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Thursday, December 13, 2012

System Selection Processes Need To Work Well To Reduce The Risk of Health IT Implementation.

The following appeared a little while ago:

Picking the Right Partner for an HIT Adventure

NOV 1, 2012
Health care provider organizations buying an information system go through a long process to select the right vendor, but oftentimes a single incident can make a difference in sealing the deal-or killing it.
For Kerry Noble, CEO at Pemiscot Memorial Health Systems in Hayti, Mo., his confidence in a particular electronic health records vendor went way up when Ramsey Evans, CEO of Prognosis Health Information Systems, wrote in the contract that he'd refund the cost of the software if the hospital did not attest to EHR meaningful use within 120 days of go-live. Noble then went to a local bank and got financing to cover the costs of implementation through attestation-with Prognosis' guarantee as collateral. The first meaningful use incentive payment exceeded the cost of the EHR by about $500,000, Noble says.
At 48-bed Sabine Medical Center in Many, La., the willingness of one vendor to make promises-and put them in writing-helped close the deal when the center purchased its first emergency department information system, says Karen Ford, R.N., chief nursing officer. Cost is-and always will be-a big part in the vendor selection process Ford says. But in this case, veEDIS Clinical Systems of Plantation, Fla., promised specific levels of 24x7 on-site, peer-to-peer support by nurses, physicians, and technicians for the first two weeks after go-live. "That is a big deal when you're trying to transition an emergency room," Ford says.
In many I.T. purchases, the final decision really comes down to cost, and at the end of the process there's typically not huge differences between the final candidates. But there are moments in the vendor selection process when the light goes on for an organization that a vendor isn't the right one. In particular, site visits to existing clients of the vendors provide valuable insight if done right, says Paul Burke, director of revenue cycle technology at IMA Consulting in Chadds Ford, Pa. He specializes in vendor selection for financial and enterprise resource planning applications.
Burke advises I.T. decision-makers to insist on a site visit to a hospital with a similar environment and network infrastructure, the same core information system and as close to the same integration package as their facility, Burke advises. If buying contract management software, you don't want to be steered to a McKesson hospital when you are using Siemens.
Bring super-users on the site visit as they know the troublesome day-to-day issues that users of your current software have. The super-users can find common ground with peers and get assurances on how they rectified similar issues. Also, start negotiations before the site visits to keep the sales cycle from going any longer than necessary, but only giving vendors information you think they need at that point, he suggests.
A great deal more is found here:
Most useful is the last section of the article covering a game plan for system selection in a hospital. Reading this section through it really seemed to cover most of the bases. A must read for those in the market for new or replacement systems.
David.

Wednesday, December 12, 2012

It Looks Like Patient Portals Are Not Exactly Proven So Far. Did We Jump The Gun On An Unproven Approach?

The following came up a few days ago.

Monday, November 26, 2012

The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

From the report: "Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care." Read more
Here is the abstract.

The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

Elske Ammenwerth1, PhD; Petra Schnell-Inderst2,3, PhD; Alexander Hoerbst4, PhD
1Institute of Health Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
2Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
3Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria
4Research Division for eHealth and Telemedicine, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
Corresponding Author:
Alexander Hoerbst, PhD

Research Division for eHealth and Telemedicine
UMIT - University for Health Sciences, Medical Informatics and Technology
Eduard-Wallnoefer-Zentrum 1
Hall in Tyrol, 6060
Austria

ABSTRACT

Background: Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care.
Objective: To systematically review the available evidence on the impact of electronic patient portals on patient care.
Methods: A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis.
Results: We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment.
Conclusions: The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.
(J Med Internet Res 2012;14(6):e162)
doi:10.2196/jmir.2238
---- End Extract.
I think we need to wait for some more evidence but given the restricted functionality of the NEHRS / PCEHR I hardly expect to see useful proof of value soon!
David.

Tuesday, December 11, 2012

Good Heavens - It Seems NEHTA Is Hiring Again - And What Are They Seeking? Policy Advice!

This advertisement appeared a few days ago.

Senior Policy Advisor

NEHTA - Sydney Area, Australia

Job Description

The Policy team at NEHTA are vital in developing and delivering consistent national policy frameworks which support eHealth into the future. The Policy team provide specialist advice on governance issues and key to the role is to engage with jurisdictional representatives, consumers and healthcare providers.
As Senior Policy Advisor you will provide specialist policy advice to key stakeholders internally and externally.  In this busy role you will work closely with other quality assurance teams, as well as product developers and implementation support teams and assist with a variety of ehealth projects and initiatives.
To be successful in the role you will have experience in the health sector, in policy and/or operational roles.  You will have experience in identification of risks and issues and have the ability to develop sound, implementable recommendations for action.   You will possess superior communication skills and must have experience developing policy briefings and recommendations, and research reports for senior audiences. 
If you are a team player, self-motivated, enjoy working in a close team, and have a passion for health reform then this role will be well suited to you.
NEHTA’s goal is to attract high performing, experienced individuals looking to be involved in a unique and exciting venture. We are committed to providing a work environment where people enjoy what they do and are motivated to achieve.
For further information regarding the position and NEHTA please visit our careers page at www.nehta.gov.au and apply online.

Desired Skills & Experience

1. Critical analysis of strategic & operational policy;
2. Identification of potential risks & the development of mitigation strategies;
3. systemic approaches to national & jurisdictional projects;
4. Sound understanding of the business drivers of government; and
5. Understanding of the application of strategic policy to operations
6. Understanding of risk management and public sector governance.
7. Effective priority management & problem solving skills
8. Effective communication and working relationships with colleagues and stakeholders.

Company Description

The National E-Health Transition Authority Limited (NEHTA) was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information.  NEHTA is the lead organisation supporting the national vision for e-health in Australia. 
You can read all about it here:
So we have a paragon of Governance failure wanting to do better. All I can say that any action in isolation on Leadership and Governance from NEHTA merely reflects how clueless they are.
What is needed is a ‘root and branch’ review of Governance of e-Health in Australia and the design of a practical, workable and sensible approaches to moving forward. The faux consultation, government secrecy and lack of industry clinical consultation just has to end.
My suspicion is that it will take a change of Government and DoHA leadership to see the required level of change.
David.