Oracle to buy GoldenGate July 27, 2009Posted by gonzalezloumiet in Oracle.
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24 July 2009 – 10:13
Oracle to buy GoldenGate
Oracle has agreed a deal to buy GoldenGate, a provider of real-time data integration software that counts Bank of America and VocaLink among its customers. Financial terms were not disclosed.
San Francisco-based, privately held GoldenGate has over 400 clients, many of them in financial services, for its technology, which pulls data from various sources in real time for analysis.
Bank of America uses the vendor’s software to help keep its ATM network running and detect fraud activity.
Oracle says the combination of its technology with GoldenGate’s "is expected to create a comprehensive heterogeneous data integration platform". This means customers will benefit from improved business intelligence and high availability of critical applications.
Hasan Rizvi, SVP, Oracle Fusion middleware product development, says: "With the addition of GoldenGate, Oracle expects to help our customers achieve better performance through improved business intelligence and business continuity with real-time information."
The transaction is expected to close later this year, subject to conditions and regulatory approval.
Oracle has already splashed out $7.4 billion on Sun Microsystems this year, although the deal is still subject to antitrust approval.
Tags: NHIN, open source, VA
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Information Management Online, July 24, 2009
July 24, 2009 - A broad cross-section of more than 70 companies, academic institutions, communities, related groups and individuals joined together to announce the formation of Open Source for America, an organization dedicated to the promotion of open source software in the U.S. Federal Government arena.
The mission of Open Source for America is to serve as a centralized advocate and to encourage broader U.S. Federal Government support of and participation in free and open source software. Specifically, Open Source for America will: help effect change in policies and practices to allow departments and agencies to better utilize these technologies; help coordinate communities to collaborate with the federal government on technology requirements; and raise awareness and create understanding among government leaders about the values and implications of open source software.
“Open source software can help deliver improved government service – plain and simple – and the administration recognizes this more than any in our nation’s history,” said David Thomas, principal with Mehlman Vogel Castagnetti and spokesman for the Open Source for America campaign.
With the U.S. Federal Government increasingly focused on utilizing and adopting technologies to better serve citizens, there is growing recognition of the freedoms that open source software and open technology solutions can provide.
Current open source initiatives have experienced success in a variety of government agencies such as the National Security Agency, National Health Information Network (NHIN) and Federal Health Architecture (FHA), the Veterans Administration and the US Navy. Additionally, Gartner Inc. estimated that by 2011 more than 25 percent of government vertical, domain-specific applications will either be open source, contain open source application components or be developed as community source.
Despite the growing interest in open source solutions, many organizations cite barriers to adoption including technical support, licensing, security and complexity concerns.
Thomas acknowledges that open source software may not be a cure-all, but he believes it could save billions of dollars, help foster innovation and empower our government to work smarter.
Membership in Open Source for America is open to any individual or entity signing the campaign’s mission pledge. Learn more at www.opensourceforamerica.org.
Julie Langenkamp, editor-in-chief of Information Management (formerly DM Review), has almost a decade of experience in print and online media. She is responsible for coordinating editorial and production aspects of the magazine as well as maintaining relationships with authors, vendors, marketers, analysts and public relations teams for the magazine, associated Web site and digital outlets.
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CAeHC Demonstrates NHIN-enabled Gateways Among Five California Health Information Exchanges July 22, 2009Posted by gonzalezloumiet in NHIN.
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San Francisco, CA (PRWEB) July 20, 2009 — California eHealth Collaborative (CAeHC), announced a successful demonstration of five community-based health information exchange (HIE) projects in California using Nationwide Health Information Network (NHIN)-enabled gateways to securely exchange clinical health information to improve patient care. As part of the "Connecting California to Improve Patient Care" conference, held on Friday July 10 at the Krug Event Center in Healdsburg, California, CAeHC hosted the live demonstration. The 160 attendees at the conference included industry leaders with direct experience in successful deployment and operation of health information technology. Another 126 people logged into a webinar service to view the live demonstration.
Using recently released NHIN-enabled CONNECT and other NHIN-enabled Gateway software, five members of the California eHealth Collaborative demonstrated their production-ready ability to share patient clinical information for treatment purposes among regional health care provider networks in California. The public test demonstrated different scenarios showing how clinicians can provide improved care by obtaining critical clinical information from a patient’s medical record even if the health data is located in another community.
"One of the key aspects that was clearly demonstrated is that the clinical data exchange is simple and clean, and yet it is accessed from within the clinical system that is familiar to the requesting provider," said John Mattison, MD, Chief Medical Information Officer for the Southern California operations of Kaiser Permanente, and a participant in the demonstration. "The beauty of this approach is that there is no training required because of how the imported information is requested, accessed, and displayed within a completely familiar user interface."HIEs that participated in the California eHealth demonstration were: � Kaiser Permanente — using the Kaiser Permanente NHIN Gateway � Long Beach Network for Health — using the MedPlus NHIN Gateway � Orange County ER Connect — using the Mirth Connect NHIN Gateway � Redwood MedNet — using the Mirth Connect NHIN Gateway � Santa Cruz HIE — using the Axolotl NHIN Gateway The demonstration proved that any community based HIE or provider network that conforms to the NHIN standards can securely exchange health care information for treatment purposes. Providing physicians, hospitals and safety net providers with low cost access to data exchange technology is a key component of the Obama Administration’s goal of achieving "meaningful use" of electronic health records (EHR) by 2014. "We are pleased that the California eHealth Collaborative is developing the ability for its member organizations to exchange data using NHIN protocols and conventions. We believe that secure, interoperable health information exchange is going to improve health care for millions of Americans when it is widely adopted," commented Ginger Price, program director for the Nationwide Health Information Network.
"This capability is exactly what Congress had in mind when it emphasized standards-based clinical data exchange as a basis for receiving incentive payments. California eHealth Collaborative is showing Californians and the country as a whole that it’s possible to share data in a safe, reliable, and affordable way to improve care," said David Lansky, CEO of Pacific Business Group on Health, and member of the Federal Health IT Policy Committee.
The HIE participants exchanged a clinical summary of each patient’s care, sending electronically the type of referral document that might otherwise be faxed or sent by paper between a referring primary care physician and a specialist. The demonstration highlighted how nationally-standardized clinical data was integrated into different physician workflows at the point of care by the local systems that were chosen by the providers in each care setting. The HL7 standard electronic documents that were exchanged included discrete data elements that can be incorporated into the receiving systems. Multiple records were exchanged to show that the process is general and not a special case. The data exchange demonstration was observed by members of the California Privacy and Security Advisory Board (CalPSAB).
"The demonstration clearly showed the technology for HIE is here and ready, now we need to focus on the remaining policy issues to get HIE deployed," said Todd Ferris, MD, Privacy Officer at Stanford University School of Medicine, and a member of CalPSAB.
"The release earlier this year of the NHIN-enabled Connect Gateway software is a game changer," said Will Ross, Project manager for Redwood MedNet, host of the conference and a participant in the demonstration. "This shows that the technology to securely exchange health data is now shovel ready for field deployment, and that the key issues facing us are the legal and operating agreements between heathcare entities to exchange the data." The exchanges were recorded in an online webinar, which is available on the California eHealth Collaborative website at http://www.caehc.org. The patient care scenario narrative behind each data exchange in the demonstration is also available on the Collaborative website.
For further information please contact: firstname.lastname@example.org or the individual participants: About California eHealth Collaborative: California eHealth Collaborative (http://www.caehealth.org) was formed in February 2009 to accelerate statewide collaboration in the development and deployment of secure and practical health information exchange. The mission of the California eHealth Collaborative (CAeHC) is to provide a unified voice for health information exchange participants promoting secure access to clinically relevant information at the point of care throughout California.
About Orange County ER Connect ER Connect was founded in 2008 to provide a fully-functioning Health Information Exchange (HIE) and suite of supporting web-based solutions under a single, fully- integrated umbrella for those public/private organizations serving the "forgotten population" in Orange County, Calif. — the underinsured and uninsured. SafetyNet Connect has accomplished this through its 5 offerings, AuthMed, eCEDA, ER Connect, Clinic Connect and Community Connect, all which assist in enrolling and tracking patients and their data throughout the health care community. The company’s name reflects its connecting role among the Orange County Safety Net, a collaboration of health-based programs serving the uninsured and underinsured in the region. SafetyNet Connect is a company created from the partnership between Internet and software solutions provider NetChemistry, Inc. and ELM Technologies – both which have a rich history of providing software that enables collaboration between hospitals, insurance companies, managed care organizations, third-party administrators, physician groups and public sector health plans. For more information please visit http://www.safetynetconnect.com.
About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, contact email@example.com.
About Long Beach Network for Health Long Beach Network for Health (http://www.lbnh.org) is a non-profit organization created in 2003 as a health information exchange (HIE) in the Los Angeles metropolitan area. As a public private collaboration of physicians, hospitals, health care organizations, and patient advocates, LBNH is committed to improving the quality and continuity of health care for area residents through the improved access and use of relevant clinical data. LBNH technology is provided by MedPlus through its Centergy health information exchange solution and Initiate Systems’ Identity Hub for master patient index. For further information, please contact Laura Landry at 562-436-2923 or firstname.lastname@example.org.
About Redwood MedNet Redwood MedNet is a 501(c)(3) nonprofit organization located in Ukiah, California.
The founding members of Redwood MedNet are physicians and information technologists working in private practice, community clinics, emergency departments and public health. The goal of Redwood MedNet is to help our Northern California region become a center of excellence in improved patient health outcomes through the adoption of appropriate information technology. For information, please contact Tanya Laino, 707.462.6369, email@example.com.
About the Santa Cruz Health Information Exchange The Santa Cruz Health Information Exchange is one of the oldest and most advanced in the country. The clinical network connects more than 600 health care doctors and staff including a large IPA, two local hospitals, the County Health Clinics, two national and two local reference labs, two imaging centers and several FQHC safety net clinics. More than one million web transactions occur each month on the Exchange as well as tens of thousands of new electronic prescriptions, electronic refill requests, pre-treatment authorizations, referrals and transcribed documents.
(c) 2009 PRWEB.COM Newswire
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July 22, 2009 | Diana Manos, Senior Editor
WASHINGTON – The number of health information exchange initiatives that report being operational and exchanging data has increased nearly 40 percent since 2008, according to the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange.
Operational HIE initiatives jumped to 57, up from 42 in 2008, according to the survey, released Wednesday. Of that number, 40 reported cost savings resulting from health information exchange. Those savings included reduced staff time spent handling lab and radiology results, reduced staff time spent on clerical administration and filing, less money spent on redundant tests, a decrease in the cost of care for chronic care patients and fewer medication errors.
In addition, HIEs have reportedly had a positive impact on physician practices, allowing physicians to become more efficient through improved access to test results without disrupting care .
Physicians also reported an improved quality of practice life – including less hassles looking for information and getting home sooner at the end of the day,
For the first time in six years, initiatives identified "addressing privacy and confidentiality issues" as the most pressing challenge they face.
According to researchers at the eHealth Initiative (eHI), there is a great deal at stake for organizations promoting the exchange of health information, thanks to this year’s passage of the American Recovery and Reinvestment Act (ARRA).
ARRA emphasizes health information exchange as a means of improving healthcare. The federal government is projected to spend at least $300 million in support of health information exchange activities in 2009 and 2010. eHI leaders say their annual survey is the most comprehensive effort to understand and explain the efforts of health information exchanges.
Since 2004, eHI has tracked the efforts, successes and failures of organizations across the country working on health information exchanges. For the 2009 survey, 150 initiatives responded to and qualified for inclusion. eHI identified 43 additional initiatives that are functioning, but which did not complete the 2009 survey. Overall, eHI has identified and collected information on 193 active health information exchange initiatives in the country.
SOURCE: HEALTH CARE IT NEWS
Tags: Meaningful use
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July 16, 2009 | Diana Manos, Senior Editor
WASHINGTON – The Office of the National Coordinator for Health Information Technology (ONC) health IT policy committee voted Thursday on long-awaited recommendations from its workgroups on how providers can qualify to receive incentives through the new stimulus package.
As part of a mandated series of steps the ONC policy committee accepted its workgroup’s complex matrix of qualifications that will define "meaningful use" of health IT, a pivitol aspect to being a candidate for reimbursement bonuses and avoiding penalties under the American Recovery and Reinvestment Act of 2009 (ARRA). Bonuses will begin in 2011, while penalties will be enacted in 2017.
Among the revised criteria providers would have to follow are allowing patients to access their health records in a timely manner and developing capabilities to exchange health information where possible. For a complete list of workgroup recommendations, click here (PDF).
The recommendations will now have to be approved by National Coordinator for Health IT David Blumenthal, MD, before they are delivered to the Centers for Medicare and Medicaid Services (CMS) to be applied as it sees fit in writing a rule expected out for comment in December.
Several other ONC workgroups’ recommendations were also approved at Thursday’s meeting, and some were approved on a preliminary basis, with details yet to be worked out. Blumenthal and other members of the committee urged a vote in the interest of progress.
"We are in the business of making recommendations, not rulemaking," Blumenthal said.
Jodi Daniel, director of the Office of Policy and Research said ONC received 790 public comments on meaningful use over a 10-day period in June. Daniel said many who provided comments showed support for the improved health outcomes approach endorsed by ARRA.
Many of those who commented were concerned over the stringent time constraints, which will require providers to establish and meaningfully use health IT by next year. Specialty physicians were concerned the rules will not be specific to their scope of practice.
Physicians were also concerned over liability issues that may arise as electronic health records are shared between various providers.
Blumenthal said the question of liability is not one the policy committee could address. "If we were to have to think through everything that could cause medical liability, we could be tied in knots."
At its June meeting, the ONC policy committee tabled recommendations on meaningful use to work out some kinks. With today’s approval of the new recommendation matrix, "there is going to be some limitation on what we can say and do after today," Daniel said. ONC and CMS will be working on the rule internally until December.
SOURCE: HealthCare IT News
Tags: Health IT, Obama, open source, VistA
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he central contention of Barack Obama’s vision for health care reform is straightforward: that our health care system today is so wasteful and poorly organized that it is possible to lower costs, expand access, and raise quality all at the same time—and even have money left over at the end to help pay for other major programs, from bank bailouts to high-speed rail.
It might sound implausible, but the math adds up. America spends nearly twice as much per person as other developed countries for health outcomes that are no better. As White House budget director Peter Orszag has repeatedly pointed out, the cost of health care has become so gigantic that pushing down its growth rate by just 1.5 percentage points per year would free up more than $2 trillion over the next decade.
The White House also has a reasonably accurate fix on what drives these excessive costs: the American health care system is rife with overtreatment. Studies by Dartmouth’s Atlas of Health Care project show that as much as thirty cents of every dollar in health care spending goes to drugs and procedures whose efficacy is unproven, and the system contains few incentives for doctors to hew to treatments that have been proven to be effective. The system is also highly fragmented. Three-quarters of Medicare spending goes to patients with five or more chronic conditions who see an annual average of fourteen different physicians, most of whom seldom talk to each other. This fragmentation leads to uncoordinated care, and is one of the reasons why costly and often deadly medical errors occur so frequently.
Almost all experts agree that in order to begin to deal with these problems, the health care industry must step into the twenty-first century and become computerized. Astonishingly, twenty years after the digital revolution, only 1.5 percent of hospitals have integrated IT systems today—and half of those are government hospitals. Digitizing the nation’s medical system would not only improve patient safety through better-coordinated care, but would also allow health professionals to practice more scientifically driven medicine, as researchers acquire the ability to mine data from millions of computerized records about what actually works.
It would seem heartening, then, that the stimulus bill President Obama signed in February contains a whopping $20 billion to help hospitals buy and implement health IT systems. But the devil, as usual, is in the details. As anybody who’s lived through an IT upgrade at the office can attest, it’s difficult in the best of circumstances. If it’s done wrong, buggy and inadequate software can paralyze an institution.
Consider this tale of two hospitals that have made the digital transition. The first is Midland Memorial Hospital, a 371-bed, three-campus community hospital in southern Texas. Just a few years ago, Midland Memorial, like the overwhelming majority of American hospitals, was totally dependent on paper records. Nurses struggled to decipher doctors’ scribbled orders and hunt down patients’ charts, which were shuttled from floor to floor in pneumatic tubes and occasionally disappeared into the ether. The professionals involved in patient care had difficulty keeping up with new clinical guidelines and coordinating treatment. In the normal confusion of day-to-day practice, medical errors were a constant danger.
This all changed in 2007 when Midland completed the installation of a health IT system. For the first time, all the different doctors involved in a patient’s care could work from the same chart, using electronic medical records, which drew data together in one place, ensuring that the information was not lost or garbled. The new system had dramatic effects. For instance, it prompted doctors to follow guidelines for preventing infection when dressing wounds or inserting IVs, which in turn caused infection rates to fall by 88 percent. The number of medical errors and deaths also dropped. David Whiles, director of information services for Midland, reports that the new health IT system was so well designed and easy to use that it took less than two hours for most users to get the hang of it. "Today it’s just part of the culture," he says. "It would be impossible to remove it."
Things did not go so smoothly at Children’s Hospital of Pittsburgh, which installed a computerized health system in 2002. Rather than a godsend, the new system turned out to be a disaster, largely because it made it harder for the doctors and nurses to do their jobs in emergency situations. The computer interface, for example, forced doctors to click a mouse ten times to make a simple order. Even when everything worked, a process that once took seconds now took minutes—an enormous difference in an emergency-room environment. The slowdown meant that two doctors were needed to attend to a child in extremis, one to deliver care and the other to work the computer. Nurses also spent less time with patients and more time staring at computer screens. In an emergency, they couldn’t just grab a medication from a nearby dispensary as before—now they had to follow the cumbersome protocols demanded by the computer system. According to a study conducted by the hospital and published in the journal Pediatrics, mortality rates for one vulnerable patient population—those brought by emergency transport from other facilities—more than doubled, from 2.8 percent before the installation to almost 6.6 percent afterward.
Why did similar attempts to bring health care into the twenty-first century lead to triumph at Midland but tragedy at Children’s? While many factors were no doubt at work, among the most crucial was a difference in the software installed by the two institutions. The system that Midland adopted is based on software originally written by doctors for doctors at the Veterans Health Administration, and it is what’s called "open source," meaning the code can be read and modified by anyone and is freely available in the public domain rather than copyrighted by a corporation. For nearly thirty years, the VA software’s code has been continuously improved by a large and ever-growing community of collaborating, computer-minded health care professionals, at first within the VA and later at medical institutions around the world. Because the program is open source, many minds over the years have had the chance to spot bugs and make improvements. By the time Midland installed it, the core software had been road-tested at hundred of different hospitals, clinics, and nursing homes by hundreds of thousands of health care professionals.
The software Children’s Hospital installed, by contrast, was the product of a private company called Cerner Corporation. It was designed by software engineers using locked, proprietary code that medical professionals were barred from seeing, let alone modifying. Unless they could persuade the vendor to do the work, they could no more adjust it than a Microsoft Office user can fine-tune Microsoft Word. While a few large institutions have managed to make meaningful use of proprietary programs, these systems have just as often led to gigantic cost overruns and sometimes life-threatening failures. Among the most notorious examples is Cedars-Sinai Medical Center, in Los Angeles, which in 2003 tore out a "state-of-the-art" $34 million proprietary system after doctors rebelled and refused to use it. And because proprietary systems aren’t necessarily able to work with similar systems designed by other companies, the software has also slowed what should be one of the great benefits of digitized medicine: the development of a truly integrated digital infrastructure allowing doctors to coordinate patient care across institutions and supply researchers with vast pools of data, which they could use to study outcomes and develop better protocols.
Unfortunately, the way things are headed, our nation’s health care system will look a lot more like Children’s and Cedars-Sinai than Midland. In the haste of Obama’s first 100 days, the administration and Congress crafted the stimulus bill in a way that disadvantages open-source vendors, who are upstarts in the commercial market. At the same time, it favors the larger, more established proprietary vendors, who lobbied to get the $20 billion in the bill. As a result, the government’s investment in health IT is unlikely to deliver the quality and cost benefits the Obama administration hopes for, and is quite likely to infuriate the medical community. Frustrated doctors will give their patients an earful about how the crashing taxpayer-financed software they are forced to use wastes money, causes two-hour waits for eight-minute appointments, and constrains treatment options.
Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation.
pen-source software has no universally recognized definition. But in general, the term means that the code is not secret, can be utilized or modified by anyone, and is usually developed collaboratively by the software’s users, not unlike the way Wikipedia entries are written and continuously edited by readers. Once the province of geeky software aficionados, open-source software is quickly becoming mainstream. Windows has an increasingly popular open-source competitor in the Linux operating system. A free program called Apache now dominates the market for Internet servers. The trend is so powerful that IBM has abandoned its propriety software business model entirely, and now gives its programs away for free while offering support, maintenance, and customization of open-source programs, increasingly including many with health care applications. Apple now shares enough of its code that we see an explosion of homemade "applets" for the iPhone—each of which makes the iPhone more useful to more people, increasing Apple’s base of potential customers.
If this is the future of computing as a whole, why should U.S. health IT be an exception? Indeed, given the scientific and ethical complexities of medicine, it is hard to think of any other realm where a commitment to transparency and collaboration in information technology is more appropriate. And, in fact, the largest and most successful example of digital medicine is an open-source program called VistA, the one Midland chose.
VistA was born in the 1970s out of an underground movement within the Veterans Health Administration known as the "Hard Hats." The group was made up of VA doctors, nurses, and administrators around the country who had become frustrated with the combination of heavy caseloads and poor record keeping at the institution. Some of them figured that then-new personal and mini computers could be the solution. The VA doctors pioneered the nation’s first functioning electronic medical record system, and began collaborating with computer programmers to develop other health IT applications, such as systems that gave doctors online advice in making diagnoses and settling on treatments.
The key advantages of this collaborative approach were both technical and personal. For one, it allowed medical professionals to innovate and learn from each other in tailoring programs to meet their own needs. And by involving medical professionals in the development and application of information technology, it achieved widespread buy-in of digitized medicine at the VA, which has often proven to be a big problem when propriety systems are imposed on doctors elsewhere.
This open approach allowed almost anyone with a good idea at the VA to innovate. In 1992, Sue Kinnick, a nurse at the Topeka, Kansas, VA hospital, was returning a rental car and saw the use of a bar-code scanner for the first time. An agent used a wand to scan her car and her rental agreement, and then quickly sent her on her way. A light went off in Kinnick’s head. "If they can do this with cars, we can do this with medicine," she later told an interviewer. With the help of other tech-savvy VA employees, Kinnick wrote software, using the Hard Hats’ public domain code, that put the new scanner technology to a new and vital use: preventing errors in dispensing medicine. Under Kinnick’s direction, patients and nurses were each given bar-coded wristbands, and all medications were bar-coded as well. Then nurses were given wands, which they used to scan themselves, the patient, and the medication bottle before dispensing drugs. This helped prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.
At first, the efforts of enterprising open-source innovators like Kinnick brought specific benefits to the VA system, such as fewer medical errors and reduced patient wait times through better scheduling. It also allowed doctors to see more patients, since they were spending less time chasing down paper records. But eventually, the open-source technology changed the way VA doctors practiced medicine in bigger ways. By mining the VA’s huge resource of digitized medical records, researchers could look back at which drugs, devices, and procedures were working and which were not. This was a huge leap forward in a profession where there is still a stunning lack of research data about the effectiveness of even the most common medical procedures. Using VistA to examine 12,000 medical records, VA researchers were able to see how diabetics were treated by different VA doctors, and by different VA hospitals and clinics, and how they fared under the different circumstances. Those findings could in turn be communicated back to doctors in clinical guidelines delivered by the VistA system. In the 1990s, the VA began using the same information technology to see which surgical teams or hospital managers were underperforming, and which deserved rewards for exceeding benchmarks of quality and safety.
Thanks to all this effective use of information technology, the VA emerged in this decade as the bright star of the American health system in the eyes of most health-quality experts. True, one still reads stories in the papers about breakdowns in care at some VA hospitals. That is evidence that the VA is far from perfect—but also that its information system is good at spotting problems. Whatever its weaknesses, the VA has been shown in study after study to be providing the highest-quality medical care in America by such metrics as patient safety, patient satisfaction, and the observance of proven clinical protocols, even while reducing the cost per patient.
Following the organization’s success, a growing number of other government-run hospitals and clinics have started adapting VistA to their own uses. This includes public hospitals in Hawaii and West Virginia, as well as all the hospitals run by the Indian Health Service. The VA’s evolving code also has been adapted by providers in many other countries, including Germany, Finland, Malaysia, Brazil, India, and, most recently, Jordan. To date, more than eighty-five countries have sent delegations to study how the VA uses the program, with four to five more coming every week.
roprietary systems, by contrast, have gotten a cool reception. Although health IT companies have been trying to convince hospitals and clinics to buy their integrated patient-record software for more than fifteen years, only a tiny fraction have installed such systems. Part of the problem is our screwed-up insurance reimbursement system, which essentially rewards health care providers for performing more and more expensive procedures rather than improving patients’ welfare. This leaves few institutions that are not government run with much of a business case for investing in health IT; using digitized records to keep patients healthier over the long term doesn’t help the bottom line.
But another big part of the problem is that proprietary systems have earned a bad reputation in the medical community for the simple reason that they often don’t work very well. The programs are written by software developers who are far removed from the realities of practicing medicine. The result is systems which tend to create, rather than prevent, medical errors once they’re in the hands of harried health care professionals. The Joint Commission, which accredits hospitals for safety, recently issued an unprecedented warning that computer technology is now implicated in an incredible 25 percent of all reported medication errors. Perversely, license agreements usually bar users of proprietary health IT systems from reporting dangerous bugs to other health care facilities. In open-source systems, users learn from each other’s mistakes; in proprietary ones, they’re not even allowed to mention them.
If proprietary health IT systems are widely adopted, even more drawbacks will come sharply into focus. The greatest benefits of health IT—and ones the Obama administration is counting on—come from the opportunities that are created when different hospitals and clinics are able to share records and stores of data with each other. Hospitals within the digitized VA system are able to deliver more services for less mostly because their digital records allow doctors and clinics to better coordinate complex treatment regimens. Electronic medical records also produce a large collection of digitized data that can be easily mined by managers and researchers (without their having access to the patients’ identities, which are privacy protected) to discover what drugs, procedures, and devices work and which are ineffective or even dangerous. For example, the first red flags about Vioxx, an arthritis medication that is now known to cause heart attacks, were raised by the VA and large private HMOs, which unearthed the link by mining their electronic records. Similarly, the IT system at the Mayo Clinic (an open-source one, incidentally) allows doctors to personalize care by mining records of specific patient populations. A doctor treating a patient for cancer, for instance, can query the treatment outcomes of hundreds of other patients who had tumors in the same area and were of similar age and family backgrounds, increasing odds that they choose the most effective therapy.
But in order for data mining to work, the data has to offer a complete picture of the care patients have gotten from all the various specialists involved in their treatment over a period of time. Otherwise it’s difficult to identify meaningful patterns or sort out confounding factors. With proprietary systems, the data is locked away in what programmers call "black boxes," and cannot be shared across hospitals and clinics. (This is partly by design; it’s difficult for doctors to switch IT providers if they can’t extract patient data.) Unless patients get all their care in one facility or system, the result is a patchwork of digital records that are of little or no use to researchers. Significantly, since proprietary systems can’t speak to each other, they also offer few advantages over paper records when it comes to coordinating care across facilities. Patients might as well be schlepping around file folders full of handwritten charts.
Of course, not all proprietary systems are equally bad. A program offered by Epic Systems Corporation of Wisconsin rivals VistA in terms of features and functionality. When it comes to cost, however, open source wins hands down, thanks to no or low licensing costs. According to Dr. Scott Shreeve, who is involved in the VistA installations in West Virginia and elsewhere, installing a proprietary system like Epic costs ten times as much as VistA and takes at least three times as long—and that’s if everything goes smoothly, which is often not the case. In 2004, Sutter Health committed $154 million to implementing electronic medical records in all the twenty-seven hospitals it operated in Northern California using Epic software. The project was supposed to be finished by 2006, but things didn’t work out as planned. Sutter pulled the plug on the project in May of this year, having completed only one installation and facing remaining cost estimates of $1 billion for finishing the project. In a letter to employees, Sutter executives explained that they could no long afford to fund employee pensions and also continue with the Epic buildout.
nfortunately, billions of taxpayers’ dollars are about to be poured into expensive, inadequate proprietary software, thanks to a provision in the stimulus package. The bill offers medical facilities as much as $64,000 per physician if they make "meaningful use" of "certified" health IT in the next year and a half, and punishes them with cuts to their Medicare reimbursements if they don’t do so by 2015. Obviously, doctors and health administrators are under pressure to act soon. But what is the meaning of "meaningful use"? And who determines which products qualify? These questions are currently the subject of bitter political wrangling.
Vendors of proprietary health IT have a powerful lobby, headed by the Healthcare Information and Management Systems Society, a group with deep ties to the Obama administration. (The chairman of HIMSS, Blackford Middleton, is an adviser to Obama’s health care team and was instrumental in getting money for health IT into the stimulus bill.) The group is not openly against open source, but last year when Rep. Pete Stark of California introduced a bill to create a low-cost, open-source health IT system for all medical providers through the Department of Health and Human Services, HIMSS used its influence to smash the legislation. The group is now deploying its lobbying clout to persuade regulators to define "meaningful use" so that only software approved by an allied group, the Certification Commission for Healthcare Information Technology, qualifies. Not only are CCHIT’s standards notoriously lax, the group is also largely funded and staffed by the very industry whose products it is supposed to certify. Giving it the authority over the field of health IT is like letting a group controlled by Big Pharma determine which drugs are safe for the market.
Even if the proprietary health IT lobby loses the battle to make CCHIT the official standard, the promise of open-source health IT is still in jeopardy. One big reason is the far greater marketing power that the big, established proprietary venders can bring to bear compared to their open-source counterparts, who are smaller and newer on the scene. A group of proprietary industry heavyweights, including Microsoft, Intel, Cisco, and Allscripts, is sponsoring the Electronic Health Record Stimulus Tour, which sends teams of traveling sales representatives to tell local doctors how they can receive tens of thousands of dollars in stimulus money by buying their products—provided that they "act now." For those medical professionals who can’t make the show personally, helpful webcasts are available. The tour is a variation on a tried-and-true strategy: when physicians are presented with samples of pricey new name-brand substitutes for equally good generic drugs, time and again they start prescribing the more expensive medicine. And they are likely to be even more suggestible when it comes to software because most don’t know enough about computing to evaluate vendors’ claims skeptically.
What can be done to counter this marketing offensive and keep proprietary companies from locking up the health care IT market? The best and simplest answer is to take the stimulus money off the table, at least for the time being. Rather than shoveling $20 billion into software that doesn’t deliver on the promise of digital medicine, the government should put a hold on that money pending the results of a federal interagency study that will be looking into the potential of open-source health IT and will deliver its findings by October 2010.
As it happens, that study is also part of the stimulus bill. The language for it was inserted by West Virginia Senator Jay Rockefeller, who has also introduced legislation that would help put open-source health IT on equal footing with the likes of Allscripts and Microsoft. Building on the systems developed by the VA and Indian Health Services, Rockefeller’s bill would create an open-source government-sponsored "public utility" that would distribute VistA-like software, along with grants to pay for installation and maintenance. The agency would also be charged with developing quality standards for open-source health IT and guidelines for interoperability. This would give us the low-cost, high-quality, fully integrated and proven health IT infrastructure we need in order to have any hope of getting truly better health care.
Delaying the spending of that $20 billion would undoubtedly infuriate makers of proprietary health software. But it would be welcomed by health care providers who have long resisted—partly for good reason—buying that industry’s product. Pushing them to do so quickly via the stimulus bill amounts to a giant taxpayer bailout of health IT companies whose business model has never really worked. That wouldn’t just be a horrendous waste of public funds; it would also lock the health care industry into software that doesn’t do the job and would be even more expensive to get rid of later.
As the administration and Congress struggle to pass a health care reform bill, questions about which software is best may seem relatively unimportant—the kind of thing you let the "tech guys" figure out. But the truth is that this bit of fine print will determine the success or failure of the whole health care reform enterprise. So it’s worth taking the time to get the details right.
Phillip Longman is a senior fellow at the New America Foundation and the author of Best Care Anywhere: Why VA Health Care Is Better Than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.
Tags: Google Health
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by Leena Rao on July 16, 2009
Whether it be bills, insurance forms, medical records or prescriptions, patients are often inundated with vast quantities of paper. Google Health is now trying to help you organize all of this paperwork in its platform. Google Health, which finally launched last May after months of rumors, has ambitions to become a centralized and secure place to store medical records online.
The new feature lets patients upload scanned paper documents into your Google Health account. Google particularly suggests that you upload an “advance directive,” which determines your end-of-life wishes so that your family and doctor can honor them if you get sick and are unable to communicate. Google Health is actually working with a advance directive provider, Caring Connections, to provide a free, downloadable form customized for all 50 states. In order to complete the form, you need to download it, print it out, complete it, scan it, and upload it back to Google Health.
Google Health also recently launched a feature that gives users the ability to share their medical history with designated family or close friends. The whole concept of hosting medical records online raises security concerns for many but Google says it is taking lengthy measures to ensure the security of the data, associating invite links to specific Email addresses and allowing users to track who has viewed their records. All shared records are also read-only.
Digitizing Health Records Not Enough; Integrated, Interoperable Enterprises Vital to U.S. Healthcare Transformation July 16, 2009Posted by gonzalezloumiet in nationwide health information exchange.
Tags: Harris Corp, NHIN
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Harris Corporation’s Jim Traficant Highlights Pathway to Health Information on Demand
WASHINGTON, July 16 /PRNewswire-FirstCall/ — The U.S. needs to go beyond simply digitizing health records and create integrated, interoperable enterprises if it hopes to truly transform the nation’s healthcare system, Harris Corporation’s Jim Traficant told a Capitol Hill steering committee yesterday.
Traficant, vice president of Healthcare Solutions for Harris Corporation (NYSE: HRS), told members of the Institute for e-Health Policy’s Steering Committee on Telehealth and Healthcare Informatics that "Healthcare reform must go beyond digitizing a broken system to enabling an integrated, interoperable one.
"Healthcare transformation will come from a connected, integrated, interoperable system where health information is delivered on demand to clinical and benefits experts with security and privacy, and with patients in control of how their information is shared. That’s the transformation the President and nation are looking for. That’s the transformation our parents and our children are counting on us to deliver."
Truly integrated and interoperable healthcare enterprises will ultimately help improve patient care and control rising costs, he told the committee. These enterprises "will lead to transparency in pricing and performance, and enable us to attack fraud and waste – all with the ultimate result of reduced costs, improved outcomes, and predictable quality."
Traficant noted that some of the challenges facing healthcare today already have been solved in other industries with large networks, such as the intelligence community and government agencies. He suggested that the lessons learned – if not some of the solutions themselves – from relevant government experience can be applied to what he referred to as a "once-in-a-lifetime opportunity to transform our healthcare system. There’s no need to start from scratch."
He cited the successful transformation of the Federal Aviation Administration (FAA) telecommunications infrastructure, which has been transitioned from a fragmented system into a comprehensive, extremely reliable and cost-effective network connecting operations and mission-support activities at 4,000 FAA facilities nationwide.
He also highlighted the tremendous progress that has been made to date with the Nationwide Health Information Network (NHIN), which is expected to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. The NHIN CONNECT Gateway allows federal agencies and private sector healthcare providers to securely exchange electronic patient information. Those participating in the network can leverage CONNECT to achieve critical mission objectives for standards-based, interoperable health information exchange. It is already in use by the Social Security Administration, where it has significantly reduced the time required to process disability claims, and could one day serve as a single portal from which Americans securely access their own clinical and claims data from any federal source.
Harris – with partners Agilex Technologies, Inc., Sun Microsystems, Inc., and Scenpro, Inc. — developed the software for the CONNECT Gateway, which was released by the U.S. Department of Health and Human Services in April for general availability as Open Source.
Traficant concluded his presentation before the steering committee by urging attendees to "make it happen. Transformation of the healthcare system is within our reach. The future of our nation depends on it. We have been given an incredible opportunity. We can’t squander it."
An archived webcast of the briefing is available on the Institute’s web site: www.e-healthpolicy.org.
Harris Healthcare Solutions provides enterprise intelligence solutions and services for commercial and government customers, including systems integration, intelligent infrastructure, advanced visualization and display, enterprise digital content management, and IT services solutions. Harris products, systems, and services improve health outcomes by assuring that critical medical information is delivered with security and privacy to the right person, on the right device, at the point of care.
About Harris Corporation
Harris is an international communications and information technology company serving government and commercial markets in more than 150 countries. Headquartered in Melbourne, Florida, the company has approximately $5 billion of annual revenue and 15,000 employees — including nearly 7,000 engineers and scientists. Harris is dedicated to developing best-in-class assured communications((R)) products, systems, and services. Additional information about Harris Corporation is available at www.harris.com.
SOURCE Harris Corporation
Top 10 Tech Skills That Stand Out July 16, 2009Posted by gonzalezloumiet in Technology.
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By Brittany Ballenstedt 07/15/09 03:40 pm ET
A recent survey by Dice.com found that hiring managers are having a difficult time finding job applicants with skills and experience related to the security, efficiency and cost effectiveness of technology, specifically to fill talent voids in areas like networks and databases, and strategies like virtualization and collaboration. "At a time when certain job openings prompt a wave of responses, managers need a way to identify the most serious contenders, just as candidates need a way to demonstrate their skill in a particular technology," the survey states. "For both, certifications are a key element."
While direct experience is key to landing a technology job, Dice says, here are the top 10 skills and certifications that can make applicants stand out:
6. Database Administrators/Administration
8. Active Federal Government Security Clearance
9. Project Manager/Management