, and Glaser says that

we do have some people who are looking at different techniques to be applied to putting a layer of logic on top of complex and idiosyncratic data coming in, and teasing out that sort of data. So, for example, if you know that there are, let’s say, 200 notes [in a patient's EHR, entered by a variety of clinicians] and that the patient is being seen by a cardiologist, you just have the system be able to identify that subset of notes that appear to have a bearing on the consultation in question and being able to categorize those notes for the doctor, so that he or she can say jeez, of the 200, there are five that are related to prior cardiac events, there are four that are related to what appear to be cardiac procedures . . . to help to filter through and surface that subset of note, or other data, which appears to be the most salient.  So we are learning.  We are trying a bunch of different techniques to figure out how to do that.

The audio file of my interview with John Glaser (about 25 minutes long) is available for download/podcast.  A full transcript is at the end of this post (and in the linked John Glaser, CIO, Partners Health Care, HealthBlawg interview transcript).

• Being John Glaser 11/10/09 (histalk2.com)

Medical Files, Pills Found In Abandoned St. Bernard Nursing Home

Maya Rodriguez reports from Louisiana on how confidential medical files were found inside the Huntington Place Senior Community. The building had been flooded during Hurricane Katrina and subsequently abandoned: When Nicholas and his friend, Christian, went into the building to get the dog out, they stumbled upon several filing cabinets, filled with medical records of [...]
Read more [Personal Health Information Privacy]

Gastroenterology

Hi,

Ok, so my first week on my medicine rotation, which is based around the GI system (top to bottom, including associated organs such as liver, pancreas etc.) and I get back to the 'proper' hands on medicine. Nurses, endoscopies, cardiac perfusion scans, X-ray meetings, hepatitis, a patient who has severe intestinal bleeding, seemingly from switching to a purely raw food diet (not healthy), 'on take' and ERCPs topped off with an upsetting surprise finding that a patient only had around 3 months to live because of a tumour found instead of gallstones. While sad in places, this is more like it. Much more proactive and time is spend 'doing things' instead of sitting around waiting for the next patient.

Lets get started on my week. To start off out medicine experience we were meant to be with the nurses for a little to 'warm up' at the start the rotation. With shifts starting at 7AM this was no mean feat, I was not used to getting up early after psych where the ward rounds started much later to give the patients time to 'get going'. While far too early for me (most definitely not a morning person) it was nice to fraternize with the nurses for a bit. Helping them give medication to the patients and get them out of bed lead to just chatting with the patients as the nurses got on with their general day to day activities. What a lovely way to start the week! I got to hear some wonderful stories from someone who grew up in Australia on a station (a ranch) and how his life lead him to the UK. While this was strictly not a nursing activity, I persuaded myself it was for the good of the patients, to prevent boredom, so continued at my leisure. I think the nurses were happy to have me out of their hair anyway. While the nurses there were more than lovely, there is sometimes a bit of disagreeability between the doctor and nursing professions. Some doctors seem to have a very patronising attitude towards nurses, and see their role as menial, and the nurses obviously do not appreciate this. Some nurses see doctors as stuck up, too big for their boots (which some are, in my opinion) and overpaid. Usually these feelings seem well under the surface though, and don't seem to affect patient care, though we have overheard one nurse telling patients that they would be 'stupid to consent to having a medical student sit in' as it was a waste of their time and we were only nosy. If we qualified as doctors without seeing any patients we would be a danger to society! We have to start somewhere.

Some time spent in the hepatitis clinic with a doctor was a real eye opener. In the morning, despite having solid appointments from 8.30 'til 12 there was only one patient before 10.30. An elderly gentleman who had contracted hepatitis from a blood transfusion some time ago, but had only found out recently. The clinic was for follow up for those who had just been diagnosed with hepatitis to see if they wanted treatment, or if their body was clearing the infection (there is a chance the body can clear the infection, depending on the strain). The only people attending the clinic were people who had the B or C strain as the other strains (A,E,G) do not lead to permanent infection. Many of those in the community who are catching hepatitis are IV drug users and in the morning they need to pick up their methadone, so will not turn up for appointments. Perhaps a different plan needs to be made for when to carry out the clinic. After 10.30 plenty of patients were showing up. Many of them apparently homeless from their unwashed state and ruined clothing, but polite and kind none the less. Drug users get a bad press, which is perhaps fair enough as it is a large cause of crime, but I think judging people in this situation is exceptionally unfair. Many of them have had horrific childhoods including problems such as abuse, and how can you look down on someone for turning to drugs in that situation when you have not been in it yourself. One of the most interesting patients who turned up to the clinic had turned up with his wife, but on reading the covering letter with which he was referred (before the consultation, to find out a little before it started) we found out that the patient had not told his wife how he had caught hepatitis C. The truth was that he had relapsed into using heroin after about 10 years abstinence due to stresses at work, and had been using since. He had told his wife that he had caught it while nursing his father, who was currently suffering from end stage liver cirrhosis due to too much alcohol. At least the patient got the right organ to lie about.

[Blog continued at A weekly blog from a 3rd year UK medical student ]
Read more [Medical Informatics Blog]

Gastroenterology

Hi,

Ok, so my first week on my medicine rotation, which is based around the GI system (top to bottom, including associated organs such as liver, pancreas etc.) and I get back to the 'proper' hands on medicine. Nurses, endoscopies, cardiac perfusion scans, X-ray meetings, hepatitis, a patient who has severe intestinal bleeding, seemingly from switching to a purely raw food diet (not healthy), 'on take' and ERCPs topped off with an upsetting surprise finding that a patient only had around 3 months to live because of a tumour found instead of gallstones. While sad in places, this is more like it. Much more proactive and time is spend 'doing things' instead of sitting around waiting for the next patient.

Lets get started on my week. To start off out medicine experience we were meant to be with the nurses for a little to 'warm up' at the start the rotation. With shifts starting at 7AM this was no mean feat, I was not used to getting up early after psych where the ward rounds started much later to give the patients time to 'get going'. While far too early for me (most definitely not a morning person) it was nice to fraternize with the nurses for a bit. Helping them give medication to the patients and get them out of bed lead to just chatting with the patients as the nurses got on with their general day to day activities. What a lovely way to start the week! I got to hear some wonderful stories from someone who grew up in Australia on a station (a ranch) and how his life lead him to the UK. While this was strictly not a nursing activity, I persuaded myself it was for the good of the patients, to prevent boredom, so continued at my leisure. I think the nurses were happy to have me out of their hair anyway. While the nurses there were more than lovely, there is sometimes a bit of disagreeability between the doctor and nursing professions. Some doctors seem to have a very patronising attitude towards nurses, and see their role as menial, and the nurses obviously do not appreciate this. Some nurses see doctors as stuck up, too big for their boots (which some are, in my opinion) and overpaid. Usually these feelings seem well under the surface though, and don't seem to affect patient care, though we have overheard one nurse telling patients that they would be 'stupid to consent to having a medical student sit in' as it was a waste of their time and we were only nosy. If we qualified as doctors without seeing any patients we would be a danger to society! We have to start somewhere.

Some time spent in the hepatitis clinic with a doctor was a real eye opener. In the morning, despite having solid appointments from 8.30 'til 12 there was only one patient before 10.30. An elderly gentleman who had contracted hepatitis from a blood transfusion some time ago, but had only found out recently. The clinic was for follow up for those who had just been diagnosed with hepatitis to see if they wanted treatment, or if their body was clearing the infection (there is a chance the body can clear the infection, depending on the strain). The only people attending the clinic were people who had the B or C strain as the other strains (A,E,G) do not lead to permanent infection. Many of those in the community who are catching hepatitis are IV drug users and in the morning they need to pick up their methadone, so will not turn up for appointments. Perhaps a different plan needs to be made for when to carry out the clinic. After 10.30 plenty of patients were showing up. Many of them apparently homeless from their unwashed state and ruined clothing, but polite and kind none the less. Drug users get a bad press, which is perhaps fair enough as it is a large cause of crime, but I think judging people in this situation is exceptionally unfair. Many of them have had horrific childhoods including problems such as abuse, and how can you look down on someone for turning to drugs in that situation when you have not been in it yourself. One of the most interesting patients who turned up to the clinic had turned up with his wife, but on reading the covering letter with which he was referred (before the consultation, to find out a little before it started) we found out that the patient had not told his wife how he had caught hepatitis C. The truth was that he had relapsed into using heroin after about 10 years abstinence due to stresses at work, and had been using since. He had told his wife that he had caught it while nursing his father, who was currently suffering from end stage liver cirrhosis due to too much alcohol. At least the patient got the right organ to lie about.

[Blog continued at A weekly blog from a 3rd year UK medical student ]
Read more [Medical Informatics Blog]

PEPID Clinical Assistant Now for Android Powered Devices

PEPID, one of the big names in clinical information for mobile devices, is gearing up to release an Android version of its popular software suite. To that end, PEPID is signing up doctors and nurses that are Android users to become beta testers of the new app. We somehow think that our readers are just a perfect audience to do the beta thing. From the announcement: We need your help to test the latest version of our software, designed specifically for the Android scheduled to be released in March. You don't need a current subscription to PEPID to become one of our beta testers, just a current mobile data plan so you can download the product and use certain modules and features. PEPID contains the most extensive drug database on the market today, along with thousands of disease profiles and medical conditions, medical and dosing calculators, a drug interactions checker, illustrations, laboratory values, and a differential diagnosis generator, all of which are available on the Google Android PEPID beta application. Link: PEPID Android Medical Software Beta Test... Press release: PEPID® RELEASES BETA APPLICATION FOR THE GOOGLE ANDROID PHONE ... Flashbacks: PEPID Is Embracing iPhone Platform ; PEPID Expands Support to The Palm Pre... Michael
Read more [Medgadget]

Commission on the Future of Nursing and Midwifery calls for the development and use of new technologies.

The report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England sets out the way forward for the future of the professions which was published yesterday, calls for the establishment of a "high-level group to determine how to build nursing and midwifery capacity to understand and influence the development and use of new technologies. It must consider how pre- and Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0
Read more [Informaticopia]

Better Health Coverage of HIMSS Starts Today

HIMSS10, one of the world's premier conferences on medical information and technology management, begins today in Atlanta, Georgia. Better Health, a community of medbloggers we are proud to be a part of, will be providing extensive coverage of the event. Dr. Nick Genes of Medgadget, Dr. Val Jones, CEO of Better Health, and Dr. Mike Sevilla who writes at Dr. Anonymous will be taking interviews, checking out the latest gear, and giving access to the vendors and presenters at the conference. Here are the ways to keep an eye on HIMSS10: 1. Watch live interviews of exhibitors, conducted by physicians on UStream. Tune in to Dr. Val's UStream coverage (beginning at 9:30am each morning at HIMSS, March 1, 2, and 3rd). Click here: http://www.ustream.tv/channel/live-from-himss-what-s-hot-in-health-it 2. Participate in real time via Twitter. Follow @drval and tweet your questions to her during the interviews. She may ask the interviewees YOUR questions LIVE. To follow Dr. Val, go to: http://www.twitter.com/drval or follow the Twitter hashtag #HIMSS10 during the event to see tweets from UStream attendees and others. 3. Meet the bloggers at HIMSS. There will be a special panel discussion with Dr. Val and other popular health IT bloggers scheduled in the HIMSS Social Media Center. Check here for times: http://www.himssconference.org/education/socialmedia.aspx 4. Watch Dr. Val Reporting from HIMSS on ABC News (DC only): Tune in to News Channel 8 at 10:50am, Wednesday March 3rd to get Dr. Val's take on the hottest technology presented at HIMSS. Dr. Val will join ABC News' Dave Lucas via Skype. 5. Follow the Better Health blog team. Better Health contributors - nurses, doctors, and health writers - will offer feedback via their blogs on HIMSS events, speakers, and exhibitors. You'll see their blog posts on their individual blogs and also at Better Health. Flip cam clips of HIMSS events (captured by one of the Better Health MDs at HIMSS) will be featured as well. 6. Blog Talk Radio: HIMSS Wrap Up With Dr. Val and Dr. Anonymous. Tune in to the Dr. Anonymous show at 8pm ET, Wednesday, March 3rd to hear final impressions about the show. Call in to discuss the event with hosts, or join the chat room. Find the show here: www.blogtalkradio.com/doctoranonymous... Michael
Read more [Medgadget]

UK: Computer boffin on NHS Spine: Get out while you can

John Leyden reports: A leading computer scientist has sounded a warning over an NHS data collection plan, urging patients to opt out. The Summary Care Record (SCR) scheme will make outlines of medical records available to hundreds of thousands of NHS staff in England. The idea is to provide doctors and nurses in England with easier access [...]
Read more [Personal Health Information Privacy]

EMR Deployment as One of the Catalysts for a Hospital-Physician Feud

The relationship between hospital executives and the physicians admitting patients to community hospitals has been undergoing significant changes lately. The deployment of an EMR in a hospital, particularly one not appealing to physicians, is one such change than can flare into outright warfare. Below is an excerpt from an article discussing such a scenario (see: from HIStalk):

Re: articles in Racine, WI paper about All Saints. Doctors are not happy with administration and a number may leave.” Doctors and administrators are feuding, with a third of the medical staff ready to bolt. The final straw, apparently, was the hospital’s contracting with a Florida anesthesia company, replacing a local group after failing to reach an agreement about pay, on-call policies, and the use of nurse anesthetists. Also noted as a key issue: the 2009 introduction of an EMR system, which the doctors complain wasn’t well supported.

The hospital business model that has dominated the landscape, at least throughout the last half of the previous century, is now undergoing substantial change. One highly significant shift for community physicians has been the trend toward hiring hospitalists to manage hospital inpatients. I am not sure how the majority of community physicians view this change. Some may, in fact, favor it and feel more comfortable managing their office-based ambulatory care practices. What is certain, however, is that many of the office-based physicians have now lost the knack of performing a number of common hospital procedures such as lumbar punctures. One subset of hospitalists, the proceduralists, are assuming responsibility for "procedures" in some hositals.

A second shift in the hospital business model has been the outsourcing of some specialty physician services, notably anesthesiology, referenced above in the excerpt, and radiology. This latter change has been well documented in Lab Soft News with multiple references to nighthawk radiology, a variant of teleradiology. A third irritant is the deployment of an EMR, particularly a system that may provide inadequate functionality and/or be difficult to maintain, resulting in unplanned service disruptions. EMR deployments, even of robust systems, can serve as catalyst for physician revolts, particularly in settings where previous grievances are in play. Readers who follow news relating to healthcare IT will recognize that pressures to deploy EMRs in hospitals are mounting as a key element of healthcare reform, so they may be deployed even in the face of simmering physician opposition.

Martin's Point Wins Nursing I.T. Award

Martin's Point Health Care, Portland, Me., is the winner of the fifth annual Nursing Information Technology Innovation Award. Health Data Management sponsors the award with CARING, the nation's largest educational and networking group for nurses interested in health care information technology.

Better Health to Cover HIMSS10, The Largest Health IT Conference

HIMSS10, one of the world's premier conferences on medical information and technology management, will be going on next week in Atlanta, Georgia. Better Health, a community of medbloggers we are proud to be a part of, will be providing extensive coverage of the event. Dr. Nick Genes of Medgadget, Dr. Val Jones, CEO of Better Health, and Dr. Mike Sevilla who writes at Dr. Anonymous will be taking interviews, checking out the latest gear, and giving access to the vendors and presenters at the conference. Here are the ways to keep an eye on HIMSS10: 1. Watch live interviews of exhibitors, conducted by physicians on UStream. Tune in to Dr. Val's UStream coverage (beginning at 9:30am each morning at HIMSS, March 1, 2, and 3rd). Click here: http://www.ustream.tv/channel/live-from-himss-what-s-hot-in-health-it 2. Participate in real time via Twitter. Follow @drval and tweet your questions to her during the interviews. She may ask the interviewees YOUR questions LIVE. To follow Dr. Val, go to: http://www.twitter.com/drval or follow the Twitter hashtag #HIMSS10 during the event to see tweets from UStream attendees and others. 3. Meet the bloggers at HIMSS. There will be a special panel discussion with Dr. Val and other popular health IT bloggers scheduled in the HIMSS Social Media Center. Check here for times: http://www.himssconference.org/education/socialmedia.aspx 4. Watch Dr. Val Reporting from HIMSS on ABC News (DC only): Tune in to News Channel 8 at 10:50am, Wednesday March 3rd to get Dr. Val's take on the hottest technology presented at HIMSS. Dr. Val will join ABC News' Dave Lucas via Skype. 5. Follow the Better Health blog team. Better Health contributors - nurses, doctors, and health writers - will offer feedback via their blogs on HIMSS events, speakers, and exhibitors. You'll see their blog posts on their individual blogs and also at Better Health. Flip cam clips of HIMSS events (captured by one of the Better Health MDs at HIMSS) will be featured as well. 6. Blog Talk Radio: HIMSS Wrap Up With Dr. Val and Dr. Anonymous. Tune in to the Dr. Anonymous show at 8pm ET, Wednesday, March 3rd to hear final impressions about the show. Call in to discuss the event with hosts, or join the chat room. Find the show here: www.blogtalkradio.com/doctoranonymous... Michael
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Why Do Hospital CIOs Have Trouble Keeping Their Jobs?

A recent joke posted by Mr. HIStalk calls attention to the relatively short job tenure of some hospital CIOs (see: HIStalk). It has a kind of "gallows humor" flavor but read on and you will get the idea.

A fired CIO’s replacement finds a note from his predecessor, saying he left three envelopes in the desk drawer to be opened only when things are going really badly. Six months later, the network goes down for most of a day, so the CIO opens up the first envelope and finds a note that says, “Blame the previous CIO.” Great idea! He makes up a convincing story about a historic lack of maintenance and capacity planning, saving his skin. Months later, the executive team complains about excessive IT operational and capital budgets, threatening to freeze expenses. Time to open another envelope. This one says, "Blame your coworkers." He does, arguing that the unchecked technology demands of his executive peers have made him the victim. Months later, doctors are pushing back against mandatory CPOE, saying that it’s typical CIO arrogance that makes him think he understands the challenges physicians face. He opens the third envelope, which says, “Prepare three envelopes.”

This "three envelopes" gag does not explain in detail why hospitals CIOs tend to draw fire at the same time that some of their relatively incompetent C-suite colleagues may stay out of the limelight and retain their positions. Here's my best shot at a list of some of the factors working against hospital CIOs. You may wish to add others or disagree:

• Mistakes by hospital CIOs, particularly when installing an EMR, tends to be obvious and greatly affect the productivity of key personnel such as nurses and physicians. They then tend to complain loudly when their routines are disrupted and they encounter what they perceive as bureaucratic miscalculations. Major decisions by the CFO, by way of contrast, affect such personnel only rarely.
• Many of the electronic record (EMR) products available in the market lack adequate functionality and can be difficult to install and maintain. If such a product is chosen by the CIO and cannot be installed or suffers from periodic and extended "downs" for maintenance, a scapegoat must be sought by other hospital execs who are eager to retain their own jobs. Guess what name tends to pop out of the deck?
• Hospital nurses and physicians would often rather modify new clinical software such as an EMR to support their preexisting work flow and processes rather than adapt to new routines dictated by the new system. The CIO and his/her staff then come under intense pressure to modify any new system. If he or she succumbs to this pressure and customizes the new system extensively, it then becomes a management nightmare. Some EMR vendors such as Epic prohibit such tampering for this reason, thus providing many CIOs a handy excuse to run the system as delivered (see:The Secret to Epic's Success in the Hospital EMR Market).
• CIOs tend to favor the EMRs and other software products of large vendors rather than confront the risk of purchasing products from smaller and sometimes unproved companies. The large companies understand this all too well and may spend more on marketing than upgrading their systems that may lack the necessary functionality to satisfy the end-users of the system in the long run. Older readers may remember the now irrelevant axiom of decades ago: you never get fired for choosing IBM.
• The goal of hospital departmental chairmen (e.g., pathology, radiology, cardiology) is to maximize the functionality and revenue of their own departments. This often results in their selecting best-of-breed LISs, RISs, and CISs. This process may dump into the lap of the CIO "one of every system" to maintain that then require a large and continuously growing central IT personnel budget. The CEO and CFO respond by cutting IT personnel and service begins to further deteriorate.  CIO then begins to stand for "career is over."

Cool, Low Pressure Plasma Disinfects Hands Perfectly, Safely

The New York Times recently ran an article discussing the latest research and development in room temperature plasma devices for hand and instrument sterilization. Because the technology essentially kills any living microorganism the plasma gets to, we may be seeing completely new devices appearing soon near hospital sinks, in nurses stations, and, maybe, even in your favorite restaurant. A snippet from NYT: Gregor Morfill, who created several prototypes using the technology at the Max Planck Institute for Extraterrestrial Physics in Garching, Germany, says the plasma quickly inactivates not only bacteria but also viruses and fungi. Dr. Morfill and his colleagues have tested their devices on hands and feet. “It works on athlete’s foot,” he said. “And the nice thing is, you don’t have to take your socks off. They are disinfected, too.” (The cleaning takes a bit longer when socks are added to the job, he said — about 25 seconds. “And it doesn’t yet work through shoes,” he added.) Plasmas engineered to zap microorganisms aren’t new. During the last decade, they have come into use to sterilize some medical instruments. But using them on human tissue is another matter, said Mark Kushner, director of the Michigan Institute for Plasma Science and Engineering and a professor at the University of Michigan in Ann Arbor. “Many thousands of volts drive the generation of plasma,” he said, “and normally one doesn’t want to touch thousands of volts.” But the design of the new hand sanitizers, he said, protects people from doing so. Reassured by that design, about five years ago he put his naked thumb into a jet of microbe-destroying plasma at the lab of another plasma researcher. Read on at New York Times: Hospital-Clean Hands, Without All the Scrubbing... Flashback: A Review of The Latest in Plasma Medicine... Michael
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An online nursing leadership literature centre at the University of Manitoba Health Sciences Librari

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 12-16-2009 at 07:16 AM
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Guest Article: Human Centering in Healthcare IT

I’ve been spending a lot of time on human-computer interactions in healthcare technology these days (both hardware and software). It’s a very hard problem to solve, especially with complex systems like EMRs. To help talk more about how to better design patient-centric healthcare technology, I’ve reached out to Steven Deal,  Vice President and systems engineer for Deal Corp, a Dayton-area engineering research firm that specializes in this kind of work.  Steven is also volunteer secretary for the Center for Innovation in Family and Community Health, a non-profit organization in the Dayton area so he knows about healthcare technology. Here’s what Steven had to say about human centering of healthcare IT:

One approach to reining in healthcare spending is the Patient Centered Medical Home (PCMH).  The PCMH model is intended to reinvigorate primary care by focusing on patient needs and desires.  Primary care reduces costs by systematizing healthcare delivery; it counters the piece parts (specialist-driven) approach that results in redundant, costly, and often unnecessary, procedures.

The PCMH delivery system is said to be patient centered, but just what does it mean to be “centered?”  Requirements for centering preferentially address the needs of one or more of a system’s stakeholders.  Alternately, a system could be centered on a particular enabling technology.  For example, personal computer systems were built around the enabling technology of microprocessors.  So if you are patient centered, you are first and foremost addressing the needs of patients.  This approach seems like a no-brainer, since healthcare, or more correctly medical care, is all about addressing patient needs?  What else would you center it on?

There are actually many options and a lot of them are being implemented today.  For example, healthcare could be centered on doctors, on payers, on medical schools, on hospitals, on the government healthcare systems (Medicare, Medicaid), on insurance companies, on research, on pharmaceuticals, or on information technology.  If you look closely at the principles of PCMH, it’s not too hard to see that it is really partially doctor centered and partially payer centered.  The tug-of-war that is the Washington healthcare-reform debate is really about which stakeholder will come out on top.

Another centering option is on the dyadic relationship between medical care providers, let’s call them doctors and understand that they actually include a broad spectrum of professionals, and patients.  Addressing a medical need is a collaborative activity between a doctor and a patient.  The doctor contributes domain expertise, capital resources, a record of treatment history, a diagnosis, an action plan, and information about the consequences of the candidate treatment options.  Patients contribute their genetic backgrounds, their lifestyle choices, their symptoms, the life context in which those symptoms arose, their treatment choices and preferences, and action plan execution.  For example, a doctor may recommend therapy; the patient has to make an appointment with the therapist, attend the sessions, follow the recommend exercise plan at home, and perhaps modify his behavior.  You might say, okay, both sides will execute, but it is not uncommon for the patient to drop the ball.  Think about all the people who hear, “You need to stop smoking,” or “You need to lose 30 pounds.”  As we all know, doctors sometimes drop the ball too.

Let’s call this dyadic centering, human centering.  Human centered design is a technique applied to the development of socio-technical systems.  In human centered design, stakeholder attributes are detailed in a Target Audience Document.  Cognitive task analyses are performed to understand the work that must be accomplished by users of the system.  Requirements are generated so that system functions and interfaces support decision making, planning, information retrieval, situation assessment, and other cognitive activities.  Screens are designed to direct attention to relevant data when they are needed.  Usable, useful and understandable systems are the result.

Dyad centering in medical care is not new.  The Planetree model of patient-centered care, which includes this concept, has been around since 1978.  Participatory medicine is another, emerging approach to cooperative healthcare.

Centering on the patient-doctor dyad has not yet materialized in the IT world.  That this is true is illustrated by a common marketing photograph used for communicating the advantages of electronic medical records.  In the photo, a doctor and a patient are shown from the back.  They are both intently pointing at a computer screen at the far end of the picture.  This image would be great if we were thinking about a two-player video game, but the work of the medical care dyad demands that the doctor and the patient look at one another.  The diagnosis depends upon looking at the patient.  The trust relationship between provider and patient is built upon eye contact.  The patient doesn’t want to see the top of the doctor’s head or a database screen.  In a human centering paradigm, medical care products will support the needs of the dyad.  Healthcare IT products need to enable the doctor to keep her eyes on the patient during the engagement.

Human centering on the dyad means that healthcare systems, which are sociotechnical systems because they incorporate people and technologies, must simultaneously address the needs of both the provider team and their patients.  Even if PCMH were really patient centered, the model would not adequately support medical care participants, because it would focus on only one half of the dyad.

Electronic medical records that eliminate the need for patients to repeatedly enter the same information on paper forms address the patient’s needs, but they don’t necessarily reduce the overload experienced by physicians and their staff.  Poorly designed EMRs may actually increase physician workload.

Doctors would benefit from a tool that addresses the “Oh, by the way,” problem.  This is the laundry list of stored-up ailments and concerns that patients tend to share as the engagement is concluding.  Such a tool might afford patients the opportunity to list their concerns before they get in the exam room.  It would help them to understand the amount of physician time required to address each issue.  It would help patients to schedule a series of appointments as opposed to trying to cram an hour’s worth of care into a 15-minute visit.  This tool would benefit doctors by alleviating overload — perhaps it would allow them to get lunch and take humane bathroom breaks.  It would help to keep the practice on schedule, and thus eliminate the time patients spend in the waiting room.  The practice and patients both benefit, but identifying the need for such a tool requires a perspective that systematically investigates both sides of the dyad individually and the dyad as a whole.

My experience in attending the Family Medicine Educator’s Association (FMEA) Northeast Region Meeting this past December provided two illustrations of failures to employ human centering.  When discussing Electronic Health Records (EHRs), a session moderator said, “What we really need are online user groups for each of the EHR products, so we can share the workarounds we’ve developed.”  I pointed out that there shouldn’t be workarounds.  The products should be designed to support their work and be understandable, useful and usable.  The discussion then moved on to certification.

Another doctor reported that their organization achieved certification that few before had achieved by modifying their processes to match what the EHR required them to do.  Once they did that, approval was easy.  Now, if modification of medical practice is the conscious intent of an EHR product, then that might be a good thing.  But I’m not sure I want an IT product developer to dictate the procedures my doctor is going to follow.  It’s not that developers aren’t good at what they do; it’s just that they don’t necessarily know the medical care work domain.  The point is medical care providers are becoming trapped by the IT products that are designed to improve healthcare quality.  Soon they, and we, their patients, will be at the mercy of these products.

I recently listened to a human factors engineer describe the redesign of the infusion pump display.  Infusion pumps are the boxy machines that are mounted on wheeled stands that are placed at bedsides.  They regulate the intravenous fluids that are administered to hospital patients.  The redesign was a marked improvement for doctors and nurses; the new display made it easy for them to determine the infusion history – when the bag was changed, when the flow rate was changed, when maintenance was last performed, etc.

While I was listening, I kept thinking back to the hours I spent sitting with my mother-in-law, my mother or my father while they were in the hospital.  Invariably, the infusion pump alarm would begin to beep.  Nurses would be too busy with other patients to shut it off, so the beeping would go on and on.  The longer the alarm continued, the more anxious I became.  I wanted to do something, to understand if this meant my mother was getting too little or too much medicine or if there was nothing to worry about.

As I’m listening to the presentation about the infusion pump display redesign, I’m thinking, ‘Well, none of that would’ve helped me when I was sitting there.  And come to think of it, I was spending more time with that pump than any nurse or doctor ever would.  Why didn’t that interface tell me whether or not this was an urgent situation or even provide some instructions on what to do?  After all, an Automated External Defibrillator (AED) can walk me through the steps of resuscitating a heart attack victim, why can’t the infusion pump do at least as much?’

That led me to think about the vital signs monitors.  Even though I copy readings into my caregiver notebook at regular intervals when I’m sitting with my family members, I don’t know what those readings mean.  I just record them and read them back when, on rare occasions, a doctor asks about the history of a particular read out.  Since I’m spending so much time looking at them, wondering what they might be telling me about my dad’s condition, it would be nice if that screen imparted information to me rather than just data for the doctors.

One of the doctors at the FMEA meeting asserted that there was no money to be made in electronic medical or health records.  As soon as one product came out with a popular feature, other manufacturers would copy it, and then they’d all have it.  Well, I know from my friend Dennis Carlson, who used to design pit stop support systems for NASCAR, that it isn’t just the technical feature; it’s the orchestration of the work that can make a differentiating performance difference.

The doctor’s comment and the comments I described earlier make me wonder if physicians are discerning enough to appreciate the difference between an approach that will add to their burden and one that will help lift it.  Many seem to flock to whatever is shiny and new only to subsequently find they’ve purchased a product that’s best suited to gathering dust on a shelf.  However, the size of their investment may influence them to field it anyway.  In my experience, doctors who are reluctant to implement electronic records might be won over by an implementation that allows them to keep their eyes on the patient and supports their self-defined work flow.

Patients will certainly appreciate IT solutions that effectively support the dyad.  They will appreciate them in the same way they appreciate iPhone apps that help them to navigate the details of their harried days.  I wouldn’t be surprised if healthcare payers, the government and private insurers, discover there is a benefit to their bottom line when the collaborative relationship that is a medical care engagement is integrally served by IT implementations.

David Harlow continues the value-based design conversation with Wayne Burton, MD and Cyndy Nayer of the Center for Health Value Innovation

Today we bring you Part II of my conversation with Wayne Burton and Cyndy Nayer of the Center for Health Innovation, where we get into some specific examples of successful programs.  The Center represents over 40 million lives, and brings together employers and providers to focus on a limited number of levers targeted at health and wellness - rather than health care.  The ROI of wellness efforts in the workplace is pegged at nearly 300% in a recent Health Affairs article by Karen Baicker et al. and accompanying Health Affairs blog post by Jaan Sidorov - one of my fellow "Health Wonks."  Clearly this is an area that demands our attention. 

The audio file of Part II of my interview with Wayne Burton and Cyndy Nayer (about 20 minutes long) is available for download/podcast.  A full transcript of Part II is at the end of this post (and in the linked Wayne Burton and Cyndy Naylor interview transcript Part II).

Part I of the interview was posted yesterday.

HealthBlawg :: David Harlow’s Health Care Law Blog

Ins and Outs

Public Share of Health Tab to Top 50%... [WSJ] Lancet retracts MMR doctor's paper... [Nature] Democrats Change Health-Care Tack ... [WSJ] The Anthrax Attacks Remain Unsolved... [WSJ] California Doctors Sue To Stop Unsupervised Nurse Anesthetists from Administering Anesthesia... [HealthLeaders Media] Internet use linked to depression... [Press Association] Brain scan allows unconscious patient to communicate... [Nature] Researchers identify regulator of human sperm cells... [UCSF] In-mouth hearing aid co AudioDent closes down... [Globes] MassDevice Q&A: Myomo CEO Steve Kelly... [MassDevice] Boston Scientific Settles Longstanding Patent Disputes With J&J... [Boston Scientific] Intuitive Surgical off the hook in erectile dysfunction lawsuit... [MassDevice] Medtronic Announces Two Late Breaking Clinical Trials Accepted for American College of Cardiology Meeting... [Medtronic] Taro gets FDA approval for biogeneric epilepsy drug ... [Globes] FDA Approves Xiaflex for Dupuytren's Contracture... [FDA] Endoscope co Medigus reports good pre-clinical study... [Globes] Wound care co Polyheal sees continued good trial results ... [Globes] Insulin Study Could Lead to New Dosage Devices... [NYT] Learning "CURVES": Bioethics Memory Aid Can Help Assess Patient Decision-Making Capacity in Medical Emergencies... [Johns Hopkins] Engineering a new way to study hepatitis C... [MIT] Why Your Eyes Are Better Than a Digital Camera... [HHMI] Parkinson disease: Another player in gene therapy for Parkinson disease... [Nature Reviews Neurology] Family history and the risk of gastric cancer... [British Journal of Cancer] Anesthetic approach stops pain without affecting motor function... [Children's Hospital Boston] Low Production of Serotonin in the Brainstem a Likely Cause for SIDS... [Children's Hospital Boston] Virus-Like Particle Vaccine Protects Monkeys from Chikungunya Virus... [NIH] The Miracle of Vitamin D: Sound Science, or Hype? [NYT] White House Proposes 9% Increase in Global-Health Funding ... [WSJ] Minimally Invasive Surgery Takes Toll on MDs, Poll Shows... [MedPageToday]... Michael
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How does social networking enhance the nursing narrative?

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 12-16-2009 at 07:16 AM
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EU Disturbs The Magnetic Force

When we're done here, I want you to sign THIS petition.  You'll see why momentarily. 

The European Union, perhaps the prototype for a world-government that some in our country seem to desire, is about to do radiology, and thus humanity, a disservice.  It seems that the folks over there in charge of such things issued a Phyical Agents (Electromagnetic Field) Directive in 2004, which was to take effect in 2008, but has now been postponed to 2012.  Feel free to read the entire Directive at your leisure, but here are some of the salient Whereases: 

(1) Under the Treaty (creating the European Union) the Council may, by means of directives, adopt minimum requirements for encouraging improvements, especially in the working environment, to guarantee a better level of protection of the health and safety of workers. Such directives are to avoid imposing administrative, financial and legal constraints in a way which would hold back the creation and development of small and medium-sized undertakings. . .

(4) It is now considered necessary to introduce measures protecting workers from the risks associated with electromagnetic fields, owing to their effects on the health and safety of workers. However, the long-term effects, including possible carcinogenic effects due to exposure to time-varying electric, magnetic and electromagnetic fields for which there is no conclusive scientific evidence establishing a causal relationship, are not addressed in this Directive. These measures are intended not only to ensure the health and safety of each worker on an individual basis, but also to create a minimum basis of protection for all Community workers, in order to avoid possible distortions of competition.
And then, the commandments:
Article 1 Aim and scope

1. This Directive, which is the 18th individual Directive within the meaning of Article 16(1) of Directive 89/391/EEC, lays down minimum requirements for the protection of workers from risks to their health and safety arising or likely to arise from exposure to electromagnetic fields (0 Hz to 300 GHz) during their work.


2. This Directive refers to the risk to the health and safety of workers due to known short-term adverse effects in the human body caused by the circulation of induced currents and by energy absorption as well as by contact currents.


3. This Directive does not address suggested long-term effects.


4. This Directive does not address the risks resulting from contact with live conductors.


5. Directive 89/391/EEC shall apply fully to the whole area referred to in paragraph 1, without prejudice to more stringent and/or more specific provisions contained in this Directive.
Article 5
Provisions aimed at avoiding or reducing risks
1. Taking account of technical progress and of the availability of measures to control the risk at source, the risks arising from exposure to electromagnetic fields shall be eliminated or reduced to a minimum..and in the Annex (I think we Yanks call that an Appendix):

A. EXPOSURE LIMIT VALUES

Depending on frequency, the following physical quantities are used to specify the exposure limit values of electromagnetic fields:


— exposure limit values are provided for current density for time-varying fields up to 1 Hz, to prevent effects on the cardiovascular and central nervous system,


— between 1 Hz and 10 MHz exposure limit values are provided on current density to prevent effects on central nervous system functions,


— between 100 kHz and 10 GHz exposure limit values on SAR are provided to prevent whole-body heat stress and


excessive localised heating of tissues. In the range 100 kHz to 10 MHz, exposure limit values on both current density and SAR are provided,


— between 10 GHz and 300 GHz an exposure limit value on power density is provided to prevent excessive tissue heating at or near the body surface.Well, I, for one, don't approve of any nasty effects upon my cardiovascular or central nervous system, and we certainly don't want any whole-body heat stress.  But, the protective action of the EU might have some unforseen consequences.  From S. F. Keevil, writing in the British Journal of Radiology in 2005: 

Not that I mind US researchers getting the upper hand in something, but you know very well that if the limits go into effect in Europe, they will eventually find their way across the Pond, given our admiration for all things European. 
In the absence of a static field limit, the gradient field limit poses the greatest problem. It will exclude staff from the vicinity of the bore during imaging, with the extent of the exclusion zone depending on magnet and gradient system design and choice of sequence. Since the limits are absolute, without scope for time averaging or relaxation for brief exposure, it will become illegal for an anaesthetist to lean into the bore even for a moment to check a patient, or for a radiographer or nurse to hold an anxious patient’s hand.


Incorporation of these limits into law will make many interventional MR procedures illegal in Europe, closing off development of a field with tremendous clinical potential. It will make it more difficult to provide appropriate care for anaesthetised, monitored and anxious patients. It will affect manufacture of MR equipment, particularly if a static field limit is adopted, and hence threaten the UK’s global position in this sector. It will give US researchers a significant advantage over European competitors, both in th development of MR methodology itself and in the growing exploitation of these techniques, for example in the pharmaceutical industry. Most importantly, it will mean that current and future MR techniques may be denied to patients, in many cases necessitating an examination with X-rays instead, with the resulting dose of ionizing radiation to both patient and staff.But Keevil then reveals the basis for the proposed limits: 
What are the known short-term adverse effects that the Directive seeks to avoid? A recent paper [4] has considered ICNIRP and NRPB documents [2, 5] in more detail than is possible here. In the gradient frequency range, peripheral nerve stimulation (PNS), due to induction of electric currents by time varying magnetic fields, is an adverse effect that forms the basis for limitation of patient exposure [6, 7]. PNS occurs at a threshold current density of around 1 A m22 – 100 times higher that the limit set in the Directive. The difference arises because ICNIRP occupational exposure guidelines rely on less well-established phenomena, such as alteration of visual evoked potentials and subtle cognitive effects. Evidence for most of these effects is sparse, often dating from the 1980s, in some cases presented in preliminary form at conferences rather than in full papers, and in other cases reported only in the 10–100 Hz frequency range but extrapolated to higher frequencies in the absence of more appropriate data.


ICNIRP concludes from these data that thresholds for acute CNS effects are exceeded above 100 mA m22, but in view of the sparse evidence, applies a safety factor of 10, resulting in the 10 mA m22 limit. In supporting the same limit, the NRPB acknowledges adoption of ‘‘a cautious approach… to indicate thresholds for adverse health effects that are scientifically plausible’’ [3]. Many things are scientifically plausible, but the exposure limits are supposed to be based not on hypothetical possibilities but on ‘‘known adverse health effects’’ causing ‘‘detectable impairment of… health’’, as opposed to biological effects that may or may not be harmful [2] if they exist at all. There is no substantial evidence for any such effects in the gradient frequency range below the PNS threshold. Could it be that the EU overreacted?  Keevil hammers the point home in in a report prepared for the Institute of Physics in London: 

Keevil goes on to outline the actions taken by the MRI community, as well as possible outcomes and alternatives.  The Directive is, as noted above, currently on hold until 2012. 
The members of ICNIRP are internationally acknowledged experts in their fields, but the guidelines that they produced are based on the cautious interpretation of sparse data and are essentially precautionary in nature. It has since come to light that the possibility of the directive causing problems with MRI was raised by some MEPs at an early stage. However, it was dismissed because the European Commission received assurances from ICNIRP that the ELVs would not be exceeded by MRI workers. It has not been possible to determine the precise nature, timing and basis of this erroneous advice. . .

For practical reasons, when an MR scan is performed the operator normally leaves the room and operates the scanner from a separate control room. However, there are instances in which a member of staff remains in the examination room and close to the scanner while it is operating. Examples of these situations include:


● interventional MRI, where a radiologist or other clinician may be reaching inside the bore of the magnet to carry out invasive procedures during scanning;


● some types of functional MRI, such as research studies on deaf-blind subjects where a member of staff touches the palm of the patient’s hand during scanning;


● imaging of children, where the close presence of a nurse or radiographer may avoid the need for anaesthesia to obtain satisfactory images;


● imaging of patients who are anaesthetised or require monitoring, where it is common for an anaesthetist to remain in the room and visually assess the patient during scanning;


● research applications, where a researcher may need to adjust experimental equipment during imaging.


Initial estimates showed that for workers remaining close to the magnet bore in these situations, when the switched gradients are operating, the exposure is likely to exceed the AV for 500–1000 Hz magnetic fields by a factor of around 504,5 and the ELV by an order of magnitude. . .

(I)t is difficult to avoid the conclusion that a range of current and emerging MRI procedures would be rendered illegal by the directive. Some of these techniques simply cannot be performed in other ways, and in other cases the only possible option would expose both the patient and workers to ionising radiation. So, far from protecting worker health and safety, in the context of medical imaging the directive might have quite the opposite effect: a recent study found that almost 40% of interventional radiologists who perform X-ray-guided procedures have signs of radiation damage to their eyes.

Electromagnetic radiation is scary to the public, be it X-rays, gamma rays, or even magnetic and electric fields.  In its zeal to protect EMF workers, the EU appears to have used questionable science and just a tincture of panic, without complete understanding of the consequences of its actions.  I am sorely tempted to compare this to the Cap and Trade/Global Climate Warming Change fiasco, but at least in this case, the data was probably misunderstood and not falsified.  That counts for something. 

I would urge all of my readers to go HERE and sign the petition that reads in part:

I urge decision-makers at all levels in Europe to endorse the position of the Alliance for MRI requesting an EU-wide exemption for the medical use of MRI and related research from any exposure limit values set in the Physical Agents 2004/40/EC (EMF) Directive and the implementation of user guidelines.Please sign, even if it helps our European friends get ahead of us in research.  While politics may be local, science is global, and there needs to be no unnecessary restriction on this aspect of imaging.
Read more [Dalai's PACS Blog]

Computers Taught How to Map Brain's Neural Geography

Scientists around the world are working on mapping out the neural connections found within the brains of animals, hopefully one day leading to a complete "connectome" of the giant human brain. It is believed that once maps of healthy brains can be compared to those troubled by disease, we should have a much better understanding of what causes some ailments and how to treat them. To this end researchers at MIT have been working on getting computers to analyze digital scans of brain slices and intelligently trace observed connections within. Because it is difficult to actually teach a machine to do this, the team is utilizing computer learning to first demonstrate how humans trace connections and then have the computer imitate the same process on different slices. With machine learning, the researchers teach computers to learn by example. They feed their computer electron micrographs as well as human tracings of these images. The computer then searches for an algorithm that allows it to imitate human performance. After the computer is trained on the human tracings, it is applied to electron micrographs that have not been traced by humans. This new technique represents the first time that computers have been effectively taught to segment any kind of images, not just neurons. Jain and Turaga [Viren Jain and Srinivas Turaga, computational neuroscience postdocs] have also invented new ways of evaluating how well the computer imitates humans at the task of tracing. Those measures are crucial for machine learning because the computer, just like students in a class, will not learn the desired task well unless the "exam" properly measures performance. In their early efforts, it took the computer weeks or even months to come up with an accurate neuron-tracing algorithm. However, Jain and Turaga cut that time dramatically when they started using computers equipped with graphics processing cards, allowing them to perform computations 50 to 100 times faster. Now, it takes only days for their computer programs to produce a new tracing algorithm. Their eventual goal is to use computers to process the bulk of the images needed to create connectomes, but they expect that humans will still need to proofread the computers' work. More from MIT: Mapping the brain... Image credit: Chris Nurse, Wellcome Images... Michael
Read more [Medgadget]

Survey: Nurses Chide Wireless Technology

Survey: Nurses Chide Wireless Technology

Critical factors for the adoption of mobile nursing information systems in Taiwan: the nursing depar

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 12-16-2009 at 07:16 AM
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RN - Nursing Informatics Manager - iMethods - Jacksonville, FL

Forum: Recruiter Posted Informatics Jobs Posted By: cgambino Post Time: 12-08-2009 at 04:26 PM
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Alliance for Nursing Informatics Statement to the Robert Wood Johnson Foundation Initiative on the F

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 11-27-2009 at 05:44 AM
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Increasing Nursing Student Communication Skills Through Electronic Health Record System Documentatio

Forum: Nursing Informatics Journal Articles Posted By: Nursing Informatics News Post Time: 11-27-2009 at 05:44 AM
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UK: Girl, 16, rejected by mum after leak of medical details

Lui Straccia reports: A sixteen-year-old is an outcast from her devout Catholic family who have branded her a ‘murderer’ after a nurse allegedly broke medical confidentiality and told them about her secret abortion. The girl lives in Luton but has been kicked out of home by her strictly religious mother, who was born and raised in the [...]
Read more [Personal Health Information Privacy]

GetWellNetwork Adds Nursing Functions

GetWellNetwork Inc. has new functions to support nurse workflow processes in its television-based communications system for patient rooms, called the PatientLife System.

Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next

Today's story begins in the Massachusetts State House Senate chamber.  Prominent in the chamber is the Holy Mackarel.  (Really.  The House chamber is graced by the Sacred Cod of Massachusetts; the Senate had to get something.)

A recent alum of the Massachusetts Senate, one Scott Brown, has been eliciting cries of Holy Mackarel (and worse) this week.  The stunning setback to health reform represented by Brown's election to Ted Kennedy's seat the people's seat in the US Senate is just sinking in -- inside the Beltway, across Massachusetts, and around the country.  While we all try to figure out what brand of libertarian/conservative/republican Brown really is (he's already disavowed some of his campaign rhetoric as just that, and he did vote for health reform as one of the very few Republican state senators in Massachusetts), and Congressional leadership and the White House go into a tizzy figuring out what Health Reform Redux is going to look like, a number of wise men (and women) have been prognosticating about what a politically viable bill might look like Health Reform Redux -- see, e.g., the recent posts by Kevin Pho and Ken Thorpe.

The now-likely-dead health reform bills are classic political sausage; my fave commentary on this point this week was the neologism, "the Nebraska Purchase."  In the end, nobody was happy with the outcome -- the bills are too socialist for the gummint-outta-my-Medicare crowd, and too conservative for the idealistic progressives among us.  Given the enormity of this setback, and the likelihood that any gains to be made legislatively this session are going to be far more incremental even than those in the recent bills, it is time to think about other avenues towards the improvement of the health care system in this country.

The federales control most of the dollars that flow through the medical-industrial complex; however, with or without a federal health reform statute, there are several paths forward to improving health care in this country along the parameters of access, cost and quality -- the famous three-legged stool of health reform. The laboratories of the states, CMS demos and pilots, and initiatives that may be undertaken without the blessing of the federales or state governments (e.g., patient-centered medical home (PCMH) pilots initiated by large -- and often self-insured -- employers) are fertile ground for experimentation.

Here are some of the changes that I would like to see, without waiting for that promised summer blockbuster, coming soon, Health Re-Reform, the Sequel:

I would hope that CMS would be as liberal as possible in rolling out demos that build on some of the demos to date (and perhaps Congress could authorize some broader demo authority for CMS to tinker with while the Sequel is in production).  I'd like to see more pay for performance and value-based purchasing, including gainsharing, global payments and more.

While some (e.g., Jeff Goldsmith) believe that we've already bent the cost curve, others (e.g., Jacob Hacker) seem to think that the federales have done pretty well for themselves on the bending-the-cost-curve front for the Medicare population, and that the lessons learned can be applied to other populations.

I expect that private employers will continue to expand PCMH programs, given the positive response from employees, and the significant ROI realized through implementation of these programs, including management of chronic disease.  The trick in this arena will be expanding PCMH programs beyond big employer-big network partnerships, so that smaller providers may be able to participate on an equal footing.

Which brings me to the states -- our laboratories.  State-level PCMH demos that provide a la carte services (including innovations like the "timesharing" of nurse case managers) to small physician practices that need them in order to participate in PCMH plans ought to become more widespread.  Again, the ROI is there, so the investments should be made by the states.  Other supports for primary care, prevention and public health should be explored, since well-conceived and well-executed programs can have a significant ROI as well.

All in all, it seems to me that there are opportunities to address the access, cost and quality issues without waiting for broad legislative action. 

What do you think?

Give Nurses A Bigger Role In Improving Health Care - Kaiser Health News

Give Nurses A Bigger Role In Improving Health Care - Kaiser Health NewsFrom Bob Pyke Jrhttp://www.blogger.com/profile/16014609332742259093noreply@blogger.com0
Read more [Informaticopia]

(Follow-up) Beach nurse gets 2 years for identity theft from patients

Tim McGlone reports: Calling the crime “very disturbing,” a federal judge sentenced a nurse to two years in prison after she admitted stealing the identities of several patients, some suffering from dementia, and then going on a $14,000 shopping spree. Erica S. Fowler, 27, of Virginia Beach, said nothing before U.S. District Judge Robert G. Doumar gave [...]
Read more [Personal Health Information Privacy]

Elsevier Acquires EHR Training System

St. Louis-based Elsevier, a medical content vendor, has acquired Nursing Data Systems of Mobile, Ala., which sells the NurseSquared simulated electronic health record system. Terms of the acquisition were not disclosed.